Cross-Lagged Dyadic Associations of Food Insecurity and Depressive Symptoms among Couples Living with HIV and Cardiometabolic Disorders in Malawi.

BACKGROUND: Household food insecurity is an important social determinant of mental health, human immunodeficiency virus (HIV), and cardiometabolic outcomes in sub-Saharan Africa. Research is limited on how couples managing chronic illness are jointly affected by household food insecurity and depressive symptoms. OBJECTIVES: The aim of our study was to investigate whether household food insecurity predicts subsequent depressive symptoms over time among couples living with HIV and cardiometabolic disorders in Malawi. METHODS: We examined longitudinal dyadic data (4 waves) from 250 couples recruited from HIV and noncommunicable disease clinics in the Zomba and Blantyre districts. Food insecurity was assessed using the 9-item Household Food Insecurity Access Scale, and depressive symptoms were assessed using the Patient Health Questionnaire. Structural equation modeling was used to model actor effects (participant's food insecurity predicting their own depression) and partner effects (partner's food insecurity predicting the participant's depression). RESULTS: Among females, there were significant actor effects; higher food insecurity at wave 1 predicted greater depressive symptoms at wave 2 (β = 0.162, P = 0.022). Among males, there were significant actor effects; higher food insecurity at wave 3 predicted greater depressive symptoms at wave 4 (β = 0.199, P = 0.030). Partner effects were not significant at any waves. Household food insecurity predicts future depressive symptoms for males and females, although at different time points. There was no evidence to suggest that one partner's food insecurity affects the other partner's depression. CONCLUSIONS: People living with HIV and cardiometabolic disorders may benefit from screening for food insecurity and depressive symptoms and subsequent linkage into services.