Not having enough food may have had a greater negative effect on mental health in the United States than unemployment or loss of income during the COVID-19 pandemic, according to a study led by Penn State researchers.
The study, published in PLOS One, examined how loss of income or employment and food sufficiency impacted the mental health of Americans during the pandemic. The researchers found that not having enough food - or food insufficiency - was more strongly linked to poorer mental health than losing income, and both food insufficiency and lower income mattered more than unemployment alone.
The team also found that families that were already food insecure before the pandemic experienced much larger mental health effects than those who became food insecure once the pandemic hit.
Linlin Fan, associate professor of agricultural economics and co-author on the paper, said the results suggest that job loss alone may not be the best signal of who is struggling mentally during a crisis.
"During the pandemic, effects of unemployment on mental health may have been buffered by factors such as unemployment insurance and stimulus payments," Fan said. "This doesn't mean that unemployment is harmless, but rather that in a crisis like the pandemic, mental health effects may depend on whether families can still afford food and basic needs, rather than from job status alone."
During the pandemic, the researchers said, many Americans faced several hardships at once, including job loss, lower income and trouble getting enough food. At the same time, rates of anxiety and depression rose. The team wanted to better understand which of these hardships mattered most for mental health.
"That question matters because policymakers often assume unemployment is the main problem during a crisis," said co-author Stephan Goetz, professor of agricultural and regional economics and director of the Northeast Regional Center for Rural Development. "But if food hardship or income loss is more damaging to mental health, then the policy response should focus more directly on helping families meet basic needs."
To conduct the study, the researchers analyzed data collected from a survey conducted by the U.S. Census Bureau for the purpose of measuring social and economic impacts of the COVID-19 pandemic. Data was collected between April 23, 2020, and March 29, 2021, from a nationally representative sample of more than 1 million households.
Information included self-reported data about anxiety and depression symptoms, involuntary loss of employment or income, and whether survey responders had enough to eat for all members of the household.
Income loss was measured by whether a household had lost income since March 13, 2020, while involuntary unemployment was defined as whether the respondent was out of work because their employer cut back positions or hours, temporarily closed or shut down due to the pandemic. The study focused on this type of job loss because it helped to identify cause and effect - the job losses were driven by the pandemic and not personal choices to stop working.
"While analyzing our data, we used a method designed to get closer to cause and effect, not just simple association," Fan said. "That's important because poorer mental health can also make it harder to work or maintain food security, so the relationships can run both ways. Our study tried to account for that."
The researchers found that food insufficiency increased the likelihood of anxiety by about 27 percentage points and depression by about 24 percentage points. Also, income loss increased the likelihood of anxiety by about 13 percentage points and depression by about 11 percentage points.
Critically, the researchers said, unemployment by itself, when separated from other factors like a loss of income, did not have an effect on mental health during the pandemic. This could potentially be due in part to the availability of generous unemployment benefits during the pandemic.
They also found that food insufficiency had a bigger effect on the mental health of men, people in more rural areas and people with a mortgage. Meanwhile, loss of income had a bigger effect on the mental health of women, people paying rent and people in more rural areas.
"Another key point is that our data showed that food assistance helped, but it did not fully remove the mental health burden of hunger," Fan said. "That suggests that a crisis response should not stop at providing benefits alone. It may also need better targeting, faster delivery and stronger coordination across food health and mental health services."
The researchers said that in the future, additional research could examine data from other countries to explore whether the findings are similar in different settings.
Yuxuan Pan, University of Kentucky, also co-authored the paper.
The U.S. Department of Agriculture's National Institute of Food and Agriculture supported this research.
