Introduction
Depression is a common mental disorder and a major public health issue that is the world’s second-biggest cause of sickness and mortality.1 2 Globally, about 322 million people have been estimated to suffer from depressive symptoms, with the highest prevalence occurring among women of reproductive age.2 Mental disorders in children and adolescents, including depression, anxiety and behavioural disorders are estimated to account for approximately 16% of the global disease burden; the prevalence is twice as high in girls as it is in boys, especially in postmenarche girls3; lifetime prevalence rates range from 8% to 16%.4 According to estimates, depression affects one-fourth of the adolescent populations in sub-Saharan Africa.5 In Ghana, depression is on the rise, especially among adolescents.5 6 About 32.5% of adolescents in Ghana’s rural areas experience depressive symptoms.5
The determinants of depression are multifaceted and can be explained by the ‘social determinants of health in adolescents and young women’.7 The framework proposes that socioeconomic status, such as income, education and occupation, as well as national-level policies, are structured determinants of health and well-being. Physical conditions, such as family structure and access to food, as well as behavioural, biological and psychosocial factors, serve as intermediary elements that affect health and well-being. Known correlates of depression among children and adolescents from previous research include older age, sex, low self-esteem, school attendance, school performance, household structure and relations, socioeconomic status and residence.8 9 According to the WHO,3 failing to address adolescent mental health disorders has long-term effects that affect adult opportunities for leading satisfying lives as well as physical and mental health.
Food insecurity is a growing concern since inadequate food intake and nutrition can have a severe impact on adolescents’ and children’s mental health and physical well-being.10 11 A little over one-third of households in Ghana’s Northern Region experience food insecurity, which affects about 1 in 10 households nationwide.12 Household food insecurity has also been linked to low income, bigger family sizes, lower educational status, high food prices and a poor quality of life.13 14 Although the possible mechanism linking food insecurity to poor mental health or depression is unknown, it is hypothesised that the underlying mechanism is related to the influence of insufficient micronutrient intake in the diet. Poor myelination and diminished oligodendrocyte function are potential mechanisms through which micronutrient deficiencies during adolescence may cause behavioural problems.15 Iron deficiency has been demonstrated to change the metabolism of neurochemicals in the hippocampus, including phosphocreatine, glutamate, N-acetyl aspartate, aspartate and aminobutyric acid, which may result in some cognitive and mental problems. A previous study found a link between micronutrients and depression as well as their importance in brain physiological functions.16 For optimum health, enough micronutrient intake is essential, notably iron, zinc, vitamin A and B vitamins, including folate and B12, as well as vitamin C.17 18 Antioxidant micronutrients, in particular, have been shown to promote mental wellness.19
Data on the association between food insecurity and depression in sub-Saharan Africa is scanty. However, one recent study in France found an association between household food insecurity and depression among young adults aged 18–36 years.20 A qualitative study in San Francisco found that food insecurity contributes to psychological distress among children aged 7–14 years.21 In the present study, we examined the association between household food insecurity and depression among adolescent girls in Northern Ghana. We hypothesised that household food insecurity is positively associated with depression among adolescent girls.