The Association of Food Insecurity, Depression, and Diabetes among Indonesian Adults: Results from Indonesian Family Life Survey 2007–2014

Background/Aims: Food insecurity has been linked to chronic diseases while little is known about the association between food insecurity, depression, and diabetes incidence among adults. Methods: Data were obtained from 3955 adults who participated in the Indonesia Family Life Survey (IFLS) in 2007 and 2014. Food insecurity was assessed using a World Food Programme (WFP) concept based on a food consumption score analysis using the ten items of food frequency questionnaire (FFQ). Depression was assessed using self-reported of ten items Center for Epidemiologic Studies Depression (CES-D) questionnaire. A generalized estimating equation (GEE), mediation analysis, and Sobel-Goodman test were used to test the hypotheses model while accounting for the health behaviors and sociodemographic characteristics in this study. Results: Food insecurity was positively associated with depression in the unadjusted and adjusted model (p = 0.002–0.043). Food insecurity was negatively associated with diabetes in both model (p = 0.005 – < 0.001). The depression was positively associated with diabetes also in both models (p = 0.004 – < 0.001). The beta coefficients were decreased (from –0.0104 to –0.0099, p < 0.05) after the depression was added into the model. The formal mediation analysis was showed that depression was significantly mediated the pathway between the food insecurity and diabetes (p < 0.001). Conclusion: The effect of food insecurity on diabetes is mediated, partly through the depressive symptoms. Strategies to improve the prevention of diabetes among adults may need to include the depression and food security together with the enrichment of nutrition education.