Preventive medicine reports
Food insecurity and mental health in South Africa: Structural pathways linking socioeconomic position, behavioural risk factors and comorbidity
By Nkosi L, Nigussie T and Ayo-Yusuf OA.
Abstract
Objective
To examine the prevalence of food insecurity in South Africa and the structural pathways linking it with mental health, hypertension-diabetes comorbidity, and socioeconomic and behavioural factors.
Methods
We analysed nationally representative data from 3095 South African adults aged ≥16 years from the South African Social Attitudes Survey conducted in 2025. Survey-weighted generalized structural equation modelling estimated direct, indirect, and reciprocal associations between food insecurity, mental illness, socioeconomic status (SES), nicotine use, alcohol use, and hypertension-diabetes comorbidity.
Results
Overall, 37.4% (95% CI: 34.5, 40.5) of adults reported household food insecurity. Mental illness was strongly associated with food insecurity (OR = 2.82, 95% CI: 1.54, 5.18), while the reciprocal pathway from food insecurity to mental illness was also statistically significant. Higher SES was protective (total effect OR = 0.40, 95% CI: 0.18, 0.86). Nicotine use showed direct associations with food insecurity, whereas alcohol use operated mainly indirectly through nicotine use. Hypertension-diabetes comorbidity was not independently associated with food insecurity.
