According to the WHO, mental health can be described as the ability to cope with the everyday stresses of life, work productively, and essentially contribute to your community and includes your emotional, psychological, and social wellbeing. The 2023 Universal Health Coverage Goal for Mental Health considers that you can not achieve global health or sustainable development without mental health. It is hardly surprising that 75 percent of all mental illness cases can be found in low-income countries. These countries fail to provide proper access to quality mental health care. As a result, those affected are vulnerable to suffering, human rights abuses, stigma, discrimination, and premature mortality. Even in regions where infectious diseases are overwhelmingly high, at least 9% of the overall burden of disease is due to mental disorders. Globally, 50% of people with psychosis do not receive proper treatment, but this number may well be over 90% in countries like Ethiopia, presenting an unacceptably high treatment gap.
One of the many drivers in these low-income countries that result in mental health issues is food insecurity, which is the quantity and quality of available food. More than 870 million people worldwide consume less than the efficient amount of daily calories, leading to disabling physical and psychological health outcomes. Food insecurity has become a political and health focus in low-income countries, particularly in Sub-Saharan Africa, and is supported within the Sustainable Development Goal 2, “Zero Hunger.” Unfortunately, the Covid Pandemic worsened global circumstances, and an additional 70-161 million people are likely to have experienced hunger during 2020. An article in the Hindawi Psychiatry Journal has taken a deep dive into the relation of food insecurity and mental distress and its impact on mothers in Ethiopia. The report claims that even though all household members suffer from the effects of food insecurity, women and children are the ones affected the most. Mothers who are malnourished and lack the capacity to provide adequate care subsequently contribute to child malnutrition, which is the cause for one-third of under-five deaths in developing countries. Malnourished mothers and young children are also vulnerable to some non-communicable diseases later in life.
Additionally, having a child struggling to flourish physically and grow strong and healthy can undermine a mother’s wellbeing through the mental distress caused by the extra effort and attention required to take care of the child. In other words, the consequences of maternal food insecurity and mental distress are transgenerational. Also, mothers tend to be the primary caregivers within households and carry the burden of providing practical help, personal care, and emotional support to their ill family members while also suffering from challenging external factors like food insecurity. This ultimately causes a spiral of problems prominently for mental distress like anxiety, depression, insomnia, and somatic disorder, leading to physiologic changes and impaired health habits that can result in illness and likely death.
Among women of reproductive age, mental distress was found to be the leading cause of morbidity, with an increasingly more significant burden in Sub-Saharan Africa, especially where the political and socioeconomic circumstances are often volatile. Furthermore, there is a 60% increased mortality rate for people with a physical medical condition while simultaneously suffering from mental distress. Although the many impacts of food insecurity on physical health have been determined, few studies have been available regarding the association between food insecurity and mental distress among mothers, particularly in Ethiopia.
The study in the Hindawi Psychiatry Journal has found a direct relation of maternal food insecurity to mental distress. Food insecurity is significantly linked with meeting the assessments for major depressive disorders. The cross-sectional study was conducted on 2,992 mothers in Ethiopia’s Tigray and Southern Nations, Nationalities, and Peoples’ regions. It found that over 57.9% of mothers are in households facing food insecurity with a substantial prevalence (39%) of mental distress among these mothers. The study confirmed that without a doubt, food insecurity brings substantial public mental distress, and the impact is potentially changeable. The remaining issue is using this study to be able to design, monitor, and evaluate food security and mental health programs to assist in forming a body of knowledge that could essentially influence public health policy in Ethiopia.
Mental illness in Ethiopia may not be as recognized as infectious diseases but it can impact overall general health and the ability to provide for one’s family. Global institutions should deliver accurate data to demonstrate the mental health treatment gap and produce a contextualized framework or approach to help reduce it. Moreover, national-level policy support and coordination are necessary for any actual development in mental health treatment coverage. Although the Ethiopian government is committed to developing mental health care, efforts have been hindered due to low financing with implementation and scale-up of mental health care. Ethiopia’s commitment to pooled risk protection through public health insurance is the most promising approach for adequate, fair, and sustainable funding.
References:
- Birhanu, T., Tadesse, A. (2019). ‘Food Insecurity and Mental Distress among Mothers in Rural Tigray and SNNP Regions, Ethiopia’, Hindawi Psychiatry Journal, Vol. 2019 [online]. Available at: https://www.hindawi.com/journals/psychiatry/2019/7458341/. (Accessed 2 October 2021).
- Bukhman, Gene, et al., (2020). ‘The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion’, The Lancet, Vol. 396 [online]. Available at: https://www-sciencedirect-com.ezproxy.is.ed.ac.uk/science/article/pii/S0140673620319073. (Accessed 3 October 2021).
- Delle, S. (2017) There is no shame in taking care of your mental health. May. Available at: https://www.ted.com/talks/sangu_delle_there_s_no_shame_in_taking_care_of_your_mental_health?language=en (Accessed 31 September 2021).
- Fekadu, A., Thornicroft, G. (2014). ‘Global mental health: Perspectives from Ethiopia’, Global Health Action, Vol.7(25447) [online]. Available at: https://doi.org/10.3402/gha.v7.25447. (Accessed October 2 2021)
- Hanlon, C., et al. (2019). ’Moving towards universal health coverage for mental disorders in Ethiopia’, International Journal of Mental Health Systems, Vol. 13(11) [online]. Available at: https://doi.org/10.1186/s13033-019-0268-9. (Accessed 2 October 2021).
- Negesse, A., et al. (2020). ’The impact of being of the female gender for household head on the prevalence of food insecurity in Ethiopia: a systematic-review and meta-analysis’, Public Health Reviews, Vol. 41(15) [online]. Available at: https://doi.org/10.1186/s40985-020-00131-8. (Accessed 2 October 2021).
- Sintayehu, M., et al. (2015). ’Prevalence of mental distress and associated factors T caregivers of patients with severe mental illness in the outpatient unit of Amanuel Hospital, Addis Ababa, Ethiopia, 2013: Cross-sectional study, Journal of Molecular Psychiatry, Vol. 3(9) [online]. Available at: https://jmolecularpsychiatry.biomedcentral.com/articles/10.1186/s40303-015-0014-4 (Accessed 2 October 2021).
- United Nations. (2021). The Sustainable Development Goals Report. Available at: https://unstats.un.org/sdgs/report/2021/The-Sustainable-Development-Goals-Report-2021.pdf.(Accessed 2 October 2021).
- World Health Organization. (2019). The WHO Special Initiative for Mental Health (2019-2023): Universal Health Coverage for Mental Health. Available at: https://www.who.int/publications/i/item/special-initiative-for-mental-health-(2019-2023). (Accessed 31 September 2021).
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Photo: World Health Organization. 2014. Ethiopia Scales up Mental Health Services into Primary Health Care, Ethiopia.
- Photo: Aljazeera. 2021. No Food for Days: Starvation Stalks Tigray As War Drags On. Ethiopia.
Hi! Looking forward to reading your blog
Hi Nafisa,
This is definitely one of the overlooked health issue amidst the many pressing global health challenges. Your focus and exhaustive evidence on the interrelationship between food insecurity and mental health among vulnerable maternal and child community is commendable. It really does help to look at one area in which health policies, community based initiatives and other actors can focus their efforts on. I am curious to understand more about the health systems and its challenges in Ethiopia on the promotion of mental health. Would you be able to touch on more on that – perhaps in your blog post or as a response?
Best,
Seraphina
Thank you, Seraphina, for your comment and interest in knowing more about the mental health challenges in Ethiopia’s health system. With a limited number of words, it was challenging to make it as concise as possible. Nevertheless, I am happy you brought up this question. Unfortunately, like many other low-income countries, Ethiopia has a tiny percentage of patients with mental health conditions who require life-saving care (5-10%) and actually receive it (Global Health Action, 2014). This is an issue for not just psychosis disorders but also patients with epilepsy. So action has been taken on improving local district-level treatment coverage like the Butajira Project for example. The Butajira Project was initiated 15 years ago with new district clinic services for people with mental illness and a program of epidemiologic and implementation research (ibid.). It implemented a stepped-care model of service to address the lack of accessible care, low demand, and poor quality care. The project mobilized the community to produce demand and inclusiveness, and it guaranteed quality care by providing periodic supportive supervision and second-opinion clinics (ibid.). Another program initiated with the help of WHO is psychiatric nursing programs that required trainee psychiatric nurses to a set training and internship period with periodic refresher courses until supervision is eventually phased out. This resulted in a major achievement of the expansion of specialized mental health services for 58 sites all over the country. As mentioned in the blog, even though Ethiopia is scaling up the provision of care, it still struggles to fully integrate mental health in all healthcare settings due to low financing.
Fekadu, A., Thornicroft, G. (2014). ‘Global Mental Health: Perspectives from Ethiopia’, Global Health Action, Vol.7(25447) [online]. Available at: https://doi.org/10.3402/gha.v7.25447.
Hi Nafisa,
This is a great piece; I especially liked the bit where you talked about the mental health effect being felt ‘intergenerationally’. Mental Health is a Complex challenge to address, and often environmental epidemiologist have looked at the link between environmental stressors and mental health from air pollution perspective and I am glad in this case you have chosen to focus on food networks, agricultural practice, and nutritional deficiency, this sadly result in high infant mortality rates in LMIC. However, it may be good to focus a little more on how these drivers intersect with the social determinants of health, for instance what is creating food insecurity in the region? I would investigate the political economy of the region to determine the impact on agricultural practices and how these ties into the failure to design mental health interventions. It’s crucial to note that the long-term burden on healthcare systems will continue to increase if mental health is not addressed, this would help bring in the political economy and social determinant perspective in full focus. You may also wish to focus on this from a planetary health perspective, and I would read papers from the following authors: Jessica Fanzo & co’s; ‘The importance of food systems and the environment for nutrition’ and the Global Panel on Food Agriculture and food systems for Nutrition. This intersects of how poverty is a threat multiplier, as you have nicely alluded to. It would be good to include more data on the mental health gap and the countries already stretched health funding. It is important to include references in text- any sources or figures must be accounted for with in text referencing.
Best,
Juwairia
Hi Nafisa,
Thank you for such a thought provoking blog. I am a paediatric nurse by training and poor nutrition (“Failure to thrive or FTT” we call it here in the UK) is larger scale than most people realise and for similar albeit different reasons / impacts. They can of course be medical but from personal experience it is often linked with poverty and lower socioeconomic circumstances and often a lack of knowledge or education. In saying this one thing I was consistently told as a trainee Health Visitor was the impact that was having on maternal mental health and it is so closely interlinked, both the effort to try and ensure it wasn’t the case and the mental capacity required to look after a child who is struggling. Often communities rallied, even if the mother didn’t know many people, and I do like your link to public distress. The links of susceptibility to other diseases and the links to mental health conditions such as depression and anxiety and how these fuel a vicious cycle is an important one, thank you for making it. I was wondering if there is any literature on stigmatisation and if there are outside pressures, particularly thinking of the multigenerational link, which compound these feelings around food insecurity? Is there any cultural assumptions in place that you are aware of which would see mother and child at a lower scaling in terms of any food that may be available?
Best wishes, Louise
Hi Nafisa, I think the focus on women’s mental health is really interesting and very important. You have also made the link with SDGs and other key concepts from the course, which add to your blog. You have a couple of really good comments with lots to consider so I only add a couple of questions. I gather the paper by Birhanu and colleagues is the main resource chosen… What do you think are the limitations of the study by Birhanu and colleagues? what questions remain unaddressed? I think adding a critical perspective on the paper could strengthen the blog. As a minor comment, you could decide to add the hyperlink in one word within the sentence to avoid having large pieces of text with different font colour.
Thanks for sharing
Evely
I have some problems posting a comment for this blog, hopefully it works now as a “reply”.
Hi Nafisa,
Thanks for this insightful blog on this underrecognized and important topic.
I liked how you started with information on mental health in general followed by the situation in Ethopia with a special focus on women’s mental health.
I have a background in psychology and psychotherapy and reading your blog I was wondering how effective treatment might differ if food insecurity is one of the central causes for mental health issues. I think there might be a significant difference as this cause in (unfortunately) likely to stay. Did you get information on treatment services that have already been implemented and whether they are found to be effective of not?
And one comment: You wrote that “Mental illness in Ethiopia may not be as recognized as other infectious diseases…” Mental disorders are not infectious. They fall under the category of non-communicable diseases.
Thanks for sharing and if you have any more information about treatments used in this area please let me know.
Cheers, Karolin
Hi Nafisa,
Thanks for this insightful blog on this underrecognized and important topic.
I liked how you started with information on mental health in general followed by the situation in Ethopia with a special focus on women’s mental health.
I have a background in psychology and psychotherapy and reading your blog I was wondering how effective treatment might differ if food insecurity is one of the central causes for mental health issues. I think there might be a significant difference as this cause in (unfortunately) likely to stay. Did you get information on treatment services that have already been implemented successfully, when food insecurity is involved, and whether they are found to be effective of not?
And one comment: You wrote that “Mental illness in Ethiopia may not be as recognized as other infectious diseases…” Mental disorders are not infectious. They fall under the category of non-communicable diseases.
Thanks for sharing and if you have any more information about treatments used in this context please let me know.
Best, Karolin
Hi Nafisa,
Thanks for this insightful blog on this underrecognized and important topic.
I liked how you started with information on mental health in general followed by the situation in Ethopia with a special focus on women’s mental health.
I have a background in psychology and psychotherapy and reading your blog I was wondering how effective treatment might differ if food insecurity is one of the central causes for mental health issues. I think there might be a significant difference as this cause in (unfortunately) likely to stay. Did you get information on treatment services that have already been implemented successfully, when food insecurity is involved, and whether they are found to be effective of not?
Thanks for sharing and if you have any more information about treatments used in this context please let me know.
Best, Karolin
And one comment: You wrote that “Mental illness in Ethiopia may not be as recognized as other infectious diseases…” Mental disorders are not infectious. They fall under the category of non-communicable diseases.
Hi Karolin, yes, I know mental illness is not infectious, but I implied that it is neglected compared to contagious diseases. I’m sorry that I wasn’t clear enough. Thank you for your comment. I mentioned above in reply to Seraphina some initiatives taken by the Ethiopian government to expand mental health care. Essentially tackling SDG 5 of gender equality and empowerment of women is vital to overcoming and addressing the issues to combat hunger, increase food productivity, and promote sustainable agriculture (Negesse et al., 2020, pg. 9). Based on their findings, Tirfessa and colleagues suggest that interventions to address food insecurity need to include both expanded access to mental health care (to reduce disability) and strategies to alleviate poverty, particularly for vulnerable individuals living with mental disorders (Tirfessa et al., 2017, pg.13). They explain that the inclusion and prioritization of people with mental illnesses in food security programs and development opportunities should be ensured. And to do so, awareness-raising and tackling the stigma are required as they undermine the inclusion of people with mental disorders (ibid.).
Negesse, A., et al. (2020).’ The impact of being of the female gender for household head on the prevalence of food insecurity in Ethiopia: a systematic-review and meta-analysis’, Public Health Reviews, Vol. 41(15) [online]. Available at: https://doi.org/10.1186/s40985-020-00131-8. (Accessed 2 October 2021).
Tirfessa, K., Lund, C., Medhin, G., Hailemichael, Y., Fekadu, A., and Hanlon, C. Food insecurity among people with severe mental disorder in a rural Ethiopian setting: a comparative, population-based study. Epidemiology and Psychiatric Sciences (2017). Available at: https://doi.org/10.1017/S2045796017000701