Past-Year Suicidal Ideation, Plans, and Attempts by Food Security Level in a Nationally Representative Sample of U.S. Adults

Objective: The Interpersonal Theory of Suicide posits that suicidal behavior results from thwarted belongingness, perceived burdensomeness, and capability for suicide. Considering that food insecurity (FI) may be linked to these constructs to differing extents based on severity of FI, this study examined cross-sectional associations between levels of FI and suicidal ideation, plans, and attempts in a nationally representative sample of adults in the United States. Methods: Data for this study were collected in 2001–2003 from 5,552 participants in the National Comorbidity Survey Replication (M_age=44.8 ± 0.5 years; 53.8% female). Prevalence ratios (PRs) and 95% confidence intervals (CIs) were generated using modified Poisson regression to examine past-year ideation, plans, and attempts with intent of lethality by past-year FI level (assessed with a modified version of the Short Form U.S. Household Food Security Scale). Results: After controlling for sociodemographic covariates, low food security was significantly associated with elevated prevalence of suicidal ideation, plans, and attempts (ideation: PR = 2.21, 95% CI 1.32–3.70; plans: PR = 5.42, 95% CI 2.71–10.83; attempts: PR = 5.35, 95% CI 2.38–12.03). Very low food security (i.e., more severe FI) exhibited stronger associations yet with suicidal ideation, plans, and attempts (ideation: PR = 6.99, 95% CI 4.10–11.92; plans: PR = 17.21, 95% CI 8.41–35.24; attempts: PR = 14.72, 95% CI 4.96–43.69). Conclusions: Findings indicative of a dose-response relationship between FI and suicidal ideation, plans, and attempts emphasize the need to increase reach of food assistance programs, increase availability of mental health services in food-insecure populations, and routinely screen for FI in mental health practice.