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Can J Psychiatry. 2018 Aug;63(8):557-569. doi: 10.1177/0706743717752879. Epub 2018 Jan 7.

The Relation between Food Insecurity and Mental Health Care Service Utilization in Ontario.

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1 Department of Nutritional Sciences, University of Toronto, Toronto, Ontario.
2 Centre for Addiction and Mental Health, Toronto, Ontario.
3 Institute for Clinical Evaluative Sciences, Toronto, Ontario.
4 Department of Agricultural and Consumer Economics, University of Illinois at Urbana-Champaign, Champaign, Illinois.
5 Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario.
6 Department of Psychiatry and Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario.



To determine the relationship between household food insecurity status over a 12-month period and adults' use of publicly funded health care services in Ontario for mental health reasons during this period.


Data for 80,942 Ontario residents, 18 to 64 years old, who participated in the Canadian Community Health Survey in 2005, 2007-2008, 2009-2010, or 2011-2012 were linked to administrative health care data to determine individuals' hospitalizations, emergency department visits, and visits to psychiatrists and primary care physicians for mental health reasons. Household food insecurity over the past 12 months was assessed using the Household Food Security Survey Module. Logistic regression models were used to estimate the odds of mental health service utilization in the past 12 months by household food insecurity status, adjusting for sociodemographic factors and prior use of mental health services.


In our fully adjusted models, in comparison to food-secure individuals, the odds of any mental health care service utilization over the past 12 months were 1.15 (95% confidence interval [CI], 1.04 to 1.29) for marginally food-insecure individuals, 1.39 (95% CI, 1.19 to 1.42) for moderately food-insecure individuals, and 1.50 (95% CI, 1.35 to 1.68) for severely food-insecure individuals. A similar pattern persisted across individual types of services, with odds of utilization highest with severe food insecurity.


Household food insecurity status is a robust predictor of mental health service utilization among working-age adults in Ontario. Policy interventions are required to address the underlying causes of food insecurity and the particular vulnerability of individuals with mental illness.


food insecurity; mental health services; ontario

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