Prevalence of Food Insecurity among College Students in Lebanon and its Association with Mental and Psychosocial Health Parameters: Findings from a Cross-Sectional Study

Abstract

Background: The transition from high school to university encompasses various prospects and challenges among young adults aged between 18-25 years old. Food insecurity (FI) and Mental Health Disorders are growing public health concerns among college students (Bruening et al., 2017, Beccera et Beccera 2020). Despite the growing interest in exploring FI among college students and its impact on various measures of wellbeing; there remains a dearth of evidence on FI among college students and young adults in low to middle-income countries (LMICs) in comparison to high-income countries (HICs).

Objective: This present study aimed to assess the prevalence of food insecurity (FI) among college students in Lebanon, identify the socio-demographic and economic factors associated with FI among college students within the study sample, and explore the associations between FI status and indicators of mental and psychosocial health among college students.

Methods: A cross-sectional study was conducted on a convenience sample of college students (aged between 18 to 24 years old) (N=745) enrolled in public and private universities across Lebanon. College students were recruited to participate in an online survey that was approved by the institutional review boards (IRB) at the American University of Beirut (AUB) and Lebanese American University (LAU) starting the spring semester of 2021. The online survey collected information on sociodemographic status, food security status, mental health, and overall well-being. FI was assessed through the Food Insecurity Experience Scale (FIES). For the Mental Health and Well-being parameters: Patient Health Questionnaire-9 (PHQ-9) was used to screen for depression, General Anxiety Disorder-7 (GAD-7) was used to screen for anxiety, and World Health Organization-5 index (WHO-5) was assessed to assess the overall well-being of college students. Chi-square tests and independent t-tests were used to examine the bivariate associations between food insecurity (FI) (Food secure vs food-insecure) and the sociodemographic characteristics and lifestyle factors of college students. Sociodemographic and lifestyle correlates of FI were explored using simple and multiple logistic regression analyses. Moreover, simple and multiple linear regression analyses were conducted to further examine the associations between FI (food secure vs. food insecure) with each mental health indicators (PHQ-9, GAD-7, WHO-5).

Results: Based on the Food Insecurity Experience Scale (FIES), an estimate of 39% of college students included in our sample were food insecure of 27.4%, 8.1%, and 3.5% were mildly, moderately, and severely food insecure respectively. Multiple logistic regression analysis showed that low maternal education, low household monthly income, and elevated levels of stress were significant correlates of FI (p-trend<0.001). According to the PHQ-9 (depression) and GAD-7 (anxiety) indicators, 22.6% and 34.4% of students showed severe symptoms of depression and anxiety, respectively. Multiple linear regression analysis showed that FI among college students was associated with higher scores on PHQ-9 and GAD-7 (β= 2.45; 95% CI (1.41,3.49)), (β=1.4; 95% CI (1.1, 2.2) ), respectively, and lower scores on WHO-5 (Wellbeing) (β=-4.84; 95% CI [-8.2, -1.5]), even after adjusting other correlates of FI. One unit increase in stress level among college students was significantly associated with higher depression (PHQ-9) and anxiety (GAD-7) and lower well-being (WHO-5) (β =1.4, 95% CI (1.23, 1.60), β=1.506, 95% CI (1.331, 1.680) and β= 4.299; 95% CI (-4.991, -3.606), respectively. Furthermore, College students with household monthly incomes greater than 5,000,000 LBP had significantly higher well-being (WHO-5) scores

Conclusion: College students in Lebanon are facing various challenges that are affecting their food security and mental health state. The results of our study highlight the need for high educational institutions to launch interventions and engage with multiple stakeholders to address and alleviate FI and improve mental health and well-being of college students