Social Support Modifies Bidirectional Linkages Between Food Insecurity and Prenatal Depressive Symptoms while Domestic Violence Alters the Unidirectional Impact of Food Insecurity on Prenatal Depressive Symptoms

To inform perinatal nutrition and mental health interventions, we used a cohort study to: 1) examine the directionality of relationships between maternal food insecurity (MFI) and prenatal depressive symptoms (PDS); and 2) see if social support (SS) or domestic violence (DV) modify this relationship. We enrolled 403 Ugandan pregnant women (33% HIV+ on antiretrovirals)) in mid-gestation and assessed them monthly through delivery for MFI (IFIAS) and the PDS (CES-D) using validated scales. Each woman contributed ~ 4.3 study visits including enrollment visits. At baseline, 58.3% of the women had probable prenatal depression (CES-D蠅17), 27.1% had experienced DV, and 74.4% reported moderate or severe MFI. Longitudinal mixed effects models indicate that MFI and PDS predicted each other. Multivariate lagged response and covariate models confirmed bidirectional relationships for MFI and PDS. SS modified the relationship in both directions ((βMFI*SS=-0.050, p<0.001), (βPDS*SS=-0.005, p=0.02)). DV modified the unidi...