Food insecurity and unemployment as mediators of the relationship between the COVID-19 pandemic and psychological well-being in young South Africans with HIV

BMC Public Health. 2024 Sep 27;24(1):2622. doi: 10.1186/s12889-024-19966-w.

Abstract

Background: Poor psychological well-being, including depression, anxiety, and low self-esteem, is both prevalent among young South Africans living with HIV and associated with poor HIV clinical outcomes. By impacting food insecurity and employment, the COVID-19 pandemic may have influenced psychological well-being in this population. This analysis sought to examine whether food insecurity and unemployment mediated the relationship between study cohort (pre- versus during-pandemic) and psychological well-being in our sample of young South Africans living with HIV.

Methods: This was a secondary analysis comparing baseline data from two cohorts of young South Africans ages 18-24 from the Cape Town and East London metro areas who tested positive for HIV at clinics (or mobile clinics) either before or during the COVID-19 pandemic. Baseline sociodemographic, economic, and psychological outcomes were analyzed through a series of bivariate logistic regression and mediation analyses. All data were analyzed in 2023 and 2024.

Results: Reported food anxiety, insufficient food quality, and insufficient food quantity were lower in the cohort recruited during the COVID-19 pandemic than those recruited before the pandemic (p < 0.001). Higher levels of food insecurity predicted higher depressive and anxiety symptoms and lower self-esteem. Food anxiety, insufficient food quality, and insufficient food quantity, but not unemployment, mediated the relationship between study cohort and depressive symptoms, anxiety symptoms, and self-esteem.

Conclusion: Food insecurity may have decreased amongst our sample of young people during the COVID-19 pandemic. Our findings build on our understanding of how the psychological well-being of young people living with HIV was affected by the COVID-19 pandemic and may lend support to interventions targeting food insecurity to improve psychological well-being in this population.

Keywords: Anxiety; COVID-19; Depression; Food insecurity; HIV/AIDS; Self-esteem; Socioeconomic factors; Young adults.

MeSH terms

  • Adolescent
  • African People
  • Anxiety / epidemiology
  • Anxiety / psychology
  • COVID-19* / epidemiology
  • COVID-19* / psychology
  • Cohort Studies
  • Depression / epidemiology
  • Depression / psychology
  • Female
  • Food Insecurity*
  • HIV Infections* / epidemiology
  • HIV Infections* / psychology
  • Humans
  • Male
  • Mental Health
  • Pandemics
  • Psychological Well-Being
  • Self Concept
  • South Africa / epidemiology
  • Unemployment* / psychology
  • Unemployment* / statistics & numerical data
  • Young Adult