In a study published in the April 2021 issue of the American Journal of Preventive Medicine, researchers found that food insufficiency — an extreme form of food insecurity defined as households without enough food to eat at least once a week — increased to 10 percent of the U.S. population in June 2020, a 25 percent increase from March 2020. Out of these households, over 90 percent reported mental health symptoms such as anxiety, lack of pleasure (anhedonia), or depression. In terms of healthcare, food insufficiency is a costly problem in the United States. The Centers for Disease Control and Prevention (CDC) found food-insecure adults incurred $1,834 more a year in healthcare costs in 2016 than those who were food secure. For the study, researchers analyzed responses to the weekly U.S Census Household Pulse Survey conducted by the U.S. Census Bureau. From June 11 to June 16, 2020, more than 60,000 participants from across the United States answered questions such as whether or not they had enough food to eat in the previous seven days, if and where they received free food, and how often they displayed symptoms of a mental health disorder. Researchers found that food-insufficient households reported higher rates of mental health symptoms, with half of the respondents reporting signs of depression and more than two-thirds reporting anxiety symptoms. These results were especially prevalent in younger and unmarried people and those with larger households, low education, income below the federal poverty line, or people who experienced employment loss — problems that disproportionately affect Black and Hispanic or Latino Americans. “Food insufficiency can lead to chronic stress, which raises levels of stress hormones like cortisol, which raises anxiety,” says Jason Nagata, MD, an assistant professor of pediatrics at the University of California in San Francisco and one of the study’s authors. This stress causes “a vicious cycle you can’t get out of,” says Dr. Nagata. “Hunger affects your ability to keep a job, and not keeping a job worsens food insecurity.” While there is an established link between mental health and food insecurity, this is one of the first published studies to analyze the connection in the context of the pandemic. Meredith Niles, PhD, an assistant professor of food systems and policy at the University of Vermont who leads the National Food Access and COVID Research Team (NFACT) and was not involved with this study, thinks the study results are significant but do not account for the more dire months of the year with less government-issued aid. “I think it’s worth noting that at that point in time in June, we had extra unemployment benefits, and we had stimulus checks that most people received." By the end of 2020, the Pulse Survey showed food insufficiency had increased to 13 percent. If you are experiencing worry or stress about food, there are multiple lifelines immediately accessible:

Feeding America has an online tool to help you locate your local food bank.Federal food assistance programs like SNAP and WIC provide money for groceries. Eligibility and distribution are determined at a state level. You can find information about applying in your state at Benefits.gov.Pandemic-EBT (P-EBT) provides food benefits to replace meals children would normally receive from the National School Lunch and Breakfast programs when they are not in school.

These programs recently received a boost from the Biden Administration’s American Rescue Plan, which invested over $12 billion in nutrition assistance. These investments include:

An extension of the 15 percent increase (about $28 per person) for SNAP benefits through September 2021Continuing Pandemic-EBT (P-EBT) through the summer of 2021Increasing funds for fruits and vegetables purchased with WIC, from $9 to $35

If food security or mental health problems persist after you seek supplemental support, Nagata suggests consulting with your doctor about your mental health and being screened for food insecurity. Your doctor could refer you to other sources of aid. “Doctors understand that food insecurity can affect your physical and mental health and will want to know if you are worried about not getting enough food,” says Nagata.

Hope for Lasting Assistance to Those in Need

While the country strives to return to normalcy, the pandemic revealed how fragile food security is in the United States. “We literally couldn’t look away,” says Dr. Niles. “The lines of cars, thousands of people lining up for food relief throughout the year, continued to highlight the long-term struggle many families are feeling.” Advocates hope that this heightened awareness will allow some of the American Rescue Plan extensions to become permanent, even after the pandemic is over. Additionally, there are calls for government policies to address long-term economic factors like higher wages, better employment opportunities, and increasing efforts to raise public awareness and funds for mental health support, food banks, and food assistance programs.