Influence of resilience and social support on the association between food insecurity and depressive symptoms during pregnancy: A moderated mediation model

Background: Food insecurity is a risk factor for depressive symptoms during pregnancy, while resilience and social support are protective. This study evaluated models testing the collective influence of food insecurity, resilience, and social support on depressive symptoms among pregnant individuals. Methods: Racially-diverse pregnant individuals (N = 669) receiving Expect With Me group prenatal care in Detroit, Michigan and Nashville, Tennessee completed surveys during second and third trimesters of pregnancy. Based on responses at both timepoints, participants were classified as food secure, acutely food insecure (second or third trimester), or chronically food insecure (second and third trimester). Mediation models explored the direct association of food insecurity (acute or chronic) with depressive symptoms and its indirect association via resilience. Additionally, we simultaneously examined how social support moderated the relationship between food insecurity, resilience, and depressive symptoms. Results: Acute and chronic food insecurity were reported by 18 % and 14 % of respondents, respectively. Resilience partially mediated (17.1-17.9 %) the association between food insecurity and depressive symptoms. Social support moderated the direct effect of the mediation model, specifically in the association between acute food insecurity and depressive symptoms (B =-0.45, 95 % CI-0.81,-0.09). This moderation effect was not observed for chronic food insecurity. Social support moderated the indirect effect of acute (B = 0.06, 95 % CI 0.01, 0.12) and chronic (B = 0.05, 95 % CI 0.01, 0.10) food insecurity on depressive symptoms through resilience. Conclusion: Efforts to strengthen resilience and social support may help mitigate the adverse effects of food insecurity on depressive symptoms during pregnancy.