Anna E. Austin, PhD

Credit: University of North Carolina

By expanding the eligibility of the Supplemental Nutrition Assistance Program (SNAP), states have reduced the rates of food insecurity, which ultimately may further decrease the rates of mental illness and suicidality among adults.¹

A team, led by Anna E. Austin, PhD, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, examined the association of state elimination of the asset test and increases in the income limit for SNAP eligibility with rates of mental health and suicidality outcomes among adults.

Food Insecurity and Mental Health

Food insecurity is linked to an increased risk of poor mental health and suicidality.

“Multiple studies show that experiencing food insecurity is associated with an increased likelihood of psychological distress, depression and anxiety, severe mental illness, suicidal ideation, and death by suicide,” the authors wrote. “Uncertainty about the ability to access or afford enough food, as well as potentially forgoing other basic needs to purchase food, may result in feelings of anxiety, stress, guilt, and shame that negatively impact mental health and increase risk for suicidality.”

Currently, the largest program addressing this growing issue in the US is the Supplemental Nutrition Assistance Program (SNAP), which allows states to expand eligibility to a greater number of households by eliminating the asset test or increasing the income limit for eligibility under the broad-based categorical eligibility (BBCE).

In the ecological cross-sectional study, the investigators used data on adults in the US from the National Vital Statistics Systems between 2014-2017 and data on adults in the US from the National Survey on Drug Use and Health (NSDUH) State-Level Small Area Estimates between 2015-2019.

The investigators sought main outcomes of the number of adults with a past-year major depressive disorder, mental illness, serious mental illness, or suicidal ideation and number of adults who died by suicide.

Overall, there were 407,391 adult NSDUH participants, as well as 173,085 adults who died via suicide.

SNAP Eligibility

The results show decreased rates of past-year major depressive episodes (rate ratio [RR], 0.92; 95% confidence interval [CI], 0.87-0.98) and mental illness (RR, 0.91; 95% CI, 0.87-0.97) among adults in states where only the asset test was eliminated.

State adoption of both SNAP eligibility policies, where the state eliminates the asset test and increases the income limit resulted in decreases in the rates of past-year major depressive episodes (RR, 0.92; 95% CI, 0.86-0.99), mental illness (RR, 0.92; 95% CI, 0.87-0.98), serious mental illness (RR, 0.91; 95% CI, 0.84-0.99), and suicidal ideation (RR, 0.89; 95% CI, 0.82-0.96).

Finally, there was a decreased rate of suicide death (RR, 0.93; 95% CI, 0.84-1.02) in states with both policies compared to the states with neither policy.

However, neither of these results were considered significant.

“State adoption of policies that expand SNAP eligibility may contribute to decreased rates of multiple mental health and suicidality outcomes at the population level,” the authors wrote.

References:

Austin AE, Frank M, Shanahan ME, Reyes HLM, Corbie G, Naumann RB. Association of State Supplemental Nutrition Assistance Program Eligibility Policies With Adult Mental Health and Suicidality. JAMA Netw Open. 2023;6(4):e238415. doi:10.1001/jamanetworkopen.2023.8415