Adolescent-level food insecurity significantly predicts common mental disorders, with 14.50% of adolescents experiencing moderate-to-severe food insecurity and 22.93% prevalence of CMDs, a relationship further driven by poor quality of life, diminished self-esteem, substance use, and financial instability.
Key Findings
Results
The prevalence of moderate-to-severe adolescent-level food insecurity (AFI) was 14.50% among school-going adolescents in Harari Region, Ethiopia.
Sample size was 3,326 adolescents in the Harari Regional State, Eastern Ethiopia
A multistage sampling strategy stratified by locality and school type was used
Food insecurity was measured using the HFIAS (Household Food Insecurity Access Scale) adapted for adolescent-level measurement
Data were collected via guided self-administration by trained BSc nurses and psychiatric nurses
Results
The prevalence of common mental disorders (CMDs) among adolescents in the study was 22.93%.
CMDs were measured using the SDQ-25 (Strengths and Difficulties Questionnaire)
Sample consisted of 3,326 adolescents in school settings
Data were analysed using structural equation modeling (SEM) with maximum likelihood estimation
The SEM demonstrated good fit: RMSEA = 0.03, CFI = 0.90, TLI = 0.89, and SRMR = 0.05
Results
Adolescent-level food insecurity was significantly associated with a higher likelihood of common mental disorders.
AFI was linked to higher CMD likelihood (β = 0.20, P < 0.001)
Analysis was conducted using SEM with maximum likelihood estimation after adjusting for relevant covariates
This represents the strongest positive predictor of CMDs among the variables examined
The relationship was assessed at the individual adolescent level, not solely household level
Results
Substance use and frequent financial difficulties were significantly associated with higher likelihood of common mental disorders.
Substance use was associated with higher CMD likelihood (β = 0.14, P < 0.001)
Frequent financial difficulties were associated with higher CMD likelihood (β = 0.06, P < 0.001)
Both associations were identified after adjustment for relevant covariates in the SEM framework
Results
Higher quality of life and stronger self-esteem were each significantly associated with a lower likelihood of common mental disorder symptoms.
Higher quality of life was associated with lower CMD likelihood (β = -0.07, P < 0.001)
Stronger self-esteem was associated with lower CMD likelihood (β = -0.06, P < 0.001)
Quality of life was measured using the KIDSCREEN-10 scale
Self-esteem was measured using the Rosenberg Scale
Results
Urban residency was a significant protective factor against common mental disorders among adolescents.
Urban residency showed a significant negative association with CMDs (β = -0.21, P < 0.001)
This was the strongest negative (protective) association found in the SEM model
The sampling strategy was stratified by locality, allowing rural-urban comparisons
The finding suggests rural adolescents face meaningfully higher CMD burden
Results
The structural equation model confirmed that AFI's relationship with CMDs is further mediated or driven by poor quality of life, diminished self-esteem, substance use, and financial instability.
SEM path coefficients were interpreted after confirming good model fit (RMSEA = 0.03, CFI = 0.90, TLI = 0.89, SRMR = 0.05)
Maximum likelihood estimation was used with adjustment for relevant covariates
The model incorporated both direct and indirect pathways between AFI and CMDs
Authors conclude that 'addressing food insecurity and its associated psychosocial factors is essential to reduce adolescents' CMD burden'
What This Means
This research suggests that food insecurity and poor mental health are closely linked among school-going teenagers in eastern Ethiopia. In a study of over 3,300 adolescents, about 1 in 7 experienced moderate-to-severe food insecurity, and nearly 1 in 4 showed signs of common mental health disorders such as emotional and behavioral difficulties. Adolescents who did not have reliable access to enough food were significantly more likely to experience mental health problems, even after accounting for other factors.
The study also found that other factors compound this risk. Substance use and frequent money problems further increased the likelihood of mental health difficulties, while having a better quality of life and stronger self-esteem appeared to be protective. Notably, rural adolescents faced considerably higher mental health burdens than their urban peers, suggesting that where a young person lives shapes their vulnerability significantly.
This research suggests that mental health programs for adolescents cannot be effective if they focus on psychological support alone — they also need to address the material conditions young people live in, including food access and financial stability. Policymakers and program designers working in similar low-resource settings may need to integrate food security interventions with mental health and psychosocial support to meaningfully reduce the burden of mental health disorders among adolescents.
Shiferaw K, Hunduma G, Dessie Y, Yadeta T, Geda B, Deyessa N. (2026). Interrelated adolescent-level food insecurity and common mental health disorders in Harari Region, Ethiopia: A cross-sectional study.. PloS one. https://doi.org/10.1371/journal.pone.0348774