Food insecurity and its association with mental health among Syrian refugees resettled in Norway: A cross-sectional study.

Background: Refugees are at a higher risk of food insecurity than the general population in high-income resettling countries. Simultaneously, the prevalence rates of mental ill health among refugees surpasses the general population in receiving countries both in high- and low-income settings. This study aims to estimate the prevalence of food insecurity and to study the association between food insecurity and mental health among Syrian refugees resettled in Norway. Methods: As part of the CHART study (Changing Health and health care needs Along the Syrian Refugees' Trajectories to Norway), 353 Syrian refugees resettled in Norway for approximately one year participated in a structured telephone survey. We assessed food insecurity with the Household Food Security Survey Module (HFSSM) and mental health (symptoms of anxiety and depression) with the Hopkins Symptom Checklist (HSCL-10). We used descriptive statistics to estimate food insecurity overall, and among women, men, and children separately. The association between food insecurity and mental health symptoms was studied using logistic regression. Results: One year after resettlement in Norway food insecurity was reported among 22% of adult Syrian refugees and 24% of their children. The most frequently reported problems were that food did not last or that they skipped meals often or sometimes (approximately 15% for each parameter). Respondents also worried that food would run out before they got money to buy more (15%), had not been eating balanced food in the past 12 months (9%), and had been eating less than before (7%). A few participants reported that they had not been eating for a whole day (5%), had been hungry (4%), or had lost weight during the last year (3%). Most of the women did not report any food insecurity among children in their households (76%), some reported that their children were moderate food insecure (13%), and a few that their children were severely food insecure (10%). Among adults, mental ill health was significantly associated with severe food insecurity (odds ratio (OR) 6.6, 95% confidence interval (CI) 2.1-20.5) but not with moderate food insecurity (OR 1.5, 95% CI 0.4-5.8). Conclusion: Food insecurity among refugees and their children after resettlement to high-income countries should be acknowledged and systematically targeted. The association with mental health reinforces the need to consider food insecurity in public health strategies towards refugees.