More Than Hunger: A Qualitative Study of Food Insecurity and Relational Coping Among Individuals with Schizophrenia-Spectrum Psychotic Disorders and Their Case Managers

Food insecurity is a critical social determinant of health among individuals with schizophrenia-spectrum psychotic disorders (SSPDs). While existing research emphasizes prevalence and clinical outcomes, less is known about how clients and case managers navigate chronic hunger relationally and emotionally. This qualitative descriptive study examined co-experiences and interpretations of food insecurity among individuals with SSPD and their case managers in a community mental health setting in the Southeastern United States. We conducted 10 semi-structured interviews with five clients diagnosed with SSPD and five case managers (30 minutes each). Reflexive thematic analysis, guided by Braun and Clarke's framework, identified five interconnected themes: structural tradeoffs that prioritize housing over food; the burden of shame and stigma when seeking help; invisible coping labor required to manage scarcity; physical health impacts, including malnutrition and chronic disease complications; and hunger as a potential catalyst for psychiatric distress and symptom relapse. Triangulation of client and case manager perspectives revealed shared and divergent understandings of these challenges. Findings from this small, single-site study suggest that food insecurity for individuals with SSPD extends beyond material deprivation and requires integrated, trauma-informed, stigma-reducing interventions that link food security with stable housing and mental health recovery in this community mental health context.