Syndemic linkages between financial hardships, food insecurity, and mental health challenges following the COVID-19 pandemic

Many households faced unprecedented financial impacts during the COVID-19 pandemic. This analysis explores how financial hardships during and since the COVID-19 pandemic, coupled with food-related inflation mitigation strategies, correlate with syndemic challenges of food insecurity, perceived stress, anxiety and depression. We used online survey data from May to July 2024 of 1,438 adults in Maine and Vermont, with a split food secure/insecure sample, and used a generalized structural equation model to assess the relationships between household characteristics, adverse financial events, inflation strategies, food security and mental health. We find that food insecure households faced significantly more financial hardships (mean = 3.0), as compared to food secure households (mean = 1.0, p < 0.001). Food insecure households also employed food inflation mitigation strategies at significantly higher levels than food secure households (p < 0.001). Food insecure respondents had double the prevalence of anxiety and depression as compared to food secure respondents (62.26% to 31.16%, p < 0.001). Challenges with paying loans and bills appear to be the most critical financial challenges associated with current levels of food insecurity and anxiety/depression. These results suggest that financial hardships that occurred during the COVID-19 pandemic continue to impact food purchasing strategies, food insecurity, stress, anxiety, and depression among adults.