Exploring the associations between food insecurity, diet diversity and mental health in women from a rural community in Northern Region, Ghana: A household survey

Low- and middle-income countries face disproportionate levels of food insecurity and poor mental health, with stark gender inequalities. In Ghana’s Northern Region, high poverty and reliance on subsistence farming exacerbate these challenges. Women in rural “Last-Mile” populations, face barriers to accessing adequate, nutritious and affordable food, which, combined with cultural gender norms, may impact mental health. This study assesses the prevalence of food insecurity, inadequate diet diversity and low self-reported mental health scores among women in Karaga District and examines associations between household food insecurity and mental health. Quantitative household survey data were analysed using descriptive statistics and linear regression models. Food insecurity was assessed using the Food Insecurity Experience Scale and Rasch modelling. Dietary diversity was calculated using the Global Diet Quality Project’s Diet Quality Questionnaire. Mental health was evaluated using the RAND Short Form Health Survey. Among 384 women surveyed (sample size calculated a priori to meet power requirements), 93.4% experienced moderate or severe food insecurity, markedly higher than national (42.4%) and global (28.9%) averages. Only 31.5% reported adequate dietary diversity and 51.8% had low mental health scores. Univariate regression showed food insecurity was negatively associated with mental health (β: -0.76, p= 0.042, 95% CI: -1.50, -0.03), though significance was lost after adjusting for confounders. Significant predictors of mental health scores (p