State supplemental nutrition assistance program helps reduce mental illness and suicidality

1. Expansion of the Supplemental Nutrition Assistance Program (SNAP) eligibility criteria is associated with decreased mental illness and suicidality. 

Evidence Rating Level: 2 (Good)

Food insecurity, the limited or unsteady access to food due to a lack of sufficient resources, is related to poor mental health and suicidality. In the United States, approximately 25 million adults report food insecurity annually.  The Supplemental Nutrition Assistance Program (SNAP) is a program that provides over 21 million low-income households with assistance with the cost of food. Federal eligibility criteria include household assets not exceeding $2250, with household income not exceeding 130% of the federal poverty level (FPL), though states are able to expand income to 200% FPL and eliminate the asset test, increasing the number of eligible households. The purpose of this retrospective cohort study was to examine whether the adoption of broader SNAP inclusion criteria at the state level reduces mental illness and suicidality among adults. Researchers included data from the National Vital Statistics System between 2014 and 2017, as well as data from the National Survey on Drug Use and Health between 2015 and 2019. State elimination of the asset test only was associated with decreased rates of past-year major depressive episodes (RR 0.92, 087-0.98) and mental illness (RR 0.91, 0.87-0.97). State elimination of both the asset test and increasing the income limit was associated with decreased rates of past year major depressive episodes (RR 0.92, 0.86-0.99), mental illness (0.92, 0.87-0.98), serious mental illness (RR 0.91, 0.84-0.99), and suicidal ideation (RR 0.89, 0.82-0.96). There was no statistically significant reduction in suicide deaths. Food insecurity is a known risk factor for mental illness and suicidality, with this study emphasizing the importance of reducing food insecurity as an important public health and psychiatric intervention. Policymakers may use the results of this study to encourage greater expansion of programs addressing food insecurity. 

Click to read the study in JAMA Network Open

Image: PD

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