Food security is the measure of food availability, and individuals' ability to access it [1]. According to the United Nations' Committee on World Food Security, food security is defined as the ability of all people, at all times, to have physical, social, and economic access to sufficient, safe, and nutritious food that meets their food preferences and dietary needs for active and healthy life [2]. This definition of food security incorporates a measure of resilience to future disruption or unavailability of critical food supply due to various risk factors including climate change, economic instability and wars. Individuals who are food secure do not live in hunger and/or fear of starvation. On the other hand food insecurity, is a situation where people have limited or uncertain availability of nutritionally adequate and safe food or limited or uncertain ability to acquire acceptable food in socially acceptable manner [3, 4]. A person is food insecure when s/he lacks regular access to enough, safe and nutritious food for normal growth and development, and active and healthy life[4]. Food insecurity can be experienced at different levels of severity, and when a person is severely food insecure, s/he has run out of food and gone a day or more without eating. In other words, this person has experienced hunger[5]. Moderate food insecurity is where access to food is uncertain, and people in moderate food insecurity might have to sacrifice other basic needs, just to be able to eat, and when they do eat, it might be whatever food that is most readily available, and/or cheapest, which might not be the most nutritious[5]. Low food insecurity is where individuals report little or no indication of reduced food intakes; or they report no reduced quantity, quality, variety, and/or desirability of diet[5].
Globally about 1.9 billion people experienced food insecurity in 2017, with the greatest numbers in Sub-Saharan Africa and South Asia [6]. About 9% of the world population i.e., 697 million people experience severe food insecurity [6]. The number of people unable to afford dissent or healthy diet around the world rose from 112 million in 2019 to almost 3.1 billion in 2020[7]. In 2021, nearly 924 million people (11.7 percent of the global population) faced food insecurity at severe levels[7]. Currently about 2.3 billion people in the world (29.3 percent) face moderate or severe food insecurity [7]. In Sub-Saharan Africa, about 30 percent of the population experienced severe food insecurity in 2020[8]. Around 37 percent of the region's population experienced food insecurity at moderate level, and close to 724 million people in south of Sahara experienced severe or moderate food insecurity [8]. In Ghana the prevalence of food insecurity is not different, it is reported that about 38.2 percent of Ghanaians experienced food insecurity [9].
Study shows that the major determinants of individuals vulnerability to food insecurity consist of clusters of risk factors that include demographic factors such as age of household head, family size, safety net programs, distance from healthcare facility and death of household members[10]. Central to these cluster of risk factors in the Ghanaian setting is the family. Families in Ghana play integral roles in individuals health seeking behaviors, decision making and resources allocation processes. Therefore, disrupting the family system in any form in Ghana could be counterproductive to individuals’ health in Ghana. In this regard it is important that researchers consider the concept of family and family size as major risk factors in the cluster of risk factors that can influence individuals’ vulnerability to adverse outcomes.
The word ‘’Family’’ originated from the Latin word ‘’familia,’’ which means a group of people related either by consanguinity (birth) or affinity (marriage and other relationship)[11]. This definition, broadly count people as “family” even though they do not live together, but are related to one another biologically or through legal contracts. In contrast to this definition, other scholars defined family as a group of people not generally related to one another by blood, but share common attitudes, interests, or goals, and frequently live together[12]. In a more concise definition, family is a basic social unit comprising the parents and their dependent children living together in one household[13]. According to the most functional definitions of family, a family is any unit in which there exists: A sharing of resources and economic property, caring and supportive relationship, commitment to and/or identification with other members [14]. It is quite difficult to get or identify one universally acceptable definition of ‘’family’’ that fit all, however, most definitions convey societally accepted beliefs about what is “normal” and “acceptable” and thus, by implication, what is “deviant” and/or socially sanctioned. Historically and in modern times, human societies use family as the primary locus of attachment, nurturance, and socialization[15-17] of which family size is of essence. Family size by definition is the number of persons in the family [18].
There are two main types of family sizes: large family size, and small family size. Large family size is the type where the number of members inside is large and thus, consist of the husband, wife, or wives, children, grandparents, uncles, aunts, cousins, nephews, nieces etc. Large family sizes, are often associated with extended family system[19]. This kind of family size most often produced consequences such as child labor, child abuse, child exploitation, neglect, drug peddling, and drop out of school leading to decline in moral and social standard[20]. Small family size on the other hand is the type of family that has fewer number of individuals, and traditionally refers to as the nuclear family system. This kind of family size consists of the husband, wife, or wives and children. Small family size allows for better planning and management in terms of feeding, clothing, shelter, education, saving for the future, promoting good moral values and standards, and give the family the ability to have intimate relationship.
Assessing the definitions of food security and family size thereof, it is clear that these variables in their adverse forms could have high propensity of causing psychological and mental disabilities including depression at varying degree among individuals. In a large-scale family policy and food insecurity observational analysis in 142 countries, Aaron R. et al., reported that moderate or severe food insecurity is higher in households with large family size[21]. However, in a separate study conducted by Julia A.W. et, al., food insecurity was shown to be associated with depression, anxiety, and stress in the early days of the COVID-19 Pandemic [22]. Di Fang et al., also noted that food insecurity is associated with 257% higher risk of anxiety (odds ratio: 3.57; 95% CI: 3.01 to 4.23) and 253% higher risk of depression (odds ratio: 3.53; 95% CI: 2.99 to 4.17)[23]. In South Africa another study conducted indicates that food insecurity and depressive symptomology increased during the COVID pandemic, with both men and women significantly reported rising depressive symptoms with different levels of food insecurity[24]. Several other studies have shown the association of food insecurity with anxiety and depressive symptoms, with significantly increasing trend globally[25-27].
In related development family size has also been shown to be associated with depressive symptom. Study conducted by Alexandros G. et al., shown that having three or more children in a family was associated with higher odds of lifetime depression[28]. In a different study, being in a polygamous family (OR = 5.781, 95% CI, 3.253 - 24.371), and having a single parent (OR = 2.236, 95% CI, 0.869 - 11.786) were significantly associated with increased odds for depression among adolescents girls[29], and yet another study indicates that marital satisfaction, and harmony with mother-in-law in family prevented adolescent girls from depression[30].
Although different studies have demonstrated significant associations between household food insecurity, and family size for depression among people in different countries, very little of such studies have been conducted in Ghana. Also, very little is done to show how these variables (household food insecurity and family size) can interact synergistically or multiplicatively to influence depression among individuals. Individuals’ vulnerability to depression and other psychiatric symptoms depends on cluster of risk factors that can exist in tandem. Since these cluster of risk factors can exist together or in tandem to influence different outcomes, it is very important that researchers examine and ascertain how these risk factors can independently, synergistically or multiplicatively act to influence depression and other psychiatric symptomatology in order to design health promotion interventions to counter these pathways. In this regard, our study seeks to assess how household food insecurity, family size and their interactions are related to depression prevalence among teenage pregnant girls in Ghana.