Prevalence of food insecurity and its association with depressive and anxiety symptoms in older adults during the COVID-19 pandemic in Mexico: A secondary analysis of ENCOVID-19 survey

**Background:** The COVID-19 pandemic disproportionately affected older adults, who faced higher morbidity and mortality from the virus alongside social determinants such as poverty, unemployment, and social isolation. Food insecurity (FI) emerged as a critical concern, particularly in low- and middle-income countries. Prior research had established links between FI and mental health conditions, but data specific to Mexican older adults during the pandemic were limited. This study aimed to analyze the prevalence of FI and its association with depressive and anxiety symptoms in this population.

**Methods:** This was a secondary analysis of the National Survey on the Effects of COVID-19 on the Wellbeing of Mexican Households (ENCOVID-19), a series of cross-sectional telephone surveys conducted monthly from April to October 2020. The subsample included 1,065 adults aged 60 years or older with complete data on FI, depression, and anxiety scales. FI was measured using the 8-item adult version of the Latin American and Caribbean Food Security Scale (ELCSA), validated for telephone administration (alpha coefficients 0.87–0.89). FI was classified as food secure (score 0), mild (1–3), moderate (4–6), or severe (7–8); moderate and severe were combined for regression analysis. Depressive symptoms were assessed with the 7-item Center for Epidemiological Studies Depression Scale (CESD-7; cutoff ≥5). Anxiety symptoms were measured with the 2-item Generalized Anxiety Disorder scale (GAD-2; cutoff ≥3). Socioeconomic status (SES) was classified using the AMAI index. ANOVA compared variables across FI groups, and logistic regression models adjusted for sex, age, SES, and schooling were used to estimate odds ratios.

**Key Results:** The mean age was 67.31±6.4 years (range 60–99); 47.75% were women. FI prevalence was 38.56% mild, 15.04% moderate, and 8.16% severe; 38.24% were food secure. Overall, 28.01% of older adults presented anxiety symptoms and 39.09% presented depressive symptoms. A clear gradient was observed: depressive symptoms were present in 65.75% of those with moderate-to-severe FI, 10.39% with mild FI, and 9.40% without FI (p≤0.000). Anxiety symptoms were present in 48% with moderate-to-severe FI, 30.05% with mild FI, and 15.38% without FI (p≤0.000). Lower SES was strongly associated with higher FI severity: among those with severe FI, 51.54% were in SES level D and 19.49% in level E, compared to 25.48% and 3.32% respectively among food-secure participants (p=0.000). In adjusted logistic regression, moderate-to-severe FI was significantly associated with depressive symptoms (OR=5.50, 95% CI 2.74–11.04). For anxiety symptoms, both mild FI (OR=2.43, 95% CI 1.66–3.59) and moderate-to-severe FI (OR=5.32, 95% CI 3.45–8.19) were significant. Female sex was also associated with anxiety symptoms (OR=1.60, 95% CI 1.18–2.18). Food consumption reductions were reported: 23.79% stopped consuming fresh fruits, 21.52% vegetables, 32.79% meats, 24.12% dairy products, 12.66% eggs, and 6.11% beans.

**Clinical Implications:** The study demonstrates a strong, graded association between food insecurity severity and both depressive and anxiety symptoms in Mexican older adults during the COVID-19 pandemic. Over 60% of participants experienced some degree of FI, and those with moderate-to-severe FI had approximately 5.5-fold higher odds of clinically significant depressive symptoms and 5.3-fold higher odds of anxiety symptoms. These findings underscore the syndemic interaction between food insecurity and mental health in vulnerable older populations. The authors recommend designing and implementing programs aimed at older adults to reduce or prevent FI, with interventions to increase access to healthy foods and mitigate socio-emotional effects, particularly among low-income and minority populations. Limitations include potential selection bias from telephone-only recruitment (underrepresenting rural/isolated areas) and the cross-sectional design precluding causal inference.