Food insecurity and mental health among migrants and refugees in high-income countries: a systematic review and meta-analysis

Abstract

Food insecurity (FI) continues to pose significant health and social challenges globally, disproportionately affecting vulnerable populations such as migrants and refugees in high-income countries (HICs). Despite their resettlement into nations of relative economic stability, migrants and refugees face structural, economic, and social barriers that frequently restrict consistent access to adequate and nutritious food. These experiences of deprivation do not merely affect physical health but are increasingly recognised as critical determinants of psychological well-being, exacerbating existing mental health vulnerabilities within displaced populations. Despite the health impact of FI on migrants and refugees in HICs, a comprehensive understanding of the magnitude of food insecurity among migrants and refugees residing in HICs, and its associated impact on mental health outcomes, particularly depression, anxiety, and stress, has remained largely absent. Hence, this thesis aims to systematically examine the prevalence of food insecurity among migrants and refugees in high-income countries (HICs) and evaluate the relationship between FI and mental health among migrants and refugees in HICs. Three full-length manuscripts form the core of this thesis. Each manuscript is presented as an individual chapter, as described in the following paragraphs. Chapter 2 focuses on the review protocol for a systematic review and a meta-analysis of FI in HICs. This process's detailed plan outlines how the review will be conducted before the actual review begins. This protocol clearly outlined the methodological framework guiding the two subsequent systematic reviews and meta-analyses, ensuring transparency and methodological rigour and was registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42024525690). A rigorous systematic review protocol was developed and published in PLOS ONE (Berhe et al., 2024). Chapter 3 presents the prevalence of FI in HICs, based on 34 observational studies involving approximately 4.4 million migrants and refugees after searching SCOPUS, Embase, PsycINFO, Medline, and Web of Science for eligible studies published from January 1, 2008, to December 16, 2024. Chapter 4 presents a systematic review and meta-analysis examining the relationship between food insecurity and mental health outcomes among migrants and refugees in HICs, incorporating data from 17 studies involving over 4.3 million participants after a comprehensive search was conducted in SCOPUS, Embase, PsycINFO, Medline, and Web of Science for eligible studies published between January 1, 2008, and December 16, 2024. Three independent reviewers screened the studies, extracted data, and assessed methodological quality using the Joanna Briggs Institute checklist and weighted pooled odds ratios were reported as the associations between food insecurity and mental health outcomes (depression, anxiety, and stress). Chapter 5 discusses the public health policy and practice implications derived from the study’s findings, emphasizing their significance for developing effective interventions to address food insecurity and associated mental health challenges among migrant and refugee populations. By translating these findings into actionable recommendations, the chapter aims to inform policymakers, practitioners, and stakeholders involved in public health and social support services. Following this, the chapter concludes by summarising the key findings of the research and highlighting areas where further investigation is needed, thereby providing a clear direction for future studies to build upon the current work.

Date of Award	2025
Original language	English
Awarding Institution	Western Sydney University
Supervisor	Kingsley Agho (Supervisor) & Amit Arora (Supervisor)