Since the start of the economic crisis in 2019, food insecurity has been widespread in Lebanon, severely impacting vulnerable groups of the population, such as children, the elderly, and pregnant women. For the latter, adequate nutrition is crucial for the expectant mother’s health and baby’s growth, and pregnancy is a period when limited access to safe and nourishing food can affect physical and emotional wellbeing.  

Until recently, the link between food insecurity and the emotional wellbeing of pregnant women in Lebanon was mostly discussed as a plausible concern, not a measured reality. A team of faculty from the School of Arts and Sciences, Assistant Professor of Nutrition Rana Rizk, Assistant Professor of Practice in Clinical Psychology Toni Sawma, and Associate Professor of Psychology Myriam El Khoury-Malhame, set out to change that.

In collaboration with researchers from several Lebanese universities, they published a study in PLOS ONE titled “Association between food insecurity and mental health outcomes among a convenient sample of Lebanese pregnant women,” exploring the level of food insecurity among a sample of pregnant women in Lebanon and its relation to anxiety, depression, distress, sleep quality, and disordered eating. 

Between January 2023 and September 2024, the research team surveyed 146 pregnant women in Lebanon using an online questionnaire in both Arabic and English. Participants answered questions about their backgrounds and pregnancies, and completed validated scales commonly used in health research, including a food insecurity access scale and brief assessments of mental health, sleep quality, and risk of disordered eating.  

The study investigated how the ongoing crises exacerbated pregnancy-related challenges, with nearly two-thirds (66.4 percent) of participants experiencing some level of food insecurity. 

At the same time, around 50 percent screened positive for anxiety symptoms and 45 percent for depression symptoms, while roughly 83 percent reported high distress. More than half (57.5 percent) experienced poor sleep quality, and close to 10 percent were considered at disordered eating risk.  

In terms of statistical significance, higher food insecurity scores were associated with higher odds of distress and disordered eating and lower odds of good sleep. However, they had no association with anxiety or depression.  

Although this may seem surprising, Dr. Sawma explained that the findings may reflect how food insecurity first affects women’s everyday emotional burden before appearing as “specific pathological anxiety or depressive symptoms.”

The Beirut Distress Scale, which was used as a measure in the study, may have captured more of the day-to-day challenges that pregnant women face in relation to food insecurity and multiple socioeconomic and environmental stressors, he explained. As such, it may reflect the more direct impact of food insecurity on distress versus its prolonged impact on anxiety and depression.

“Food insecurity can also affect mental health through behavioral pathways, such as disordered eating and sleep, before contributing to clinical symptoms of anxiety and depression,” said Dr. El Khoury-Malhame, adding that the already high levels of anxiety and depression in the pregnant sample may have made it harder to detect the separate contribution of food insecurity to these two outcomes. 

The study points to the need for a more comprehensive approach to maternal health in Lebanon. It also highlights the interdisciplinary collaboration within LAU and the national resource pooling with other sister institutions.

The authors call for food security screening to become part of antenatal care, alongside screening for mental health, sleep problems, and disordered eating risk. Such screening would help healthcare providers identify pregnant women who may need nutritional, psychological, or social support early on. 

“Food security is a nutrition issue, a mental health issue, and a maternal health issue,” said Dr. Rizk. “Screening for food insecurity should become a routine part of antenatal care, especially in settings facing economic hardship.”

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