Climate Change, Food Insecurity, and Mental Health in Southwestern Madagascar

Abstract

There have been no culturally validated measures to screen for depression in Madagascar. In 2022-2023, we conducted qualitative studies in the Bay of Ranobe area in southwestern Madagascar to understand local mental health syndromes specific to this region. In Chapter 1, we first culturally validated the 8-item Patient Health Questionnaire (PHQ-8) in southwestern Madagascar. We found that the 8-item Patient Health Questionnaire (PHQ-8) shares symptoms with the general distress-like, depressive-like, and grief-like syndromes elicited locally. We adapted the PHQ-8 to align with unique symptoms found in the region that were missing from the measure. In Chapter 2, we assessed the contribution of aquatic foods to household diets. Aquatic foods—such as fish, shellfish, and seaweeds—are highly beneficial to global human nutrition because they provide essential nutrients like omega-3 fatty acids, high-quality protein, and micronutrients that support health, particularly in regions where other nutrient-dense foods are less accessible. To understand the role of diverse food groups, and specifically aquatic foods, in human nutrition in southwestern Madagascar, we assessed their contributions to household nutrient intakes and adequacy using food system and dietary intake data. Climate change poses threats to both the food system and the mental health of the Malagasy population. In Chapter 3, we evaluated the association among environmental shocks, food insecurity, and mental health in southwestern Madagascar. Specifically, we answered three research questions: (1) Is there an association between environmental shocks and food insecurity? (2) Is food insecurity associated with anxiety and depressive symptoms? (3) Are environmental shocks associated with depressive and anxiety disorder symptoms? We used a multilevel generalized mixed-effect Poisson model for each research question.