global mental health and nutrition moving toward a convergent research agenda CORD-Papers-2022-06-02 (Version 1)

Title: Global Mental Health and Nutrition: Moving Toward a Convergent Research Agenda
Abstract: Both malnutrition and poor mental health are leading sources of global mortality disease and disability. The fields of global food security and nutrition (FSN) and mental health have historically been seen as separate fields of research. Each have undergone substantial transformation especially from clinical primary care orientations to wider sociopolitical approaches to achieve Sustainable Development Goals. In recent years the trajectories of research on mental health and FSN are further evolving into an intersection of evidence. FSN impacts mental health through various pathways such as food insecurity and nutrients important for neurotransmission. Mental health drives FSN outcomes for example through loss of motivation and caregiving capacities. They are also linked through a complex and interrelated set of determinants. However the heterogeneity of the evidence base limits inferences about these important dynamics. Furthermore interdisciplinary projects and programmes are gaining ground in methodology and impact but further guidance in integration is much needed. An evidence-driven conceptual framework should inform hypothesis testing and programme implementation. The intersection of mental health and FSN can be an opportunity to invest holistically in advancing thinking in both fields.
Published: 2021-10-08
Journal: Front Public Health
DOI: 10.3389/fpubh.2021.722290
DOI_URL: http://doi.org/10.3389/fpubh.2021.722290
Author Name: Sparling Thalia M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/sparling_thalia_m
Author Name: Cheng Bryan
Author link: https://covid19-data.nist.gov/pid/rest/local/author/cheng_bryan
Author Name: Deeney Megan
Author link: https://covid19-data.nist.gov/pid/rest/local/author/deeney_megan
Author Name: Santoso Marianne V
Author link: https://covid19-data.nist.gov/pid/rest/local/author/santoso_marianne_v
Author Name: Pfeiffer Erin
Author link: https://covid19-data.nist.gov/pid/rest/local/author/pfeiffer_erin
Author Name: Emerson Jillian A
Author link: https://covid19-data.nist.gov/pid/rest/local/author/emerson_jillian_a
Author Name: Amadi Florence Mariamu
Author link: https://covid19-data.nist.gov/pid/rest/local/author/amadi_florence_mariamu
Author Name: Mitu Khadija
Author link: https://covid19-data.nist.gov/pid/rest/local/author/mitu_khadija
Author Name: Corvalan Camila
Author link: https://covid19-data.nist.gov/pid/rest/local/author/corvalan_camila
Author Name: Verdeli Helen
Author link: https://covid19-data.nist.gov/pid/rest/local/author/verdeli_helen
Author Name: Araya Ricardo
Author link: https://covid19-data.nist.gov/pid/rest/local/author/araya_ricardo
Author Name: Kadiyala Suneetha
Author link: https://covid19-data.nist.gov/pid/rest/local/author/kadiyala_suneetha
sha: fad8a83ee224c984d2791b4707b848c76aed499c
license: cc-by
license_url: https://creativecommons.org/licenses/by/4.0/
source_x: Medline; PMC
source_x_url: https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/
pubmed_id: 34722437
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/34722437
pmcid: PMC8548935
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8548935
url: https://www.ncbi.nlm.nih.gov/pubmed/34722437/ https://doi.org/10.3389/fpubh.2021.722290
has_full_text: TRUE
Keywords Extracted from Text Content: SDG women evidence-driven (psycho)social cross-contextual Food children mother FSN LMICs stem maternal mental body SDGs lowresource highburden people lines UN's Development Agenda Covid-19 Sylvia Aimiani IMMANA Nadine Seward
Extracted Text Content in Record: First 5000 Characters:• Global progress toward health goals will be sooner realized by working toward an empirical framework for hypothesis testing that incorporates common determinants and synergistic dynamics of mental health and FSN. Malnutrition in all forms is a leading source of disability and disease which affects a considerable proportion of the world's population: 1 in 9 people is hungry and undernourished and 1 in 3 people is overweight or obese (1). Unhealthy diets are among the top three underlying causes of mortality worldwide (2) . Moreover, the coexistence of undernutrition and obesity is increasing in several low-and middle-income countries (LMIC), compounding associated health risks (3) . Food security, or everyone at all times having access to affordable, safe, sufficient, and nutritious foods (4) , is a key determinant of nutritional outcomes such as diet quality, nutrient adequacy, and nutritional status, and thus are considered together here forth. Another major source of disability and disease is poor mental health. In 2019, mental health was the second leading cause of years lost to disability (YLD) worldwide, accounting for 15% FIGURE 1 | Graphic timeline linking mental health to food security and nutrition. of the total YLD (2) . A recent meta-analysis estimated that about 20% of mothers in developing countries experience clinical depression after childbirth (5) . LMICs spend on average a mere 0.5% of national health budgets on mental health, despite the fact that they constitute over 80% of the global population (6) . Although they are often thought of as two very separate fields of study, in the context of the internationally agreed Sustainable Development Goals (SDG) on health and well-being (7), there is an increasing recognition that each these areas should be key focal points of action to leave no one behind (8, 9) . Furthermore, there is an opportunity to focus on synergies between food security and nutrition (FSN) and mental health. We aim to summarize the developments of both fields in this regard, as well as how they have intersected empirically, and suggest ways forward to advance progress toward global public health goals. We trace the progression of both mental health and FSN on the global agenda, marked by the Millennium Development Goals (MDGs) in 2000, to the SDGs in 2015 and beyond (Figure 1) . The MDGs focused many of their targets and indicators on health, but linked to nutrition only though a narrow focus on hunger and underweight status (7) . Mental health was almost entirely ignored in the MDGs (10) . Implicitly, however, both FSN and mental health were recognized by the research community as contributing to and interrelated with the goals of eradicating poverty, promoting gender equality, reducing child mortality, and improving maternal health (11) . Since 2007, there has been strident progress toward elucidating these contributions, albeit as largely separate fields. Prince et al. contributed a paper on the state of evidence on global mental health in 2007, arguing that achieving global health goals would not be possible without addressing mental health (12) . It described mental health as both a precursor to and an outcome of other major health burdens, such as parental depression compromising child care or diabetes and obesity fueling poor mental health. A Lancet series in 2008 focused on maternal and child undernutrition similarly made the case that investing in nutrition actions (specifically the impact of scaling 10 effective nutrition-specific interventions to 90% in 36 highburden countries), would be a significant stride toward achieving global health goals (13) . Both fields underwent transformations as the MDG period came to its conclusion, situating respective burdens within a broader context. Prevailing evidence coalesced around nutritionsensitive interventions and enabling environments (13) . For FSN, this evidence signaled the importance of underlying factors such as agriculture, food environments, caregiving and gender dynamics, and poverty in limiting the success of even highquality, large scale nutrition-specific interventions (14) . For mental health, this wider perspective was more nascent, though it was apparent in the growing body of evidence showing the potential positive effects of addressing maternal mental health, especially for children's health (15) . Within the UN's Development Agenda for the post-2015 era, the 17 Sustainable Development Goals (SDGs) incorporated a broader view of FSN. SDG 2 to "End hunger, achieve food security and improved nutrition and promote sustainable agriculture" included elements of agricultural productivity, diversity, and sustainability. The Global Nutrition report in 2017 made a clear case for the importance of improving nutrition in achieving at least five SDG goals (16) . However, FSN targets and indicators are still missing important aspects of global food systems and environments. The focus on mental health lags behind FS
Keywords Extracted from PMC Text: SDG maternal mental " SDGs lines JE cross-contextual (psycho)social BC evidence-driven 52–54 FMA RA FCDO children body UN's Development Agenda SK each Bill people stem FSN mother IMMANA LMICs women Food Covid-19 UK Foreign Commonwealth
Extracted PMC Text Content in Record: First 5000 Characters:Malnutrition in all forms is a leading source of disability and disease which affects a considerable proportion of the world's population: 1 in 9 people is hungry and undernourished and 1 in 3 people is overweight or obese (1). Unhealthy diets are among the top three underlying causes of mortality worldwide (2). Moreover, the coexistence of undernutrition and obesity is increasing in several low- and middle-income countries (LMIC), compounding associated health risks (3). Food security, or everyone at all times having access to affordable, safe, sufficient, and nutritious foods (4), is a key determinant of nutritional outcomes such as diet quality, nutrient adequacy, and nutritional status, and thus are considered together here forth. Another major source of disability and disease is poor mental health. In 2019, mental health was the second leading cause of years lost to disability (YLD) worldwide, accounting for 15% of the total YLD (2). A recent meta-analysis estimated that about 20% of mothers in developing countries experience clinical depression after childbirth (5). LMICs spend on average a mere 0.5% of national health budgets on mental health, despite the fact that they constitute over 80% of the global population (6). Although they are often thought of as two very separate fields of study, in the context of the internationally agreed Sustainable Development Goals (SDG) on health and well-being (7), there is an increasing recognition that each these areas should be key focal points of action to leave no one behind (8, 9). Furthermore, there is an opportunity to focus on synergies between food security and nutrition (FSN) and mental health. We aim to summarize the developments of both fields in this regard, as well as how they have intersected empirically, and suggest ways forward to advance progress toward global public health goals. We trace the progression of both mental health and FSN on the global agenda, marked by the Millennium Development Goals (MDGs) in 2000, to the SDGs in 2015 and beyond (Figure 1). The MDGs focused many of their targets and indicators on health, but linked to nutrition only though a narrow focus on hunger and underweight status (7). Mental health was almost entirely ignored in the MDGs (10). Implicitly, however, both FSN and mental health were recognized by the research community as contributing to and interrelated with the goals of eradicating poverty, promoting gender equality, reducing child mortality, and improving maternal health (11). Since 2007, there has been strident progress toward elucidating these contributions, albeit as largely separate fields. Prince et al. contributed a paper on the state of evidence on global mental health in 2007, arguing that achieving global health goals would not be possible without addressing mental health (12). It described mental health as both a precursor to and an outcome of other major health burdens, such as parental depression compromising child care or diabetes and obesity fueling poor mental health. A Lancet series in 2008 focused on maternal and child undernutrition similarly made the case that investing in nutrition actions (specifically the impact of scaling 10 effective nutrition-specific interventions to 90% in 36 high-burden countries), would be a significant stride toward achieving global health goals (13). Both fields underwent transformations as the MDG period came to its conclusion, situating respective burdens within a broader context. Prevailing evidence coalesced around nutrition-sensitive interventions and enabling environments (13). For FSN, this evidence signaled the importance of underlying factors such as agriculture, food environments, caregiving and gender dynamics, and poverty in limiting the success of even high-quality, large scale nutrition-specific interventions (14). For mental health, this wider perspective was more nascent, though it was apparent in the growing body of evidence showing the potential positive effects of addressing maternal mental health, especially for children's health (15). Within the UN's Development Agenda for the post-2015 era, the 17 Sustainable Development Goals (SDGs) incorporated a broader view of FSN. SDG 2 to "End hunger, achieve food security and improved nutrition and promote sustainable agriculture" included elements of agricultural productivity, diversity, and sustainability. The Global Nutrition report in 2017 made a clear case for the importance of improving nutrition in achieving at least five SDG goals (16). However, FSN targets and indicators are still missing important aspects of global food systems and environments. The focus on mental health lags behind FSN within the SDGs. Goal 3 brought non-communicable diseases into focus, with target 3.4: "By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being" (17). However, mental health as a part of NCDs is rarely mentione
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