Correlates of Food Insecurity and Its Association with Mental Health and Healthcare Financial Hardship Among U.S. Veterans

Background and Purpose: Food insecurity (FI) is an important yet underrecognized social determinant of health among U.S. veterans. Addressing FI may reduce mental health challenges and improve healthcare utilization. Although veterans report lower FI rates than non-veterans, FI remains prevalent among economically vulnerable, younger, and racially minoritized veterans. Studies show FI is associated with housing instability, social isolation, and trauma exposure, disproportionately affecting veterans. FI has also been linked to higher rates of unplanned emergency room visits, hospital readmissions, medication nonadherence, and care attrition. Despite growing recognition, the association of FI with mental health and healthcare financial hardship (HCFH) among U.S. veterans remains understudied. This study examines the association between FI and mental health and HCFH outcomes using data from a nationally representative sample of U.S. veterans.

Methods: Cross-sectional data from the 2024 National Health Interview Survey (NHIS) were analyzed to examine correlates of FI and its association with health outcomes. The NHIS is a nationally representative survey that uses a stratified, multistage cluster probability sampling design. The analytic sample was restricted to U.S. veterans aged 18 and older (n=2,721), representing an estimated 18.1 million U.S. veterans. The primary explanatory variable was food insecurity status, measured using the U.S. Household Food Security Survey Module. Mental health outcomes included serious psychological distress, anxiety and depression diagnosis, frequency and severity of anxiety and depression, and loneliness. HCFH outcomes included concerns about paying medical bills and delaying or forgoing medical care or prescriptions. All outcome variables were dichotomous. We estimated prevalence ratios (PRs) and 95% confidence intervals using separate survey-weighted modified Poisson regression models with a log link and robust standard errors. Each model was adjusted for the same set of covariates to ensure comparable estimates.

Results: In this nationally representative sample of U.S. veterans, food insecurity was significantly less prevalent among those who were older, owned a home, had a higher household income-to-poverty ratio, and consistently had social or emotional support, whereas being Latino/Hispanic was significantly associated with higher prevalence. Food insecurity was consistently associated (p < .05) with a higher prevalence of serious psychological distress, anxiety disorders, more frequent anxiety and depressive symptoms, severe depressive symptoms, and loneliness. Food insecurity was also significantly associated with healthcare-related financial hardship, including greater worry about paying medical bills and a higher prevalence of cost-related unmet medical and prescription needs. These associations persisted after adjustment for potential confounders.

Conclusions and Implications: Inadequate access to food is not merely a nutritional or physiological concern but also a critical determinant of mental health and healthcare utilization outcomes among U.S. veterans. Results indicate that FI is a marker of low socioeconomic status and a consistent risk factor linked to adverse mental health outcomes and healthcare financial hardships. These findings underscore the urgent need for interventions to strengthen food access among U.S. veterans. Addressing food insecurity may offer benefits beyond improving nutrition, including reduced mental health challenges and better healthcare utilization, while potentially disrupting pathways that compound health disparities in U.S. veterans.