Published in PLOS One on 2026-05-07, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Kasiye Shiferaw, Gari Hunduma, Yadeta Dessie, Tesfaye Assebe Yadeta, Biftu Geda, Negussie Deyessa, Othman Alfuqaha
Source: PLOS One • DOI 10.1371/journal.pone.0348774
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Global adolescent-level food insecurity (AFI) and common mental disorders (CMD) represent a significant public health burden. While household-level food security is known to be associated with mental health disorders, there is a dearth of evidence regarding the specific association between AFI and CMDs in Ethiopia, particularly in the Harari Regional State.
A school-based cross-sectional study was conducted among 3,326 adolescents in the Harari Regional State, Eastern Ethiopia, utilizing a multistage sampling strategy stratified by locality and school type. Data were collected using validated scales adapted from previous studies, including the HFIAS for adolescent-level food insecurity, KIDSCREEN-10 for health-related quality of life, the Rosenberg Scale for self-esteem, and the SDQ-25 for CMDs. Data were collected using a structured questionnaire translated into Amharic and Afan Oromo and pre-tested for validity. A guided self-administration approach was employed by eight trained BSc nurses and psychiatric nurses. All data collectors and supervisors underwent rigorous training to ensure data quality. Questionnaires were subjected to daily checks for completeness during fieldwork, and double data entry was utilized for final validations and accuracy. Data were analysed using STATA version 16.1. Prior to analysis, data were screened for outliers, missing values, and normality. The structural equation model (SEM) demonstrated a good fit to the data (RMSEA = 0.03, CFI = 0.90, TLI = 0.89 and SRMR = 0.05), confirming the structural integrity of the model prior to the interpretation of path coefficients. We conducted SEM using maximum likelihood estimation after adjusting for relevant covariates.
The descriptive results revealed that 14.50% of adolescents experienced moderate-to-severe food insecurity, while the prevalence of CMDs was 22.93%. Several factors were significantly associated with the prevalence of CMDs. AFI was linked to a higher likelihood of CMDs (β = 0.20, P < 0.001), as were substance use (β = 0.14, P < 0.001) and frequent financial difficulties (β = 0.06, P < 0.001). Conversely, higher quality of life (β = −0.07, P < 0.001) and stronger self-esteem (β = −0.06, P < 0.001) were associated with a lower likelihood of CMD symptoms. Furthermore, urban residency emerged as a protective factor, showing a significant negative association with CMDs (β = −0.21, P < 0.001).
AFI significantly predicts the occurrence of CMDs. A relationship is further driven by poor quality of life, diminished self-esteem, substance use, and financial instability. The study highlights the need for tailored interventions to tackle these functional drivers, suggesting that addressing food insecurity and its associated psychosocial factors is essential to reduce adolescents’ CMD burden.
Introduction
Ending hunger, food insecurity and all forms of malnutrition by 2030 are among sustainable development goal target 2 (SDG 2) [1]. However, around 2.3 billion people (28.0%) globally faced moderate or severe food insecurity in 2024 [2]. While global hunger showed a slight decline to 8.2% in 2024, the situation in Africa has deteriorated. Currently, approximately one in eleven people globally and one in five people in Africa suffer from chronic hunger [1,3], which may be slipping behind schedule. Driven by a combination of conflict, drought, high living cost and natural disasters, Ethiopia remains a severe food crisis zone; an estimated 15.0–15.9 million people in the country were projected to face high levels of acute food insecurity by 2026, a decrease from earlier 2025 peak [4,5].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider public health desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Kasiye Shiferaw, Gari Hunduma, Yadeta Dessie, Tesfaye Assebe Yadeta, Biftu Geda, Negussie Deyessa, Othman Alfuqaha. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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