Associations Between Food Insecurity, Psychological Distress and Disordered Eating Risk in University Students: Evidence from a Cross-Sectional Mediation Analysis

Background/Objective: Food insecurity is increasingly recognised as a concern among university students. Less is known about the interrelationships between food insecurity, psychological distress, and disordered eating risk in this population. This study aimed to examine associations between food insecurity, psychological distress, and disordered eating risk among university students, and to explore whether psychological distress mediates the association between food insecurity and disordered eating. Methods: A cross-sectional survey among university students assessed food insecurity using the USDA HFSSM. Psychological distress was assessed using the Kessler Psychological Distress Scale (K6), with disordered eating risk measured using EAT-8. Adjusted logistic regression models examined associations between food insecurity severity with psychological distress and disordered eating risk, controlling for age, living situation, and enrolment type. Mediation analysis explored whether psychological distress statistically mediated the association between food insecurity and disordered eating. Results: Overall, 63.2% of the 348 students surveyed reported some level of food insecurity, 15.8% met criteria for psychological distress and 42.0% were classified as being at high risk of disordered eating. In adjusted models, moderate (OR 2.46, 95% CI: 1.06–5.69) and severe food insecurity (OR 4.27, 95% CI: 1.83–9.97) were associated with higher odds of psychological distress. Severe food insecurity was also associated with higher odds of disordered eating risk (OR 2.07, 95% CI: 1.12–3.84). Mediation analysis indicated a statistically significant indirect association between food insecurity and disordered eating through psychological distress (B = 0.241, 95% CI: 0.065–0.418), with 43.5% of the total association statistically accounted for by psychological distress. Conclusions: Findings indicate an indirect statistical association in which food insecurity is associated with higher psychological distress, which is in turn associated with higher disordered eating risk, based on cross-sectional analysis. Longitudinal studies are needed to clarify temporality and better understand these relationships.