Food as medicine, community as medicine: Mental health effects of a social care intervention

Abstract

Objective: To assess mental health related outcomes of Recipe4Health, a multisectoral social care partnership implementing produce prescriptions with or without group medical visits (GMVs). Study Setting and Design: Recipe4Health was implemented at five community health centers from 2020 to 2023. Primary care teams referred patients with food insecurity and/or nutrition-sensitive chronic conditions (e.g., diabetes, depression) to 16 weeks of Food Farmacy (produce prescriptions) with the option of GMV participation. We used a convergent mixed-methods design including survey and interview data. Data Sources and Analytic Sample: We conducted (1) participant surveys pre- and post-intervention and (2) semi-structured interviews with Recipe4Health participants and partner organization staff. Linear mixed effects models examined changes in mental health and related outcomes. Interviews were analyzed using codebook thematic analysis. Principal Findings: Program participants were middle-aged, primarily women, and from diverse racial/ethnic backgrounds (majority Latine and Black). At baseline, moderate or severe depression and/or anxiety symptoms were reported by 77/188 (41%) of Food Farmacy-only participants, and 113/284 (40%) of Food Farmacy +GMV participants. Among Food Farmacy-only participants, post-intervention depression and anxiety symptoms significantly improved only among those who did not have baseline depression/anxiety (PHQ9: −1.7 [95% CI: −2.8, −0.6]; GAD7: −1.8 [95% CI: −2.9, −0.8]). Among Food Farmacy +GMV participants, mental health symptoms improved regardless of baseline mental health; among those with baseline depression/anxiety: PHQ9: −2.4 (95% CI: −3.6, −1.2); GAD7: −0.9 (95% CI: −2.0, 0.1); among those without: PHQ9: −2.2 (95% CI: −3.2, −1.2); GAD7: −2.2 (95% CI: −3.1, −1.2). Improvements in social needs (food insecurity, loneliness) and health-related behaviors (fruit/vegetable intake, physical activity) varied by intervention arm and baseline depression/anxiety symptom level. In interviews, staff and patients endorsed produce prescriptions for improving nutrition and food insecurity, and GMVs for increasing social support. Conclusion: Social care interventions providing vegetables and fruit, with or without group medical visits, may concurrently address mental health symptoms and social needs.