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Background: 

Adverse socioeconomic conditions are strongly associated with worse mental health outcomes, underscoring the potential impact of clinical interventions that address both social and economic drivers of health. The Medical-Financial Partnership (MFP), is a clinic-based model that integrates health systems, financial services, and community resources to improve social, economic, physical, and mental health and well-being. MFP models have demonstrated improvements in mental health for parents but the mechanism through which these improvements occur is unclear. The perinatal period is a critical window in which changes in social drivers of health may influence mental health trajectories. Among social drivers, food security is prominent as changes in access to adequate nutrition are common and associated with mental health. Understanding whether changes in food insecurity explain mental health improvements driven by MFPs is essential for understanding the mechanisms of the intervention. 

Objective: 

The objective of this study is to evaluate whether food insecurity mediates the MFP intervention effect on mental health over time. 

Methods & Analysis: 

This study builds on a randomized controlled trial of families enrolled in an MFP intervention by assessing whether changes in measures of food security during the RCT study period and prior mediate the association between the MFP intervention and mental health over time. Following delivery, participants were randomized to either standard of care pediatric primary care visits or the MFP program. Social risk and mental health outcomes were assessed via electronic surveys completed at six time points over a three year period. The primary outcome measures of the study included food security status, enrollment in public benefits addressing food insecurity (SNAP, WIC, CalWORKS), and global mental health t-scores (PROMIS-10 mental health subscale). Longitudinal analyses were conducted in STATA to estimate the effect of MFP on mental health trajectories and to assess whether changes in food security over time mediated observed  changes in mental health. 

Results: 

Analyses are in progress. We hypothesize food security and public benefits enrollment will partially mediate the impact of the MFP on longitudinal global mental health scores over time among study participants. 

Conclusion: 

Identifying changes in food insecurity as a mechanism for mental health improvement driven by the MFP intervention will contribute to emerging evidence on how upstream clinical interventions can better support economic well-being, address social drivers, and improve mental health in tandem.