Abstract
IMPORTANCE: The national-scale mental health effects of energy insecurity-the inability to meet household energy needs-remain unknown. As energy insecurity becomes more prevalent in the US, these findings can help guide programs and health interventions aimed at addressing energy insecurity and reducing its health consequences. OBJECTIVE: To investigate whether energy insecurity is associated with depression and anxiety symptoms among the US adult population. DESIGN, SETTING, AND PARTICIPANTS: This study relied on repeated cross-sectional, nationally representative survey data from the US Census Bureau's online Household Pulse Survey administered between December 9, 2022, and September 16, 2024. Eligible participants included US adults with email and mobile phone numbers. EXPOSURES: Two exposure models were analyzed. One model included 3 energy insecurity components: (1) inability to pay full or partial energy bills, (2) keeping the home at unsafe or unhealthy temperatures; and (3) forgoing expenses for necessities, such as food and medicine, to pay energy bills. The second model included a composite measure for respondents who reported experiencing at least 1 of the 3 energy insecurity components in the past 12 months. MAIN OUTCOMES AND MEASURES: Depression and anxiety symptoms were assessed using shortened versions of the Patient Health Questionnaire and Generalized Anxiety Disorder scale. The composite questionnaire scores were used to determine the respondents' symptoms. Weighted bivariate and multivariable logistic regressions adjusting for sociodemographic characteristics were conducted. RESULTS: The weighted sample included 187 356 336 US adults (45 551 454 [24.3%] aged 18-34 years; 96 305 955 [51.4%] female). A total of 81 176 522 adults (43.3%) reported experiencing at least 1 component of energy insecurity. Multivariable analyses showed that energy-insecure individuals had higher odds of reporting symptoms of depression and anxiety compared with those without energy insecurity. After adjusting for other social determinants of health, energy insecurity was associated with increased odds of anxiety (OR, 2.29; 95% CI, 2.24-2.34) and depression (OR, 2.31; 95% CI, 2.26-2.37) symptoms. CONCLUSIONS AND RELEVANCE: In this cross-sectional study of US adults, energy insecurity was associated with mental health symptoms. As household energy insecurity is expected to increase, these findings provide valuable evidence for policymakers deliberating the future of federally funded assistance programs.