Abstract summary 

Water insecurity and inadequate sanitation have adverse impacts on the mental health of individuals.To review and synthesize evidence on the relationship between water insecurity, inadequate sanitation, and mental health globally.Relevant studies were identified by searching PubMed, PsycINFO, and EMBASE databases from inception up to March 2023.Only quantitative studies were included. The exposure was water insecurity and or inadequate sanitation. The outcome was common mental disorders (CMD: depression or anxiety), mental distress, mental health or well-being. There was no restriction on geographical location.General population or people attending health facilities or other services.Water insecurity and/ or inadequate sanitation.The effective Public Health Practice Project (EPHPP) assessment tool was used to assess quality of selected studies.A meta-analysis was conducted using a random effects statistical model.Twenty-five studies were included, with 23,103 participants from 16 countries in three continents: Africa (Kenya, Ethiopia, Ghana, Uganda, South Africa, Malawi, Mozambique, and Lesotho), Asia (Nepal, Bangladesh, India, and Iran) and the Americas (Brazil, Haiti, Bolivia and Vietnam). There was a statistically significant association between water insecurity and CMD symptoms. Nine studies reported a continuous outcome (5,248 participants): overall standardized mean difference (SMD = 1.38; 95% CI = 0.88, 1.87). Five studies reported a binary outcome (5,776 participants): odds ratio 5.03; 95% CI = 2.26, 11.18. There was a statistically significant association between inadequate sanitation and CMD symptoms (7415 participants), overall SMD = 5.36; 95% CI = 2.51, 8.20.Most of the included studies were cross-sectional which were unable to examine temporal relationships.Water insecurity and inadequate sanitation contribute to poorer mental health globally.Interventions to provide basic water, sanitation and psychosocial support, could substantially contribute to reducing the burden of CMD alongside other health and social benefits.PROSPERO registration number: CRD42022322528.

Authors & Co-authors:  Kimutai Lund Moturi Shewangizaw Feyasa Hanlon

Study Outcome 

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