"When you have no water, it means you have no peace": A mixed-methods, whole-population study of water insecurity and depression in rural Uganda.

Journal: Social science & medicine (1982)

Volume: 245

Issue: 

Year of Publication: 2020

Affiliated Institutions:  Harvard Medical School, Boston, USA; Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, USA; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, USA. Electronic address: rmushavi@partners.org. Department of Urban Studies and Planning, Massachusetts Institute of Technology, Boston, USA; Center for Global Health, Massachusetts General Hospital, Boston, USA. Mbarara University of Science and Technology, Mbarara, Uganda. Center for Global Health, Massachusetts General Hospital, Boston, USA. Département de Psychiatrie, Universitié de Genève, Switzerland. Center for Global Health, Massachusetts General Hospital, Boston, USA; Department of Psychology & Neuroscience, Duke University, Durham, USA. Mbarara University of Science and Technology, Mbarara, Uganda; Oregon Health and Science University-Portland State University School of Public Health, Portland, USA. Harvard Medical School, Boston, USA; Center for Global Health, Massachusetts General Hospital, Boston, USA; Mbarara University of Science and Technology, Mbarara, Uganda; Harvard Center for Population and Development Studies, Cambridge, USA.

Abstract summary 

Lack of access to clean water has well known implications for communicable disease risks, but the broader construct of water insecurity is little studied, and its mental health impacts are even less well understood.We conducted a mixed-methods, whole-population study in rural Uganda to estimate the association between water insecurity and depression symptom severity, and to identify the mechanisms underlying the observed association. The whole-population sample included 1776 adults (response rate, 91.5%). Depression symptom severity was measured using a modified 15-item Hopkins Symptom Checklist for Depression. Water insecurity was measured with a locally validated 8-item Household Water Insecurity Access Scale. We fitted multivariable linear and Poisson regression models to the data to estimate the association between water insecurity and depression symptom severity, adjusting for age, marital status, self-reported overall health, household asset wealth, and educational attainment. These models showed that water insecurity was associated with depression symptom severity (b = 0.009; 95% confidence interval [CI], 0.004-0.15) and that the estimated association was larger among men (b = 0.012; 95% CI, 0.008-0.015) than among women (b = 0.008; 95% CI, 0.004-0.012. We conducted qualitative interviews with a sub-group of 30 participants, focusing on women given their traditional role in household water procurement in the Ugandan context. Qualitative analysis, following an inductive approach, showed that water insecurity led to "choice-less-ness" and undesirable social outcomes, which in turn led to emotional distress. These pathways were amplified by gender-unequal norms.Among men and women in rural Uganda, the association between water insecurity and depression symptom severity is statistically significant, substantive in magnitude, and robust to potential confounding. Data from the qualitative interviews provide key narratives that reveal the mechanisms through which women's lived experiences with water insecurity may lead to emotional distress.

Authors & Co-authors:  Mushavi Rumbidzai C RC Burns Bridget F O BFO Kakuhikire Bernard B Owembabazi Moran M Vořechovská Dagmar D McDonough Amy Q AQ Cooper-Vince Christine E CE Baguma Charles C Rasmussen Justin D JD Bangsberg David R DR Tsai Alexander C AC

Study Outcome 

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Statistics
Citations :  Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet. 2013;382(9904):1575–86.
Authors :  11
Identifiers
Doi : 10.1016/j.socscimed.2019.112561
SSN : 1873-5347
Study Population
Men,Women
Mesh Terms
Adult
Other Terms
Depression;Mental health;Psychological distress;Resource insecurity;Stress;Sub-Saharan Africa;Uganda;Water insecurity;Water security
Study Design
Cross Sectional Study
Study Approach
Qualitative
Country of Study
Uganda
Publication Country
England