Abstract
BackgroundWater insecurity is linked to depression in low- and middle-income countries (LMICs), though it remains unclear how geospatial clustering of water insecurity in rural regions is associated with risk for depression.MethodsWe conducted a population-based survey of a rural parish in southwestern Uganda (N = 1603) to evaluate the joint geospatial clustering of water insecurity and risk for depression among men and women living in rural Uganda.ResultsGeospatial clustering of self-reported water insecurity and depressive symptoms was found to be present among both men and women. Depression hotspots were more often observed near water insecurity hotspots among women, relative to men. Multivariable regression revealed that residing in a water insecurity hotspot significantly increased risk for depressive symptoms among women, but not among men.ConclusionsResiding in a water insecurity hotspot is associated with greater risk for probable depression among women, but not among men, pointing to the need for focused depression screening among women residing in water insecure households.
Highlights
Water insecurity is linked to depression in low- and middle-income countries (LMICs), though it remains unclear how geospatial clustering of water insecurity in rural regions is associated with risk for depression
Visual inspection revealed that clusters (“hotspots”) of elevated depression symptoms co-occurred with clusters of high water insecurity among women and men but co-occurred more frequently among women
This finding was robust to a sensitivity analysis that did not define probable depression at the customary threshold score
Summary
Water insecurity is linked to depression in low- and middle-income countries (LMICs), though it remains unclear how geospatial clustering of water insecurity in rural regions is associated with risk for depression. Women living in low and middle income countries (LMICs) are at increased risk for common mental disorders including depression, in part due to the high prevalence of poverty-related stressors that disproportionately affect women, such as food insecurity, limited education, financial hardship, intimate partner violence, and high fertility rates [5,6,7,8,9,10,11]. Water insecurity, defined as the limited or uncertain availability of safe water acquired via culturally acceptable means, has been associated with depression and anxiety among women in LMICs, as women bear the primary burden of ensuring household access to water for drinking and other household uses [18,19,20,21,22,23,24,25,26]. Women residing in LMICs have reported greater concern about water access than their male counterparts [20, 24, 28]
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