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Evidence on the links between water insecurity, inadequate sanitation and mental health: A systematic review and meta-analysis

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  • Joan J Kimutai
  • Crick Lund
  • Wilkister N Moturi
  • Seble Shewangizaw
  • Merga Feyasa
  • Charlotte Hanlon

Abstract

Background: Water insecurity and inadequate sanitation have adverse impacts on the mental health of individuals. Objective: To review and synthesize evidence on the relationship between water insecurity, inadequate sanitation, and mental health globally. Data sources: Relevant studies were identified by searching PubMed, PsycINFO, and EMBASE databases from inception up to March 2023. Study eligibility criteria: 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. Participants: General population or people attending health facilities or other services. Exposure: Water insecurity and/ or inadequate sanitation. Risk of bias: The effective Public Health Practice Project (EPHPP) assessment tool was used to assess quality of selected studies. Synthesis of results: A meta-analysis was conducted using a random effects statistical model. Results: 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. Limitations: Most of the included studies were cross-sectional which were unable to examine temporal relationships. Conclusions: Water insecurity and inadequate sanitation contribute to poorer mental health globally. Implications of key findings: Interventions to provide basic water, sanitation and psychosocial support, could substantially contribute to reducing the burden of CMD alongside other health and social benefits. Trial registration: PROSPERO registration number: CRD42022322528.

Suggested Citation

  • Joan J Kimutai & Crick Lund & Wilkister N Moturi & Seble Shewangizaw & Merga Feyasa & Charlotte Hanlon, 2023. "Evidence on the links between water insecurity, inadequate sanitation and mental health: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 18(5), pages 1-22, May.
    • Handle: RePEc:plo:pone00:0286146
    DOI: 10.1371/journal.pone.0286146
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    References listed on IDEAS

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    1. Boateng, Godfred O. & Workman, Cassandra L. & Miller, Joshua D. & Onono, Maricianah & Neilands, Torsten B. & Young, Sera L., 2022. "The syndemic effects of food insecurity, water insecurity, and HIV on depressive symptomatology among Kenyan women," Social Science & Medicine, Elsevier, vol. 295(C).
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    3. Shin Kue Ryu, 2019. "Variation in Access to Safe Drinking Water across Different Countries: An Explanatory Framework," Social Sciences, MDPI, vol. 8(2), pages 1-31, February.
    4. Brewis, Alexandra & Choudhary, Neetu & Wutich, Amber, 2019. "Household water insecurity may influence common mental disorders directly and indirectly through multiple pathways: Evidence from Haiti," Social Science & Medicine, Elsevier, vol. 238(C), pages 1-1.
    5. Wutich, Amber & Ragsdale, Kathleen, 2008. "Water insecurity and emotional distress: Coping with supply, access, and seasonal variability of water in a Bolivian squatter settlement," Social Science & Medicine, Elsevier, vol. 67(12), pages 2116-2125, December.
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