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

Joan J Kimutai^1,2, Crick Lund^3,4, Wilkister N Moturi⁵

¹Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.

|May 25, 2023

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.

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