TY - JOUR
T1 - “When you have no water, it means you have no peace”
T2 - A mixed-methods, whole-population study of water insecurity and depression in rural Uganda
AU - Mushavi, Rumbidzai C.
AU - Burns, Bridget F.O.
AU - Kakuhikire, Bernard
AU - Owembabazi, Moran
AU - Vořechovská, Dagmar
AU - McDonough, Amy Q.
AU - Cooper-Vince, Christine E.
AU - Baguma, Charles
AU - Rasmussen, Justin D.
AU - Bangsberg, David R.
AU - Tsai, Alexander C.
N1 - Funding Information:
The study was funded by Friends for a Healthy Uganda. Dr. Mushavi acknowledges financial support from the Doris Duke Charitable Foundation through a grant supporting the Doris Duke International Clinical Research Fellows Program at Harvard Medical School. Dr. Tsai acknowledges financial support from U.S. National Institutes of Health R01MH113494. We thank the HopeNet cohort study participants, without whom this research would not be possible. We also thank members of the HopeNet study team for research assistance; in addition to the named study authors, HopeNet and other collaborative team members who contributed to data collection and/or study administration during all or any part of the study were as follows: Phiona Ahereza, Owen Alleluya, Patience Ayebare, Dickson Beinomugisha, Anna Baylor, Ryan Carroll, Patrick Gumisiriza, Mercy Juliet, Clare Kamagara, Allen Kiconco, Viola Kyokunda, Patrick Lukwago Muleke, Rhina Mushagara, Elijah Musinguzi, Elizabeth Betty Namara, Immaculate Ninsiima, Mellon Tayebwa, Ezra Turinawe, and Julius Turyasingura. We also thank Roger Hofmann of West Portal Software Corporation (San Francisco, Calif.), for developing and customizing the Computer Assisted Survey Information Collection Builder(TM) software program used for survey administration. No endorsement of manuscript contents or conclusions should be inferred from these acknowledgements.
Funding Information:
The study was funded by Friends for a Healthy Uganda. Dr. Mushavi acknowledges financial support from the Doris Duke Charitable Foundation through a grant supporting the Doris Duke International Clinical Research Fellows Program at Harvard Medical School . Dr. Tsai acknowledges financial support from U.S. National Institutes of Health R01MH113494 . We thank the HopeNet cohort study participants, without whom this research would not be possible. We also thank members of the HopeNet study team for research assistance; in addition to the named study authors, HopeNet and other collaborative team members who contributed to data collection and/or study administration during all or any part of the study were as follows: Phiona Ahereza, Owen Alleluya, Patience Ayebare, Dickson Beinomugisha, Anna Baylor, Ryan Carroll, Patrick Gumisiriza, Mercy Juliet, Clare Kamagara, Allen Kiconco, Viola Kyokunda, Patrick Lukwago Muleke, Rhina Mushagara, Elijah Musinguzi, Elizabeth Betty Namara, Immaculate Ninsiima, Mellon Tayebwa, Ezra Turinawe, and Julius Turyasingura. We also thank Roger Hofmann of West Portal Software Corporation (San Francisco, Calif.), for developing and customizing the Computer Assisted Survey Information Collection Builder(TM) software program used for survey administration. No endorsement of manuscript contents or conclusions should be inferred from these acknowledgements. Appendix A
Publisher Copyright:
© 2019 Elsevier Ltd
PY - 2020/1
Y1 - 2020/1
N2 - Background: 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. Methods and findings: 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. Conclusions: 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.
AB - Background: 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. Methods and findings: 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. Conclusions: 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.
KW - Depression
KW - Mental health
KW - Psychological distress
KW - Resource insecurity
KW - Stress
KW - Sub-Saharan Africa
KW - Uganda
KW - Water insecurity
KW - Water security
UR - http://www.scopus.com/inward/record.url?scp=85075628035&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85075628035&partnerID=8YFLogxK
U2 - 10.1016/j.socscimed.2019.112561
DO - 10.1016/j.socscimed.2019.112561
M3 - Article
C2 - 31790879
AN - SCOPUS:85075628035
SN - 0277-9536
VL - 245
JO - Ethics in Science and Medicine
JF - Ethics in Science and Medicine
M1 - 112561
ER -