School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA.
Center for Global Health, Arizona State University, Tempe, AZ, USA.
Soc Sci Med. 2019 Oct;238:112520. doi: 10.1016/j.socscimed.2019.112520. Epub 2019 Aug 26.
Living in poverty significantly elevates risk of common mental disorders, but the underlying mechanisms are poorly specified. The stress of coping with household food insecurity is posed as one fundamental driver. While much less tested, the stress of failing to meet household water needs may also matter. We test (a) a hypothesized direct influence of household water insecurity (as household access to water sources and quality/quantity of water available in the household) on anxiety and depression symptoms. We also test (b) if there are indirect (mediated) effects of these aspects of water insecurity on common mental disorder symptom levels via household food insecurity, and (c) via their association with sanitation insecurity (lack of toilet). Data were collected in Haiti in June-July 2016 from 4,055 geographically-sampled households representing three distinct low-resource communities, purposefully differentiated as urban, town, and rural. We confirm that household water insecurity exerts a direct, strong independent effect on anxiety and depression levels, even once food insecurity and household assets are taken into account. Additionally, household water insecurity appears to have an indirect effect on anxiety and depression levels through its influence on household food insecurity. In the rural community sample, there is also support for the proposition of additional influence of household water on anxiety through its association with lack of sanitation. This Haitian case supports theories posing a central, influential role for household water insecurity as a potential driver of common mental illness in low-resource households via direct and indirect (food insecurity, sanitation) pathways.
生活贫困会显著增加常见精神障碍的风险，但潜在机制尚不清楚。应对家庭粮食不安全的压力被认为是一个基本驱动因素。虽然测试的较少，但无法满足家庭用水需求的压力也可能很重要。我们检验了（a）家庭用水不安全（家庭获得水源的情况以及家庭中可用水的质量/数量）对焦虑和抑郁症状的假设直接影响。我们还检验了（b）这些水不安全方面是否通过家庭粮食不安全对常见精神障碍症状水平有间接（中介）影响，以及（c）是否通过与卫生不安全（缺乏厕所）相关。这些数据是 2016 年 6 月至 7 月在海地从 4055 个地理采样家庭中收集的，这些家庭代表了三个不同的资源匮乏社区，有意分为城市、城镇和农村。我们证实，即使考虑到粮食不安全和家庭资产，家庭用水不安全也会对焦虑和抑郁水平产生直接的、强烈的独立影响。此外，家庭用水不安全似乎通过对家庭粮食不安全的影响对焦虑和抑郁水平产生间接影响。在农村社区样本中，家庭用水与缺乏卫生设施之间的关联也支持了家庭用水对焦虑有额外影响的观点。这种海地情况支持了这样一种理论，即家庭用水不安全作为资源匮乏家庭中常见精神疾病的潜在驱动因素，通过直接和间接（粮食不安全、卫生）途径，对常见精神疾病起着核心的、有影响力的作用。
