Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
PLoS One. 2023 May 25;18(5):e0286146. doi: 10.1371/journal.pone.0286146. eCollection 2023.
Water insecurity and inadequate sanitation have adverse impacts on the mental health of individuals.
To review and synthesize evidence on the relationship between water insecurity, inadequate sanitation, and mental health globally.
Relevant studies were identified by searching PubMed, PsycINFO, and EMBASE databases from inception up to March 2023.
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.
General population or people attending health facilities or other services.
Water insecurity and/ or inadequate sanitation.
The effective Public Health Practice Project (EPHPP) assessment tool was used to assess quality of selected studies.
A meta-analysis was conducted using a random effects statistical model.
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.
Most of the included studies were cross-sectional which were unable to examine temporal relationships.
Water insecurity and inadequate sanitation contribute to poorer mental health globally.
Interventions to provide basic water, sanitation and psychosocial support, could substantially contribute to reducing the burden of CMD alongside other health and social benefits.
PROSPERO registration number: CRD42022322528.
水不安全和卫生条件不足会对个人的心理健康产生不利影响。
综述和综合全球范围内水不安全、卫生条件不足与心理健康之间关系的证据。
通过检索 PubMed、PsycINFO 和 EMBASE 数据库，从建库至 2023 年 3 月，确定了相关研究。
仅纳入定量研究。暴露因素为水不安全和/或卫生条件不足。结局为常见精神障碍（CMD：抑郁或焦虑）、精神困扰、心理健康或幸福感。无地理位置限制。
一般人群或就诊于卫生保健机构或其他服务机构的人群。
水不安全和/或卫生条件不足。
采用有效公共卫生实践项目（EPHPP）评估工具对入选研究进行质量评估。
采用随机效应统计模型进行荟萃分析。
纳入了 25 项研究，涉及来自三个大洲 16 个国家的 23103 名参与者：非洲（肯尼亚、埃塞俄比亚、加纳、乌干达、南非、马拉维、莫桑比克和莱索托）、亚洲（尼泊尔、孟加拉国、印度和伊朗）和美洲（巴西、海地、玻利维亚和越南）。水不安全与 CMD 症状之间存在统计学显著关联。9 项研究报告了连续结局（5248 名参与者）：总体标准化均数差（SMD=1.38；95%CI=0.88，1.87）。5 项研究报告了二分类结局（5776 名参与者）：比值比 5.03；95%CI=2.26，11.18。卫生条件不足与 CMD 症状之间存在统计学显著关联（7415 名参与者），总体 SMD=5.36；95%CI=2.51，8.20。
大多数纳入的研究为横断面研究，无法考察时间关系。
水不安全和卫生条件不足会导致全球范围内的心理健康状况恶化。
提供基本的水、卫生和心理社会支持的干预措施，可以显著减轻 CMD 负担，并带来其他健康和社会效益。
PROSPERO 注册号：CRD42022322528。
