Examining the association between toilet access and major depression among older adults in India: a cross-sectional analysis of the Longitudinal Aging Study in India from 2017 to 2018.

Inadequate access to toilets, which often results in open defecation, could be a risk factor for depression among India's older and ageing population. Using cross-sectional data from the Longitudinal Aging Study in India from 2017 to 2018, we assessed associations between the lack of a toilet and major depression among 64 082 women and men above the age of 45. In our adjusted multilevel model, we found no association between the lack of a household toilet and the risk of major depression (OR = 0.94, 95% CI: 0.79 to 1.11). We also found no association when we stratified by respondent's sex or age. Finally, we did not find any consistent association between toilet access and major depression across India's states and Union Territories. Despite our results, it is possible that inadequate access to sanitation is associated with acute feelings of anxiety, stress and shame-as has been shown in previous studies-but that this is not associated with major depression. Therefore, more research is required to examine associations between toilet access and other more proximal mental health outcomes.