Associations between water, sanitation, and depression among older people in Ghana: empirical evidence from WHO-SAGE Wave 2 survey

Meeting the WHO Physical Activity Guidelines is Associated With Lower Odds of Depression in Older Adults: Potential Psychosomatic Mechanisms

OBJECTIVES

Limited data exist on the association between physical activity (PA) and depression in older adults from low- and middle-income countries (LMICs). In this study, we examine the association between meeting the World Health Organization (WHO) PA guidelines and depression in adults aged ≥50 years in Ghana and investigate the psychosomatic factors explaining this association.

METHODS

Cross-sectional data from the Aging, Health, Psychological Well-being, and Health-seeking Behavior Study in Ghana (2016-18) were analyzed. Depression was assessed with the Center for Epidemiological Studies Depression Scale (CES-D-10). PA was assessed using the International Physical Activity Questionnaire Short Form (IPAQ-SF). Multivariable logistic regression and Hayes PROCESS macro with bootstrapping mediation analyses were performed to evaluate the hypothesized associations.

RESULTS

The study included 1201 individuals (mean [SD] age 66.1 [11.9] years; 63.3% women). The prevalence of meeting PA guidelines and depression was 36.7% and 29.5%, respectively. Meeting the WHO-recommended PA guidelines was associated with a 16% lower rate of developing depression even after adjusting for potential confounders (OR = 0.84, p <0.001). This association was much stronger among men and those aged 50-64 years. Loneliness, social isolation, sleep problems, functional limitations, and pain characteristics largely mediated the association of PA with depression.

CONCLUSIONS

PA was negatively associated with depression among older adults in Ghana, and psychosocial and physical factors partially explained the association. The promotion of PA in old age may aid in the prevention of depression, especially in men and those aged 50-64 years. Longitudinal data may confirm our findings.

Serial mediation effect of physical activity and sleep quality between dietary behaviour and depression symptoms: A nationwide cross-sectional survey

Background

Substantial studies have revealed the potential mechanisms underlying the link between dietary behaviour and depression symptoms. This study investigated the relationship between depression symptoms and dietary behaviour, physical activity, and sleep quality in a nationwide sample of Chinese residents.

Methods

A total of 18 819 Chinese Residents completed the dietary behaviour, patient health questionnaire, international physical activity questionnaire, and Pittsburgh sleep quality index. We used the Hayes' serial mediation model to investigate the correlation between the variables.

Results

Among the participants, 85.5% were aged between 18 and 59, 41.2% were male, and 73.8% were urban residents. There is a negative correlation between dietary behaviour and physical activity (r = -0.038, P < 0.001), while there is a positive correlation with depression symptoms (r = 0.238, P < 0.001) and sleep quality (r = 0.115, P < 0.001). Additionally, depression shows a positive correlation with physical activity (r = 0.024, P < 0.001) and sleep quality (r = 0.298, P < 0.001), while there is a negative correlation between physical activity and sleep quality (r = -0.035, P < 0.001). Dietary behaviour was found to be connected with depression symptoms via three mediation pathways: (1) physical activity (B = -0.003, 95% confidence interval (CI) = -0.016, -0.007), (2) sleep quality (B = 0.034, 95% CI = 0.126, 0.164), and (3) physical activity and sleep quality (B = 0.001, 95% CI = 0.001, 0.003).

Conclusions

These findings highlight the significance of psychological and physical factors in exploring the mechanisms through which dietary behaviour is related to depression symptoms. Overall, this study showed the important role of lifestyle factors in depression symptoms, suggesting that appropriate dietary behaviours, appropriate physical activity, and good sleep quality are necessary for the avoidance or improvement of depression symptoms.

Social determinants of health and gender differences in depression among adults: A cohort study

The role of social determinants of health (SDoH) in gender differences in depression remains unclear among Chinese adults. We aimed to explore the association between SDoH and depression and investigate their role in explaining gender differences in depression. This prospective longitudinal cohort study used four wave surveys (2012, 2016, 2018, and 2020) of the China Family Panel Study (CFPS). Fourteen SDoH variables were assessed, and depression was measured using the 8-item short version of the Center for Epidemiologic Studies Depression Scale. The Cox proportional hazards regression and multiple mediation analysis were performed to estimate the effect sizes. The longitudinal sample included 18,874 participants aged 18-92 years (51.4 % males and 48.6 % females). Women had higher risk of depression than men. Unfavorable SDoH were associated with higher risk of depression. After including multiple SDoH in mediation analysis, multiple SDoH mediated 15.7 % of the total effect of gender on depression. In sum, SDoH significantly influenced depression, and specific factors explained gender differences in depression. Supporting women in education, employment, and community involvement could help reduce gender differences in depression.

Examining the Relationships between the Incidence of Infectious Diseases and Mood Disorders: An Analysis of Data from the Global Burden of Disease Studies, 1990-2019

Mood disorders are among the commonest mental disorders worldwide. Epidemiological and clinical evidence suggests that there are close links between infectious diseases and mood disorders, but the strength and direction of these association remain largely unknown. Theoretical models have attempted to explain this link based on evolutionary or immune-related factors, but these have not been empirically verified. The current study examined cross-sectional and longitudinal associations between the incidence of infectious diseases and mood disorders, while correcting for climate and economic factors, based on data from the Global Burden of Disease Studies, 1990-2019. It was found that major depressive disorder was positively associated with lower respiratory infections, while bipolar disorder was positively associated with upper respiratory infections and negatively associated with enteric and tropical infections, both cross-sectionally and over a period of 30 years. These results suggest that a complex, bidirectional relationship exists between these disorders. This relationship may be mediated through the immune system as well as through the gut-brain and lung-brain axes. Understanding the mechanisms that link these groups of disorders could lead to advances in the prevention and treatment of both.

Making waves: Mental health impacts of inadequate drinking water services - From sidenote to research focus

The paramount significance of the harmful impacts of poor drinking water services on physical health have been recognized for decades. Besides, over the past twenty years, an additional body of literature on their negative mental health impacts has emerged. With this brief review, we summarise the findings of the scholarship to advance addressing overall health (physical, mental, and social) in the water sector. We furthermore review the key policy documents of this field with a focus on mental health aspects and give recommendations for practitioners and decision-makers on addressing mental health in water service delivery. We reviewed the existing published works (42) assessing psychological impacts of deficient drinking water services in low-income settings. We then identified and compared the different mechanisms causing negative mental health outcomes described in them. For these purposes, we used a water insecurity experience -model and the vulnerability-stress model of clinical psychology. Next, we probed key international and national guiding documents of the water sector to analyse how mental health issues resulting from poor services are addressed today. We found that according to the literature, poor quality and quantity of water was predictably one of the most important psychosocial stressors to users. Surprisingly, however, various kinds of water-service-related inequalities (e.g. between genders, communities or socio-economic groups) showed up as equally significant stressors. Our analysis with the vulnerability-stress model furthermore indicates that insufficient drinking water services may predispose to common mental disorders particularly through external stress. Existing field guidelines have evolved to highlight the values of non-discrimination and participation, whilst mental health aspects remain ignored. This should not be the case. Therefore, practices for addressing mental health effectively in documentation and water service development should be further researched. But already in the light of the existing literature, we urge stakeholders to focus more on the negative mental health impacts of unequal service provision for users and nearby people left without improved services.

Water, sanitation and depression in rural communities: evidence from nationally representative study data in South Africa

Clean water and sanitation provisions are essential for good hygiene and health, with rural South Africa facing a simultaneous access crisis of both, the direct health effect of restricted access to both on mental health remaining scarce and largely overlooked. This study investigated the association between access to clean water and sanitation on depression in rural South Africa utilizing the most recent data (year 2017) from the South African National Income Dynamics Study. Our study outcome was depression, based on the 10-item abridged version of the Center for Epidemiologic Studies Depression Scale (data available in SA-NIDS), the main exposures being access to clean water and adequate sanitation facilities (i.e. flushing toilets). Two types of analyses were conducted: first, adjusted logistic regression models were fitted to assess the relationship between lack of access to clean water and adequate sanitation to depression. Second, we conducted mediation analysis to investigate whether access to clean water mediated the relationship between lack of access to toilets and depression. A high proportion of rural participants lacked access to clean water (n = 6,188, 47.6%) and adequate toilets (n = 9,797, 81.6%). The regression analyses indicated that lack of access to both clean water (OR = 1.21, 95% CI: 1.06-1.39) and adequate sanitation (OR = 1.36, 95% CI: 1.10-1.69) were significantly associated with greater odds of depression. The mediation analysis indicated that access to clean water partially mediated the relationship between lack of access to adequate sanitation and depression, the total mediated effect being 18.2% (95% CI: 11.0%-51.0%). Most rural communities in South Africa lack access to basic services that are essential for human dignity and a decent quality of life, leading to opportunities for poor mental health, with its various consequences for socio-economic development and personal wellbeing, including avoidable depression.

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

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.

Healthy Aging at Family Mealtimes: Associations of Clean Cooking, Protein Intake, and Dining Together with Mental Health of Chinese Older Adults amid COVID-19 Pandemic

The present study aims to examine whether multiple dietary factors affect the mental health of older adults amid the COVID-19 pandemic. It proposes an integrative dietary framework that highlights environmental, nutritional, and social aspects of diet for healthy aging. Based on a sample of 7858 Chinese older adults, the associations between diet and depressive symptoms, along with the rural-urban divide, were examined using zero-inflated negative binomial regression. Overall, protein intake (incidence-rate ratio [IRR] = 0.89, p < 0.001), frequency of family dining together (IRR = 0.98, p < 0.001), and using tap water for cooking (IRR = 0.92, p < 0.01) were associated with lower incidence rates of depressive symptoms among older adults. Among rural older adults, frequency of family dining together (IRR = 0.97, p < 0.001) and tap water use (IRR = 0.89, p < 0.001) were associated with fewer depressive symptoms. However, urban residents who had a higher frequency of family dining together (IRR = 0.98, p < 0.05) and protein intake (IRR = 0.81, p < 0.001) exhibited fewer depressive symptoms. The findings revealed multifaceted dietary pathways towards healthy aging, which call for policies and interventions that improve diet quality for community-dwelling older adults.