ArticleSocial science & medicine (1982)2020
"When you have no water, it means you have no peace": A mixed-methods, whole-population study of water insecurity and depression in rural Uganda.
Article in Social science & medicine (1982), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 71 papers, 3 of them syntheses that pooled it.
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Who cites it
71 citing papers in PubMed, 3 syntheses or guidelines pooled it, 150 citations in OpenAlex.
- Evidence on the links between water insecurity, inadequate sanitation and mental health: A systematic review and meta-analysis.PloS one · 2023Pooled it
- "Thinking Too Much": A Systematic Review of the Idiom of Distress in Sub-Saharan Africa.Culture, medicine and psychiatry · 2021Pooled it
- Diverse Health, Gender and Economic Impacts from Domestic Transport of Water and Solid Fuel: A Systematic Review.International journal of environmental research and public health · 2021Pooled it
- Water Insecurity is Associated with Intimate Partner Violence Among Women Living with HIV in Western Kenya.AIDS and behavior · 2026Trial
- Effect of Household Air Pollution on the Gut Microbiome and Virome of Adult Women Living in Uganda.Environmental health perspectives · 2026Trial
- "If you have light, your heart will be at peace": A qualitative study of household lighting and social integration in southwestern Uganda.Journal of global health · 2023Trial
- Trial
- Pathways to suicide attempts in rural Uganda: a qualitative study of survivors, family members, and healthcare providers, and community health workers.International journal of mental health · 2026Article
- Prevalence of severe neurobehavioral disorders among adults with traumatic brain injury at Mbarara Regional Referral Hospital in southwestern Uganda.BMC psychiatry · 2026Article
- Development and pilot testing of an empowerment-based intervention for adolescents and young adults living with HIV transitioning to adult HIV care in Uganda.medRxiv : the preprint server for health sciences · 2026Article
- Psychosocial stressors related to extreme weather events and multiple resource insecurities: qualitative insights from refugee youth in an Ugandan humanitarian setting.SSM. Mental health · 2026Article
- Declining but increasingly concentrated HIV stigma in rural Uganda: population-based cohort study, 2014-2024.medRxiv : the preprint server for health sciences · 2026Article
- Suicidality and associated factors among people living with mental illness attending an outpatient clinic at a tertiary hospital in Uganda.BMC psychiatry · 2026Article
- Longitudinal Trends in Physical Activity Among Older Adults With and Without HIV in Uganda.Journal of aging and health · 2026Article
- Water, sanitation, and hygiene insecurity and psychological distress in South Sudan.Social psychiatry and psychiatric epidemiology · 2026Article
- Mental Health Awareness and Stigma in the General Population: A Mixed-Methods Approach in Semi-Urban Areas.Cureus · 2025Review
- Factor Structure, Reliability, and Validity of the 10-Item HIV Stigma Scale for Adolescents and Youth Living with HIV in Rural, Southwestern Uganda.AIDS and behavior · 2025Article
- The Impact of Climate Change Awareness on Fertility Intentions in Palestinian Society: Mediating Role of Threat Perception.International journal of environmental research and public health · 2025Article
- Drinking water access and quality in the Gaza Strip prior to 7 October 2023 and implications for reconstruction.Environmental health : a global access science source · 2025Article
- 'We would look at the chickens as a source of security': microenterprise and health in rural Uganda.Journal of global health · 2025Article
11 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
11 authors at 8 institutions in 3 countries.
Funding
Abstract
backgroundLack 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
findingsWe 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.
conclusionsAmong 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.