The association between women's sanitation experiences and mental health: A cross-sectional study in Rural, Odisha India

• Type of Material: Article
• Authors: Bethany A. Caruso, Rollins School of Public Health; Hannah Cooper, Emory University; Regine Haardoerfer, Emory University; Kathryn Yount, Emory University; Parimita Routray, London School of Hygiene & Tropical Medicine; Belen Torondel, London School of Hygiene & Tropical Medicine; Thomas Clasen, Emory University
• Language: English
• Date: 2018-08-01
• Publisher: Elsevier: Creative Commons Attribution Non-Commercial No-Derivatives License
• Publication Version: Final Published Version
• Copyright Statement: © 2018 The Authors
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ssmph.2018.06.005
• Title of Journal or Parent Work: SSM - Population Health
• ISSN: 2352-8273
• Volume: 5
• Start Page: 257
• End Page: 266
• Grant/Funding Information: The study was funded by the Bill and Melinda Gates Foundation. BAC was funded in part by the NIH/NIGMS Institutional Research and Academic Career Development Award (IRACDA) (5K12-GM000680-18).
• Keywords: Urination; Well-being; Mental health; Defecation; Gender; Life course
• Research Categories: Health Sciences, Mental Health; Psychology, Behavioral; Health Sciences, Public Health

Abstract

Emerging qualitative research suggests women's sanitation experiences may impact mental health. However, specific associations remain unclear. We aimed to determine if sanitation access and sanitation experiences were associated with mental health among women in rural Odisha, India. Using a cross-sectional design, we evaluated the association between sanitation access and sanitation experiences and selected mental health outcomes. Data were collected from 1347 randomly selected women across four life course stages in 60 rural communities (December 2014-February 2015). Our four primary outcomes included: mental well-being, and symptoms of anxiety, depression, and distress. The primary exposures were (1) access to a functional latrine within the household compound and (2) sanitation insecurity (SI), evaluated using a seven domain measure assessing women's negative sanitation experiences and concerns. We used hierarchical linear modeling to determine associations between the exposures and mental health outcomes, adjusting for covariates (life stage, poverty, current health status, social support). Mean well-being scores were moderate and mean anxiety, depression, and distress scores were above a threshold indicating the potential presence of any of the three conditions. Access to a functional household latrine was associated with higher well-being scores, but not with anxiety, depression or distress. Women's SI domains were associated with all four outcomes: four domains were significantly associated with lower well-being scores, two were significantly associated with higher anxiety scores, three were significantly associated with higher depression scores, and three were significantly associated with higher distress scores, all independent of functional household latrine access. Women in rural Odisha, India may suffer assaults to their well-being and have higher symptoms of anxiety, depression, and distress when urinating and defecating, even if they have an available facility. These findings suggest that sanitation-related interventions should consider how to accommodate women's experiences beyond excreta management to comprehensively impact health.