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

Abstract

Background

While depression is the most frequent psychiatric disorder among the older adults, the use of water and sanitation has been associated with both physical and psychological adverse outcomes. We investigated the associations of water and sanitation with depressive symptoms among older adults in Ghana.

Methods

The study used data from 4,735 participants in the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 2 of adults aged ≥50 years. Major depressive episode (MDE) was assessed using the World Mental Health Survey version of the Composite International Diagnostic Interview and we classified water and sanitation sources based on the Joint Monitoring Program. Multivariate logistic regressions evaluated the associations.

Results

Approximately 7.3% of respondents reported a MDE, 90% and 78% used improved water sources and sanitation facilities respectively, and 77% shared sanitation facilities. Individuals who used unimproved water sources and unimproved sanitation were 1.6 and 1.3 times more likely to report MDE respectively. Also, sex-based analysis showed that the effect of the use of unimproved water and sanitation on depression was much appreciable and more substantial among women compared to men.

Conclusions

The findings suggest the importance of water and sanitation to the well-being of older people, particularly among women. Policies targeted at improving the mental health in old age should include water and sanitation.

Keywords:

• Ghana
• major depressive episode
• older people
• sanitation
• water

Acknowledgements

We are grateful to all respondents and interviewers who made the SAGE survey in Ghana possible.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical approval

This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving human subjects/patients were approved by the World Health Organization’s Ethical Review Board (reference number RPC149) and the Ethical and Protocol Review Committee of the College of Health Sciences at the University of Ghana. Written informed consent was obtained from all respondents.

Additional information

Funding

Financial support was provided by the U.S. National Institute on Aging through Interagency Agreements (OGHA 04034785; YA1323-08-CN-0020; Y1-AG-1005-01) with the World Health Organization and a Research Project Grant (R01 AG034479- 64401A1). WHO contributed financial and human resources to SAGE. The Ministry of Health, Ghana, is supportive of SAGE. The University of Ghana’s Department of Community Health contributed training facilities, data entry support, and storage of materials. The Ghana Statistical Office provided the sampling information for the sampling frame and updates.