Water insecurity in a syndemic context: Understanding the psycho-emotional stress of water insecurity in Lesotho, Africa

Abstract

Syndemics occur when populations experience synergistic and multiplicative effects of co-occurring epidemics. Proponents of syndemic theory highlight the importance of understanding the social context in which diseases spread and cogently argue that there are biocultural effects of external stresses such as food insecurity and water insecurity. Thus, a holistic understanding of disease or social vulnerability must incorporate an examination of the emotional and social effects of these phenomena. This paper is a response to the call for a renewed focus on measuring the psycho-emotional and psychosocial effects of food insecurity and water insecurity. Using a mixed-method approach of qualitative interviews and quantitative assessment, including a household demographic, illness, and water insecurity scale, the Household Food Insecurity Access Scale, and the Hopkins Symptoms Checklist-25, this research explored the psycho-emotional effects of water insecurity, food insecurity, and household illness on women and men residing in three low-land districts in Lesotho (n = 75). Conducted between February and November of 2011, this exploratory study first examined the complicated interaction of water insecurity, food insecurity and illness to understand and quantify the relationship between these co-occurring stresses in the context of HIV/AIDS. Second, it sought to separate the role of water insecurity in predicting psycho-emotional stress from other factors, such as food insecurity and household illness. When asked directly about water, qualitative research revealed water availability, access, usage amount, and perceived water cleanliness as important dimensions of water insecurity, creating stress in respondents' daily lives. Qualitative and quantitative data show that water insecurity, food insecurity and changing household demographics, likely resulting from the HIV/AIDS epidemic, are all associated with increased anxiety and depression, and support the conclusion that water insecurity is a critical syndemic dimension in Lesotho. Together, these data provide compelling evidence of the psycho-emotional burden of water insecurity.

A Novel Household Water Insecurity Scale: Procedures and Psychometric Analysis among Postpartum Women in Western Kenya

“…This finding also affirms the fact that water insecurity is inextricably linked with food insecurity and has significant implications for sustainable development and poverty reduction [97,98]. The positive correlation between water insecurity and maternal stress also points to the psychosocial effects that water insecurity could have on households [4,20,99]. Future research will benefit from exploring the joint influences of food and water insecurity on health and well-being.…”

Socio‐environmental confounders of safe water interventions

“…Psychosocial stress and anxiety have increasingly been appreciated as important individual‐level components of water insecurity that shaped water seeking behavior (Collins et al, 2018; Hadley & Wutich, 2009; Mushavi et al, 2020; Workman & Ureksoy, 2017). Both a lack of water access and the process of negotiating access could lead to psychosocial distress, and women have borne most of this burden given the gender inequities in household water management responsibilities in many societies (Bisung & Elliott, 2017).…”

Water insecurity: An agenda for research and call to action for human biology

“…Importantly, some of this newer work has shown that water insecurity is associated with symptoms of common mental disorders, as measured by validated screeners for symptoms of common mental disorders such as anxiety and depression (Aihara et al, ; Cooper‐Vince et al, ; Stevenson et al, ; Subbaraman et al, ; Workman & Ureksoy, ). In our own work in Bolivia, we found in a study of women from 28 informal communities that water insecurity was not just associated with emotional distress; it was also associated with symptoms of common mental disorders like anxiety and depression as measured by the Standard Reporting Questionnaire and Hopkins Symptom Checklist (Wutich, Brewis, et al, ).…”

“…Farhana Sultana (), based on her work in Bangladesh, Ennis‐McMillan's (, ) work in Mexico, my work in Bolivia (Wutich & Ragsdale, ), and my cross‐cultural work with Alex Brewis (Wutich & Brewis, ) all indicate that stigma, uncertainty, and social injustice are key mechanisms for understanding when and why water insecurity causes negative psychosocial outcomes. Beyond this, Tallman () on biocultural vulnerabilities in Bolivia and Workman and Ureksoy () on syndemics in Lesotho indicate that these dynamics can be incredibly complex.…”