Effects of food and water insecurity on depression scores among women living in urban informal settlements in Makassar, Indonesia during the COVID-19 pandemic: a longitudinal cohort study Open Access

Abstract

Background: Women living in urban informal settlements may be particularly vulnerable to the detrimental effects of the COVID-19 pandemic due to increased economic and psychosocial stressors in already resource-strapped environments. The objective of this study was to assess the effect of food and water insecurity during the pandemic on depression among women living in urban informal settlements in Makassar, Indonesia.

Methods: We implemented surveys at three time points among women enrolled in the Revitalizing Informal Settlements and their Environments trial. Depression was measured using the Center for Epidemiologic Studies Depression Scale – 10 (CESD-10) in November-December 2019 and again in February-March 2021. Food and water insecurity were measured in August-September 2020. Food insecurity was measured using two questions from Innovation for Poverty Action’s Research for Effective COVID-19 Reponses survey. Water insecurity was measured using the short form of the Household Water Insecurity Experiences scale. We ran three multivariate quantile linear regression models to assess the effects of water insecurity, food insecurity, and joint food and water insecurity during the COVID-19 pandemic on subsequent CESD-10 score. Pre-pandemic CESD-10 score, self-reported financial satisfaction, disability, and wealth were included as control variables. There were 323 women with data from the last two time points and 221 women with data from all three time points.

Results: In models with the full sample, food insecurity (β: 1.48, 95% CI: 0.79-2.17), water insecurity (β: 0.13, 95% CI: -0.01-0.26), and joint food/water insecurity (β: 2.40, 95% CI: 1.43-3.38) all had positive relationships with CESD-10 score. In sub-group analyses of respondents for whom we had pre-pandemic CESD-10 scores, results were similar but attenuated. Joint food/water insecurity (β: 1.96, 95% CI: 0.78-3.15) maintained the strongest relationship with CESD-10 score.

Conclusions: In our study, joint food and water insecurity predicted higher (worse) scores on a depression scale among women living in urban informal settlements in Makassar, Indonesia. Our results highlight the importance of addressing food and water insecurity together, rather than in silos as is standard practice. Cross-sectoral coordination may be vital for delivering effective interventions that reflect the complexity of their beneficiaries’ lived experiences.

Table of Contents

I. Introduction………………………………………………………………………………………………1

II. Literature Review……………………………………………………………………………………….3

A. The Global State of Urban Informal Settlements………………………………………………..3

B. Urban Informal Settlements in Indonesia…………………………………………………………5

C. Psychological Wellbeing in Urban Informal Settlements……………………………………...6

D. COVID-19 and Psychological Wellbeing…………………………………………………………..8

E. Food Insecurity and Psychological Wellbeing in Urban Informal Settlements…….........11

F. Water Insecurity and Psychological Wellbeing in Urban Informal Settlements…...........14

G. Food and Water Insecurity, Psychological Wellbeing, and COVID-19 in Urban Informal Settlements………………………17

H. Conclusions……………………………………………………………………………………………………….21

III. Methods………………………………………………………………………………………………………………………24

A. Overview…………………………………………………………………………………………………………..24

B. Study Population & Recruitment……………………………………………………………………….24

C. Data Collection………………………………………………………………………………………………….27

D. Statistical Analysis…………………………………………………………………………………………….29

E. Covariate Selection……………………………………………………………………………………………30

F. Ethics…………………………………………………………………………………………………………………31

IV. Results…………………………………………………………………………………………………………………………32

A. Descriptive Analysis…………………………………………………………………………………………..32

B. Bivariate Analysis………………………………………………………………………………………………36

C. Multivariate Analysis…………………………………………………………………………………………37

V. Discussion…………………………………………………………………………………………………………………….40

VI. Strengths and Limitations……………………………………………………………………………………………42

VII. Public Health Implications…………………………………………………………………………………………..44

VIII. References…………………………………………………………………………………………………………………46

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Nutrition Health Sciences, Public Health Health Sciences, Mental Health
Keyword	water security Indonesia urban informal settlements women's health food security water insecurity mental health WASH food insecurity slum health depression
Committee Chair / Thesis Advisor	Sheela Sinharoy, PhD, Emory University
Committee Members	Allison Salinger, MPH, Emory University

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