ABSTRACT
Background: Water insecurity poses a significant global challenge to health and development. While the biophysical and economic impacts of inadequate water and
sanitation are well documented, the complex emotional and social tolls of water
insecurity are less understood – particularly in the global North. In this article, we
advance understandings of the psychosocial dimensions of water insecurity in Detroit,
Michigan, where an estimated 100,000 households have been disconnected from
water and sanitation services since the city declared bankruptcy in 2013.
Methods: A community-based participatory research study was conducted among
residents at a local food pantry. Phase I involved ethnographic research and openended
questions informing design of a culturally-relevant measure of water insecurity.
In Phase II, the survey was administered alongside the Kessler Psychological Distress
scale by local researchers. We use an ordinary least squares regression model to
demonstrate statistical associations between variables.
Results: Our models reveal a substantial, statistically significant effect of water
insecurity on psychological distress. These results are robust to the inclusion of a
number of socioeconomic and demographic controls. Additionally, financial stress in
paying for water and sanitation produces significant distress, even independent of
water supply status.
Conclusions: Curtailing water and sanitation access has complex, intersecting effects,
including for community mental health. Rapidly rising rates across many U.S. cities with
stagnating incomes and shrinking populations underscores the urgency of addressing
this issue. The present study is the first we know of in the United States to examine the
relationship between water insecurity and psychosocial distress.
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