Water and sanitation quality on depressive symptoms across urban and rural areas in Indonesia: evidence from IFLS-5 data

This study assesses the association between water and sanitation quality with depressive symptoms across urban and rural areas in Indonesia. A cross-sectional study involving 30,446 participants using Indonesian Family Life Survey wave 5 (IFLS-5). Multivariate logistic regression models and mediation analysis were used. Among rural residents, unimproved water sources (OR: 1.12, 95% CI: 1.01-1.26), un-boiled water consumption (OR: 1.46, 95% CI: 1.27-1.68), and open defecation facility (OR: 1.24, 95% CI: 1.09-1.41) were associated with increased odds of depressive symptoms. On the other hand, environmentally unfriendly garbage disposal was associated with lower odds of depressive symptoms (OR: 0.82, 95% CI: 0.74-0.91). In urban areas, similarly, unimproved water sources (OR: 1.35, 95% CI: 1.18-1.54), un-boiled water consumption (OR: 1.44, 95% CI: 1.20-1.71), open defecation facility (OR: 1.16, 95% CI: 0.99-1.36), and limited sanitation facility (OR: 1.15, 95% CI: 1.01-1.31) were associated with higher odds of depressive symptoms, while environmentally unfriendly garbage disposal increased the odds (OR: 1.14, 95% CI: 1.06-1.23). No significance was noted regarding drainage sewage quality either for rural or urban areas. Mediation analysis indicated that comorbidity is significantly mediating WASH variables and depressive symptoms highlight the need for targeted interventions.