Examining the association between household water insecurity, food insecurity and depression among people living with HIV in Ghana

Although recent literature increasingly recognizes HIV, food insecurity, water insecurity, and depression as interconnected syndemics, research simultaneously evaluating the role of all these factors is limited among people living with HIV. We assessed the associations between water insecurity and food insecurity and how they relate to depression among people living with HIV in Ghana. This was a cross-sectional analysis of the baseline data of an ongoing cohort in three regions of Ghana. PHQ-9 depression scale was used, summed up to generate a depression score, which was then recoded into 4 categories of ‘none-minimal’,’mild’,’moderate’, and ‘severe’. Multivariable ordered logistic regression analysis (controlling for a priori identified confounders) was used to quantify the association between water insecurity and depression. Overall average depression score was 5.88 (SD = 4.82), with 47.1% of the participants having ‘none-minimal’ depression, 32.2% having mild, 19.9% having moderate, and only 0.8% having severe depression. In the multivariate model, depression was more prevalent among participants experiencing low (aOR = 1.96; 95% CI: 1.30–2.95) or moderate water insecurity (aOR = 2.64; 95% CI: 1.45–4.82), and moderate (aOR = 2.22; 95% CI: 1.27–3.87) or high food insecurity (aOR = 3.32; 95% CI: 2.22–4.95). Higher odds of depression were also observed among females (aOR = 1.73; 95% CI: 1.23–2.44), and those reporting moderate (aOR = 6.22; 95% CI: 1.85–20.86) or high perceived stress (aOR = 21.07; 95% CI: 6.75–65.80). Lower odds of depression was observed among widowed women (aOR = 0.61; 95% CI: 0.41–0.86). The study demonstrates that both water insecurity and food insecurity are strongly associated with depression among people living with HIV. The substantially higher odds of depression among women and those experiencing moderate to high perceived stress highlight the importance of incorporating gender-responsive and stress-focused mental health interventions into HIV care.