Associations between water insecurity and mental health outcomes among lesbian, gay, bisexual, transgender and queer persons in Bangkok, Thailand and Mumbai, India: Cross-sectional survey findings

Abstract

Background: Water insecurity disproportionally affects socially marginalized populations and may harm mental health. Lesbian, gay, bisexual, transgender and queer (LGBTQ) persons are at the nexus of social marginalization and mental health disparities; however, they are understudied in water insecurity research. Yet LGBTQ persons likely have distinct water needs. We explored associations between water insecurity and mental health outcomes among LGBTQ adults in Mumbai, India and Bangkok, Thailand. Methods: This cross-sectional survey with a sample of LGBTQ adults in Mumbai and Bangkok assessed associations between water insecurity and mental health outcomes, including anxiety symptoms, depression symptoms, loneliness, alcohol misuse, COVID-19 stress and resilience. We conducted multivariable logistic and linear regression analyses to examine associations between water insecurity and mental health outcomes. Results: Water insecurity prevalence was 28.9% in Mumbai and 18.6% in Bangkok samples. In adjusted analyses, in both sites, water insecurity was associated with higher likelihood of depression symptoms, anxiety symptoms, COVID-19 stress, alcohol misuse and loneliness. In Mumbai, water insecurity was also associated with reduced resilience. Conclusion: Water insecurity was common among LGBTQ participants in Bangkok and Mumbai and associated with poorer well-being. Findings signal the importance of assessing water security as a stressor harmful to LGBTQ mental health. Impact statementWater insecuritydisproportionately impacting socially marginalized communitiesaffects two billion people and is an urgent global health concern. Water insecurity is linked with poorer mental health outcomes through complex pathways, including distress, uncertainty, reduced self-efficacy and relationship conflict. Yet water insecurity and linkages to mental health are understudied with lesbian, gay, bisexual, transgender and queer (LGBTQ) persons. Structural violence, the ways in which social structures (e.g., political, economic religious) limit persons from realizing their potential, contributes to social marginalization of LGBTQ persons and poorer mental health outcomes. India and Thailand are LMICs affected by water insecurity, where there are also notable LGBTQ mental health disparities. In these two contexts, LGBTQ persons may also, as a result of social, educational and economic marginalization, live in housing with insufficient water, sanitation and hygiene (WASH) access. We conducted the first study to examine water insecurity and associations with mental health among LGBTQ persons in Mumbai, India and Bangkok, Thailand. We found that water insecurity is widespreadaffecting approximately one-fifth of LGBTQ participants in Bangkok (18.6%) and one-quarter (28.9%) in Mumbaiand was associated with anxiety symptoms, depression symptoms, loneliness, alcohol misuse, COVID-19 stress and resilience. This points to water insecurity as a possible additional minority stressor that can harm LGBTQ mental health in LMICs that warrants furthe...