Geriatric depression in India: Inadequate access to water and sanitation as risk factors

PROJECT SUMMARY Inadequate access to water and sanitation remains extremely prevalent among India’s older adults. Recent estimates show that almost a third of India’s adults over the age of 60 did not have access to water or a toilet inside their home. Like children, adolescents, and younger adults, inadequate access to water and sanitation is associated with infectious diseases among the elderly. What is less known, however, is the extent to which inadequate access to these core resources is associated with depression among India’s aging population. The disablement process conceptual model suggests that inadequate access to water and sanitation could exacerbate the pre-existing relationships between underlying pathologies – incontinence, injury, infections – and depression. Until now, the extent to which this is true has not been examined. I will now fill this gap by using data from the Longitudinal Aging Study in India (LASI), an NIH funded study. In aim 1 I will estimate the effects of improved household toilet coverage and tapped water access on geriatric depression. I will estimate the population intervention effect of having a household toilet on the risk of depression among women and men about the age of 60 in India. I will also use a state-of-the-art quasi-experimental technique to examine the impact of a nation-wide program to improve access to tapped water inside the home on geriatric depression. In aim 2 I will estimate the extent to which inadequate water and sanitation access moderates the relationship between physical impairment and depression among the elderly. In this case, I am conceptualizing water and sanitation access as variables that moderate the already existing and proven pathway between physical impairment and depression. In aim 3 I will develop an instrument to assess the role of household water and sanitation access in the epidemiology of geriatric mental health and wellbeing. While LASI is a rich dataset, it was not designed with an explicit focus on water and sanitation as exposures. Thus, I will develop and test a new instrument that better captures the complex and unique relationship between aging and water and sanitation infrastructure. My K01 portfolio of mentored research and training will enable me to develop expertise in the epidemiology of aging and depression, the disablement process, and advanced causal methods, and will enhance my overall professional development. I have defined a detailed career development plan and assembled an experienced team of mentors including Professors Maria Glymour, Jinkook Lee, S.V. Subramanian, and Justin White. As such, the training and mentorship I receive as a part of this award will enable me to achieve my long-term goal of leading global efforts to better understand and highlight how water and sanitation interventions can shape health outcomes and reduce disparities among vulnerable populations across the lifecourse.