Joint Food and Water Insecurity Had a Multiplicative Effect on Women’s Depression in Urban Informal Settlements in Makassar, Indonesia during the COVID-19 Pandemic

Background: Women living in urban informal settlements may be particularly ulnerable to the detrimental effects of the COVID-19 pandemic because of increased economic and psychosocial stressors in resource-limited environments. Objectives: The objective of this study was to assess the associations between food and water insecurity during the pandemic and depression among women living in the urban informal settlements in Makassar, Indonesia. Methods: We implemented surveys at 3 time points among women enrolled in the Revitalizing Informal Settlements and their Environments trial. Depression was measured using the Center for Epidemiologic Studies Depression Scale—10 (CESD-10) between November and December 2019 and again between February and March 2021. Food insecurity was measured using questions from the Innovation for Poverty Action’s Research for Effective COVID-19 Reponses survey and water insecurity was measured using the Household Water Inse- curity Experiences Short Form. Both were measured between August and September 2020. We built 3 multivariate quantile linear regression models to assess the effects of water insecurity, food insecurity, and joint food and water insecurity during the COVID-19 pandemic on CESD-10 score. Results: In models with the full sample (n 1⁄4 323), food insecurity (β: 1.48; 95% CI: 0.79, 2.17), water insecurity (β: 0.13; 95% CI: 0.01, 0.26), and joint food and water insecurity (β: 2.40; 95% CI: 1.43, 3.38) were positively associated with CESD-10 score. In subgroup analyses of respondents for whom we had prepandemic CESD-10 scores (n 1⁄4 221), joint food and water insecurity (β: 1.96; 95% CI: 0.78, 3.15) maintained the strongest relationship with CESD-10 score. A limitation of this study is that inconsistency in respondents from households across the survey waves reduced the sample size used for this study. Conclusions: Our results find a larger association between depression and joint resource insecurity than with water or food insecurity alone, underlining the importance of addressing food and water insecurity together, particularly as they relate to women’s mental health and well- being.