BMC Public Health. 2025 Oct 9;25(1):3448. doi: 10.1186/s12889-025-24665-1.
ABSTRACT
BACKGROUND: Unstable access to safe drinking water may harm mental health, yet its impact by sex remains unclear. We aimed to explore sex-specific associations between household water sources and depressive symptoms (DS) in Chinese middle-aged and older adults.
METHODS: 5,868 participants aged ≥ 40 years were selected from China Family Panel Studies (2012-2020). We used time-varying Cox models to assess the association between household water sources and DS. Group-based trajectory models were employed to identify water-use trajectories, and logistic regression was used to examine the relationship between trajectory groups and post-follow-up DS. Meanwhile, we quantified the increase in DS burden attributable to the use of unstable water.
RESULTS: There was a significant association between household water sources and DS, with notable differences between sexes. For females, relative to stable water, using unstable water was significantly associated with higher follow-up DS risk [hazard ratio (HR) = 1.260, 95% confidence interval (CI): 1.116, 1.423], and this risk increased with greater water instability (cellar-stored water: HR = 1.240, 95% CI: 1.091, 1.409; surface-exposed water: HR = 1.403, 95% CI: 1.062, 1.853). However, these associations were not observed in males. Meanwhile, we identified three water-use trajectories by sex: compared to the constant stable water group, constant unstable water was significantly linked to post-follow-up DS, whereas switching from unstable to stable water reduced this risk in females but not in males. In addition, 5.42% of DS burden in females was attributed to unstable water use.
CONCLUSIONS: Unstable household water sources were associated with an increased DS risk in females but not in males. Sustainable policies securing reliable water supply are needed to protect females’ mental health.
PMID:41068701 | DOI:10.1186/s12889-025-24665-1
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