Water, economic systems, and mental health: A review of theorized relationships

Water insecurity—the lack of access to sufficient, safe water to meet all household needs—is an escalating challenge in all world regions. It is also associated with unfavorable mental health outcomes, like anxiety and depression. Often situated in the context of drought or general water scarcity, connections between water and mental health often manifest out of the unique characteristics of water—as an important economic and household resource, and one managed primarily by women. This article identifies recognized and theorized pathways between water insecurity and common mental health conditions, as mediated by broader socioeconomic systems in which households are embedded. To this end, we synthesize and connect different literature sets, including limited economic studies in a resource insecurity framework and a small but authoritative body of ethnographic literature. Our review identifies multiple proximate candidate pathways connecting water insecurity with mental health outcomes including community conflicts and/or perceived injustice around water sharing and upkeep, agricultural decline and unemployment, food insecurity or distress migration, decreased water intake, non-exposure to blue spaces, and stress around water management. The gendered role of water management is an overlapping theme across pathways, exposing women disproportionately to forms of conflict, violence, and injustice associated with the risk of common mental illness. In general, there are varied forms of marginalization that people experience within water-insecure contexts. Greater engagement between economics and other disciplines can lend additional theoretical pathways to empirically test the water and mental health connections, associated with people’s water insecurity experiences.