Social and Environmental Correlates of Women's Depression in Informal Settlements in Nairobi, Kenya: Indicators of Risk and Protection

Background and Purpose: Globally, one billion people reside in informal settlements, and this number is expanding. Over half of Nairobi, Kenya’s three million residents, alone, live in informal settlements. These settlements are often marked by physical and environmental deprivations such as substandard housing, insufficient living space, lack of adequate water and sanitation, and insecure tenancy as well as social challenges such as lack of educational and employment opportunities—conditions which can pose mental health risks to residents who live there, particularly women. Yet, there is a paucity of studies focused on women’s mental health in informal settlements and its risk and protective factors. The purpose of this study was to help fill this gap by exploring risk and protective factors associated with depression among women living in a large informal settlement in Nairobi.

Methods: Data for this study were taken from responses to 552 household surveys with women collected in the Mathare Valley informal settlement in Nairobi in 2018. Households were randomly selected from 11 villages in Mathare. A multi-level, random intercept, logistic regression was run to explore potential risk and protective factors for depression. Individual responses were nested in villages. Depression was measured using the 9-item Patient Health Questionnaire (PHQ-9).

Results: Results suggest that infectious disease (specifically acute diarrhea) and reports of daily problems with family are significant risk factors for depression. Protective factors included having a supportive partner; having a monthly household income over 15,000 KES (US$150); having good to excellent health; and having access to water from outside one’s housing plot or building.

Conclusions and Implications: Findings from this study highlight unique and important factors associated with women’s depression in an informal settlement context. First, findings suggest diarrhea was a risk factor for depression in informal settlements. Infectious diseases, e.g. chronic diarrhea, are serious concerns in these communities where access to healthcare, safe and hygienic toilets, and clean water is often challenging and fluctuations in the physical environment, such as flooding of open sewerage during the rainy season or utility/government water rationing during dry months, can exacerbate risks of infectious diseases. Many studies have highlighted the importance of social supports in mitigating the risk of mental health issues—findings that are corroborated by results from this study that suggest having a supportive partner is associated with lower odds of depression. Conversely, having daily problems with family was associated with depression. Higher incomes, good health, and access to outside water sources also emerged as protective factors against depression. Water from sources outside women’s plots or buildings are often regulated and have been associated with lower risk of diarrhea in other studies—highlighting, further, the importance of health to women’s mental wellbeing. Overall, findings from this study suggest key areas for intervention and policy to improve mental health for women in informal settlements including strengthening social supports, bolstering women’s access to essential services like sanitation and clean water, and increasing women’s access to employment and income-generating activities.