Associations between Extreme Weather Events and Resource Insecurities with Depression and Anxiety Symptoms Among Older Adults In Moshi, Tanzania: Cross-Sectional Analyses

Background and Purpose: There is growing evidence that extreme weather events and associated resource insecurities (i.e., water, food, sanitation) are associated with adverse mental health outcomes in climate-affected contexts such as Tanzania, yet this is understudied among older adults. These pathways connecting extreme weather events and resource insecurities to mental health can be understood through an intersectional lens which asserts that social categories shape access to resources and opportunities that impact needs, priorities, and capacities to respond to stressors. The lack of research focusing on older adults reflects a significant intersectional knowledge gap in climate change in the Tanzanian context. The current study examined the associations between resource insecurities (food, water, and sanitation insecurity), extreme weather event exposure, socio-demographics, and protective factors (social support, resilience) with depressive symptoms, anxiety symptoms, and alcohol use disorder among older adults in Moshi, Tanzania.

Methods: We conducted a community-based cross-sectional survey of a random sample of older adults from the Prospective Urban Rural Epidemiology cohort in Moshi, Tanzania to examine associations between resource insecurities, extreme weather event exposure, and mental health symptoms. Multivariable linear regression analyses were conducted to identify resource insecurity (food, water, sanitation insecurity), extreme weather event exposure, socio-demographic, and protective factors (social support, resilience) associated with depressive and anxiety symptoms.

Results: Among participants (n=250; mean age=60.6 years; SD=11.1), in adjusted analyses, low food security (aβ=0.86 [95%CI: 0.54,1.18] p<0.001), very low food security (aβ=1.07 [95%CI:0.73,1.41] p<0.001), sanitation insecurity (aβ=0.05 [95%CI:0.01,0.09] p=0.022), and experiencing a past-year extreme weather event (aβ=0.39 [95%CI:0.07,0.70] p=0.017) were associated with higher depression scores. Low food security (aβ=0.51 [95%CI:0.22,0.79] p=0.001), very low food security (aβ=0.62 [95%CI:0.32,0.93] p<0.001), and water insecurity (aβ=0.53 [95%CI:0.02,1.03] p=0.040) were associated with higher anxiety scores, while resilience was negatively associated with anxiety (aβ=-0.07 [95% CI:-0.14,-0.01] p<0.001).

Conclusions and Implications: We found that multiple (food, water, sanitation) resource insecurity indicators and exposure to extreme weather events were associated with adverse mental health outcomes among older adults, with some variation observed by resource insecurity type and mental health outcome. In particular, low levels of food security, low levels of sanitation security, and experiencing a past-year extreme weather event were significantly associated with higher depression scores, while low levels of both food security and water security were significantly associated higher anxiety scores. Understanding these relationships is essential in order to develop targeted age-friendly interventions that can support the mental health of older people at the nexus of extreme weather and multiple resource scarcities. By highlighting the mental health needs of this population, this resource underscores the importance of developing mental health policies and programs that integrate the needs of older people in climate-affected contexts.