Applying the Index of Vulnerability approach to understand water insecurity and other social-ecological factors associated with depression among urban refugee youth in Kampala, Uganda

Water insecurity and other social-ecological factors may be associated with depression in low and middle-income contexts (LMICs). This is understudied among urban refugee youth in LMICs, who experience multiple forms of marginalization. We conducted a cross-sectional survey with a peer-driven sample of urban refugee youth aged 16–24 in Kampala, Uganda. We explored: the prevalence of depression (moderate, moderately severe); associations between social-ecological (structural, community, interpersonal, intrapersonal) factors and depression; and associations between an Index of Vulnerability (IoV) comprised of social-ecological stressors and depression. Among n = 335 participants (mean age: 20.8 years, standard deviation: 3.1), in multivariable analyses, longer time in Uganda, water insecurity, lower social support, parenthood, and recent intimate partner violence were associated with moderate depression; and longer time in Uganda, water insecurity, and lower social support were associated with moderately severe depression. IoV scores were associated with moderate depression among men and women, and moderately severe depression among women. The IoV scores accounted for more variance in moderate/moderately severe depression among women than any single indicator; among men, water insecurity was most strongly associated with moderate depression. Future research can explore strategies to address water insecurity and other social-ecological stressors to promote health and wellbeing with urban refugee youth.