Classifications of sanitation conditions.

Access to clean water and adequate sanitation is vital for public health. However, the effects of water and sanitation on depressive symptoms remain insufficiently explored among the general population in low- and middle-income countries (LMICs). This study aims to examine the links between sanitation conditions and depressive symptoms, and to evaluate the mediating role of life satisfaction (LS) among adults in Indonesia. We used the fifth wave of the Indonesian Family Life Survey (IFLS-5) dataset with participants aged 15 and above (mean: 37.32 years; SD: 14.93), collected in September 2014/March 2015. Depressive symptoms were measured using the CES-D-10 scale. Five sanitation indicators were included: drinking water, water source, toilet facilities, liquid waste disposal and safe waste disposal methods. Structural equation modelling (SEM) was employed to estimate the direct and indirect pathways linking sanitation factors and depressive symptoms through LS, adjusting for age and sex. The study involved 31,446 participants, of whom 7,312 (23%) were classified as having depressive symptoms. In the first SEM model, drinking water (β = 0.023, p