Poor mental health is a neglected problem worldwide. People living through humanitarian emergencies suffer not only from scarcity of water, food and poor hygiene but also from poor mental health. Mental disorders can impair health-related daily behavior, handwashing with soap, of vulnerable individuals. However, it is unknown whether handwashing interventions have a different impact on people with poor mental health. A longitudinal study collected data from 638 people in Malawi at baseline and follow-up. We conducted face-to-face interviews with a quantitative questionnaire that used the RANAS approach to behavior change to measure factors underlying handwashing. We assessed mental health using the validated Chichewa version of the Self-Reporting Questionnaire (SRQ-20). Mental health was impaired in 27% of the people assessed. We found a negative relationship between mental health and handwashing after the intervention (r= − 0.083*). The mediation analysis revealed significant indirect effects of mental health on handwashing via factors feelings and difficulty in getting soap for handwashing. These findings imply that mental health assessment should be included in WASH surveys. Interventions that increase positive emotions would make behavior change more successful in populations with a significant proportion of people with poor mental health. This research is especially relevant to emergency contexts.


  • Persons with poor mental health change their handwashing less after an intervention.

  • Changes in psychosocial factors underlying handwashing depend on mental health.

  • Feelings play a key role in behavior change for individuals with poor mental health.

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