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.

精神健康状况差是全球范围内被忽略的问题。由于人道主义紧急情况而生活的人们不仅遭受水，食物和卫生条件的匮乏之苦，而且还遭受精神健康的困扰。精神疾病会损害弱势群体与健康相关的日常行为，如用肥皂洗手。但是，洗手干预是否会对精神健康不良的人产生不同的影响，这一点尚不清楚。一项纵向研究在基线和随访时从马拉维的638人中收集了数据。我们使用定量调查表进行了面对面的采访，该调查表使用了RANAS的行为改变方法来衡量洗手的潜在因素。我们使用经过验证的Chichewa版本的自我报告问卷（SRQ-20）评估了心理健康。接受评估的人中有27％的人的心理健康受损。r = -0.083 *）。调解分析表明，心理健康对洗手具有间接的显着影响，其影响因素包括感觉和难以获得洗手皂的因素。这些发现暗示精神健康评估应纳入WASH调查中。增加积极情绪的干预措施将使心理健康状况不佳的人群中的行为改变更为成功。这项研究与紧急情况特别相关。