Exploring the mediating role of depression and anxiety in the relationship between social and biological factors and quality of life in Indonesia: A structural equation modelling approach

Susanti, H ORCID: 0000-0002-6033-741X, Fajri, M ORCID: 0009-0005-2072-7447, Keliat, BA, Brooks, H, Bee, P and Maharani, A (2025) Exploring the mediating role of depression and anxiety in the relationship between social and biological factors and quality of life in Indonesia: A structural equation modelling approach. BMJ Open, 15 (4). ISSN 2044-6055

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Abstract

Objectives To examine the association between social and biological factors and quality of life (QoL), and whether depression and anxiety mediate this relationship. Design Cross-sectional study with individual level as the unit of analysis. Main outcome measures Depression and anxiety were measured using the Center for Epidemiologic Studies Short Depression scale and Generalized Anxiety Disorder scale, while QoL was assessed using the EuroQol Five-Dimension scale. Social factors were assessed using the self-reported number of close persons, and biological factors were measured using the number of self-reported physical health comorbidities. Setting Country-level data. Participants General population aged 18 and older with data available. Results Among participants, 849 (4.42%) had depression and 2339 (12.17%) had anxiety. Structural equation modelling (SEM) analysis, adjusted by age and sex, showed that social factors (β=-0.004, p<0.001) and biological factors (β=-0.051, p<0.001) were directly associated with QoL. Mediation analysis revealed that depression and anxiety fully mediated the relationship between social factors and QoL. For biological factors, depression and anxiety partially mediated the relationship with QoL, accounting for 29.30% and 22.83% of the total effect, respectively. Conclusions Depression and anxiety mediate the relationship between social and biological factors and QoL. Strengthening social support and improving mental health access can mitigate these risks. Future research should examine long-term trends and intervention effectiveness to inform targeted policies for at-risk populations.

Item Type:	Article
Uncontrolled Keywords:	MENTAL HEALTH; Quality of Life; Anxiety disorders; Depression & mood disorders; Anxiety disorders; Depression & mood disorders; MENTAL HEALTH; Quality of Life; Humans; Quality of Life; Female; Male; Adult; Cross-Sectional Studies; Indonesia; Middle Aged; Depression; Anxiety; Latent Class Analysis; Young Adult; Adolescent; Aged; Social Factors; 5203 Clinical and Health Psychology; 42 Health Sciences; 52 Psychology; Mental Health; Brain Disorders; Depression; Social Determinants of Health; Mental Illness; Behavioral and Social Science; 2.3 Psychological, social and economic factors; Mental health; 3 Good Health and Well Being; Humans; Quality of Life; Female; Male; Adult; Cross-Sectional Studies; Indonesia; Middle Aged; Depression; Anxiety; Latent Class Analysis; Young Adult; Adolescent; Aged; Social Factors; 1103 Clinical Sciences; 1117 Public Health and Health Services; 1199 Other Medical and Health Sciences; 32 Biomedical and clinical sciences; 42 Health sciences; 52 Psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Divisions:	Nursing, Public and Allied Health
Publisher:	BMJ
Date of acceptance:	14 April 2025
Date of first compliant Open Access:	15 October 2026
Date Deposited:	15 Oct 2026 12:00
Last Modified:	15 Oct 2026 12:00
DOI or ID number:	10.1136/bmjopen-2024-095110
URI:	https://researchonline.ljmu.ac.uk/id/eprint/29684

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