Biopsychosocial Determinants of Depressive Symptoms among Middle-Aged Adults in Indonesia: Findings from the Indonesian Family Life Survey (IFLS-5)

Sylivia Lugereka; Revi Gama Hatta Novika; Argyo Demartoto; Eti Poncorini Pamungkasari; Setyo Sri Rahardjo

doi:10.56741/IISTR.jphs.002105

Authors

Sylivia Lugereka
sylviasamuel598@gmail.com
Universitas Sebelas Maret https://orcid.org/0009-0000-7349-2956
Revi Gama Hatta Novika Universitas Sebelas Maret https://orcid.org/0000-0002-5606-835X
Argyo Demartoto Universitas Sebelas Maret https://orcid.org/0000-0002-8245-0720
Eti Poncorini Pamungkasari Universitas Sebelas Maret https://orcid.org/0000-0002-4197-3226
Setyo Sri Rahardjo Universitas Sebelas Maret https://orcid.org/0000-0002-8736-5963

Keywords:

Bio Psychosocial Factors, Chronic Disease, Depression, IFLS-5, Mental Health

Abstract

Depression has been recognized as a major public health issue that affects middle-aged people in developing countries. The research explored how diabetes mellitus and stroke history affected depressive symptoms in Indonesian among middle-aged adults. This is a cross-sectional study that used data from the IFLS-5, which included 7,503 participants. Weighted descriptive, bivariate, and multivariable logistic regression analyses were performed. The prevalence of depressive symptoms was 17.72%, while 5.62% reported diabetes and 1.00% reported stroke. In adjusted analysis, diabetes only ((AOR = 0.77; 95% CI: 0.57–1.03; p= 0.082)), stroke only (AOR = 1.32; 95% CI: 0.70–2.52; p= 0.387), and combined diabetes and stroke (AOR = 0.91; 95% CI: 0.18–4.50; p= 0.912) were not significantly associated with depressive symptoms. Female (AOR = 1.20; 95% CI: 1.05–1.39; p= 0.009), unhealthy self-rated health (AOR= 2.48; 95% CI: 2.17–2.84; p= 0.001), and lack of community participation (AOR = 0.86; 95% CI: 0.74–0.99; p= 0.043) were significant. However, BMI had lower odds of depressive symptoms. Marital status, education, residence, smoking status, and physical activity were not significantly associated with depressive symptoms. These findings suggest that psychosocial and perceptual factors play a more prominent role in midlife depressive symptoms than chronic disease status. Integrated public health strategies addressing self-perceived health, social engagement, and gender disparities are necessary.

Downloads

Download data is not yet available.

Author Biographies

Sylivia Lugereka, Universitas Sebelas Maret

Sylivia Lugereka is currently pursuing a Master of Public Health (MPH) at Sebelas Maret University. She earned her Bachelor of Science in Radiography in India and has academic and research interests in public health, medical imaging, epidemiology, and global health. She also serves as a reviewer for several international scientific journals and actively contributes to scholarly publications and academic collaborations. (email: sylviasamuel598@gmail.com).

Revi Gama Hatta Novika, Universitas Sebelas Maret

Revi Gama Hatta Novika affiliated with the Midwifery Study Program, Faculty of Medicine, and the Master’s Program in Public Health at Sebelas Maret University. She serves as the Head of the Master’s Program in Public Health and is actively involved in research on reproductive health, public health, and maternal health. She is also a member of the COVID-19 Consortium of the Indonesian National Research and Innovation Agency (BRIN) and has received several international research and innovation awards. (email: revi.gama@staff.uns.ac.id).

Argyo Demartoto, Universitas Sebelas Maret

Argyo Demartoto is affiliated with the Department of Sociology, Faculty of Social and Political Sciences, Sebelas Maret University. He is actively involved in teaching and interdisciplinary research in sociology and public health, focusing on community empowerment, health behavior, gender studies, and social transformation. He also serves on editorial and reviewer boards of several scientific journals and participates in community-based social and health development programs in Indonesia. (email: argyodemartoto_fisip@staff.uns.ac.id).

Eti Poncorini Pamungkasari, Universitas Sebelas Maret

Eti Poncorini Pamungkasari is affiliated with the Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Sebelas Maret. She serves as the Vice Dean for Academic and Research at the Faculty of Medicine and is actively involved in medical education, public health, and interdisciplinary health research. Her scholarly work focuses on medical education, curriculum development, preventive medicine, and health promotion, with extensive contributions to national and international scientific publications. (email: etiponco@staff.uns.ac.id).

Setyo Sri Rahardjo, Universitas Sebelas Maret

Setyo Sri Rahardjo is affiliated with the Department of Pharmacology, Faculty of Medicine, Universitas Sebelas Maret, where he serves as the Head of the Pharmacology Laboratory. His research focuses on environmental toxicology, public health, herbal medicine, and environmental health, with active involvement in postgraduate public health supervision and interdisciplinary health research. He has contributed extensively to national and international scientific publications and academic collaborations. (email: setyosri@staff.uns.ac.id).

References

T. Sustainable and D. Goals, “The Sustainable Development Goals Report,” 2025, [Online]. Available: https://unstats.un.org/sdgs/report/2025

World Health Organization, “Depression,” 2023. [Online]. Available: https://www.who.int/news-room/fact-sheets/detail/depression

G. S. Malhi and J. J. Mann, “Depression,” Lancet, vol. 392, no. 10161, pp. 2299–2312, Nov. 2018, doi: 10.1016/S0140-6736(18)31948-2. DOI: https://doi.org/10.1016/S0140-6736(18)31948-2

V. Patel et al., “The Lancet Commission on global mental health and sustainable development,” Lancet, vol. 392, no. 10157, pp. 1553–1598, Oct. 2018, doi: 10.1016/S0140-6736(18)31612-X. DOI: https://doi.org/10.1016/S0140-6736(18)31612-X

D. Gondek, L. Bernardi, E. McElroy, and C. L. Comolli, Why do Middle-Aged Adults Report Worse Mental Health and Wellbeing than Younger Adults? An Exploratory Network Analysis of the Swiss Household Panel Data, vol. 19, no. 4. Springer Netherlands, 2024. doi: 10.1007/s11482-024-10274-4. DOI: https://doi.org/10.1007/s11482-024-10274-4

F. J. Infurna, D. Gerstorf, and M. E. Lachman, “Midlife in the 2020s: Opportunities and Challenges,” Physiol. Behav., vol. 176, no. 12, pp. 139–148, 2020, doi: 10.1037/amp0000591.Midlife.

WHO, “Noncommunicable diseases,” Essentials of Community Medicine: A Practical Approach, pp. 76–76, 2025. doi: 10.5005/jp/books/11660_5. DOI: https://doi.org/10.5005/jp/books/11660_5

M. J. Hossain, M. Al-Mamun, and M. R. Islam, “Diabetes mellitus, the fastest growing global public health concern: Early detection should be focused,” Heal. Sci. Reports, vol. 7, no. 3, pp. 5–9, 2024, doi: 10.1002/hsr2.2004. DOI: https://doi.org/10.1002/hsr2.2004

R. I. G. Holt, M. De Groot, and S. H. Golden, “Diabetes and depression,” Curr. Diab. Rep., vol. 14, no. 6, 2014, doi: 10.1007/s11892-014-0491-3. DOI: https://doi.org/10.1007/s11892-014-0491-3

A. H. Miller and C. L. Raison, “Role of inflammation in depression,” Nat Rev Immunol, vol. 16, no. 1, pp. 22–34, 2017, doi: 10.1038/nri.2015.5.The. DOI: https://doi.org/10.1038/nri.2015.5

M. S. Ummah, “Anxiety And Physical Health Conditions In Older Adults,” Sustain., vol. 11, no. 1, pp. 1–14, 2019, [Online]. Available: http://scioteca.caf.com/bitstream/handle/123456789/1091/RED2017-Eng-8ene.pdf?sequence=12&isAllowed=y%0Ahttp://dx.doi.org/10.1016/j.regsciurbeco.2008.06.005%0Ahttps://www.researchgate.net/publication/305320484_SISTEM_PEMBETUNGAN_TERPUSAT_STRATEGI_MELESTARI

T. Schwarz, A. E. Schmidt, J. Bobek, and J. Ladurner, “Barriers to accessing health care for people with chronic conditions: a qualitative interview study,” BMC Health Serv. Res., vol. 22, no. 1, pp. 1–15, 2022, doi: 10.1186/s12913-022-08426-z. DOI: https://doi.org/10.1186/s12913-022-08426-z

C. Abbafati et al., “Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019,” Lancet, vol. 396, no. 10258, pp. 1204–1222, 2020, doi: 10.1016/S0140-6736(20)30925-9. DOI: https://doi.org/10.1016/S0140-6736(20)30925-9

V. L. Feigin et al., “World Stroke Organization (WSO): Global Stroke Fact Sheet 2022,” Int. J. Stroke, vol. 17, no. 1, pp. 18–29, Jan. 2022, doi: 10.1177/17474930211065917. DOI: https://doi.org/10.1177/17474930211065917

H. Arifin et al., “Analysis of Modifiable, Non-Modifiable, and Physiological Risk Factors of Non-Communicable Diseases in Indonesia: Evidence from the 2018 Indonesian Basic Health Research,” J. Multidiscip. Healthc., vol. 15, no. September, pp. 2203–2221, 2022, doi: 10.2147/JMDH.S382191. DOI: https://doi.org/10.2147/JMDH.S382191

Health research and development agency, Ministry of Health of Indonesia, “Laporan Riskesdas 2018 Nasional,” 2018.

Kemenkes RI, Profil Kesehatan Indonesia 2021. 2022.

T. Roy and C. E. Lloyd, “Epidemiology of depression and diabetes: A systematic review,” J. Affect. Disord., vol. 142, no. SUPPL., pp. S8–S21, Oct. 2012, doi: 10.1016/S0165-0327(12)70004-6. DOI: https://doi.org/10.1016/S0165-0327(12)70004-6

M. Khaledi, F. Haghighatdoost, A. Feizi, and A. Aminorroaya, “The prevalence of comorbid depression in patients with type 2 diabetes: an updated systematic review and meta-analysis on a huge number of observational studies,” Acta Diabetol., vol. 56, no. 6, pp. 631–650, 2019, doi: 10.1007/s00592-019-01295-9. DOI: https://doi.org/10.1007/s00592-019-01295-9

T. C. Lai, C. C. McDaniel, and C. Chou, “Diabetes management behaviors associated with depression in the U.S.,” Diabetol. Metab. Syndr., vol. 14, no. 1, pp. 1–9, 2022, doi: 10.1186/s13098-022-00953-3. DOI: https://doi.org/10.1186/s13098-022-00953-3

A. Towfighi et al., “Poststroke Depression: A Scientific Statement for Healthcare Professionals from the American Heart Association/American Stroke Association,” Stroke, vol. 48, no. 2, pp. e30–e43, 2017, doi: 10.1161/STR.0000000000000113. DOI: https://doi.org/10.1161/STR.0000000000000113

A. Naghedi, R. Delgado-Mederos, and C. Vives-Bauza, “Stroke Survivors Have Almost Three Times Higher Risk of Depression: A Systematic Review and Meta-Analysis,” J. Clin. Med., vol. 14, no. 23, pp. 1–20, 2025, doi: 10.3390/jcm14238410. DOI: https://doi.org/10.3390/jcm14238410

C. Kuehner, “Why is depression more common among women than among men?,” The Lancet Psychiatry, vol. 4, no. 2, pp. 146–158, Feb. 2017, doi: 10.1016/S2215-0366(16)30263-2. DOI: https://doi.org/10.1016/S2215-0366(16)30263-2

M. G. Di Benedetto, P. Landi, C. Mencacci, and A. Cattaneo, “Depression in Women: Potential Biological and Sociocultural Factors Driving the Sex Effect,” Neuropsychobiology, vol. 83, no. 1, pp. 2–16, 2024, doi: 10.1159/000531588. DOI: https://doi.org/10.1159/000531588

Á. Denche-Zamorano et al., “The Obesity Paradox: Associations between the Body Mass Index and Self-Perceived Health, Depression Status, and Pain Level in Older People,” Appl. Sci., vol. 13, no. 1, 2023, doi: 10.3390/app13010588. DOI: https://doi.org/10.3390/app13010588

F. S. Luppino et al., “Overweight, Obesity, and Depression,” Arch. Gen. Psychiatry, vol. 67, no. 3, p. 220, Mar. 2010, doi: 10.1001/archgenpsychiatry.2010.2. DOI: https://doi.org/10.1001/archgenpsychiatry.2010.2

H. Cui, Y. Xiong, C. Wang, J. Ye, and W. Zhao, “The relationship between BMI and depression: a cross-sectional study,” Front. Psychiatry, vol. 15, no. October, pp. 1–9, 2024, doi: 10.3389/fpsyt.2024.1410782. DOI: https://doi.org/10.3389/fpsyt.2024.1410782

B. C. Ünsal, Z. Demetrovics, and M. Reinhardt, “Stronger together: community participation, structural stigma, and depression among sexual and gender minority adults in 28 European countries,” Soc. Psychiatry Psychiatr. Epidemiol., vol. 58, no. 4, pp. 657–669, 2023, doi: 10.1007/s00127-022-02385-w. DOI: https://doi.org/10.1007/s00127-022-02385-w

N. Yamamoto-Takiguchi, E. Uchiyama, H. Fukahori, A. Taguchi, and S. Nagata, “Age Group Differences in Daily Life Changes among Community Residents during the COVID-19 Pandemic: A Pilot Study on Intergenerational Comparison,” Keio J. Med., vol. 72, no. 1, pp. 11–20, 2023, doi: 10.2302/kjm.2022-0007-OA. DOI: https://doi.org/10.2302/kjm.2022-0007-OA

M. Wuorela, S. Lavonius, M. Salminen, T. Vahlberg, M. Viitanen, and L. Viikari, “Self-rated health and objective health status as predictors of all-cause mortality among older people: A prospective study with a 5-, 10-, and 27-year follow-up,” BMC Geriatr., vol. 20, no. 1, pp. 1–7, 2020, doi: 10.1186/s12877-020-01516-9. DOI: https://doi.org/10.1186/s12877-020-01516-9

G. Ambresin, P. Chondros, C. Dowrick, H. Herrman, and J. M. Gunn, “Self-rated health and long-term prognosis of depression,” Ann. Fam. Med., vol. 12, no. 1, pp. 57–65, 2014, doi: 10.1370/afm.1562. DOI: https://doi.org/10.1370/afm.1562