The Role of Health Status and Social Relationships on Mental Well-Being over the Life Course

Jeroen Spijker , Universitat Internacional de Catalunya
Julia Almeida, London School of Hygiene & Tropical Medicine
Elisenda Rentería, Centre for Demographic Studies

Background: Mental well-being in adults with disabilities reflects interrelated effects from health, social relationships, and the home and urban environment. We assess how these domains act directly and indirectly to shape anxiety/depression. Methods: Using the 2020 Spanish Survey on Disability, Personal Autonomy and Dependency Situations, we study adults aged 20+. Mental health is binary (chronic anxiety/depression vs none). Predictors include counts of chronic conditions and disabilities, disability severity/type, social interaction (frequency and perceived adequacy), and accessibility barriers at home, in public buildings, neighbourhoods, and transport. We estimate sex-stratified structural equation models (SEMs) to map direct and indirect pathways from health, social, and spatial factors to mental health. To address potential endogeneity, we use elevator presence as an instrument for residential accessibility, and include standard sociodemographic controls. Results: Women report higher anxiety/depression than men (29% vs 19%). Poorer mental health is associated with more chronic conditions, limited or insufficient social interaction, and more accessibility difficulties. Disability shows a direct effect in women and indirect effects via accessibility and social interaction in both sexes. By disability type, personal-care limitations relate most strongly to poor mental health, whereas hearing impairments relate least. Conclusions: Among Spanish adults with disabilities, mental well-being is shaped not only by accumulated chronic conditions but also by social and spatial enablers that can be modified. Policy and practice should pair chronic-disease management with measures that expand meaningful social contact and remove accessibility barriers in homes, public buildings, neighbourhoods, and transport.

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 Presented in Session P6. Health, Mortality, and Ageing 2