A Structural Equation Modeling Approach to Disease Burden, Functional Limitation, Loneliness, and Depression in Older Adults: Evidence from the Indonesian Family Life Survey

Abstract

Depression in later life is a growing public health concern, as it often emerges from the complex pathways. This study aimed to examine the direct and indirect association between multimorbidity, functional ability, physical dependency, loneliness, and depression among the elderly. A total of 2,928 individuals aged 60 years who were participated on the 5th Indonesian Family Life Survey (IFLS). Structural Equation Modeling (SEM) was employed to investigate the relationships among key variables, including gender, place of residence, marital status, healthcare services, comorbidities, functional ability, history of falls, loneliness, and depression. Model fit was evaluated using the Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI), and Tucker–Lewis Index (TLI). Depression was directly influenced by loneliness (b = 0.30; 95% CI: 0.26 to 0.33; p < 0.001), functional ability (b = -0.04; 95% CI: -0.07 to -0.01; p = 0.039), history of falls (b = 0.09; 95% CI: 0.05 to 0.12; p < 0.001), and adequacy of healthcare services (b = -0.07; 95% CI: -0.10 to -0.03; p < 0.001). Depression was indirectly affected by gender, marital status, comorbidities, functional independence, and place of residence. These findings underscore the complex and interconnected nature of physical and psychosocial factors in late-life depression and highlight the necessity for integrated interventions that address both the physical and emotional needs of the aging population.