Depressive Symptoms, Spiritual Well-Being, Healthy Aging, and Health-Related Quality of Life in Older Adults with and Without Mild Cognitive Impairment: A Cross-Sectional Multi-Group Path Analysis

Depressive symptoms are common among older adults with mild cognitive impairment (MCI) and are associated with poorer health-related quality of life (HRQoL) and lower healthy-aging scores, yet the pathways underlying these associations remain unclear. Drawing on stress-and-coping and meaning-making perspectives, this study examined whether spiritual well-being statistically accounted for part of the associations of depressive symptoms with healthy aging and HRQoL, and whether these indirect associations differed by cognitive status. In this cross-sectional comparative study, 281 older adults with MCI and 295 older adults without a diagnosed cognitive impairment (aged 65–75 years) were recruited from a geriatric outpatient clinic. A just-identified multi-group path model was estimated with age as a covariate and 5000 bootstrap resamples. The MCI group had higher depressive symptom scores, poorer HRQoL, and lower healthy-aging and spiritual well-being scores than the comparison group (all p < 0.001, |d| = 0.45–0.67). In both groups, depressive symptoms were directly associated with lower healthy-aging scores and poorer HRQoL. A statistically significant but modest indirect association through spiritual well-being was observed between depressive symptoms and healthy aging (standardized indirect effect: −0.18 in the MCI group and −0.08 in the comparison group); this association was robust to adjustment for sociodemographic and clinical covariates and to the exclusion of conceptually overlapping healthy-aging subscales. The indirect association with HRQoL was small, and no indirect association differed significantly between groups. Because the design was cross-sectional, these findings do not establish causal mediation; they indicate that spiritual well-being is a psychosocial correlate of healthy aging that warrants examination in longitudinal and intervention studies.