Psychological Distress in Rapidly Urbanizing Settings: A Cross-Sectional Study of Structural Pathways Linking Age, Blood Pressure, and Metabolic Health

Depression, anxiety, and stress have become significant public health issues in rapidly urbanizing environments, especially among younger and working-age individuals facing escalating social, economic, and vocational demands. Urban surroundings are increasingly associated with metabolic disorders, such as changed body composition, dyslipidemia, and hypertension, which may influence psychological outcomes. Nonetheless, integrated models investigating the correlations between age, metabolic status (including skeletal muscle mass, body fat composition, and dyslipidemia), and psychological outcomes within urban adult populations are scarce.

This study aimed to construct and assess a structural model delineating the interconnections among age, metabolic status (skeletal muscle mass, body fat composition, and dyslipidemia), and psychological consequences, such as depression, anxiety, and stress, in urban adults in Jakarta.

A cross-sectional study was conducted in 2025 across five administrative regions of Jakarta. A total of 1,123 adults aged 18-98 years were recruited using consecutive sampling. Psychological distress was assessed using the Depression Anxiety Stress Scale-42 (DASS-42). Body composition, muscle strength, blood pressure, and biochemical markers were measured using standardized instruments and laboratory procedures. Data were analyzed using SPSS version 25 for univariate, bivariate (Spearman correlation), and age-controlled partial correlation analyses, followed by Partial Least Squares-Structural Equation Modeling (PLS-SEM) using SmartPLS version 3 to estimate path coefficients and explained variance (R²).

PLS-SEM analysis revealed that younger age was associated with greater psychological distress (β = −0.116; R² = 0.042), whereas age was positively associated with blood pressure (β = 0.278). Blood pressure was inversely associated with psychological distress, while dyslipidemia and body fat profile demonstrated only minimal direct effects. Skeletal muscle status was more strongly related to physiological markers than to psychological distress.

Hypertension and psychological distress in urban populations are increasingly recognized among younger, working-age adults rather than being exclusively associated with aging. Urban adults, many of whom belong to the “sandwich generation,” may experience concurrent responsibilities of supporting both aging parents and dependent children while maintaining career progression, creating psychosocial pressures that could influence cardiovascular and metabolic health. Importantly, the findings suggest that physical fitness alone may provide limited protection against psychological distress in these high-stress environments, highlighting the importance of broader structural interventions, including healthier workplaces, strengthened social protection, expanded green spaces, and the promotion of early hypertension screening and risk identification among urban adults.

Psychological distress in urban people was only marginally elucidated by metabolic and physiological parameters, but cardiovascular and musculoskeletal outcomes exhibited more pronounced correlations with age and hemoglobin levels. The findings indicate that mental health outcomes in urban populations are influenced by multiple factors and are not exclusively determined by biological aging, underscoring the significance of larger structural and environmental variables in increasingly urbanizing settings.