Health Behaviors, Informal Employment, and Depression Among Female Workers in Indonesia’s Geographically Disadvantaged Regions

Abstract

Introduction: Employment insecurity, chronic illness, and health-risk behaviours may be associated with depressive symptoms among women working in Indonesia's disadvantaged, frontier, and outermost (3T) regions. However, nationally representative survey evidence for this population remains limited. Objective: This study aimed to identify factors associated with depressive symptoms among female workers in Indonesia's 3T regions using data from the 2023 Indonesian Health Survey. Methods: This cross-sectional study used data from the 2023 Indonesian Health Survey (Survei Kesehatan Indonesia; SKI 2023), which employed a multistage sampling design. The final analytic sample comprised 15,218 women aged ≥15 years living and working in 3T regions. Depressive symptoms were assessed using a module of the Mini International Neuropsychiatric Interview (MINI) and classified as positive or negative. Statistical analyses accounted for the complex survey design and sampling weights. Survey-adjusted chi-square tests were used for preliminary associations, and multivariable binary logistic regression was used to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results: Depressive symptoms were identified in 1.2% (n=180) of female workers in 3T regions. After adjustment, depressive symptoms were associated with informal employment (aOR=3.60; 95% CI: 1.30–9.90), one comorbid condition (aOR=3.10; 95% CI: 2.10–4.56), two or more comorbid conditions (aOR=4.88; 95% CI: 2.30–10.30), insufficient physical activity (aOR=2.29; 95% CI: 1.70–3.10), and alcohol consumption (aOR=3.05; 95% CI: 1.05–8.90). Age, marital status, education level, and current smoking were not significantly associated with depressive symptoms after adjustment. Conclusion: Among female workers in Indonesia's 3T regions, depressive symptoms were associated with informal employment, chronic disease burden, insufficient physical activity, and alcohol consumption. These findings support consideration of strengthened early detection and screening in primary and community healthcare, with particular attention to female informal workers and women with chronic health conditions, alongside feasible physical-activity promotion and brief alcohol screening.