Abstract
Background: This study aimed to analyze the relationship between dietary habits and mental health among people with disability (PWD) using the Panel Survey of Employment for the Disabled (PSED). Significant differences according to gender and age were identified. Methods: This study used secondary data (the second wave of the PSED) collected from 2016 to 2018 (n = 4345). Dietary habits (i.e., skipping meals and regular meal timing) were analyzed as independent variables, and mental health indicators (depression and stress) were treated as dependent variables. Results: Compared with participants who rarely skipped meals, those who skipped meals occasionally and frequently had significantly higher odds of depression (OR = 1.44, 95% CI 1.23–1.68, p < 0.001; OR = 2.30, 95% CI 1.70–3.10, p < 0.001, respectively). Occasional meal skipping was also associated with higher odds of stress (OR = 1.13, 95% CI 1.01–1.26, p = 0.038), but frequent meal skipping was not significantly associated with stress (OR = 1.27, 95% CI 0.97–1.65, p = 0.080). Irregular meal timing was consistently associated with both depressive symptoms (sometimes irregular: OR = 1.27, 95% CI 1.09–1.49, p = 0.003; irregular: OR = 1.82, 95% CI 1.37–2.41, p < 0.001) and perceived stress (sometimes irregular: OR = 1.35, 95% CI 1.21–1.51, p < 0.001; irregular: OR = 1.42, 95% CI 1.11–1.80, p = 0.005). Gender-stratified analyses showed outcome-specific patterns: frequent meal skipping was strongly associated with depressive symptoms among women (OR = 3.11, 95% CI 1.94–4.98) and was also significant among men (OR = 1.89, 95% CI 1.28–2.80), whereas occasional meal skipping was significantly associated with perceived stress among men (OR = 1.16, 95% CI 1.01–1.33) but not among women. Conclusions: Meal skipping and irregular meal timing were associated with poorer mental health outcomes among people with disabilities. In particular, meal skipping was consistently associated with higher odds of self-reported depressive symptoms, whereas meal regularity was associated with both depressive symptoms and perceived stress. These findings suggest that disability-sensitive nutritional support and integrated mental health interventions may help promote psychological wellbeing among people with disabilities.
1. Introduction
People with disabilities (PWD) are individuals who experience temporary or permanent limitations in daily living or social participation due to physical, sensory, intellectual, or mental impairments. The number of PWD has continued to increase globally and nationally, reflecting population aging, chronic disease burden, injuries, and broader environmental and social factors [1]. In Korea, the number of registered PWD increased from 2,580,340 in 2017 to 2,622,950 in 2020, representing an increase of approximately 4.2% over three years [2]. As the population of PWD continues to grow, greater attention is needed not only to demographic trends but also to the health-related challenges and barriers experienced in everyday life [3]. Despite the growing interest in disability and health, little is known about how dietary behaviors are associated with mental health outcomes such as depression and stress in this population. Because mental health is closely linked to life satisfaction and quality of life among PWD, identifying modifiable behavioral factors may have important public health implications [4].
PWD often encounter difficulties in performing routine activities such as personal hygiene, dressing, and eating, which may require additional time, effort, or assistance compared with individuals without disabilities [5]. These barriers can negatively influence dietary behaviors by making regular meal preparation and consumption more difficult, potentially resulting in meal skipping, irregular eating patterns, and poorer nutritional intake. Such dietary patterns have been associated with chronic health conditions including obesity, diabetes, hypertension, and cardiovascular disease, as well as other health complications [6]. Furthermore, limitations in physical activity and access to health-promoting resources may place PWD at elevated risk of secondary health problems and poorer overall health outcomes [7]. Because physical health and mental health are closely interconnected, these challenges may also contribute to adverse psychological outcomes such as depression and stress [8].
Previous studies in the general population have shown that unhealthy dietary behaviors are associated with poorer mental health, including higher levels of depression and perceived stress [9]. For PWD, these associations may be particularly important because disability-related barriers, chronic health conditions, and reduced social participation can increase vulnerability to psychological distress and social isolation [7,8]. Poor dietary habits may therefore contribute not only to physical morbidity but also to reduced quality of life and serious public health consequences, including increased suicide risk [10].
From a psychoneuroendocrinological perspective, irregular food intake may influence affective symptoms through several interrelated biological pathways. Meal skipping and inconsistent meal timing can contribute to fluctuations in blood glucose and energy availability, which may adversely affect mood stability, fatigue, irritability, and emotional regulation [11]. Repeated metabolic instability may also activate stress-response pathways, including the sympathetic nervous system and the hypothalamic–pituitary–adrenal axis, leading to altered cortisol regulation and greater vulnerability to depressive and stress-related symptoms [12]. In addition, irregular meal timing may disrupt circadian alignment because food intake functions as an important cue for peripheral metabolic rhythms [13]. Such circadian and neuroendocrine dysregulation may further influence sleep, inflammation, and neurotransmitter-related processes involved in mood regulation. These mechanisms provide a plausible biological basis for the association between irregular dietary patterns and adverse mental health outcomes.
Mental health among PWD should be understood as a multidimensional issue linked to overall wellbeing, social participation, and quality of life rather than as an isolated clinical outcome. Although numerous studies have examined the relationship between dietary habits and mental health among adolescents, university students, and the general population, relatively few studies have focused specifically on PWD [9,14,15]. Therefore, this study aimed to investigate the association between dietary habits and mental health among PWD using nationally representative panel data from Korea.
2. Methods
2.1. Data Source
This study used the annual data (second wave) from 2016 to 2018 of the Panel Survey of Employment for the Disabled organized by the Korea Employment Agency for the Disabled to understand the relationship between dietary habits and the overall health status of people with disabilities.
As of 15 May 2016, the survey sample of the Panel Survey of Employment for the Disabled was for registered disabled people aged 15 to 64, while a total of 4557 people with disabilities were registered in 2016.
The measurement year of variables related to dietary habits and mental health is thus from 2016 to 2018, and the participants included in this study are a total of 4345 people. Missing or inconsistent responses were excluded.
2.2. Variable
2.2.1. Independent Variable
This study used data from the Panel Survey of Employment for the Disabled. Meal skipping and meal regularity were assessed using one survey question each.
- (1)
- Skipping meals
The answers to the question, “Have you often skipped meals?” were divided into three groups: rarely, occasionally, and frequently. The three responses were used for analysis as they were in the panel survey.
- (2)
- Meal regularity
Responses to the question, “Do you eat at regular times?” were categorized into three groups: regular meals, sometimes irregular meals, and irregular meals. These three response categories were used in the analysis as provided in the panel survey.
2.2.2. Dependent Variables: Self-Reported Depressive Symptoms and Perceived Stress
This study analyzed two self-reported mental health indicators available in the PSED: depressive symptoms and perceived stress. Both outcomes were measured using single-item survey questions. Because the PSED is a secondary panel survey and does not include validated multi-item psychometric instruments such as the Patient Health Questionnaire-9(PHQ-9), Kessler Psychological Distress Scale(K6), or Perceived Stress Scale-10(PSS-10), these variables should be interpreted as screening-level indicators rather than clinical diagnoses. Nevertheless, these items were used because they are standardized mental health indicators repeatedly collected in the PSED and were the only available measures that allowed consistent assessment of depressive symptoms and perceived stress across the study period.
- (1)
- Depressive symptoms
Depressive symptoms were assessed using the question, “Have you ever felt sad or hopeless enough to interfere with your daily life for more than two weeks in the past year?” Responses were categorized as yes or no and used in the analysis as provided in the panel survey.
- (2)
- Perceived stress
Perceived stress was assessed using the question, “How much stress do you feel in your daily life?” The original responses included five categories: “I do not feel it at all,” “I do not tend to feel it,” “I usually feel it,” “I tend to feel it,” and “I feel it very much.” For the main analysis, responses were dichotomized into no perceived stress and perceived stress. Participants who responded “I do not feel it at all” or “I do not tend to feel it” were classified as having no perceived stress, whereas those who responded “I usually feel it,” “I tend to feel it,” or “I feel it very much” were classified as having perceived stress. This dichotomization was used to distinguish participants with low or no perceived stress from those reporting at least usual levels of perceived stress and to allow comparable binary GEE models for both mental health outcomes. However, because dichotomization may reduce information from the original ordinal scale, this issue was considered when interpreting the findings.
2.2.3. Control Variable
Control variables are gender, age, residential area, marital status (marriage/cohabitation, unmarried, divorce/bereavement/separate), smoking, drinking, disability rating (1–3, 4–6), disability type (physical disability, other), chronic disease (cancer, gastritis, diabetes mellitus, hypertension, etc.), overall health condition, economic activity (paid worker, owner-operator, unpaid family worker, unemployed, not economically active population).
2.3. Statistical Analysis
This study performed chi-square tests and generalized estimating equation (GEE) models to investigate the association between dietary habits and mental health outcomes among people with disabilities (PWD). Chi-square tests were used to examine differences in depressive symptoms and perceived stress according to participants’ general characteristics and dietary habits. Because this study used repeated panel data from 2016 to 2018, GEE models were applied to account for within-subject correlations arising from repeated observations of the same participants over time.
For the GEE analyses, depressive symptoms and perceived stress were treated as binary outcome variables. A binomial distribution with a logit link function was specified, and participant identification number was used as the subject variable. The models included all covariates, including sex, age, residential region, marital status, smoking status, alcohol consumption, disability level, disability type, chronic disease, overall health condition, economic activity status, and survey year. Because depressive symptoms and perceived stress are closely related but conceptually distinct mental health indicators, each model also included the other mental health outcome as a covariate. Specifically, perceived stress was included as a covariate in the model for depressive symptoms, and depressive symptoms were included as a covariate in the model for perceived stress. This approach was used to estimate the association between dietary patterns and each mental health outcome independent of the co-occurring mental health indicator. Therefore, the estimated odds ratios should be interpreted as conditional associations rather than total associations between dietary patterns and mental health.
Because depressive symptoms and perceived stress may be interrelated or lie on the same causal pathway, this mutual adjustment may yield conservative estimates, and the findings should be interpreted as associations independent of concurrent psychological distress.
An exchangeable working correlation structure was used to model the correlation among repeated observations within individuals. Empirical sandwich robust standard errors were estimated to obtain valid standard errors, odds ratios (ORs), 95% confidence intervals (CIs), and p-values.
All statistical tests were two-sided, and statistical significance was set at p < 0.05. All analyses were performed using SAS statistical software, version 9.4 (SAS Institute Inc., Cary, NC, USA).
3. Results
3.1. General Characteristics of Subjects
Table 1 shows the general characteristics of subjects (total = 4345). When examining skipping meals, depression, and stress, 13.1% (n = 366) reported depressive symptoms and 53.9% (n = 1506) reported perceived stress among 2794 subjects who answered that they rarely skipped meals. Of 1341 subjects who skipped meals occasionally, 25.0% (n = 335) reported depressive symptoms, and 65.1% (n = 873) reported perceived stress. 38.1% (n = 80) reported depressive symptoms and 72.9% (n = 153) reported perceived stress among 210 subjects who often skipped meals.
Table 1.
General characteristics of study participants.
Regarding meal regularity, among 2707 participants who reported regular meals, 12.6% (n = 342) reported depressive symptoms and 53.3% (n = 1442) reported perceived stress. Among 1388 participants who reported sometimes irregular meals, 24.9% (n = 346) reported depressive symptoms and 66.4% (n = 921) reported perceived stress. Among 250 participants who reported irregular meals, 37.2% (n = 93) reported depressive symptoms and 67.6% (n = 169) reported perceived stress.
3.2. Association Between Skipping Meals, Meal Regularity, Depressive Symptoms, and Perceived Stress
Table 2 presents the associations between dietary habits and mental health outcomes. Compared with participants who rarely skipped meals, those who occasionally skipped meals had significantly higher odds of self-reported depressive symptoms (OR = 1.44, 95% CI: 1.23–1.68, p < 0.001). Participants who frequently skipped meals also had higher odds of self-reported depressive symptoms than those who rarely skipped meals (OR = 2.30, 95% CI: 1.70–3.10, p < 0.001).
Table 2.
Factors associated with depressive symptoms and perceived stress among study participants.
Regarding meal regularity, participants who sometimes ate irregularly had significantly higher odds of self-reported depressive symptoms than those who ate regularly (OR = 1.27, 95% CI: 1.09–1.49, p = 0.003). Participants who ate irregularly also had higher odds of self-reported depressive symptoms than those who ate regularly (OR = 1.82, 95% CI: 1.37–2.41, p < 0.001).
For perceived stress, participants who occasionally skipped meals had significantly higher odds of perceived stress than those who rarely skipped meals (OR = 1.13, 95% CI: 1.01–1.26, p = 0.038). However, frequent meal skipping was not significantly associated with perceived stress (OR = 1.27, 95% CI: 0.97–1.65, p = 0.080). Participants who sometimes ate irregularly had higher odds of perceived stress than those who ate regularly (OR = 1.35, 95% CI: 1.21–1.51, p < 0.001), as did those who ate irregularly (OR = 1.42, 95% CI: 1.11–1.80, p = 0.005).
3.3. Gender-Stratified Associations Between Dietary Patterns and Mental Health Outcomes
Table 3 presents the gender-stratified associations between dietary patterns and mental health outcomes. Among men, occasional meal skipping was significantly associated with higher odds of self-reported depressive symptoms compared with rarely skipping meals (OR = 1.47, 95% CI: 1.20–1.80, p < 0.001). Frequent meal skipping was also associated with higher odds of self-reported depressive symptoms among men (OR = 1.89, 95% CI: 1.28–2.80, p = 0.002). Among women, occasional meal skipping was associated with higher odds of self-reported depressive symptoms (OR = 1.41, 95% CI: 1.10–1.80, p = 0.008), and the association was stronger for frequent meal skipping (OR = 3.11, 95% CI: 1.94–4.98, p < 0.001).
Table 3.
Gender-stratified associations between dietary patterns and mental health outcomes among study participants.
Regarding meal regularity, men who sometimes ate irregularly had higher odds of self-reported depressive symptoms than those who ate regular meals (OR = 1.31, 95% CI: 1.07–1.60, p = 0.009). Men who ate irregular meals also had higher odds of self-reported depressive symptoms (OR = 1.94, 95% CI: 1.34–2.80, p < 0.001). Among women, irregular meals were significantly associated with higher odds of self-reported depressive symptoms compared with regular meals (OR = 1.59, 95% CI: 1.02–2.47, p = 0.041).
For perceived stress, occasional meal skipping was significantly associated with higher odds of perceived stress among men (OR = 1.16, 95% CI: 1.01–1.33, p = 0.035), whereas this association was not significant among women (OR = 1.03, 95% CI: 0.85–1.25, p = 0.779). Frequent meal skipping was not significantly associated with perceived stress in either men or women.
Meal regularity showed different patterns by gender. Among men, sometimes irregular meals were associated with higher odds of perceived stress compared with regular meals (OR = 1.25, 95% CI: 1.09–1.43, p = 0.001). Among women, both sometimes irregular meals (OR = 1.63, 95% CI: 1.34–1.97, p < 0.001) and irregular meals (OR = 2.17, 95% CI: 1.44–3.25, p < 0.001) were significantly associated with higher odds of perceived stress.
3.4. Age-Stratified Associations Between Dietary Patterns and Mental Health Outcomes
Table 4 presents the age-stratified associations between dietary patterns and mental health outcomes. For self-reported depressive symptoms, occasional meal skipping was significantly associated with higher odds of depressive symptoms across all age groups: 15–39 years (OR = 1.53, 95% CI: 1.16–2.02, p = 0.002), 40–49 years (OR = 1.38, 95% CI: 1.03–1.83, p = 0.029), and 50–65 years (OR = 1.41, 95% CI: 1.08–1.84, p = 0.011). Frequent meal skipping was also significantly associated with higher odds of depressive symptoms among participants aged 15–39 years (OR = 3.51, 95% CI: 2.17–5.67, p < 0.001) and 40–49 years (OR = 2.11, 95% CI: 1.21–3.67, p = 0.009), but not among those aged 50–65 years (OR = 1.63, 95% CI: 0.94–2.85, p = 0.085).
Table 4.
Age-stratified associations between dietary patterns and mental health outcomes among study participants.
Regarding meal regularity, irregular meals were significantly associated with higher odds of self-reported depressive symptoms among participants aged 40–49 years (OR = 1.86, 95% CI: 1.12–3.10, p = 0.017) and 50–65 years (OR = 2.51, 95% CI: 1.52–4.16, p < 0.001). Sometimes irregular meals were significantly associated with depressive symptoms only among participants aged 50–65 years (OR = 1.32, 95% CI: 1.01–1.71, p = 0.039).
For perceived stress, occasional meal skipping was significantly associated with higher odds of stress only among participants aged 15–39 years (OR = 1.23, 95% CI: 1.03–1.47, p = 0.021). Frequent meal skipping was not significantly associated with perceived stress in any age group.
Meal regularity was more consistently associated with perceived stress. Sometimes irregular meals were associated with higher odds of perceived stress among participants aged 15–39 years (OR = 1.20, 95% CI: 1.01–1.43, p = 0.040), 40–49 years (OR = 1.43, 95% CI: 1.17–1.74, p = 0.001), and 50–65 years (OR = 1.47, 95% CI: 1.21–1.80, p < 0.001). Irregular meals were also associated with higher odds of perceived stress among participants aged 15–39 years (OR = 1.46, 95% CI: 1.02–2.10, p = 0.038) and 50–65 years (OR = 1.80, 95% CI: 1.10–2.93, p = 0.019), but not among those aged 40–49 years (OR = 1.10, 95% CI: 0.71–1.70, p = 0.681).
4. Discussion
This study examined the association between dietary habits and mental health among people with disabilities (PWD) using nationally representative panel data from Korea. The principal findings were as follows. First, skipping meals was significantly associated with higher odds of depression, and occasional meal skipping was also associated with higher stress levels. Second, irregular meal timing was consistently associated with both depression and stress. Overall, these findings suggest that regular meal consumption and stable eating patterns may play an important role in the mental wellbeing of PWD.
The association between meal skipping and depression observed in this study is consistent with previous research showing that unhealthy dietary behaviors are linked to poorer psychological outcomes, including depressive symptoms and stress [15,16]. Meal skipping may contribute to inadequate nutrient intake, unstable blood glucose regulation, and poorer overall health status, all of which may adversely affect mood and emotional regulation [17,18]. In addition, individuals who frequently skip meals may experience greater disruption in daily routines, which has also been associated with psychological distress.
Irregular meal timing was significantly associated with both depression and stress in the present study. This finding aligns with growing evidence that consistent dietary routines may support mental health through regulation of circadian rhythm, metabolic stability, and healthier lifestyle behaviors [19,20,21]. For PWD, maintaining regular mealtimes may be especially challenging because of mobility limitations, dependence on caregivers, economic barriers, or reduced access to healthy food environments [22]. These structural barriers may partly explain the stronger association between irregular eating patterns and adverse mental health outcomes in this population.
Interestingly, frequent meal skipping was not significantly associated with perceived stress after adjustment for covariates. This attenuation may indicate that the relationship between meal skipping and perceived stress is more complex than that between meal skipping and depressive symptoms. Perceived stress may be more strongly influenced by immediate socioeconomic conditions, disability severity, employment status, caregiving burden, and daily environmental demands than by dietary behavior alone. In addition, meal skipping and meal regularity may capture overlapping but distinct dimensions of dietary behavior, and their simultaneous inclusion in the multivariable model may have attenuated the independent association between frequent meal skipping and perceived stress. The mutual adjustment for depressive symptoms may also have contributed to conservative estimates because depressive symptoms and perceived stress are closely related mental health indicators. Therefore, the null association should not be interpreted as evidence that frequent meal skipping is unrelated to stress, but rather as suggesting that the association may depend on co-occurring psychological, social, and disability-related factors. Future studies should examine potential mediating and moderating pathways using more detailed measures of stress, diet, caregiving support, and disability-related limitations.
The findings also have important practical implications. Because PWD often face increased risks of chronic disease, obesity, and limited physical activity, improving dietary habits may provide dual benefits for both physical and mental health. The gender- and age-stratified findings suggest that interventions may need to be tailored to specific subgroups. For women, the stronger association between frequent meal skipping and depressive symptoms suggests the need for integrated nutritional support and depression screening in community-based disability services. For men, occasional meal skipping was associated with perceived stress, indicating that regular meal access and stress-management support may be particularly relevant for those experiencing work-related or daily-life stress. In the age-stratified analyses, younger participants showed stronger associations between meal skipping and depressive symptoms, suggesting that nutritional counseling and regular meal support may be useful in school-to-work transition, vocational rehabilitation, and early adulthood support programs. Among middle-aged and older participants, irregular meal timing was more consistently associated with depressive symptoms and perceived stress, suggesting the importance of caregiver-supported meal routines, accessible community meal services, and regular mental health screening. These subgroup-specific approaches may help improve both dietary regularity and mental wellbeing among people with disabilities.
Mental health among PWD should be understood within a broader framework of quality of life, health equity, and social participation. Depression and stress may worsen functional limitations and social isolation, creating a cycle of poorer health outcomes [23]. Therefore, integrated health policies that combine nutrition support, mental health services, and disability-sensitive community care may be especially beneficial.
Several limitations should be considered. First, because this study used secondary survey data, causal relationships cannot be definitively established. Second, the mental health outcomes were measured using single-item self-reported survey questions rather than validated multi-item psychometric instruments such as the Patient Health Questionnaire-9, Kessler Psychological Distress Scale, or Perceived Stress Scale. Although these single-item measures were the only available mental health indicators in the PSED, they cannot establish clinical diagnoses of depressive disorders or provide the same level of diagnostic validity, symptom severity assessment, or psychometric reliability as validated instruments. Therefore, the findings should be interpreted as associations with self-reported depressive symptoms and perceived stress rather than clinically confirmed depression or stress disorders. Third, some potentially relevant factors, such as detailed nutrient intake, caregiver support, or severity-specific functional limitations, were not available in the dataset. Fourth, because this study used data collected from 2016 to 2018, the findings should be interpreted in light of potential changes in the living conditions, service environments, employment circumstances, and health-related needs of people with disabilities after the study period. Therefore, the generalizability of the findings to more recent periods may be limited.
Despite these limitations, this study has strength in using a large, nationally representative panel dataset to investigate an understudied but important public health issue among PWD.
5. Conclusions
This study examined the association between dietary patterns and mental health outcomes among people with disabilities using nationally representative panel data from Korea. Meal skipping was associated with higher odds of self-reported depressive symptoms, while irregular meal timing was associated with both depressive symptoms and perceived stress. These findings suggest that dietary patterns may represent an important modifiable factor related to mental health in people with disabilities. Disability-sensitive nutritional support, improved access to regular meals, and integrated mental health screening may be useful components of community-based health programs for this population. In particular, subgroup-tailored approaches may be needed, such as nutritional support and depression screening for women who frequently skip meals, stress-management support for men with meal skipping, and age-specific meal regularity support for younger, middle-aged, and older adults with disabilities. Future prospective studies using validated psychometric instruments, detailed dietary assessments, and biological markers of stress are needed to further clarify the mechanisms linking dietary behaviors and mental health outcomes.
Author Contributions
Y.N.K.: Conceptualization, Methodology, Formal analysis, Visualization, Writing—original draft. G.M.L.: Conceptualization, Methodology, Formal analysis, Visualization, Writing—original draft. H.J.L. (Hyeon Ji Lee): Data curation, Investigation, Writing—review and editing. H.J.L. (Hyun Jun Lee): Data curation, Validation, Software, Writing—review and editing. J.-H.K.: Conceptualization, Supervision, Project administration, Resources, Writing—review and editing. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
Ethical review and approval were not required for this study because it used existing de-identified secondary data and did not involve direct interaction with participants or the collection of personally identifiable information. In accordance with Article 15(2) of the Bioethics and Safety Act of the Republic of Korea and Article 13 of its Enforcement Rule, research using existing data or documents that meets the prescribed criteria may be exempted from institutional review board review. The authors did not directly recruit human participants, did not intervene with participants, and had no access to personally identifiable information. Therefore, additional institutional review board approval was not required for the present secondary analysis.
Informed Consent Statement
Not applicable. This study used anonymized secondary data from a publicly available survey database. Individual informed consent was not required.
Data Availability Statement
The data that support the findings of this study are publicly available from the Korea Employment Agency for the Disabled through the Panel Survey of Employment for the Disabled (PSED). Access to the dataset can be requested at https://www.kead.or.kr (accessed on 1 July 2026).
Conflicts of Interest
The authors declare no conflicts of interest.
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