# The improvement path of depression and anxiety among adult women in Shanxi Province, China: a fuzzy-set qualitative comparative analysis

## TL;DR

This study explores factors influencing depression and anxiety in women in Shanxi Province, China, using regression and fsQCA to identify multiple pathways to mental well-being.

## Contribution

The study introduces a novel application of fsQCA to uncover diverse pathways to mental health in women with depression and anxiety.

## Key findings

- Better self-rated health and absence of recent illness were key protective factors against depression and anxiety.
- Occupational stress significantly increased the risk of both depression and anxiety.
- FsQCA identified eight configurations for mental health and two for resilience to anxiety, emphasizing the importance of self-rated health and social support.

## Abstract

Depression and anxiety (D&A) are currently recognized as complex and prevalent mental disorders that pose major threats to mental health. Women are more susceptible to D&A than men.

We collected data from female participants in Shanxi Province between November 2021 and March 2022 through on-site investigations and an online survey. The survey collected information on sociodemographic traits, lifestyle factors, and physical and mental health. The degree of D&A was evaluated using the Center for Epidemiological Studies Depression Scale (CESD-10) and the Generalized Anxiety Disorder Assessment Scale (GAD-7). We assessed the impact of these factors on D&A symptoms among women using regression and fuzzy-set qualitative comparative analysis (fsQCA).

D&A symptoms had many common influencing factors. Regression analysis identified key protective factors against D&A, including better self-rated health (Depression: OR = 0.11, 95% CI = 0.03–0.47; Anxiety: OR = 0.11, 95% CI = 0.02–0.57) and the absence of recent illness (Depression: OR = 0.56, 95% CI = 0.38–0.83; Anxiety: OR = 0.49, 95% CI = 0.35–0.70). Age exhibited marginal protective effects for both conditions (OR = 0.99, 95% CI = 0.98–1.00). In contrast, occupational stress constituted a significant risk factor, substantially increasing the likelihood of depression (OR = 2.66, 95% CI = 1.43–4.96) and anxiety (OR = 2.99, 95% CI = 1.43–4.96). FsQCA analysis did not identify the conditions for ideal mental health (all consistency < 0.9). However, it did identify eight condition configurations predicting mental health (absence of depression symptoms), each achieving consistency ≥0.87. Additionally, two distinct configurations explained resilience to anxiety (consistency ≥0.80). All configurations met fsQCA’s consistency requirements, with self-rated health (present in 10/10 pathways), social support (9/10), and marital status (9/10) playing important roles in most configurations.

Women’s mental health faces significant challenges, with D&A being closely intertwined. FsQCA did not identify any specific condition for the absence of D&A symptoms. However, it revealed multiple pathways to mental well-being, highlighting the need for personalized, multifactorial interventions rather than a one-size-fits-all approach. Regression and fsQCA complement each other, offering unique strengths, and their combined insights should be widely applied to broader research and practice.