Factors Affecting Life Satisfaction Among People With Physical Disabilities During COVID-19: Observational Evidence from a Korean Cohort Study
Article information
Abstract
Objective
To determine the factors influencing the life satisfaction of people with physical disabilities during the COVID-19 pandemic, considering demographics, disability-related characteristics, health behaviors, and psychosocial characteristics.
Methods
We used cross-sectional data from 301 respondents of the 2021/2022 survey of the Korean Health Cohort Study for People with Physical Disabilities. Descriptive statistics were used to analyze the research subjects’ characteristics, and chi-square tests and multiple logistic regression were used to identify the determinants of life satisfaction.
Results
Among socio demographic variables, occupation had a strong association with life satisfaction. Significant health behavior variables included daily regular meals, weight control effort, and chronic pain. All psychosocial characteristics (perceived stress, depression, suicidal ideation, cognitive function assessment, subjective health status, family satisfaction, income satisfaction) were strongly associated with life satisfaction. Results of the analysis of factors affecting life satisfaction showed that unemployment, lack of regular exercise, elevated stress, suicidal thoughts, and dissatisfaction with family contributed to increased life dissatisfaction.
Conclusion
Economic support through job creation that considers the specific characteristics of people with disabilities, and social access through community integration services that encourage participation in social activities, should be prioritized.
INTRODUCTION
Life satisfaction has been widely used as a representative measure of happiness across societies. It is a subjective cognitive assessment by which an individual recognizes happiness and satisfaction in life overall [1,2]. Thus, life satisfaction can be defined as a comprehensive cognitive evaluation of one’s overall quality of life [3] and general sense of happiness and contentment as a psychological function one experiences [1,2]. This important concept has been studied in various fields. In particular, measures have been explored to enhance the life satisfaction of people with disabilities, who might face unique challenges [4]. Given the rising population of individuals with disabilities, and especially in the context of the coronavirus disease 2019 (COVID-19) pandemic, interest in the quality of life of this population has increased. The life satisfaction of people with disabilities is defined as an evaluation of their overall quality of life shaped by both subjective conditions (e.g., subjective health status, social relationships) and objective sociodemographic characteristics, considering the multifaceted attributes of life satisfaction, including social, economic, and psychological factors [5].
“Quality of life” often overlaps with terms such as life satisfaction, living satisfaction, psychological well-being, happiness, and morale. Although its definition can vary among researchers, “life satisfaction” is currently the most widely accepted term, as it is believed to encompass many facets of quality of life [6]. Life satisfaction was initially studied using objective indicators that could be measured externally. However, emphasis gradually shifted toward psychological metrics to capture an individual’s subjective assessment, especially because the term became synonymous with happiness and psychological well-being [7]. This shift indicates that satisfaction levels are influenced more by subjective perceptions than objective reality. As a result, interpretations of “life satisfaction” can diverge, contingent upon the different situations in which individuals find themselves [8].
Thus, while an individual’s life satisfaction can be influenced by multiple factors—including sex, age, education, health, social activity, relationships with children, and economic status—it inherently varies based on circumstances specific to each individual [7]. Given its conceptual complexity encompassing an array of factors, and its strong association with individual characteristics, pinpointing the factors associated with life satisfaction can be challenging [9].
People with disabilities face challenges from various environmental factors, including physical, mental, psychological, and social constraints. Consequently, their quality of life or life satisfaction is inevitably lower than that of the general population [10]. Previous studies comparing the life satisfaction of individuals with and without disabilities have shown that individuals with disabilities consistently report lower levels of satisfaction, whereas individuals without disabilities maintain higher levels of satisfaction across all age groups [11].
In the wake of the COVID-19 pandemic, people with disabilities experienced a substantial decline in life satisfaction that was 1.3 times more pronounced than that of the general population compared with the pre-COVID-19 period. This decline can be attributed to heightened physical, mental, and social challenges, including worsening health issues; increased feelings of loneliness, anxiety, and depression; apprehensions about infection; interruptions in care services; and barriers to accessing information [12].
According to Korea’s Ministry of Health and Welfare, the number of registered persons with disabilities in Korea was 2.65 million as of 2022, accounting for 5.2% of the total population, showing a steadily increasing trend. Korea recognizes 15 types of disability, with physical disability being the most prevalent, representing 44.3% of all registered individuals with disabilities. In the Enforcement Decree of the Act on Welfare of Persons with Disabilities (revised December 31, 2018), physical disability is defined as “a condition that results in the permanent impairment of motor functions of the limbs and torso owing to factors such as injury, congenital deformity, paralysis, disease, or amputation.” According to the Disability Status Survey [13], 45.6% of people with physical disabilities have lower limb disabilities, 32.7% have spinal disabilities, and 21.7% have upper limb disabilities, indicating substantial physical limitations. In one life satisfaction survey [13], only 5.2% of people with physical disabilities reported being very satisfied with their lives. A key characteristic of people with physical disability is the significant effect of the disability on psychological development due to physical and motor developmental delays. Since such people often experience marginalization in terms of mobility, access to information, and educational access [14], they tend to experience feelings of anxiety, maladjustment, and inferiority, contributing to lower life satisfaction.
In light of this background, it is worth investigating the factors influencing the life satisfaction of people with physical disabilities—who account for the largest segment of the disabled population—and developing targeted support strategies. Most previous studies [4,8,13-16] have investigated life satisfaction regarding individual variables, without exploring them in a more comprehensive, multidimensional manner. Furthermore, no existing study has comprehensively analyzed the factors affecting the life satisfaction of people with physical disabilities in the context of the COVID-19 pandemic.
This study investigated the factors shaping the life satisfaction of people with physical disabilities in the COVID-19 context in terms of demographic and disability-specific characteristics, health behavior, and psychosocial characteristics. Based on the findings, we suggested targeted support strategies.
METHODS
Participants and procedures
Data were extracted from the cross-sectional data of respondents who participated in the 2021/2022 survey of the Korean Health Cohort Study for People with Physical Disabilities, conducted by the National Rehabilitation Center under the Ministry of Health and Welfare. This longitudinal study has been conducted since 2015, with participant follow-ups occurring every two years, alternating between odd and even years. As of 2022, the study included data from a total of 301 cohort registrants after excluding dropouts. The survey was conducted using the same questionnaire that has been used since 2015. The participants were individuals who were diagnosed with physical disabilities, were residents of Seoul, were aged 40–69 years, had scored 24 or above on the Korean version of the Mini-Mental State Examination (K-MMSE) (proxy respondents for those scoring below 24), understood the research purpose, and voluntarily agreed to participate. Participants received surveys and clinical examinations at two-year intervals. Analyses were conducted after excluding missing values for some items. The Korean Health Cohort Study for People with Physical Disabilities was approved by the Institutional Review Board of the National Rehabilitation Center (NRC-2015-04-034). Written consent was obtained from all participants before the study began.
Study design
This study sought to verify factors affecting the life satisfaction of people with physical disabilities. Sociodemographic characteristics, disability characteristics, health behaviors, and psychosocial characteristics were used as independent variables, and life satisfaction was used as the dependent variable. The research model is shown in Fig. 1.
Study design. ADL, activities of daily living; IADL, instrumental activities of daily living; K-MMSE, Korean version of the Mini-Mental State Examination.
Measures
Sociodemographic characteristics
Sociodemographic characteristics included sex, age, marital status, education level, occupation, and income. Age was categorized into 40s, 50s, 60s, and ≥70. Marital status was categorized into married, single, and other (divorced, widowed, cohabiting). Education level was grouped into elementary school or lower, middle school, high school, and college or higher. Occupation was treated as a binary variable (employed or unemployed). Income was categorized into 3.01 million won or more, 2.01 to 3 million won, 1.01 to 2 million won, and 1 million won or less.
Disability characteristics
Disability characteristics were determined based on primary disability, severity of disability, activities of daily living (ADL), and instrumental activities of daily living (IADL). Primary disability, based on the participant’s principal diagnosis, was categorized into polio, spinal cord injury and disease, and other physical disabilities. Severity of disability was divided into mild and severe. ADL and IADL were both treated as binary variables (independent and dependent). ADL items included dressing, washing face, brushing teeth, bathing, eating, changing posture, standing up, moving seats, going outside, using the restroom, controlling bowel movements, and controlling urination. IADL items included using the phone, shopping, preparing meals, housekeeping, doing laundry, taking medication, managing money, and using public transportation. Each item was scored on a three-point scale as “independent,” “partially dependent,” and “fully dependent.” The scores were regrouped into binary categories of independent and dependent (combining “partially dependent” and “fully dependent”).
Health behavior
“Smoking status,” “drinking status,” “regular exercise,” and “moderate physical activity” were treated as binary variables (yes/no). “Regular daily meals” and “unrestricted food preferences” were categorized into yes, sometimes, and no. Moderate physical activity was based on the question, “In the last week, have you engaged in physical activity for at least 10 minutes that made you feel a little tired or breathe a bit heavily?”; it was categorized as yes or no. “Regular daily meals” refers to consistently having three meals a day without skipping, and “unrestricted food preferences” means consuming a diverse range of foods. “Sleep duration” was categorized into less than five hours, five to less than six hours, six to less than seven hours, and seven hours or more. “Perceived body shape” was divided into thin, average, and obese. “Weight control effort” in the past year was categorized as yes or no. Perceived oral health was categorized as good, average, and poor while “masticatory discomfort” was divided into no, average, and yes. Experience of falling, fear of falling, chronic pain, hypertension, diabetes, obesity, and osteoporosis were treated as binary variables. Falling experience refers to having fallen in the past year, including slips, stumbles, and collapses. Chronic pain refers to pain lasting more than 30 days in the past three months. Chronic disease status was determined based on clinical tests, previous diagnoses, or current medication.
Psychosocial characteristics
Perceived stress was categorized into no, somewhat, and yes. Feelings of depression and suicidal ideation were treated as binary variables. Cognitive function was evaluated using the K-MMSE, with scores of 24 or above (from a total of 30 points) classified as normal, 18–23 as mild cognitive impairment, and 17 or below as severe cognitive impairment [17-19]. Subjective health status was categorized as good or poor. Family satisfaction and income satisfaction were categorized as satisfied or dissatisfied.
Life satisfaction
Life satisfaction was evaluated based on the survey question, “Are you generally satisfied with your current life?” Responses were scored on a five-point scale and subsequently categorized into binary groups: satisfied (strongly agree, agree, neutral) and dissatisfied (disagree, strongly disagree).
Statistical analysis
Before analyzing the factors affecting participants’ life satisfaction, we used descriptive statistics to analyze sociodemographic characteristics, disability characteristics, health behavior, and psychosocial characteristics. A chi-square test and Fisher’s exact test were used to analyze associations between life satisfaction and individual-related characteristics. To identify the factors influencing life satisfaction, we conducted multiple logistic regression to estimate the odds ratios and 95% confidence intervals. All analyses were performed using SPSS version 27.0 (IBM Corp.). We set the statistical significance level to p<0.05.
RESULTS
Descriptive results
The average age of the respondents was 61 years, and females (53.5%) outnumbered males. The most prevalent marital status and education level were married (55.8%) and high school graduate (33.6%). More than half of the respondents were unemployed (51.5%). The most common income level was less than one million won (40.1%), while the average income, excluding missing values, was 2.07 million won. Polio (44.5%) was the most common diagnosis, and severe disabilities (71.4%) were more prevalent than mild ones (28.6%). While 17.6% more participants were capable of performing independent ADLs than those who were not, those unable to perform independent IADLs outnumbered those who could by 14.2%.
Most respondents were nonsmokers (83.1%) while drinkers (57.1%) outnumbered nondrinkers. Regular exercise was undertaken by 57.5%, but 65.8% did not engage in moderate physical activity. Those who perceived themselves as obese comprised the largest group (49.8%). Over half (55.8%) had experienced a fall, and 74.1% harbored a fear of falling. The absence or presence of chronic pain was almost evenly distributed among respondents. Among chronic diseases, hypertension (57.1%) was the most prevalent, surpassing diabetes, obesity, and osteoporosis. While similar proportions of respondents reported mild (39.2%) and strong (37.2%) perceived stress, feelings of depression and suicidal ideation were also close, at 20.3% and 19.6%, respectively. Overall, 12.3% expressed dissatisfaction with their current life (Table 1).
Descriptive statistics for subjects’ general characteristics (n=301)
Sociodemographic characteristics and life satisfaction
Among the sociodemographic characteristics examined in this study (sex, age, marital status, education level, occupation, and income), only occupation exhibited a significant association with current life satisfaction (p<0.001). Specifically, unemployed respondents had a 4.04-fold higher rate of dissatisfaction than did employed respondents, suggesting employment is associated with greater life satisfaction (Table 2).
Association between sociodemographic characteristics, disability characteristics, and life satisfaction
Disability characteristics and life satisfaction
Among disability-related characteristics (primary disability, severity of disability, ADL, and IADL), none showed a significant association with current life satisfaction (Table 2).
Health behavior and life satisfaction
Among health behavior variables, regular daily meals (p<0.05), weight control effort (p<0.05), and chronic pain (p<0.01) showed significant associations with current life satisfaction. Those who answered “no” (21.3%) to “regular daily meals” had higher dissatisfaction rates than those who answered “yes” and “sometimes.” Those who did not make weight control efforts (20.3%) had a higher dissatisfaction rate than those who did, and those with chronic pain (18.4%) were more dissatisfied than those without (Table 3).
Association between health behavior and life satisfaction
Psychosocial characteristics and life satisfaction
All variables included as psychosocial characteristics exhibited highly significant associations with life satisfaction: perceived stress (p<0.001), depression (p<0.001), suicidal ideation (p<0.001), K-MMSE (p<0.01), subjective health status (p<0.001), family satisfaction (p<0.001), and income satisfaction (p<0.01). The higher the level of perceived stress, the higher the dissatisfaction rate (24.1%). Those with depression had a 27.7% higher life dissatisfaction level than those without, and those with suicidal ideation had a 35.3% higher rate. Poor subjective health status resulted in a 16.5% higher dissatisfaction level than good subjective health status, and dissatisfaction with family led to a 40.5% higher life dissatisfaction level (Table 4).
Association between psychosocial characteristics and life satisfaction
Determinants affecting the life satisfaction of people with physical disabilities
We conducted multiple logistic regression to identify factors affecting the life satisfaction of people with physical disabilities. The logistic regression model was verified as statistically significant (Hosmer–Lemeshow test: x2=7.913, p=0.442), with the total explanatory power estimated at 56% (R2=0.560). The significance test of the regression coefficients confirmed occupation (odds ratio [OR]=4.230, p<0.05), regular exercise (OR=5.963, p<0.01), perceived stress (OR=9.191, p<0.05), suicidal ideation (OR=4.943, p<0.01), and family satisfaction (OR=11.009, p<0.001) as factors significantly affecting life satisfaction. Those without an occupation had 4.23 times higher dissatisfaction than those with an occupation. Those who did not exercise regularly had 5.96 times more dissatisfaction than those who did. Perceived stress increased dissatisfaction by 9.19 times more than no perceived stress, and suicidal ideation increased dissatisfaction by 4.94 times more than no suicidal thoughts. Dissatisfaction with family increased life dissatisfaction by 11 times compared with satisfaction with family (Table 5).
Determinants affecting the life satisfaction of people with physical disabilities
DISCUSSION
To our knowledge, research on the life satisfaction of people with disabilities remains limited, and in-depth research on the life satisfaction of this group during the COVID-19 pandemic is lacking. This study, therefore, aimed to evaluate the determinants of life satisfaction among people with physical disabilities in Korea by analyzing data from the 2021/2022 Korean Health Cohort Study for People with Physical Disabilities.
Crude association analysis results showed that occupation was highly significantly associated with life satisfaction. In terms of health behavior, daily regular meals, weight control efforts, and chronic pain were identified as significant variables. All variables included as psychosocial characteristics (perceived stress, depression, suicidal ideation, cognitive function assessment, subjective health status, family satisfaction, and income satisfaction) exhibited highly significant associations with life satisfaction. The results of our analysis of the factors affecting life satisfaction provide evidence that being unemployed, not exercising regularly, perceiving increased stress, having suicidal ideation, and being dissatisfied with family increase life dissatisfaction. By contrast, factors related to personal characteristics, such as sex, education level, and marital status, had no significant association with life satisfaction, supporting previous research findings [20].
In aging populations with disabilities, the amount of engagement in productive activities is related to higher well-being and a lower prevalence of depression [21]. This suggests that the higher the level of productive engagement, the greater the likelihood of experiencing appreciation, reward, self-esteem, personal control, or feelings of usefulness [22,23]. Since loneliness and social isolation are highly prevalent in people with disabilities and are risk factors for reduced well-being and depression [24,25], the positive effects of rewarding work can reduce feelings of isolation and loneliness and lead to income satisfaction, ultimately improving life satisfaction.
Our adjusted association analysis results identified psychosocial characteristics, such as perceived stress, suicidal ideation, and family satisfaction, as key determinants of life satisfaction. As demonstrated in previous studies [26-28], the lower the life satisfaction, the poorer the mental health status. Stress is a major variable affecting life satisfaction and quality of life for individuals with and without disabilities [29]. People with disabilities are more likely to face problems related to daily functioning, such as unstable employment, mobility limitations, communication restrictions [30], and social discrimination, making them substantially more vulnerable to stress than people without disabilities [31]. In particular, people with physical disabilities often lead reclusive lives, avoiding external contact because of their physical limitations. This behavior manifests as helplessness in the face of environmental pressure, stress, limited capability, and uncontrollable circumstances [32]. Such psychological conflicts, coupled with individual traits and behavioral issues caused by disabilities, can exacerbate both physical and mental health conditions [33].
The families of individuals with disabilities often face myriad challenges because they must provide constant protection and care. People with pronounced physical disabilities who rely extensively on caregivers for their daily needs tend to spend considerable time with these caregivers, affecting the life satisfaction of both individuals. Thus, our results suggest that interventions supporting the quality of life of people with disabilities and their families should be integrated rather than treated separately. Moreover, it is necessary to conduct proactive interventions before a crisis occurs; these can include providing psycho-emotional support counseling or community integration services through regular quality-of-life checks for the vulnerable families of people with disabilities.
This study comprised 18 detailed items in the “health behavior” area and derived research results that were differentiated from those of previous studies. We found that having regular meals three times a day was associated with life satisfaction. Such dietary habits lower blood sugar levels and help prevent chronic diseases such as obesity and diabetes [34]. We identified adherence to regular exercise as a factor influencing life satisfaction. The most common effect of exercise is weight control, which we also identified as a significant variable associated with life satisfaction. Regular exercise not only promotes physical health, such as by reducing the risk of diabetes, metabolic syndrome, cardiovascular disease, and some cancers (e.g., colon, breast) and strengthening bones and muscles, but also enhances cognition, learning ability, judgment, mood, and quality sleep, thus positively influencing mental health [35]. Accordingly, physical resilience against various diseases is reinforced, and chronic pain, which adversely affects life satisfaction, as verified in this study, is alleviated. This leads to a more positive psychological state and, ultimately, an improved quality of life.
Meanwhile, some pre-COVID-19 studies mentioned that mobility [36], leisure [37], the living environment, social support [20], and social relationships of people with disabilities [33] are related to life satisfaction. Recently, Emerson and Llewellyn [38] compared life satisfaction and happiness by disability status and sex in 27 low- and middle-income countries and reported that female and male with disabilities had lower life satisfaction and happiness than people without disabilities, and that differences in life satisfaction between people with and without disabilities were partly attributed to living conditions and life experiences in relation to household wealth, level of education, partnership status and exposure to violence and discrimination. Furthermore, higher levels of country wealth (per capita Gross National Income) and human development index were associated with greater life satisfaction and happiness, regardless of disability status, applying to everyone [38].
This study is the first of its kind to investigate the factors affecting the life satisfaction of people with physical disabilities in Korea against the backdrop of COVID-19. The association with life satisfaction and the influencing factors affecting life satisfaction were examined in detail according to the sociodemographic characteristics, disability characteristics, health behavior, and psychosocial characteristics of people with physical disabilities, using a total of 36 variables. This study’s significance lies in providing evidence to support innovative, sustainable mental health interventions, encompassing socioeconomic determinants, to enhance the life satisfaction of people with physical disabilities. Nevertheless, there are some limitations. First, given the cross-sectional nature of the study, the causal relationships between life satisfaction and the independent variables could not be inferred. Second, since the sample size was relatively small, ensuring representativeness for the entire population of people with physical disabilities in Korea was difficult. Third, since life satisfaction was measured only once at baseline, errors attributable to respondents’ temporary emotions could not be excluded. Fourth, certain variables that might influence life satisfaction based on disability characteristics were not included in this study.
Based on our findings, we make the following suggestions for enhancing the life satisfaction of people with physical disabilities:
First, South Korea is experiencing a rapid demographic transition caused by population aging, and the health issues of people with physical disabilities are likely to worsen, inevitably lowering their quality of life. To address this, we should expand rehabilitation sports programs and increase the availability of dedicated facilities for people with disabilities in local communities. Creating environments where people with disabilities can regularly engage in physical activity is important and can foster their motivation to lead more active lives.
Second, psychosocial aspects have the most influence on the quality of life of people with physical disabilities. Therefore, more research is needed that considers psychological aspects according to different disability types and age groups. While previous measures have focused on preventive strategies, ensuring the early detection and treatment of mental health problems in individuals with disabilities is also crucial.
Third, institutional support and the expansion of employment opportunities for people with disabilities are needed. The employment rate among people with disabilities in South Korea was 34.3% in 2022, revealing a 28.4% lower rate than that of the overall population.
Their unemployment rate during the same period was 2.1% higher than that of the overall population [39]. Creating jobs that reflect the specific disability characteristics, conditions, circumstances, and needs of people with disabilities can enhance their participation in social and productive activities, leading to improved life satisfaction. Vocational rehabilitation education services must be leveraged in various ways, such as helping people with mental disabilities who face employment difficulties improve their job skills and ability to adapt.
Fourth, given the inherent interdependence between individuals with physical disabilities and their families, policies that are customized for families with disabled members must be implemented. Their specific needs and circumstances must be taken into account when establishing an integrated network of people with disabilities, welfare services, and healthcare facilities within the community.
Conclusion
Using data from the Korean Health Cohort Study for People with Physical Disabilities database, we investigated the factors influencing the life satisfaction of people with physical disabilities during the COVID-19 pandemic. We found that occupation, regular exercise, perceived stress, suicidal ideation, and family satisfaction were significant factors affecting their life satisfaction. This suggests a need to strengthen economic support through job creation that accounts for the specific characteristics of people with disabilities in terms of socioeconomic factors. Social approaches should be adopted through community integration services that encourage participation in social activities. Along with the development of community-based rehabilitation and suicide prevention programs, a detailed community care system that regularly monitors the mental health status of people with disabilities and provides on-site care should be established.
Notes
CONFLICTS OF INTEREST
No potential conflict of interest relevant to this article was reported.
FUNDING INFORMATION
This research was funded by a grant from the Ministry of Health & Welfare (MOHW) in South Korea (grant number 2023-MOHW). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
AUTHOR CONTRIBUTION
Conceptualization: Kim M, Ho SH. Methodology: Kim M. Formal analysis: Kim M. Funding acquisition: Ho SH. Project administration: Kim M, Ho SH. Resources: Ho SH. Software: Kim M, Kim H. Supervision: Ho SH, Kim M, Kim H. Data collection: Kim M, Kim H, Park J. Validation: Kim M. Visualization: Kim M. Wrting – original draft: Kim M. Wrting – review and editing: Kim M. Approval of final manuscript: all authors.