Socio-Demographic and Psychological Factors Influencing the Happiness of Gyeongsangbuk-do Residents

Article information

Res Community Public Health Nurs. 2025;36(4):435-446

Publication date (electronic) : 2025 December 31

doi : https://doi.org/10.12799/rcphn.2025.01277

Sung Jung Hong¹, See Jo Kim², Nam Hyun Cha^,3

¹Associate Professor, Department of Nursing, College of Health Welfare, GyeongKuk National University, Andong, Korea

²Professor, School of Electronics & Mechanical Engineering, GyeongKuk National University, Andong, Korea

³Professor, Department of Nursing, College of Health Welfare, GyeongKuk National University, Andong, Korea

Corresponding author: Nam Hyun Cha Department of Nursing, College of Health Welfare, 1375, Gyeongdong-ro(SongCheon-dong), Andong, Gyeongsangbuk-do, 36729, Korea Tel: 82-010-9248-1422, Fax: +82-54-820-6730, E-mail: yeoreo@hanmail.net

Received 2025 August 25; Revised 2025 December 1; Accepted 2025 December 7.

Abstract

Introduction

Recent advances in health and medical technology, socioeconomic development, and improved living standards have qualitatively and quantitatively enhanced the overall living environment of modern societies. Consequently, as human life expectancy increases, interest in quality of life (QoL) and subjective well-being has expanded as central topics of public health and social research [1]. According to the World Health Organization (WHO), health is defined not merely as the absence of disease or infirmity but as “a state of complete physical, mental, and social well-being” [2]. This holistic definition underscores that health must be understood in connection with broader constructs such as QoL, happiness, and well-being [3].

Within this context, QoL is conceptualized as an individual’s perception of their position in life in the context of their culture and value systems [4]. It is typically operationalized using multidimensional tools such as the WHOQOL-BREF, encompassing physical, psychological, social, and environmental domains. In contrast, happiness and life satisfaction represent core components of subjective well-being (SWB)—with life satisfaction reflecting the cognitive evaluation of one’s life circumstances and happiness reflecting the affective or experiential dimension [3,5]. The World Happiness Report (WHR) operationalizes happiness through the Cantril Ladder life-evaluation scale, while life satisfaction is often assessed through the Satisfaction With Life Scale (SWLS) [7,8]. Distinguishing between these constructs strengthens conceptual validity by allowing for differentiated interpretation of cognitive and affective aspects of well-being.

Theoretically, QoL functions as a determinant or contextual domain influencing SWB, while happiness and life satisfaction represent subjective evaluations of these life conditions [9]. The OECD Well-Being Framework further illustrates that objective indicators such as income, social connections, environmental quality, and health collectively contribute to subjective life evaluations [10]. This multidimensional perspective suggests that promoting happiness and life satisfaction requires an integrated understanding of psychological, social, and structural determinants.

Moreover, happiness extends beyond the prevention of individual diseases; it is intrinsically tied to population health and the sustainability of society [11]. Empirical studies demonstrate that higher levels of individual happiness are associated with better physical and mental health outcomes, greater social trust, and stronger community cohesion [12,13]. In this sense, happiness operates as both an indicator and a determinant of societal well-being.

Despite the abundance of prior research examining relationships among stress, depression, and QoL, relatively few studies have clearly differentiated the conceptual domains of happiness and life satisfaction or have contextualized them within specific regional and social environments. Therefore, further investigation is warranted to clarify the theoretical boundaries between happiness and life satisfaction and to explore how regional characteristics—such as socioeconomic context, community support systems, and local health policies—interact with psychological factors to influence subjective well-being. Such clarification is essential to enhance the construct validity of key variables and to establish evidence-based regional strategies for improving the happiness and mental health of community residents.

This study was conducted to analyze the various factors influencing the happiness of residents in Gyeongsangbuk-do, with the aim of providing foundational data for promoting mental health within local communities. Through this, the study seeks to contribute to the establishment of effective health policies and the development of community-based mental health promotion programs.

Methods

Results

General characteristics of the participants

The demographic and sociological characteristics of the 21,490 study participants are presented in Table 1. Regarding community type, the majority of participants resided in dong areas (urban neighborhoods, 27.1%), while 72.9% lived in eup/myeon areas (rural towns and villages). The sex distribution showed a slight female predominance, with 53.2% females and 46.8% males.

Table 1.

Differences in Stress, Depression, and Happiness according to the Demographic and Sociological Characteristics of the Participants, as well as their Lifestyle and Mental Health (N=21,490)

The age distribution revealed that participants in their 50s comprised the largest group (43.7%), followed by those aged 60 years and older (29.0%), participants in their 40s (12.8%), 30s (7.7%), and 20s (6.8%). Regarding educational attainment, 41.5% had completed middle school education or lower, 28.6% had completed high school education, and 29.9% had attained college-level education or higher.

With respect to economic characteristics, the majority of participants (65.6%) reported being economically active, while 34.4% were not engaged in economic activities. The Income distribution showed 44.9% in the lowest quartile, 22.4% in the middle quartile, 13.9% in the middle high quartile, and 18.8% in the highest quartile.

Health behaviors demonstrated that 76.4% of participants consumed alcohol, while 23.6% were non-drinkers. Regarding smoking status, 84.3% were non-smokers and 15.7% were current smokers. Physical activity engagement was reported by 79.3% of participants, while 20.7% reported no regular exercise.

Subjective health status assessment revealed that 43.8% of participants rated their health as average, 28.9% as good, 17.9% as bad, 5.2% as very good, and 4.3% as very bad.

Psycho-emotional characteristics indicated that the majority of participants (92.4%) reported no suicidal ideation, while 7.6% had experienced suicidal thoughts. Additionally, 97.9% had not received stress counseling, and 92.7% reported no prior experience with depression-related issues (Table 1).

Correlation between the participants’ stress, depression, and happiness index

Pearson product-moment correlations were computed to examine the relationships among the three primary outcome variables: subjective stress level, depression, and happiness index. The correlation matrix is presented in Table 2.

Table 2.

Correlation between Stress, Depression, and Happiness (N=21,490)

The analysis revealed significant intercorrelations among all three variables (all p<.001). Stress and depression demonstrated a significant positive correlation (r= p<.001), indicating that participants with higher stress levels tended to report greater depressive symptoms.

Stress and happiness showed a significant negative correlation (r=-.25, p<.001), suggesting that increased stress was associated with decreased happiness levels. Similarly, depression and happiness exhibited a significant negative correlation (r=-.37, p<.001), representing the strongest association among the three variables and indicating that higher depressive symptoms were associated with substantially lower happiness levels.

The magnitude of these correlations suggests moderate relationships among the variables. The strongest correlation was observed between depression and happiness (r=-.37), followed by the stress-happiness relationship (r=-.25), and the stress-depression relationship (r=.24). These findings support the theoretical framework that stress, depression, and happiness represent interconnected but distinct dimensions of psychological well-being.

All correlations were statistically significant at the p<.001 level, indicating robust associations that are unlikely to have occurred by chance. The pattern of relationships aligns with established psychological theories suggesting that stress and depression are positively associated, while both negatively impact happiness and overall well-being.

Influencing factors on happiness

As shown in Table 3, all variance inflation factor (VIF) values were below 10, indicating no evidence of multicollinearity among the independent variables. The Durbin-Watson statistic was 1.77, which is also reported in Table 3, and is close to the ideal value of 2. This suggests that there was no significant autocorrelation of residuals and that the assumption of independence was satisfied. The overall regression model was statistically significant, supporting the validity of the model in explaining the variation in happiness.

Table 3.

Predictive Variables for Participants' Happiness (N=21,490)

As a result of the regression analysis, the most significant positive predictors of happiness were subjective health status (β=.07 to .27), having a college-level or higher education (β=.10), exercise (β=.04), and high income (β=.04). Additionally, increasing age(specially 50's) was associated with a significant rise in happiness levels. In contrast, perceived stress levels (β=–.19), depression scores (β=–.17), suicidal thoughts (β=–.11), and smoking (β=–.08) emerged as key negative predictors of happiness. The explanatory power of the model was 25.6% (F=337.76, p<.001), indicating that the included variables significantly explained the variance in happiness levels.

Discussion

Using the 2022 community health survey data, this study aims to identify the stress, depression, and happiness of residents living in the Gyeongsangbuk-do community and identify factors that affect their happiness to provide basic data to improve the condition of residents’ lives. A comparison of the drinking, smoking, exercise habits, and subjective health levels of Korean people in 2022 with those of Gyeongsangbuk-do showed that the monthly drinking rate in Gyeongsangbuk-do was 76.4%, much higher than the national average (57.4%) [16]. In South Korea, drinking is often embedded in social rituals (e.g., after-work gatherings), and drinking behaviours have been associated with stress relief in some study contexts. Recent research also suggests that normative attitudes toward drinking remain relatively permissive, although trends vary by demographic group [17,18]. However, residents of Gyeongsangbuk-do communities drink more frequently than the national average, suggesting that Gyeongsangbuk-do communities have more tolerant local cultural characteristics regarding drinking than the entire country. In 2022, the national average smoking rate was 17.7%, while it was 15.7% in Gyeongsangbuk-do [19], suggesting that smoking cessation policies or health-education programmes implemented in Gyeongsangbuk-do may have had some effect. For example, the region’s “Creating a smoke-free living environment” initiative offers 1:1 tailored cessation counselling [20], provides nicotine-replacement aids and behaviour-reinforcement items, and runs outreach programmes in schools, workplaces and low-income housing via the Gyeongbuk Smoking-Cessation Support Centre [21]. In addition, the provincial government expanded smoke-free zones around kindergartens, children’s daycare centres and schools (extending from 10 m to 30 m) and strengthened regional tobacco-control regulations [22]. In terms of exercise habits, 79.3% of Gyeongsangbuk-do say they were exercising, which is considerably higher than the national average of 45.5% [23], indicating that local residents are engaged in physical activities. Thus, Gyeongsangbuk-do practices health promotion programs well in consideration of community characteristics and is thought to be a result of the positive effect of the accessibility of having a lot of space to exercise, as it is the largest administrative district in Korea [24].

The analysis of subjective health status revealed significant regional disparities among study participants. As presented in Table 1, only 34.1% of Gyeongsangbuk-do residents rated their health status as either "good" (28.9%) or "very good" (5.2%), representing a substantial deviation from the national average of 53.1% reported in the Community Health Survey. This 19.0 percentage point difference indicates that residents in Gyeongsangbuk-do demonstrate significantly more negative health perceptions compared to the general Korean population, thereby highlighting pronounced regional disparities in self-rated health status. These observed disparities may be attributed to regional characteristics including accelerated demographic aging and challenging living conditions characterized by limited healthcare accessibility [25]. The ratio of depression risk groups was 7.3% lower in Gyeongsangbuk-do than the national average of 16.9% [26]. This might have affected Gyeongsangbuk-do because there are many farming and fishing villages [25] with high access to the natural environment, providing psychological stability.

These results show that the health-related behaviors and perceptions of Gyeongsangbuk-do residents differ from those of other regions and can be used as important basic data for future policy development and health promotion programs. It is necessary to analyze the factors related to these differences in greater depth through additional research. The analysis of the effects of demographic factors, health behaviors, and psychological and emotional characteristics of residents in Gyeongsangbuk-do on stress, depression, and happiness revealed that the type of residential area, among the demographic factors, had a significant influence on all three outcomes. Specifically, residents living in urban areas exhibited higher levels of stress, depression, and happiness than those residing in town or myeonareas. This finding aligns with the results of a recent analysis using data from the 2017 Korean Community Health Survey, which reported that the prevalence of depressive symptoms was approximately 1.29 times higher among urban residents compared with those living in rural areas [27]. The elevated stress and depression levels among city residents may be attributed to overcrowded and polluted urban environments that increase exposure to stressors [28], as well as to greater social isolation, relative deprivation, and competitive social climates that undermine social support [27] . Nevertheless, the paradoxical coexistence of higher happiness levels among urban residents can be explained by the broader range of opportunities and resources available in cities. Urban environments provide greater access to leisure, cultural, and social activities [29] enhanced educational, employment, and consumption opportunities [30] and superior transportation accessibility [31]. These conditions may foster higher life satisfaction and expectations, thereby contributing to increased happiness despite elevated stress and depression. In other words, although city residents are more susceptible to stress and depressive symptoms, they may simultaneously experience greater positive emotions and higher levels of subjective well-being due to enriched activity opportunities and lifestyle satisfaction compared with residents of towns or villages. Furthermore, a recent study confirmed that happiness, while inversely related to depression and suicidal ideation, is also influenced by a variety of contextual and environmental factors [32]. Therefore, the coexistence of “higher stress and depression along with higher happiness” observed among urban residents in this study should not be interpreted as a contradiction but rather as a reflection of the complex realities of urban life.

In addition, significant sex differences were observed, with females reporting higher levels of stress and depression, and lower levels of happiness compared to males. This is consistent with the result of a previous study, which showed that females’ mental suffering tends to be more severe than males’ [33]. Perceived stress levels reported by participants were higher among individuals in their 30s and 40s, whereas depression scores were notably higher among those aged 60 and above. This age-related pattern suggests that younger adults may be more vulnerable to external stressors related to employment and social competition, while older adults may be more susceptible to depressive symptoms potentially due to increased social isolation and age-related health issues [34].

Regarding educational level, highly educated people had high levels of stress and happiness, but depression was higher in those who had graduated from middle school or lower. This demonstrates that educational level can positively influence mental well-being [35]. Depending on whether or not they are economically active, stress and happiness were higher in the economically active group, but depression was higher in the non-economically active group. This finding is consistent with previous studies showing that economic stability positively affects mental health [35]. In terms of health behaviors, the effects of drinking and smoking on stress and depression were confirmed.

Stress was higher in the drinking group, whereas depression was higher in the nondrinking group. This suggests that drinking may provide temporary stress relief [36] but may have a long-term negative impact on mental health in the long run. Exercise positively affected stress and happiness, whereas depression was higher in the non-exercise group. This is consistent with previous studies [37] showing that physical activity plays an important role in mental well-being. When subjective health was poor, stress and depression tended to be high, and happiness tended to be low. This implies that health conditions have a significant impact on an individual's mental well-being [38]. In addition, the effects of suicidal ideation and stress counseling experiences, which are psychological and emotional factors, on stress and depression were found to be significant. In the suicidal ideation group, stress and depression were high, and happiness was low, emphasizing the need for social support in mental crisis situations [39]. These results provide important basic data for understanding the various stressors and causes of mental pain experienced by residents of Gyeongsangbuk-do and can be used for policy development and mental health promotion programs in the future.

Table 2 demonstrates significant intercorrelations among stress, depression, and happiness variables. Stress showed positive correlation with depression (r=.24, p<.001) and negative correlation with happiness (r=-.25, p<.001), consistent with established research identifying stress as a major depression risk factor [40]. The strongest negative association was observed between depression and happiness (r=-.37, p<.001). These findings emphasize the critical role of stress and depression management in maintaining psychological well-being [10].

Since happiness is closely associated with quality of life, an effective management program is needed to alleviate mental burden and promote well-being. There was also a significant negative correlation between depression and happiness, which means that the higher the depression, the lower the individual's happiness [41], confirming that depression negatively affects an individual's overall life satisfaction. These results highlight the need for psychological interventions to treat and prevent depression and suggest that various programs are needed to promote well-being. Therefore, stress, depression, and happiness are correlated and can provide important basic data for mental health management. In future studies, it is necessary to analyze these correlations in more depth and apply mental health management programs to solve them.

The factor with the greatest influence on happiness was the subjective level of good health. This is significant because health status has an important influence on mental well-being. In poor health, stress and depression may increase, while happiness may decrease [42].

Both depression and subjective stress levels demonstrated significant negative associations with happiness. Effective depression and stress management represents a critical component in promoting psychological well-being, while suicidal ideation showed particularly detrimental effects on happiness [39]. These findings highlight the clinical significance of psycho-emotional problems and underscore the need for comprehensive mental health interventions.

Low happiness in groups with suicidal thoughts indicates that mental support is important for residents and the need for state and social intervention. Additionally, normal health levels and very good health cases affect happiness. Considering the effect of health levels on happiness, health promotion programs can contribute to improving happiness. Participants with poor subjective health conditions, stress, and depression had higher suicidal thoughts than those who did not [43], which affects happiness; therefore, it is considered necessary to prepare and apply a plan to focus on managing participants’ stress and depression. Stress counseling and smoking were identified as factors influencing happiness. In particular, the finding that smoking negatively affects happiness is consistent with previous research demonstrating a significant association between smoking and mental health [44,45].

Furthermore, higher educational attainment, regular physical activity, and higher income were identified as significant predictors of happiness. Both emgagement in physical activity and economic stability were positively contribute to individuals' subjective well-being. Consequently, it is imperative for the government to support underserved populations, such as low-income individuals, by providing continuous and comprehensive economic assistance. Additionally, the development and widespread implementation of exercise programs for the general population should be prioritized to enhance overall happiness.

However, some studies, have reported that education level and smoking status were not significant predictors of depression or happiness [43], so it is necessary to analyze the results of national surveys in the future to identify factors influencing happiness according to the general characteristics, health behavior, and mental health of our people.

This study's methodological strengths include a large representative sample (N=21,490) and comprehensive variable assessment. Multiple regression analysis identified significant happiness predictors including health status, depression, stress, suicidal ideation, education, smoking, exercise, and income. The model explained 25.6% of happiness variance (adjusted R²=.256, p<.001), demonstrating substantial predictive validity.

To enhance the well-being of residents in Gyeongsangbuk-do, maintaining their health is of paramount importance. This can be achieved by providing health-related education and intervention programs that promote and sustain health through activities such as stress, depression, and suicide management, as well as encouraging regular exercise and smoking cessation. Active support should be extended to all residents to enable them to lead healthy and fulfilling lives. Furthermore, it is essential to continuously identify populations characterized by low educational attainment, low income, and smoking habits, and to connect these groups with community resources to ensure a minimum standard of living and access to economic support.

Measuring happiness using quality of life–based indicators has several limitations. As this study relied on secondary data, the measure does not sufficiently capture the emotional and experiential dimensions of happiness and may be restricted to interpretations centered on cognitive evaluation. Accordingly, the happiness variable in this study should be interpreted as “subjective well-being based on overall life satisfaction” rather than emotional happiness in the strict sense. Future research should employ multidimensional instruments that directly assess emotional happiness in conjunction with life satisfaction. Despite these limitations, this study is meaningful in that it identified the overall level of subjective well-being among community residents and analyzed the factors influencing happiness.

Conclusions

Residents of Gyeongsangbuk-do exhibited high rates of alcohol consumption, smoking, and exercise participation; however, their subjective health status was lower than the national average. These findings suggest that regional characteristics and cultural factors influence residents' health behaviors. A significant positive correlation was observed between stress and depression, indicating that higher stress levels are associated with increased depressive symptoms. The most influential factors affecting happiness were health status, stress, depression, suicidal ideation, educational attainment (e.g., college graduation or higher), smoking, exercise, and income level.

The final model demonstrated robust predictive validity, accounting for 25.6% of the variance in happiness scores (adjusted R²=.256, F=337.76, p<.001).

These findings underscore the complex interplay between health behaviors, mental health, and subjective well-being among residents of Gyeongsangbuk-do. Despite relatively high levels of health-related behaviors such as exercise participation, the lower subjective health status compared to the national average highlights the influence of regional and cultural contexts on health perceptions. The strong positive correlation between stress and depression, along with the identification of multiple psychosocial and behavioral factors—such as health status, stress, depression, suicidal ideation, education, smoking, exercise, and income—as key predictors of happiness, suggests that a multidimensional approach is essential for promoting well-being. Therefore, regionally tailored public health strategies that address both mental health and socioeconomic disparities are needed to effectively enhance the happiness and quality of life of local residents.

In future research, it will be necessary to analyze various factors that can be used as basic data for policy development to improve the mental health of Gyeongsangbuk-do residents. In particular, efforts are needed to reduce stress and depression and promote happiness by strengthening the mental health support system and developing customized health promotion programs for local residents. In addition, it is important to support residents in maintaining healthy behaviors by implementing health education and prevention programs that reflect the characteristics of local communities.

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