Inter-Connections Among Multidimensional Domains of Quality of Life in Middle-Aged and Older Adults in Hong Kong: A Network Analysis

The World Health Organization Quality of Life (WHOQOL-BREF) is a widely used measure of quality of life (QoL) in physical, psychological, social, and environmental domains. However, existing studies have not examined their inter-relationships at the item level. The present study aimed to use a network approach to investigate the item-level connections among the QoL items and their linkages to spiritual well-being. The study recruited 843 middle-aged and older adults (Mage = 75.7, SD = 8.65) from elderly centres in Hong Kong in 2018–2020. Participants completed the WHOQOL-BREF and measures on spiritual well-being. Network analysis was used to examine the relationships among the WHOQOL-BREF items and spiritual well-being and identify the central and bridge nodes. The WHOQOL-BREF did not show a clear and interpretable 4-factor structure in the present sample and spiritual well-being showed a reliable three-factor structure (tranquility, disorientation, resilience). Network models found intertwined linkages across various QoL domains, particularly between physical and psychological QoL. Work capacity, Satisfaction with self, and Concentration were the bridge nodes in the WHOQOL-BREF network. Disorientation showed negative partial correlations with four QoL items (Life meaning, Affect, Concentration, Sleep). Tranquility showed a positive linkage with Affect and Resilience showed a positive linkage ) with Transport. There were no significant differences in the network structure or global strength across age groups and sensory impairment. The present study elucidates the complex inter-relationships among various QoL dimensions and supports mind-body connections in middle-aged and older adults. Our results support a holistic approach including spirituality to improve overall well-being.