Behavioral and psychological factors associated with pre-frailty and frailty in adults aged 40–65 years: a cross-sectional study

Abstract

Abstract This study identifies psychosocial and lifestyle factors associated with pre-frailty in adults (40–65) and examines the indirect associations between ageing perceptions and frailty status through the potential explanatory mechanism of psychological distress. A cross-sectional study was conducted with 196 community-dwelling volunteers. Data were collected via online surveys using the FRAIL Scale, AAQ-SF, PHQ-4, and B-PSQI-3. Statistical analyses included hierarchical logistic regression with prespecified sociodemographic, clinical, lifestyle, and psychosocial covariates, model diagnostics, and Hayes’ PROCESS Macro (Model 4). More than half of the participants (57.1%) were pre-frail or frail, with pre-frailty observed in 44.9% of this sample. In the fully adjusted model including education and marital status, poor sleep quality (OR = 1.27, p  = 0.011), high psychological distress (OR = 1.28, p  = 0.003), and physical ageing perception (OR = 0.86, p  = 0.003) were independently associated with higher odds of frailty. Final-model diagnostics showed no problematic multicollinearity (maximum VIF = 1.47), acceptable calibration (Hosmer-Lemeshow p  = 0.762), and good discrimination (AUC = 0.852). Mediation analysis revealed that perceiving ageing as a ‘psychosocial loss’ was indirectly associated with frailty status through its statistical co-occurrence with psychological distress severity (Indirect Effect: 0.035, 95% CI [0.019, 0.055]). Subjective ageing perceptions and mental health markers show critical concurrent risk associations with pre-frailty in middle age, even among individuals with high educational attainment. Preventive strategies may benefit from integrating sleep hygiene and psychological support alongside lifestyle modifications.