Obesity and Depressive Disorders Among U.S. Adults with Disabilities: The Mediating Role of Healthcare Access and the Moderating Effect of Physical Activity

Background Adults with disabilities in the United States experience disproportionately high rates of depressive disorders due to various biopsychosocial factors.Purpose Guided by the ecological systems framework, this study examined the mediating role of healthcare access and the moderating effect of physical activity (PA) in the association between body mass index (BMI) and depressive disorders among U.S. adults with disabilities.Methods Data were drawn from the 2020–2023 Behavioral Risk Factor Surveillance System (N = 305,633). Logistic regression and moderated mediation were conducted using JASP, controlling for sociodemographic covariates.Results Females (OR = 1.791), cognitive disability (OR = 4.142), and healthcare access (OR = 1.631) were associated with greater odds of depressive disorders. In contrast, PA (OR = 0.973), older age (OR = 0.420), and higher income (OR = 0.864) were protective. BMI had a direct effect on depressive disorders (β = .070) and an indirect effect through healthcare access (β = .002), moderated by PA, such that higher activity levels weakened the direct effects of BMI on depressive disorders.Discussion Findings emphasize multilevel biopsychosocial factors influencing depressive disorders within ecological systems.Translation to Health Education Practice Interventions should promote inclusive, disability-sensitive programs integrating weight management, PA, and mental health education.