Mental health and social exclusion in Indonesia: A public health perspective.

Background: Mental health and social exclusion are increasingly recognized as intertwined public health challenges. The aftermath of the COVID-19 underscores the need to integrate psychological well-being into national development and social inclusion agendas. Evidence and causal analyses from Southeast Asia remain sparse.

Design and methods: This study combines longitudinal descriptive trends from the Indonesian Family Life Survey with an instrumental variable probit regression using cross-sectional data and examines the causal relationship between mental health and key dimensions of social exclusion: employment status and community participation. To address potential endogeneity and bidirectionality, "family mental health history" was employed as an instrumental variable, offering a theoretically plausible and statistically valid proxy for exogenous variation in individual mental health.

Results: Descriptive findings showed that poorer mental health was associated with lower levels of employment and community participation. Instrumental variable results indicated that a one-point increase in the mental health index (worse mental health) reduced the probability of working by 25.3% and of participating in community life by 26.8%. The results support a robust negative association between mental health and social inclusion.

Conclusions: This study makes a novel contribution by isolating the causal effect of mental health on social exclusion in an LMIC. Grounded in the capability approach, the findings illustrate how impaired mental health limits real freedoms and reinforces exclusion. The IFLS provides rare longitudinal, nationally representative evidence from Indonesia.

Public health implications: Findings support integrated strategies to improve mental health and enhance inclusion-critical for LMICs navigating post-pandemic recovery and social transformations.