Health-promoting lifestyle as a predictor of well-being in Honduran university students: a structural equation modeling approach with mental health and sleep quality as mediators

Introduction: Although a health-promoting lifestyle is associated with greater well-being among university students, the psychological (anxiety, depression) and physiological (sleep quality) mechanisms underlying this relationship remain insufficiently established, highlighting the need for integrative models that better explain well-being. Moreover, empirical evidence on these relationships is still limited in lower-middle-income countries. Accordingly, this study tested a model in which a health-promoting lifestyle predicts subjective well-being, with depression, anxiety, and sleep quality serving as mediating variables within a Latin American context. Method: A cross-sectional design was employed with a sample of 6,704 Honduran university students. The instruments included a short version of the Health-Promoting Lifestyle Profile II (HPLP-II), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder 7-item Scale (GAD-7), the Single-Item Sleep Quality Scale (SQS), and the World Health Organization Well-Being Index (WHO-5). Measurement models for each instrument and a multiple-mediation structural equation model were estimated. Results: The final structural model demonstrated adequate fit and explained 61.6% of the variance in well-being. A health-promoting lifestyle predicted greater well-being both directly and indirectly. Among the mediators, depression and sleep quality showed significant indirect effects, whereas anxiety did not play a statistically significant mediating role. Overall, the findings confirm that a health-promoting lifestyle is associated with lower depressive symptomatology and better sleep quality, which in turn enhances subjective well-being. Conclusion: The findings support an integrative model in which a health-promoting lifestyle explains student well-being, highlighting depression and sleep quality as key pathways of influence. These results broaden the understanding of well-being from a multidimensional perspective and provide actionable evidence for designing institutional policies and intervention strategies that promote healthy lifestyle behaviors and well-being, particularly in Latin American settings.