Longitudinal Associations between Living Alone and Mental Health and Mortality in Ageing Adults in South Africa

Abstract The aim of this study was to assess the longitudinal associations between living alone and eight mental health indicators and mortality in ageing adults from 2015 to 2022 in rural South Africa. The analysis utilized data from the South African 7-year longitudinal Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) (analytic sample: n = 3,707, aged 40 years and older). The proportion of living alone was 9.3% in 2015, 10.6% in 2019 and 12.0% in 2022. In the adjusted model, living alone was positively associated depressive symptoms, loneliness, impaired cognition, current tobacco use, and mortality. Compared to not living alone in all three study waves, living alone in one wave and/or two to three waves was positively associated with incident loneliness, incident current tobacco use, and incident current heavy alcohol use. Living alone was positively associated with the prevalence and/or incidence of depressive symptoms, loneliness, impaired cognition, current tobacco use, current heavy alcohol use and mortality. Enhanced screening and management of living alone may reduce mental ill-health in South Africa.