Longitudinal associations between living alone, childlessness and mental health and mortality in ageing adults in Thailand

Background: This study aimed to evaluate the longitudinal relationships between living alone, being childless, and six mental health indicators and mortality in older adults in Thailand between 2015 and 2020. Methods: We examined prospective cohort data from the Health, Aging and Retirement in Thailand (HART) study, which included participants 45 years of age and older (N = 2863) from three successive waves in 2015, 2017, and 2020. Mental health indicators were assessed by self-report. We used Generalized Estimating Equations analysis (GEE) to evaluate the longitudinal relationships between measures of living alone, childlessness and six mental health indicators and mortality. Results: The proportion of living alone was 6.3 % and childlessness 9.9 % in 2015, while living alone only was 3.9 %, childlessness only 7.5 % and both living alone and childlessness 2.4 % in 2015. In the adjusted model, living alone only was among men positively associated with depressive symptoms, loneliness, poor quality of life and mortality, and among women only positively associated with poor quality of life. Childlessness only was among women positively associated with depressive symptoms, insomnia symptoms, loneliness, poor quality of life, poor self-rated mental health, and mortality, and among men with depressive symptoms, loneliness, poor quality of life and poor self-rated mental health. Both living alone and childlessness was among men associated with four mental health indicators (depressive symptoms, insomnia symptoms, loneliness, and poor quality of life), and among women two mental health indicators (loneliness and poor quality of life), all with higher odds ratios than in living alone only and childlessness only. Conclusions: Living alone only, childlessness only and/or both living alone and childlessness were associated with several poor mental health indicators and/or mortality. Enhanced screening and management of living alone and being childless may improve mental health in Thailand.