The Onset of Parental Loss of a Child Decreases Psychosocial Well-Being Among Persons 40 Years and Older: Longitudinal Evidence from South Africa, 2015-2022.

OBJECTIVES: To assess the longitudinal association between the onset of child death and psychosocial outcomes among adults aged 40 years and older in South Africa between 2015 and 2022. METHODS: Data were drawn from three waves of the HAALSI study. Child death was modelled as a time-varying indicator capturing the onset of child death between survey waves. Fixed-effects regression models estimated within-person changes in psychosocial outcomes following bereavement. RESULTS: The pooled analytic sample included 9,494 person-wave observations from adults aged 40 years and older across the 2015, 2019, and 2022 survey waves. Of these, 3,935 observations were among parents with a history of child loss and 5,559 among parents without such a history. During follow-up, 432 participants experienced the onset of child death. Adjusted fixed-effects analyses showed that the onset of child death was associated with increased depressive symptoms, poorer sleep quality, more PTSD symptoms, poorer self-rated health, reduced cognitive functioning, and marginally lower life satisfaction. No significant sex differences were observed. CONCLUSIONS: The onset of child death was associated with worsening psychological, sleep, physical health, and cognitive outcomes among adults aged 40 years and older, highlighting the need for routine screening and targeted bereavement support. CLINICAL IMPLICATIONS: Findings support the development of feasible, community-led bereavement support in rural South Africa, with primary healthcare and community health workers helping to identify adults experiencing persistent distress and facilitating appropriate support or referral.