Sociodemographic patterns of psychological distress, non-communicable diseases, and disability among south Africans 60 years and older: a generalized structural equation modelling approach

Background South Africa is experiencing a steady increase in ageing population alongside a growing burden of non-communicable diseases (NCDs), disability and mental health challenges. However, the interplay between these conditions in later life remains underexplored. Methods The study draws data from the sixth South African National HIV Prevalence, Incidence and Behaviour Survey which used a multi-stage, stratified, cluster random sampling design. The analysis estimated the prevalence of self-reported psychological distress, NCDs and disability among adults aged 60 years and older. Sociodemographic factors associated with these outcomes were examined using a Generalized Structural Equation Model. Results Among adults aged 60 years and older, the prevalence of psychological distress was 3.1%, NCDs 59.7%, and disability 64.1%. Having at least one NCD significantly increased the likelihood of psychological distress, while having a disability increased the likelihood of having an NCD. Women and those aged 70–79 years had higher odds of both NCDs, and disability compared to men and those aged 60–69 years, respectively. Compared to Black Africans, participants from other racial groups had lower odds of distress but higher odds of NCDs. Relative to primary education, secondary education lowered the odds of distress and disability but increased the odds of NCD, while tertiary education was only protective against disability. Unemployment was associated with higher odds of NCDs, while residing in rural informal areas and never being married was associated with lower odds of NCDs only, compared to those who were employed, living in urban areas and ever married, respectively. Conclusion The findings highlight strong interconnections between chronic disease, disability and mental health in later life, shaped by age, sex, education, marital status and place of residence. Interventions that integrate social, physical and psychological care are essential to improving healthy ageing outcomes in South Africa.