Living alone with depression and anxiety raises suicide risk by more than 500%, study of Korean adults suggests

An international team including Charité Universitätsmedizin Berlin, Soongsil University, and Sungkyunkwan University has found that Korean adults living alone with both depression and anxiety face a 558% increased risk of suicide. Individuals aged 40 to 64 and men experienced the highest risk.

Suicide is a global health issue responsible for over 700,000 deaths each year. South Korea has reported the highest suicide rate among Organization for Economic Co-operation and Development (OECD) countries from 2003 to 2023, with 24.1 suicides per 100,000 individuals. Living alone has emerged as a social determinant of health, often linked with social isolation and psychiatric conditions.

Social isolation has previously been associated with adverse outcomes, including psychiatric, dementia, poor nutrition, diabetes, and cardiovascular disease. It can also intensify loneliness and hopelessness, which are psychological precursors to suicidal behavior.

One-person households now account for more than one-third of all households in Korea, reflecting shifting family structures, declining multigenerational households, and increasing divorce rates. While living alone is not inherently equal to experiencing social isolation, it is often used as a stand-in for social isolation in population studies as it can increase the likelihood of experiencing it.

In the study, “Suicide Risk and Living Alone With Depression or Anxiety,” published in JAMA Network Open, researchers conducted a population-based cohort study to examine the association of living arrangements and depression or anxiety with suicide risk.

Data included 3,764,279 Korean adults aged 20 years or older who participated in the Korean National Health Insurance Service General Health Screening Program in 2009. Individuals with incomplete data and those who died by suicide within the first year were excluded. Follow-up extended from 2009 through 2021.

Living arrangements were classified using national registration records. Individuals were categorized as living alone if registered as a one-person household for five or more years at baseline. Depression and anxiety were identified using codes from health insurance claims in the year preceding the health examination. Suicide deaths were determined through national death records.

Among 3,764,279 participants, 112,460 individuals (3.0%) had depression, 232,305 (6.2%) had anxiety, and 319,993 (8.5%) lived alone. Suicide occurred in 11,648 individuals over the study period. Living alone with both depression and anxiety was associated with a 558% increased risk of suicide (adjusted hazard ratio [AHR], 6.58; 95% CI, 4.86–8.92).

Living alone with depression was associated with a 290% increased risk (AHR, 3.91; 95% CI, 2.96–5.16). Living alone with anxiety was associated with a 90% increased risk (AHR, 1.90; 95% CI, 1.48–2.43). Even those living alone without depression or anxiety had a 44% increased risk compared to individuals living with others and without psychiatric conditions (AHR, 1.44; 95% CI, 1.35–1.54).

Individuals living with others but diagnosed with depression had a 198% increased risk (AHR, 2.98; 95% CI, 2.74–3.25). Those with anxiety but no depression, living with others, had a 64% increased risk (AHR, 1.64; 95% CI, 1.52–1.76).

Males and adults aged 40 to 64 experienced the highest suicide risk across all groups. Among individuals with depression living alone, men had a 332% increased risk of suicide (AHR, 4.32; 95% CI, 3.30–5.67), and adults aged 40 to 64 had a 502% increased risk (AHR, 6.02; 95% CI, 4.70–7.71).

Living alone with depression or anxiety was associated with a significantly increased risk of suicide, with individuals experiencing both conditions facing the highest risk. These associations remained after adjusting for lifestyle, clinical, and psychiatric factors. Middle-aged adults and men experienced the highest risk, consistent with previous findings on suicide and all-cause mortality in these groups.

Researchers speculate that living alone may intensify feelings of hopelessness and isolation, which are established psychological precursors to suicidal behavior.

Cultural stigma surrounding mental illness and traditional gender expectations may contribute to reduced help-seeking, especially among men. Authors recommend further research to determine whether similar patterns are observed in other social and cultural settings.

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