Social Psychiatry and Psychiatric Epidemiology

, Volume 53, Issue 8, pp 823–831 | Cite as

Psychiatric morbidity and subsequent divorce: a couple-level register-based study in Finland

  • Niina Metsä-SimolaEmail author
  • Pekka Martikainen
  • Christiaan W. Monden
Original Paper



Studies that assess the role of mental health for the risk of divorce are scarce and mostly rely on individual-level data, although divorce is a couple-level phenomenon. Using data on couples, we examine the effects of both spouses’ psychiatric morbidity on the risk of divorce, and whether socio-demographic factors affect these associations.


We followed 96,222 Finnish married couples for 6 years using register-based data on both spouses and their household. New incidence of psychiatric morbidity and subsequent divorce was identified from dates of prescription medication purchases and hospital admissions, and dates of registered divorce. Socio-demographic factors were measured annually for both spouses and their household. The effect of incident psychiatric morbidity on divorce risk was analyzed using Cox regression.


Psychiatric morbidity in men increased the age-adjusted risk of divorce more than twofold and in women nearly twofold. The risk of divorce was particularly pronounced immediately after new incidence of psychiatric morbidity, before settling to a persistently high level. Psychiatric morbidity in both spouses increased the risk of divorce almost threefold. Adjustment for socio-economic factors had little effect on these associations.


Psychiatric morbidity is a persistent risk factor of divorce. The risk is larger when both spouses experience psychiatric morbidity compared to only one spouse. The findings are consistent with the idea that poor relationship quality and dissatisfaction in couples suffering from mental health problems have long-term consequences for marital stability. Treatment of psychiatric morbidity should not focus only on the individual but on couple-level dynamics.


Psychiatric morbidity Couples Divorce Marital status Finland 



The authors acknowledge the support of the Academy of Finland and the Signe and Ane Gyllenberg Foundation, and are grateful to Statistics Finland, National Institute of Health and Welfare, and the Social Insurance Institution for permission to use the data.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


  1. 1.
    Afifi TO, Cox BJ, Enns MW (2006) Mental health profiles among married, never-married, and separated/divorced mothers in a nationally representative sample. Soc Psychiatry Psychiatr Epidemiol 41:122–129. CrossRefPubMedGoogle Scholar
  2. 2.
    Blekesaune M (2008) Partnership transitions and mental distress: investigating temporal order. J Marriage Fam 70:879–890. CrossRefGoogle Scholar
  3. 3.
    Breslau J, Miller E, Jin R et al (2011) A multinational study of mental disorders, marriage, and divorce. Acta Psychiatr Scand 124:474–486. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Hughes ME, Waite LJ (2009) Marital Biography and Health at Mid-Life. J Health Soc Behav 50:344–358CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Liu RX, Chen Z (2006) The effects of marital conflict and marital disruption on depressive affect: a comparison between women in and out of poverty*. Soc Sci Q 87:250–271. CrossRefGoogle Scholar
  6. 6.
    Meadows SO, McLanahan SS, Brooks-Gunn J (2008) Stability and change in family structure and maternal health trajectories. Am Sociol Rev 73:314–334. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Strohschein L, McDonough P, Monette G, Shao Q (2005) Marital transitions and mental health: are there gender differences in the short-term effects of marital status change? Soc Sci Med 1982 61:2293–2303. CrossRefGoogle Scholar
  8. 8.
    Wade TJ, Pevalin DJ (2004) Marital transitions and mental health. J Health Soc Behav 45:155–170. CrossRefPubMedGoogle Scholar
  9. 9.
    Amato PR (2000) The consequences of divorce for adults and children. J Marriage Fam 62:1269–1287. CrossRefGoogle Scholar
  10. 10.
    Kalmijn M (2017) The ambiguous link between marriage and health: a dynamic reanalysis of loss and gain effects. Soc Forces 95:1607–1636. CrossRefGoogle Scholar
  11. 11.
    Hemstrom O (1996) Is marriage dissolution linked to differences in mortality risks for men and women? J Marriage Fam 58:366–378CrossRefGoogle Scholar
  12. 12.
    Bulloch AG, Williams JV, Lavorato DH, Patten SB (2009) The relationship between major depression and marital disruption is bidirectional. Depress Anxiety 26:1172–1177. CrossRefPubMedGoogle Scholar
  13. 13.
    Kessler RC, Walters EE, Forthofer MS (1998) The social consequences of psychiatric disorders, III: probability of marital stability. Am J Psychiatry 155:1092–1096. CrossRefPubMedGoogle Scholar
  14. 14.
    Lund R, Holstein BE, Osler M (2004) Marital history from age 15 to 40 years and subsequent 10-year mortality: a longitudinal study of Danish males born in 1953. Int J Epidemiol 33:389–397. CrossRefPubMedGoogle Scholar
  15. 15.
    Murray JE (2000) Marital protection and marital selection: evidence from a historical-prospective sample of American men. Demography 37:511–521CrossRefPubMedGoogle Scholar
  16. 16.
    Metsä-Simola N, Martikainen P (2013) Divorce and changes in the prevalence of psychotropic medication use: a register-based longitudinal study among middle-aged Finns. Soc Sci Med 94:71–80. CrossRefPubMedGoogle Scholar
  17. 17.
    Mojtabai R, Stuart EA, Hwang I et al (2017) Long-term effects of mental disorders on marital outcomes in the National Comorbidity Survey ten-year follow-up. Soc Psychiatry Psychiatr Epidemiol 52:1217–1226. CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Butterworth P, Rodgers B (2008) Mental health problems and marital disruption: is it the combination of husbands and wives’ mental health problems that predicts later divorce? Soc Psychiatry Psychiatr Epidemiol 43:758–763. CrossRefPubMedGoogle Scholar
  19. 19.
    Idstad M, Torvik FA, Borren I et al (2015) Mental distress predicts divorce over 16 years: the HUNT study. BMC Public Health. PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    OECD (1982) The OECD List of social indicators. OECD, ParisGoogle Scholar
  21. 21.
    StataCorp (2009) Stata: release 11. statistical software. StataCorp LP, College StationGoogle Scholar
  22. 22.
    Nihtilä E, Martikainen P (2008) Institutionalization of older adults after the death of a spouse. Am J Public Health 98:1228–1234. CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Metsä-Simola N, Martikainen P (2013) The short-term and long-term effects of divorce on mortality risk in a large Finnish cohort, 1990–2003. Popul Stud 67:97–110. CrossRefGoogle Scholar
  24. 24.
    Waite LJ, Luo Y, Lewin AC (2009) Marital happiness and marital stability: consequences for psychological well-being. Soc Sci Res 38:201–212. CrossRefGoogle Scholar
  25. 25.
    Willitts M, Benzeval M, Stansfeld S (2004) Partnership history and mental health over time. J Epidemiol Community Health 58:53–58CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Wilson SE, Waddoups SL (2002) Good marriages gone bad: health mismatches as a cause of later-life marital dissolution. Popul Res Policy Rev 21:505–533. CrossRefGoogle Scholar
  27. 27.
    Burman B, Margolin G (1992) Analysis of the association between marital relationships and health problems: an interactional perspective. Psychol Bull 112:39–63CrossRefPubMedGoogle Scholar
  28. 28.
    Lillard LA, Panis CW (1996) Marital status and mortality: the role of health. Demography 33:313–327CrossRefPubMedGoogle Scholar
  29. 29.
    Halleröd B, Gustafsson J-E (2011) A longitudinal analysis of the relationship between changes in socio-economic status and changes in health. Soc Sci Med 72:116–123. CrossRefPubMedGoogle Scholar
  30. 30.
    Lahelma E, Martikainen P, Laaksonen M, Aittomaki A (2004) Pathways between socioeconomic determinants of health. J Epidemiol Community Health 58:327–332. CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Jalovaara M (2013) Socioeconomic resources and the dissolution of cohabitations and marriages. Eur J Popul Rev Eur Démographie. CrossRefGoogle Scholar
  32. 32.
    Lyngstad T, Jalovaara M (2010) A review of the antecedents of union dissolution. Demogr Res 23:257–292. CrossRefGoogle Scholar
  33. 33.
    Gerstel N, Riessman CK, Rosenfield S (1985) Explaining the symptomatology of separated and divorced women and men: the role of material conditions and social networks. Soc Forces 64:84–101. CrossRefGoogle Scholar
  34. 34.
    Lee S, Cho E, Grodstein F et al (2005) Effects of marital transitions on changes in dietary and other health behaviours in US women. Int J Epidemiol 34:69–78. CrossRefPubMedGoogle Scholar
  35. 35.
    Umberson D (1992) Gender, marital status and the social control of health behavior. Soc Sci Med 1982 34:907–917Google Scholar
  36. 36.
    Poortman A-R (2000) Sex differences in the economic consequences of separation: a panel study of the Netherlands. Eur Sociol Rev 16:367–383CrossRefGoogle Scholar
  37. 37.
    Pienta AM, Hayward MD, Jenkins KR (2000) Health consequences of marriage for the retirement years. J Fam Issues 21:559–586. CrossRefGoogle Scholar
  38. 38.
    Garvin V, Kalter N, Hansell J (1993) Divorced women: individual differences in stressors, mediating factors, and adjustment outcome. Am J Orthopsychiatry 63:232–240CrossRefPubMedGoogle Scholar
  39. 39.
    Alonso J, Angermeyer MC, Bernert S et al (2004) Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl. CrossRefPubMedGoogle Scholar
  40. 40.
    Jacobi F, Wittchen H-U, Holting C et al (2004) Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychol Med 34:597–611. CrossRefPubMedGoogle Scholar
  41. 41.
    de Graaf R, Bijl RV, Smit F et al (2002) Risk factors for 12-month comorbidity of mood, anxiety, and substance use disorders: findings from the Netherlands Mental Health Survey and Incidence Study. Am J Psychiatry 159:620–629. CrossRefPubMedGoogle Scholar
  42. 42.
    Pirkola SP, Isometsä E, Suvisaari J et al (2005) DSM-IV mood-, anxiety- and alcohol use disorders and their comorbidity in the Finnish general population. Soc Psychiatry Psychiatr Epidemiol 40:1–10. CrossRefPubMedGoogle Scholar
  43. 43.
    Boschloo L, Vogelzangs N, Smit JH et al (2011) Comorbidity and risk indicators for alcohol use disorders among persons with anxiety and/or depressive disorders: findings from the Netherlands Study of Depression and Anxiety (NESDA). J Affect Disord 131:233–242. CrossRefPubMedGoogle Scholar
  44. 44.
    Amato PR, Previti D (2003) People’s reasons for divorcing: gender, social class, the life course, and adjustment. J Fam Issues 24:602–626. CrossRefGoogle Scholar
  45. 45.
    Collins RL, Ellickson PL, Klein DJ (2007) The role of substance use in young adult divorce. Addict Abingdon Engl 102:786–794. CrossRefGoogle Scholar
  46. 46.
    Joutsenniemi K, Moustgaard H, Koskinen S et al (2011) Psychiatric comorbidity in couples: a longitudinal study of 202,959 married and cohabiting individuals. Soc Psychiatry Psychiatr Epidemiol 46:623–633. CrossRefPubMedGoogle Scholar
  47. 47.
    Linjakumpu T, Hartikainen S, Klaukka T et al (2002) Psychotropics among the home-dwelling elderly—increasing trends. Int J Geriatr Psychiatry 17:874–883. CrossRefPubMedGoogle Scholar
  48. 48.
    Desplenter F, Caenen C, Meelberghs J et al (2011) Change in psychotropic drug use among community-dwelling people aged 75 years and older in Finland: repeated cross-sectional population studies. Int Psychogeriatr 23:1278–1284. CrossRefPubMedGoogle Scholar
  49. 49.
    Hämäläinen J, Isometsä E, Laukkala T et al (2004) Use of health services for major depressive episode in Finland. J Affect Disord 79:105–112. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Population Research Unit, Faculty of Social SciencesUniversity of HelsinkiHelsinkiFinland
  2. 2.Department of Sociology and Nuffield CollegeUniversity of OxfordOxfordUK

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