Skip to main content

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

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  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. https://doi.org/10.1007/s00127-005-0005-3

    Article  PubMed  Google Scholar 

  2. Blekesaune M (2008) Partnership transitions and mental distress: investigating temporal order. J Marriage Fam 70:879–890. https://doi.org/10.1111/j.1741-3737.2008.00533.x

    Article  Google Scholar 

  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. https://doi.org/10.1111/j.1600-0447.2011.01712.x

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. Hughes ME, Waite LJ (2009) Marital Biography and Health at Mid-Life. J Health Soc Behav 50:344–358

    Article  PubMed  PubMed Central  Google Scholar 

  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. https://doi.org/10.1111/j.1540-6237.2006.00379.x

    Article  Google Scholar 

  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. https://doi.org/10.1177/000312240807300207

    Article  PubMed  PubMed Central  Google Scholar 

  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. https://doi.org/10.1016/j.socscimed.2005.07.020

    Article  Google Scholar 

  8. Wade TJ, Pevalin DJ (2004) Marital transitions and mental health. J Health Soc Behav 45:155–170. https://doi.org/10.1177/002214650404500203

    Article  PubMed  Google Scholar 

  9. Amato PR (2000) The consequences of divorce for adults and children. J Marriage Fam 62:1269–1287. https://doi.org/10.1111/j.1741-3737.2000.01269.x

    Article  Google Scholar 

  10. Kalmijn M (2017) The ambiguous link between marriage and health: a dynamic reanalysis of loss and gain effects. Soc Forces 95:1607–1636. https://doi.org/10.1093/sf/sox015

    Article  Google Scholar 

  11. Hemstrom O (1996) Is marriage dissolution linked to differences in mortality risks for men and women? J Marriage Fam 58:366–378

    Article  Google Scholar 

  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. https://doi.org/10.1002/da.20618

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1176/ajp.155.8.1092

    Article  PubMed  CAS  Google Scholar 

  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. https://doi.org/10.1093/ije/dyh065

    Article  PubMed  Google Scholar 

  15. Murray JE (2000) Marital protection and marital selection: evidence from a historical-prospective sample of American men. Demography 37:511–521

    Article  PubMed  CAS  Google Scholar 

  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. https://doi.org/10.1016/j.socscimed.2013.06.027

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1007/s00127-017-1373-1

    Article  PubMed  PubMed Central  Google Scholar 

  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. https://doi.org/10.1007/s00127-008-0366-5

    Article  PubMed  Google Scholar 

  19. Idstad M, Torvik FA, Borren I et al (2015) Mental distress predicts divorce over 16 years: the HUNT study. BMC Public Health. https://doi.org/10.1186/s12889-015-1662-0

    PubMed  PubMed Central  Article  Google Scholar 

  20. OECD (1982) The OECD List of social indicators. OECD, Paris

    Google Scholar 

  21. StataCorp (2009) Stata: release 11. statistical software. StataCorp LP, College Station

    Google Scholar 

  22. Nihtilä E, Martikainen P (2008) Institutionalization of older adults after the death of a spouse. Am J Public Health 98:1228–1234. https://doi.org/10.2105/AJPH.2007.119271

    Article  PubMed  PubMed Central  Google Scholar 

  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. https://doi.org/10.1080/00324728.2012.746386

    Article  Google Scholar 

  24. Waite LJ, Luo Y, Lewin AC (2009) Marital happiness and marital stability: consequences for psychological well-being. Soc Sci Res 38:201–212. https://doi.org/10.1016/j.ssresearch.2008.07.001

    Article  Google Scholar 

  25. Willitts M, Benzeval M, Stansfeld S (2004) Partnership history and mental health over time. J Epidemiol Community Health 58:53–58

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  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. https://doi.org/10.1023/A:1022990517611

    Article  Google Scholar 

  27. Burman B, Margolin G (1992) Analysis of the association between marital relationships and health problems: an interactional perspective. Psychol Bull 112:39–63

    Article  PubMed  CAS  Google Scholar 

  28. Lillard LA, Panis CW (1996) Marital status and mortality: the role of health. Demography 33:313–327

    Article  PubMed  CAS  Google Scholar 

  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. https://doi.org/10.1016/j.socscimed.2010.09.036

    Article  PubMed  Google Scholar 

  30. Lahelma E, Martikainen P, Laaksonen M, Aittomaki A (2004) Pathways between socioeconomic determinants of health. J Epidemiol Community Health 58:327–332. https://doi.org/10.1136/jech.2003.011148

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  31. Jalovaara M (2013) Socioeconomic resources and the dissolution of cohabitations and marriages. Eur J Popul Rev Eur Démographie. https://doi.org/10.1007/s10680-012-9280-3

    Article  Google Scholar 

  32. Lyngstad T, Jalovaara M (2010) A review of the antecedents of union dissolution. Demogr Res 23:257–292. https://doi.org/10.4054/DemRes.2010.23.10

    Article  Google Scholar 

  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. https://doi.org/10.1093/sf/64.1.84

    Article  Google Scholar 

  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. https://doi.org/10.1093/ije/dyh258

    Article  PubMed  Google Scholar 

  35. Umberson D (1992) Gender, marital status and the social control of health behavior. Soc Sci Med 1982 34:907–917

    CAS  Google Scholar 

  36. Poortman A-R (2000) Sex differences in the economic consequences of separation: a panel study of the Netherlands. Eur Sociol Rev 16:367–383

    Article  Google Scholar 

  37. Pienta AM, Hayward MD, Jenkins KR (2000) Health consequences of marriage for the retirement years. J Fam Issues 21:559–586. https://doi.org/10.1177/019251300021005003

    Article  Google Scholar 

  38. Garvin V, Kalter N, Hansell J (1993) Divorced women: individual differences in stressors, mediating factors, and adjustment outcome. Am J Orthopsychiatry 63:232–240

    Article  PubMed  CAS  Google Scholar 

  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. https://doi.org/10.1111/j.1600-0047.2004.00327.x

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1017/S0033291703001399

    Article  PubMed  CAS  Google Scholar 

  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. https://doi.org/10.1176/appi.ajp.159.4.620

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1007/s00127-005-0848-7

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1016/j.jad.2010.12.014

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1177/0192513X03254507

    Article  Google Scholar 

  45. Collins RL, Ellickson PL, Klein DJ (2007) The role of substance use in young adult divorce. Addict Abingdon Engl 102:786–794. https://doi.org/10.1111/j.1360-0443.2007.01803.x

    Article  Google Scholar 

  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. https://doi.org/10.1007/s00127-010-0228-9

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1002/gps.712

    Article  PubMed  CAS  Google Scholar 

  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. https://doi.org/10.1017/S1041610211000718

    Article  PubMed  Google Scholar 

  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. https://doi.org/10.1016/S0165-0327(02)00342-7

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

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.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Niina Metsä-Simola.

Ethics declarations

Conflict of interest

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

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Metsä-Simola, N., Martikainen, P. & Monden, C.W. Psychiatric morbidity and subsequent divorce: a couple-level register-based study in Finland. Soc Psychiatry Psychiatr Epidemiol 53, 823–831 (2018). https://doi.org/10.1007/s00127-018-1521-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-018-1521-2

Keywords

  • Psychiatric morbidity
  • Couples
  • Divorce
  • Marital status
  • Finland