A multinational study of mental disorders, marriage, and divorce
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Breslau J, Miller E, Jin R, Sampson NA, Alonso J, Andrade LH, Bromet EJ, de Girolamo G, Demyttenaere K, Fayyad J, Fukao A, Gălăon M, Gureje O, He Y, Hinkov HR, Hu C, Kovess‐Masfety V, Matschinger H, Medina‐Mora ME, Ormel J, Posada‐Villa J, Sagar R, Scott KM, Kessler RC. A multinational study of mental disorders, marriage, and divorce. Objective: Estimate predictive associations of mental disorders with marriage and divorce in a cross‐national sample. Method: Population surveys of mental disorders included assessment of age at first marriage in 19 countries (n = 46 128) and age at first divorce in a subset of 12 countries (n = 30 729). Associations between mental disorders and subsequent marriage and divorce were estimated in discrete time survival models. Results: Fourteen of 18 premarital mental disorders are associated with lower likelihood of ever marrying (odds ratios ranging from 0.6 to 0.9), but these associations vary across ages of marriage. Associations between premarital mental disorders and marriage are generally null for early marriage (age 17 or younger), but negative associations come to predominate at later ages. All 18 mental disorders are positively associated with divorce (odds ratios ranging from 1.2 to 1.8). Three disorders, specific phobia, major depression, and alcohol abuse, are associated with the largest population attributable risk proportions for both marriage and divorce. Conclusion: This evidence adds to research demonstrating adverse effects of mental disorders on life course altering events across a diverse range of socioeconomic and cultural settings. These effects should be included in considerations of public health investments in preventing and treating mental disorders.
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Early-onset major depressive disorder predicts later difficulties in role transitions, such as lower educational attainment, higher risk of teen childbearing, marital disruption, and unstable employment.
“Early-onset MDD is found to predict difficulties in subsequent role transitions, including low educational attainment, high risk of teen child-bearing, marital disruption, and unstable employment.”
From The Costs of Depression (2012) · cites this paper as [27]
Early-onset mental disorders predict a lower probability of ever marrying, are either positively associated or unrelated with marriage before age 18, and are negatively associated with on-time and late marriage; these patterns are largely similar for men and women and across countries, and major depressive disorder is one of the most important pre-marital mental disorders.
“Early-onset mental disorders predict low probability of ever marrying, but are either positively associated28 or unrelated27 with early (before age 18) marriage, which is known to be associated with a number of adverse outcomes, and negatively associated with on-time and late marriage, which are known to be associated with a number of benefits (e.g., financial security, social support). These ass”
From The Costs of Depression (2012) · cites this paper as [27]
Pre-marital history of mental disorders predicts divorce, with associations quite similar for husbands and wives across all countries, and major depressive disorder is among the most important disorders in this regard.
“A separate set of studies has shown that pre-marital history of mental disorders predicts divorce,30, 31 again with associations quite similar for husbands and wives across all countries and MDD among the most important disorders in this regard.27”
From The Costs of Depression (2012) · cites this paper as [27]
The relative contribution of depression to suicide is smaller in low- and middle-income countries where a mood disorder was identified in 25% of people who died by suicide.
“That said, it appears that the relative contribution of depression to suicide is smaller in low- and middle-income countries 205,206 where a mood disorder was identified in 25% of people who died by suicide.”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [205]
Previous studies have suggested that individuals with MDD are less likely to get married and on average have fewer children.
“previous studies have suggested that individuals with MDD are less likely to get married and on average have fewer children [40,41]”
From The Economic Burden of Adults with Major Depressive Disorder in the United States (2019) (2023) · cites this paper as [40]
Results of prior studies on associations of child and adolescent mental disorders with subsequent educational attainment have been inconsistent.
“Results have been inconsistent, with the majority of studies, but not all [9], finding significant gross associations of childhood and adolescent mental disorders with low levels of educational attainment and some finding that significant gross associations are explained by childhood adversities that preceded onset of the disorders [11,22].”
From Long-term effects of mental disorders on educational attainment in the National Comorbidity Survey ten-year follow-up (2015) · cites this paper as [13]
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- Authors
- Breslau, J., Miller, E., Jin, R., Sampson, N. A., Alonso, J., Andrade, L. H., Bromet, E. J., de Girolamo, G., Demyttenaere, K., Fayyad, J., Fukao, A., Gălăon, M., Gureje, O., He, Y., Hinkov, H. R., Hu, C., Kovess‐Masfety, V., Matschinger, H., Medina‐Mora, M. E., Ormel, J., Posada‐Villa, J., Sagar, R., Scott, K. M., & Kessler, R. C.
- Affiliations
- University of California System (US)
- University of California, Davis (US)
- Harvard University (US)
- Municipal Institute for Medical Research (ES)
- Universidade de São Paulo (BR)
- Stony Brook University (US)
- Universitair Ziekenhuis Leuven (BE)
- University of Balamand (LB)
- Yamagata University (JP)
- National School of Public Health, Management and Professional Development (RO)
- University College Hospital, Ibadan (NG)
- Shanghai Mental Health Center (CN)
- Leipzig University (DE)
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (MX)
- University Medical Center Groningen (NL)
- All India Institute of Medical Sciences (IN)
- University of Otago (NZ)
- Corresponding author
- He, Y.
- Kessler, R. C.
- ORCID
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 2011-04-30
- Volume
- 124
- Issue
- 6
- Pages
- 474-486
- ISSN
- 0001-690X (ISSN-L)
- 1600-0447
- PMC
- PMC4011132
- OpenAlex
- W2149338329
- Cited by
- 198
- References
- 48
- Citations by year
- 2026: 11 · 2025: 10 · 2024: 13 · 2023: 16 · 2022: 21 · 2021: 9 · 2020: 19 · 2019: 17 · 2018: 16 · 2017: 12 · 2016: 9 · 2015: 13 · 2014: 13 · 2013: 15 · 2012: 3
- FWCI
- 14.40
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Lirias (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Funders
- John D. and Catherine T. MacArthur Foundation (R01 DA016558, R13-MH066849)
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- GlaxoSmithKline
- Sanofi
- World Health Organization
- Kaiser Permanente
- European Commission (QLG5–1999-01042, SANCO2004123, 2004123)
- Fundação de Amparo à Pesquisa do Estado de São Paulo
- Generalitat de Catalunya (01042)
- Ministry of Health, Labour and Welfare (H16-KOKORO-013, H14-TOKUBETSU-026, H13-SHOGAI-023)
- Shire
- Jawaharlal Institute Of Postgraduate Medical Education and Research
- Regione Piemonte
- National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
- Pfizer Foundation (R01‐MH069864, R01-DA016558, R13-MH066849, R03-TW006481)
- Pan American Health Organization
- National Health and Medical Research Council
- Instituto de Salud Carlos III
- Departament de Salut, Generalitat de Catalunya
- National Institute of Mental Health (R13-MH-066849, NIMH R01MH070884, R0 1-MH61905, R01‐MH070884, U01-MH-60220, R01MH061905, MH070884, HHSN271200700030C, U01MH060220, R01‐MH069864)
- National Institute on Drug Abuse (K05DA015799, R01DA016558)
- Fogarty International Center (FIRCA R03TW006481, R03TW006481)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12HD051958)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Demography › Family Dynamics and Relationships
- Social Sciences › Sociology and Political Science › Marriage and Family Dynamics
- Keywords
- mental illness, marriage, divorce, age at marriage, major depressive disorder, alcohol abuse, specific phobia, population attributable risk, life course, cross-national comparison
- MeSH terms
- Adolescent, Adult, Aged, Mental Disorders, Cultural Characteristics, Divorce, Female, Humans, Male, Marriage, Middle Aged, Population Surveillance, Risk Factors, Socioeconomic Factors, Global Health, Comorbidity, Precipitating Factors, Prevalence, Age of Onset, Internationality, Diagnostic and Statistical Manual of Mental Disorders
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