Divorce Doesn’t Always Lead to Depression

While many studies have previously identified divorce as a contributor to later depression, new research sheds light on which patients are at the highest risk. Divorce or separation increased the likelihood of future depressive episodes—but only for patients who reported a history of depression, according to a recent study in Clinical Psychological Science.

David A. Sbarra, PhD, and colleagues used data from the longitudinal Midlife Development in the United States (MIDUS) study, which investigated more than 7,000 Americans ages 25-74. They matched each participant who had separated or divorced during the study to a continuously married person in the study with the same potential for divorce, based on a number of previously identified factors.

Nearly 60% of those with a history of depression who divorced during the study experienced a depressive episode at follow-up. In contrast, only 10% of all other participants had a depressive episode at follow-up, including those with a history of depression who hadn’t divorced and those who had divorced but had no history of depression.

These findings suggest that most people readjust after a marital separation without falling into depression. The research also highlights a specific subset of patients who could benefit from additional support or mental health services.

Dr Sbarra said it’s most advisable to look carefully at clinical depression around 6 to 8 months after the divorce or separation, when most people are starting to readjust after the period of upheaval. “Those who are not returning to baseline, warrant further attention,” he said. “If a PCP knows a person has a history of depression and that person then experiences a marital separation, our data suggest a psychotherapy referral would indeed be warranted.” 

So in addition to asking patients if there have been any changes in their health since their last visit, you may want to see if they’ve gone through any major changes in their home life as well.

“Primary care physicians must do—or start doing—a better job tracking their patients’ marital status, marital quality, and social connections at large,” Dr Sbarra said. “Some of the most well-replicated and consistent findings in the epidemiological literature on broad-based morbidity and mortality center on these variables, and they matter quite a lot for promoting positive health behaviors.

Do you talk with your patients about their marital status or quality? Do you feel that asking about these topics falls within the scope of practice for a general practitioner? Let us know in the comments below.

—Colleen Mullarkey

Reference

Sbarra DA, Emery RE, Beam CR, Ocker BL. Marital dissolution and major depression in midlife: a propensity score analysis. Clin Psych Sci. August 13, 2013.