Risk of major depressive episodes after separation

In their article “Risk of Major Depressive Episodes After Separation: The Gender-Specific Contribution of the Income and Support Lost Through Union Dissolution,” Anne-Lise Biotteau, Carole Bonnet and Emmanuelle Cambois analyze the social and economic determinants of mental health deterioration after separation. Union dissolutions have increased considerably in the last decades, and attaining a better understanding of the possible implications of separation is now a major public policy concern (Amato 2010).

The authors base their study on the observation that the social and economic losses involved in separation—lower living standard, loss of social support—affect men and women differently: on average, women more often have to cope with income loss whereas men lose social support. Women are also more likely to head single-parent families. Differences in impacts by sex are due in part to the fact that society is still largely organized in terms of gender-specific roles, notably within couples (Anxo et al. 2011). Furthermore, research has regularly shown that social and economic situations are closely related to health risks (Marmot 2000; Berkman et al. 2015). The authors hypothesize that one way men and women are not equal in relation to union dissolution pertains to adverse effects on their mental health.

Living with a life partner is beneficial to an individual’s health

Living with a life partner implies better living conditions (e.g., higher income) (Browning et al. 2014) and a wider social network—two points that we know are positively correlated with health. Moreover, a range of studies have shown that separation increases the risk of poor health, namely depression (Lapierre 2012; Monden and Uunk 2013). In addition to the psychological effects of union dissolution itself and the tension that may have preceded it, the authors aim here is to assess the degree to which separation-related changes in living conditions increase the risk of depression in men and women who have undergone separation.

Their data source is the two-wave (2006 and 2010) longitudinal Health and Occupational Trajectories survey (SIP) of a representative sample of the population of metropolitan France. The survey questionnaires collected information relevant to respondents’ health, including their conjugal situation and history and whether they had undergone a depressive episode. In 2010, questions were added on events that had occurred since 2006, including separation. The authors used a subsample of the survey: 3743 men and 3578 women aged 25 to 74 who reported living with a life partner in 2006. After finding correlations between separation (N = 205 separated women + 135 separated men) and major depressive episodes (MDE), they moved to take into account changes in income and social support. Mental health was assessed using the Mini International Neuropsychiatric Interview, a non-clinical questionnaire used to detect MDE through self-reported symptoms in the previous two weeks (Sheehan et al. 1998; Amorim et al. 1998). Specifically, the questionnaire presented a selection of seven symptoms that may have been felt; MDE is diagnosed if the respondent answers positively to at least four of the seven questions. Though such episodes are not a diagnosed mental health disorder, the MDE indicator has been validated and found to be a good predictor of major depressive episodes.

Results

The study confirms the correlation between separation and risk of MDE: the probability of self-reporting a depressive state in 2010 is greater among people living in a couple in 2006 who underwent union breakup between those two dates than among people still living in couple in 2010—a result that holds when differences in social, family, and health situations between the two groups are taken into account. For men, the probability of MDE decreases over time elapsed since separation; meanwhile, that probability increases with number of children living with them. For women, the probability of reporting an MDE is positively related to number of prior unions.

The study then confirms that the socioeconomic effects of separation vary by sex. While 60% of women who separated between 2006 and 2010 experienced a loss of income and 34% a gain, the proportions are reversed for men: 33% of separated men saw their living standard fall after separation and 60% saw it rise. Men’s support network shrinks more often than women’s (Kaljmin 2015).

Last, the study shows that mental health deterioration among separated women is partially explained by income loss (19.2% of the increase in MDE risk is related to a fall in living standards). This criterion is not relevant to men’s mental health; they tend instead to lose social support, though that loss only explains 5.5% of the increase in their risk of MDE.

A number of limitations in the data made it impossible to further pursue explanatory mechanisms. The data did not allow for identifying variations in effects by initial living conditions (position on the income distribution before separation, for example), for studying the effects of repartnering; or for studying improved health after separation (that is, separations that put an end to destructive couple relationships). Moreover, as there was no information on the timing of socioeconomic changes between the two survey waves, it was difficult to identify causalities (and their direction) between the different interwoven phenomena implicated in union dissolution, loss of social support or income and depression.

In spite of these limitations, the study shows that concomitance of those changes upon separation increases the risk of worsening mental health. And it brings to light different mechanisms by sex. Women on average have lower individual income, a fact related to the asymmetrical distribution of domestic and paid work activities between partners. This resource disparity within the couple means that women experience a post-separation fall in living standards more often than men (Bonnet et al. 2015a). The authors also show that in addition to the economic cost of separation itself, the fall in living standards experienced by women afterwards also adversely effects their mental health.

Table - Effect of separation on risk of reporting a major depressive episode (MDE) in 2010 and impact of social and economic changes during the period

References

Amorim, P., Lecrubier, Y., Weiller, E., Hergueta, T., & Sheehan, D. (1998). DSM-IH-R psychotic disorders: Procedural validity of the Mini International Neuropsychiatric Interview (MINI). Concordance and causes for discordance with the CIDI. European Psychiatry, 13(1), 26–34.

Sheehan, D. V., Lecrubier, Y., Harnett Sheehan, K., Amorim, P., Janavs, J., Weiller, E., et al. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59 (Supplement 20), 22–33.

Source: Anne-Lise Biotteau, Carole Bonnet, Emmanuelle Cambois, 2018, Risk of Major Depressive Episodes After Separation: The Gender-Specific Contribution of the Income and Support Lost Through Union Dissolution, European Journal of Population.

Contacts: Carole Bonnet, Emmanuelle Cambois

Online: December 2019