Risk of new psychiatric episodes in the year following divorce in midlife: Cause or selection? A nationwide register-based study of 703,960 individuals

Aims: To examine if divorce is associated with an increased risk of psychiatric disorder. Methods: A register-based cohort study of all married or divorced individuals aged 45-54 in Sweden in 2006. After exclusion of 129,669 individuals with a history of psychiatric care in 1987-2005, we followed 703,960 persons for psychiatric disorder during 2007, measured as psychiatric inpatient care, outpatient care and use of psychotropic medication. Marital trajectories were taken into consideration. Data were analysed using Poisson regression. Results: Divorced women and men had a higher risk for psychiatric inpatient care compared to married (ORwomen = 3.2, 95%CI = 1.6-6.3, ORmen = 3.3, 95%CI = 2.0-5.4). The longer the marriage, the lower the risk for psychiatric disorders. Lower educational level increased the risk for psychiatric inpatient care. Conclusions: In conclusion, our study supports both the selection hypothesis, linking healthy individuals to long and stable marriages, and the social causation hypothesis, linking the stress of recent divorce to increased psychiatric disorder for both women and men.