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-W. Bradford Wilcox
Associate Professor of Sociology, University of Virginia 

Divorced and Depressed—in Denver and Dijon

Bryce J. Christensen and Nicole M. King

Few mental conditions worry public-health officials more than that of depression. Indeed, when researchers from Harvard Medical School and the State University of New York at Stony Brook recently launched a global study of the problem, they strongly stressed its severity. After all, World Health Organization data identify “depression [as] the 4th leading cause of disability worldwide” and indicate (by extrapolation) that “by 2020, it will be the second leading cause.”

Nor does it surprise the Harvard and Stony Brook scholars that depression causes disability. “It is now well established,” they remark, “that MDD [Major Depressive Disorder] is significantly associated with a wide variety of chronic physical disorders, including arthritis, asthma, cancer, cardiovascular disease, diabetes, hypertension, chronic respiratory disorders, and a variety of chronic pain conditions.” Medical authorities, in fact, have “good reason to believe that MDD is a causal risk factor for at least some chronic physical disorders.” Consequently, the authors of the new study are justifiably concerned about the “costs of depression,” costs incident to the “increased prevalence” of chronic physical disorders caused by depression and “all their associated financial costs, impairments, and increased mortality risk.” These are unquestionably costs of “considerable individual and public health significance.”

In order to assess “the prevalence, course, socio-demographic correlates, and societal costs of major depression throughout the world,” the Harvard and Stony Brook scholars review epidemiological data collected by the World Health Organization in eighteen countries. These countries included nations with high income (the United States, France, Germany, New Zealand, Israel, Italy, Belgium, Spain, the Netherlands, and Japan) and nations with low-middle income (Brazil, Mexico, China, Lebanon, Ukraine, Columbia, India, and South Africa).

The researches note marked differences in the prevalence of depression in this culturally diverse range of countries. Interestingly, the data indicate that incidence of “lifetime MDE [Major Depressive Episode] runs “higher in surveys carried out in high income (28.1%) than low-middle income (19.8%) countries,” with “the highest prevalence estimates found in some of the wealthiest countries in the world” (including the United States). The researchers quite plausibly invoke the idea that “depression is to some extent an illness of affluence.”

But the researchers also establish that some aspects of depression—including age of onset and persistence—are “quite consistent across countries.” What is more, “evidence for a wide range of adverse effects of major depression has also been found consistently across countries.”

As they seek to identify the circumstances that might incubate depression, the researchers also highlight “a number of consistent socio-demographic correlates [that] have . . . been found across countries.” Among these correlates, marital status merits particularly close attention. “Marital status,” remark the researchers, “was consistently associated with MDE in the [World Health Organization] surveys.”

Still, marital status predicts vulnerability to depression somewhat differently in more affluent countries than it does in poorer countries. “Overall,” the researchers conclude, “the association between marital status and MDE differed significantly between high and low-middle income countries due to stronger associations of being separated and never married with MDE in high income countries and stronger associations of being divorced and widowed with MDE in low-middle income countries.”

Interestingly, though, when the researchers set widowhood next to divorce and separation, they find that “being widowed, in comparison, was less consistently and more modestly associated with MDE”—except (curiously) in Ukraine. In most places, it seems, losing a spouse through divorce is harder on the psyche than losing a spouse to death.

As they reflect on their findings, the researchers acknowledge that marital status is “typically considered [one of the] predictors of depression.” They conjecture, however, that the relationship between depression and marital statuses might be more complex. Perhaps, the researchers speculate, unfavorable marital statuses are actually “consequences [of depression] or involved in reciprocal causal relationships.” In other words, depression might mark people as poor candidates for marriage in the first place or might expose those who are married to greater risk of divorce; then, failure to marry or to stay married might make depressed men and women all that much more vulnerable to even deeper depression.

Researchers will no doubt continue to delve into the tangled relationship between depression and marital status. But it is already clear that in a world where divorce rates are high and marriage rates are falling, psychologists will not lack for work.

(Ronald C. Kessler and Evelyn J. Bromet, “The Epidemiology of Depression across Cultures,” Annual Review of Public Health 34 [2013]: 119-38.)