Divorce and changes in psychiatric morbidity: register-based trajectories of psychotropic medication among middle-aged Finns

Niina Metsä-Simola, University of Helsinki
Pekka Martikainen, University of Helsinki

Background: The prevalence of psychiatric morbidity might change before and after divorce in a manner similar to psychological distress. We measure psychiatric morbidity with prescribed psychotropic medication, and examine changes in medication prevalence 5 years before and 5 years after divorce. Methods: We used population-registration data on 166,049 married Finns aged 25-64, of whom 23,956 divorced during 1995-2003. We divided time before and after the date of divorce into three-month intervals, and assessed the prevalence of psychotropic medication (ATC-codes N05 & N06 excluding NO6D) during each interval. These data were analyzed with repeated measures logistic regression using generalized estimating equations. We report changes in prevalence by sex, medication type and socio-demographic characteristics. Results: The average three-month prevalence of psychotropic medication was 7% among divorced men and 10% among divorced women. Compared to those whose marriage continued, men who eventually divorced had 1.57 and women 1.40-times higher odds for medication purchases already 3.5-5 years before divorce. Medication prevalence increased thereafter, the increase accelerating 2 years before divorce to 29% per year among men and 27% among women. The highest prevalence was reached 6-9 months before divorce. A decrease during the next 18 months followed, after which little change occurred. Largest pre- and post-divorce changes were observed in the purchases of antidepressants, and more so among those who were younger, employed, had high level of income or education, owned their home, or divorced from their first marriage. However, socio-economic resources had little mediating effect on the excess medication among the divorced. Conclusions: Pronounced psychiatric morbidity seems to be related to the process of divorce rather than to post-divorce disadvantage. Age and socio-economic factors moderate the effect divorce has on psychiatric morbidity, but excess medication among the divorced is not explained by socio-economic disadvantage, suggesting a need for psychological rather than socio-economic support.