Unmarried individuals are 80% more likely to experience depressive symptoms compared to their married counterparts

Unmarried individuals are 80% more likely to experience depressive symptoms compared to their married counterparts

The researchers suggest that the lower rates of depression among married couples may be due to the exchange of social support, greater access to economic resources and a positive influence on each other's well-being.

In a recently published study inNatures human behaviorA group of researchers examined the association between marital status and depressive symptoms in seven culturally diverse countries and examined the mediating effects of education level, gender, and substance use in this relationship.

background

Depression is a significant public health challenge with an estimated prevalence of 5% in adults, which will exceed over 10% by 2025 in the post-pandemic era. It is associated with various somatic conditions, disability and suicide, highlighting the need to identify modifiable risk factors.

While marital status is linked to mental health, most research has focused on Western countries, suggesting that marriage may protect against depression. Socioeconomic, cultural, and educational differences may influence these associations worldwide.

Further research is needed to examine the moderating factors and causal mechanisms influencing the association between marital status and depressive symptoms.

About the study

The present study used deidentified, nationally representative, individual-level data from seven culturally diverse countries, including the United States of America (US), United Kingdom (UK), Mexico, Korea, Ireland, China, and Indonesia, to examine the relationship between marital status and depressive symptoms.

In the first stage, a cross-sectional analysis was conducted using population-based data from various surveys, including a total of 106,556 participants after excluding those with missing data. The second stage involved a prospective longitudinal analysis focusing on causal mechanisms that included 20,865 participants after excluding those with incomplete baseline data or pre-existing depressive symptoms.

Marital status was divided into four groups based on self-reported status: married, divorced/separated, single, and widowed. Mediators such as alcohol consumption and smoking were assessed through self-administered questionnaires. Depressive symptoms were assessed using standardized instruments to ensure comparability across countries. Key covariates included age, gender, income, education level, and body mass index (BMI).

Statistical analyzes included measurement-weighted logistic regression and multivariate causal mediation analysis to determine associations and underlying mechanisms, using methods such as bootstrapping for validation. All analyzes were conducted using SAS, R, or Graphpad Prisma, with a significance threshold set at P < 0.05, highlighting the study's rigorous approach to examining complex relationships between marital status and mental health.

Study results

The present study integrated a two-stage design with cross-sectional and longitudinal analyses, involving a total of 106,556 participants from eight cohorts in seven countries. Of these, 49,547 were male and 22,490 people showed depressive symptoms. The proportion of participants reporting marital status varied across cohorts and was 64.3% in the National Health and Nutrition Examination (NHANES) cohort (USA) and 87.6% in the longitudinal study (China). In particular, educational law also differs in the states.

The longitudinal stage of the study included 20,865 participants, with an average follow-up duration of four years in the Korean Longitudinal Study of Aging Cohort (KLOSA) in the Wisconsin Longitudinal Study (WLS) cohort. During this period, 4,486 participants developed depressive symptoms.

Multivariable adjusted analysis revealed that unmarried individuals had a significantly higher risk of depressive symptoms compared to their married counterparts, with a pooled odds ratio (OR) of 1.86 across all cohorts. The analysis further examined subcategories of unmarried status and found increased risk of depressive symptoms for singles (OR: 1.79), divorced/separated (OR: 1.99), and widowed participants (OR: 1.64). These associations remained consistent across sensitivity analyses.

The study identified several moderators that influenced the association between marital status and depressive symptoms, including gender, country, and education level. Unmarried people in Western countries showed a higher risk of depressive symptoms compared to Easterners. In addition, men showed a higher risk of depressive symptoms related to marital status than women, especially among individuals. The relationship between marital status and depressive symptoms was strongest among participants with higher levels of education.

When examining causal mediators, the analysis revealed alcohol consumption and smoking as significant pathways linking marital status to depressive symptoms. For example, alcohol consumption mediated a notable portion of the risk among divorced/separated individuals in Korea, Mexico, and China. Similarly, smoking was identified as a significant causal pathway in individuals from Mexico and China. However, no significant mediation effects were observed among unmarried Americans or Irish.

Conclusions

In summary, results showed that unmarried individuals had a higher risk of depressive symptoms compared to married counterparts, with variations based on gender, country and education level.

In particular, alcohol consumption and smoking served as significant mediators of increased depressive symptoms among unmarried individuals in China, Korea, and Mexico. The study highlighted the influence of cultural and societal factors on mental health and the importance of these issues.

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