Elsevier

Journal of Affective Disorders

Volume 223, 1 December 2017, Pages 65-68
Journal of Affective Disorders

The depression and marital status relationship is modified by both age and gender

https://doi.org/10.1016/j.jad.2017.06.007Get rights and content

Highlights

  • In terms of gender, the odds of depression was lower for females (vs men) who were single, widowed or separated.

  • Regarding age, the odds of depression showed a steady rise with increasing age for those in single and in common-law relationships. In contrast the odds of depression declined with age for those widowed, separated and divorced. The strength of the interaction terms showed no change from 1996 to 2013.

  • Use of large numbers of participants has revealed some robust modifying effects of both gender and age on the depression/marital status relationship. The clinical significance of our findings is that the vulnerability to development of depression is not only related to marital status, but that this relationship is modified by age and gender.

Abstract

Background

Marital status is associated with major depression prevalence, however, the strength of association may be modified by age and gender.

Methods

The data sources were a series of cross sectional national health surveys of the Canadian population carried out by Statistics Canada during 1996–2013. These were cross-sectional files from the National Population Health Survey of 1996, together with the Canadian Community Health Surveys from 2000 to 2013; the respondents were 18 years and older. The data was analyzed with meta-analytic techniques and logistic regression.

Results

In terms of gender, the odds ratios of depression were smaller for females (vs males) who were single, widowed or separated compared to married people. Regarding age, the odds ratios for depression showed a steady rise with increasing age for those in single and in common-law relationships compared to married people. In contrast the odds ratios for depression declined with age for those widowed, separated and divorced compared to married people. The strength of the interaction terms used to quantify these moderating effects showed no change from 1996 to 2013.

Limitations

Only one member of each household was included, so that relationship issues could not be studied. The generalizability of our findings requires international data. Also the diagnostic interviews used are not as accurate as clinical assessments.

Conclusion

Use of large numbers of participants has revealed some robust modifying effects of both gender and age on the depression/marital status relationship. The clinical significance of our findings is that the vulnerability to development of depression is not only related to marital status, but that this relationship is modified by age and gender.

Introduction

According to the Global Burden of Disease Study 2015 major depression is a leading cause of years lived with disability globally, coming third after lower back and neck pain, and sense organ diseases, respectively (GBD, 2015 Collaborators). Major depression can be the cause or the result of social, psychological and biological factors such as age and sex Studies have repeatedly shown that the prevalence of depression is higher in women than men worldwide (Kessler et al., 2015). In terms of age, the prevalence of depression decreases steadily with advancing age, and although depression is more prevalent in young women compared to men, this prevalence difference decreases with age and in no longer evident in people over 75 years old (Patten et al., 2016).

One key social factor that modifies depression is marital status, and research has repeatedly shown that married people have better mental health than those who are single, widowed, separated and divorced (Bebbington 1987; Jang et al., 2009; Bulloch et al., 2009; LaPierre, 2009). It has also been shown that the relationship between marital disruption and depression is bidirectional (Bulloch et al., 2009). That being married is protective for depression is not an exclusively Western phenomenon as depression is also relatively high in unmarried Japanese (Inaba et al., 2005). A meta-analysis of people > (or = ) 55 years old showed that being unmarried is a significant risk factor for depression in late life (Yan et al., 2011). However in Koreans aged 75–85 years no relationship between marital status and depression was found for women, whereas divorced and widowed men had higher rates of depressive symptoms than their married counterparts (Jang et al., 2009). Taken together these studies show that there is a complex relationship between age, sex, marital status and depression. In this study we examined how age and sex modify modify the association of marital status with major depression as an outcome. Interaction terms in regression models were used to quantify the modification observed, such that the term interaction is used in the remainder of this paper to refer to the resulting subgroup variations. Use of a very large data set enabled us to examine married and common-law categories separately, whereas these are usually combined in existing studies. Similarly we were able to study widowed, separated and divorced categories which are also often combined.

Section snippets

Methods

This study used the cross-sectional data files collected in an early cycle of the National Population Health Survey (1996), the general health surveys of the Canadian Community Health Survey (2000, 2003, 2005, 2007/2008, 2009/2010, 2011/2012 and 2013), plus the two mental health Canadian Community Health Survey of 2002 and 2012 (Table 1). These surveys used a complex multistage sampling procedure to obtain a representative sample of the Canadian population. First geographical clusters were

Results

First we performed a 1-step analysis on the pooled data from all 10 surveys. We were able to include all 5 categories of marital status (Table 2) and we calculated the odds ratios of depression in each category, and estimated the influence of sex and age. A significant interaction was found for age and sex (OR = 0.99, 95% CI 0.99–1.00) indicating that the effect of sex became weaker with age. Similarly significant interactions were found for all 5 marital statuses, providing statistical

Discussion

Here we report a series of interactions of age and sex with different categories of marital status. All of the interactions found in the initial 1-step analysis were reproduced in the 2-step analysis (Table 2) which helps to confirm their robustness. Since some of the latter have wider CIs they are more conservative and may be considered the principal findings of our study since the replicate sampling weights used in each estimate were unmodified and therefore may more effectively adjust for

Contributors

Authors Williams and Lavorato conducted the analysis of the Statistics Canada data. Authors Bulloch and Patten wrote the manuscript. All authors contributed to and have approved the final manuscript.

Role of funding

This work was supported by an operating grant from the Canadian Institutes of Health Research (MOP-130415), the Hotchkiss Brain Institute and the Alberta Mental Health and Addictions Strategic Clinical Network, none of whom had any involvement the planning or execution of the research.

Acknowledgements

The analysis was conducted at the Prairie Regional Data Centre, a part of the Canadian Research Data Centre Network (CRDCN). The services provided by the CRDCN are made possible by the financial or in-kind support of the SSHRC, the CIHR, the CFI, Statistics Canada and participating universities. The views expressed in this paper do not necessarily reflect the views of CRDCN or of its partners. This work was supported by an operating grant from the Canadian Institutes of Health Research (MOP-

References (14)

  • A. Inaba et al.

    Depression in the United States and Japan: Gender, marital status, and SES patterns

    Soc. Sci. Med.

    (2005)
  • S.-N. Jang et al.

    Marital status, gender, and depression: analysis of the baseline survey of the Korean longitudinal study of ageing (KLoSA)

    Soc. Sci. Med.

    (2009)
  • P. Bebbington

    Marital status and depression: a study of English national admission statistics

    Acta Psychiatr. Scand.

    (1987)
  • A.G.M. Bulloch et al.

    The relationship between major depression and marital disruption and is bidirectional

    Depression Anxiety

    (2009)
  • Global, regional, and national incidence, prevalence, and years lived with disability for 310 acute and chronic diseases and injuries in 188 countries, 1990–2015: a systematic analysis for the Global Burden of Disease Study

    Lancet

    (2015)
  • R.C. Kessler et al.

    The World Health Organization composite international diagnostic interview short-form (CIDI-SF)

    Int J. Methods Psychiatr. Res.

    (1998)
  • R.C. Kessler et al.

    The World mental health (WMH) survey initiative version of the World Health Organization (WHO) composite international diagnostic interview (CIDI)

    Int. J. Methods Psychiatr. Res.

    (2004)
There are more references available in the full text version of this article.

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