Department of Community Health Sciences and Hotchkiss Brain Institute, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada T2N 4N1.
Depress Anxiety. 2009;26(12):1172-7. doi: 10.1002/da.20618.
Marital status is important to the epidemiology of psychiatric disorders. In particular, the high prevalence of major depression in individuals with separated, divorced, or widowed status has been well documented. However, the literature is divided as to whether marital disruption results in major depression and/or vise versa. We examined whether major depression influences changes of marital status, and, conversely, whether marital status influences the incidence of this disorder.
We employed data from the longitudinal Canadian National Population Health Survey (1994-2004), and proportional hazards models with time-varying covariates.
Major depression had no effect on the proportion of individuals who changed from single to common-law, single to married, or common-law to married status. In contrast, exposure to depression doubled the proportion of transitions from common-law or married to separated or divorced status (HR=2.0; 95% CI 1.4-2.9 P<0.001). Conversely an increased proportion of nondepressed individuals with separated or divorced status subsequently experienced major depression (hazard ratio, HR=1.3; 95% CI 1.0-1.5 P=0.04).
The high prevalence of major depression in separated or divorced individuals is due to both an increased risk of marital disruption in those with major depression, and also to the higher risk of this disorder in those with divorced or separated marital status. Thus a clinically significant interplay exists between major depression and marital status. Clinicians should be aware of the deleterious impact of major depression on marital relationships. Proactive management of marital problems in clinical settings may help minimize the psycho-social "scar" that is sometimes associated with this disorder.
婚姻状况对精神障碍的流行病学研究很重要。特别是，有分居、离婚或丧偶状况的个体中重度抑郁症的高发病率已有充分的文献记载。然而，关于婚姻破裂是否会导致重度抑郁症，以及反之是否会导致重度抑郁症，文献存在分歧。我们研究了重度抑郁症是否会影响婚姻状况的变化，以及反之婚姻状况是否会影响这种疾病的发病率。
我们使用了来自纵向加拿大国家人口健康调查（1994-2004 年）的数据，以及带有时间变化协变量的比例风险模型。
重度抑郁症对从单身到同居、从单身到已婚或从同居到已婚状态的个体比例没有影响。相反，暴露于抑郁症使从同居或已婚状态转为分居或离婚状态的比例增加了一倍（HR=2.0；95%CI 1.4-2.9 P<0.001）。相反，有分居或离婚状况的非抑郁个体随后经历重度抑郁症的比例增加（风险比，HR=1.3；95%CI 1.0-1.5 P=0.04）。
分居或离婚个体中重度抑郁症的高发病率归因于以下两个因素：患有重度抑郁症的个体中婚姻破裂的风险增加，以及离异或分居婚姻状况的个体中这种疾病的风险增加。因此，重度抑郁症和婚姻状况之间存在显著的相互作用。临床医生应该意识到重度抑郁症对婚姻关系的有害影响。在临床环境中积极管理婚姻问题可能有助于最大限度地减少与这种疾病相关的心理社会“创伤”。
