The effects of marriage and separation on the psychotropic medication use of non-married cohabiters: A register-based longitudinal study among adult Finns

Time patterns of external and alcohol-related mortality after marital and non-marital separation: the contribution of psychiatric morbidity

“…While among women adjustment for poor mental health 2 to 3 years before separation largely attenuated the postseparation excess suicide mortality, among men also poor mental health during and after separation attenuate excess mortality considerably. While among both Finnish men and women the prevalence of psychotropic medication use clearly increases before divorce and separation from long-term non-marital unions, 8 20 these changes in mental health during the separation process seem to be more important for the postseparation suicide risk of men. Among men, the suicide risk is also particularly high immediately after separation, whereas among women the decline in suicide risk continues for a longer time, suggesting that men may be more prone to commit suicide as an immediate reaction to the psychological strain of separation.…”

“…5 24 26 In addition, the prevalence of psychotropic medication use hardly changes at the time of separation from short-term non-marital cohabitation, while the changes in prevalence are quite similar before and after separation from long-term non-marital unions and marital divorce. 8 20…”

“…In Finland, most first unions start as non-marital cohabitations, and most of the unions that do not dissolve within 5 years turn into marriages. 17 Previous research among working-age Finns has shown that in long-term unions of at least 10 years, psychotropic medication use is uncommon in all union types, 8 20 suggesting that long-term commitment is important for mental health. In this study, the postseparation excess mortality was also higher after separation from first unions, and the greater stability of first unions as compared with later unions may also be an indicator of stronger commitment.…”

“…The 3-year threshold was chosen because short-term cohabitation is quite common among younger individuals, 17 and separation from these short-term unions has little effect on the levels of psychotropic medication use. 20 In contrast, longer non-marital unions are thought to resemble marital unions, and accordingly the changes in psychotropic medication prevalent are quite similar before and after formal divorce and separation from long-term non-marital unions. 8 20 Furthermore, we wanted to capture pre-separation psychiatric morbidity comprehensively over a relatively long period—up to 3 years before separation—and for shorter unions that would have reflected morbidity before even entering the union and thus not yet at risk of separation.…”

“…9 On the other hand, deterioration of mental health at the time of separation could increase postdivorce mortality since psychotropic medication prevalence has been shown to clearly increase at the time of marital divorce and separation from long-term non-marital cohabitation. 8 20 To our knowledge, only one prospective study based on the Health and Retirement Study (HRS) in the United States has examined how the emergence of depression predicts postdivorce mortality. 21 It showed that depression that emerged at the time of marital divorce predicted increased mortality, whereas depression that was already present before divorce did not have a similar effect.…”