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  • Trajectories of antidepressant use before and after union dissolution and re-partnering in later life: a prospective total population register-based cohort study

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Original research
Trajectories of antidepressant use before and after union dissolution and re-partnering in later life: a prospective total population register-based cohort study
  1. Yaoyue Hu1,
  2. Niina Metsä-Simola2,
  3. Satu Malmberg2,
  4. Pekka Martikainen2,3,4
  1. 1 School of Public Health, Chongqing Medical University, Chongqing, China
  2. 2 Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
  3. 3 Max Planck Institute for Demographic Research, Rostock, Mecklenburg-Vorpommern, Germany
  4. 4 Max Planck – University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
  1. Correspondence to Professor Yaoyue Hu, School of Public Health, Chongqing Medical University, Chongqing, Chongqing, China; yaoyue.hu{at}cqmu.edu.cn

Abstract

Background Grey divorce and later remarriage have become increasingly common in high-income countries, but previous evidence on their impacts on mental health is scarce. Even less is known about the effects of non-marital separation and re-partnering in later life.

Methods Using Finnish registry data from 1996 to 2018 on 228 644 individuals aged 50–70 in 2000–2014, trajectories of antidepressant (AD) use 4 years before and 4 years after divorce, non-marital separation, bereavement and subsequent re-partnering were examined using individual fixed-effects (FE) linear probability models.

Results In adjusted FE models, for both genders AD use increased during the 4 years before divorce (men: 5.00 percentage points (95% CI 4.50 to 5.50); women: 6.96 (95% CI 6.34 to 7.59)), non-marital separation (men: 3.20 (95% CI 2.72 to 3.69); women: 5.98 (95% CI 5.30 to 6.66)) and bereavement (men: 4.53 (95% CI 3.97 to 5.09); women: 5.64 (95% CI 5.25 to 6.04)), with the increase accelerating immediately before the event. AD use gradually declined after union dissolution, after which it stabilised on a persistently higher level compared with pre-dissolution. Re-partnering was only associated with a small and transitory reduction in AD use (0.1–1.5 percentage points). The increases in AD use associated with union dissolution were larger in women than in men, whereas the small reductions in AD use associated with re-partnering were particularly short-lived among women.

Conclusions Our results suggest that union dissolution in later life is associated with large and persistent increases in AD use, whereas the reductions associated with re-partnering are limited both in magnitude and duration.

  • DEPRESSION
  • GERONTOLOGY
  • SOCIAL SCIENCES

Data availability statement

No data are available. The data that support the findings of this study are available from Statistics Finland and the Social Insurance Institution of Finland. Restrictions apply to the availability of these data, which were used under licence for this study.

https://doi.org/10.1136/jech-2023-221529

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    Data availability statement

    No data are available. The data that support the findings of this study are available from Statistics Finland and the Social Insurance Institution of Finland. Restrictions apply to the availability of these data, which were used under licence for this study.

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    Footnotes

    • YH and NM-S are joint first authors.

    • Contributors YH and NM-S conceptualised and designed the study. YH and NM-S accepted the full responsability for the work and the conduct of the study, has access to the data, and controlled the decision to publish. YH drafted the manuscript. SM analysed the data. PM supervised the work. All authors were involved in interpretation of the data and critically reviewed the manuscript. All authors approved the final manuscript.

    • Funding YH was supported by the Future Medical Youth Innovation Team Development Support Programme of Chongqing Medical University (#W0103). PM was supported by the European Research Council under the European Union’s Horizon 2020 Research and Innovation Programme (#101019329), the Strategic Research Council (SRC) within the Academy of Finland grants for ACElife (#352543-352572) and LIFECON (#308247), and grants to the Max Planck – University of Helsinki Center from the Jane and Aatos Erkko Foundation, the Max Planck Society, University of Helsinki, and Cities of Helsinki, Vantaa and Espoo.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.