Women experience larger increase in antidepressant use after break-up than men, study suggests

By Dr. Liji Thomas, MDFeb 9 2024Reviewed by Danielle Ellis, B.Sc.

While both divorce and remarriage in later life are becoming more frequent, there is inadequate research on their effects on mental health. A new study in the Journal of Epidemiology and Community Health explored patterns of antidepressant use among Finnish adults aged 50–70 years experiencing divorce, separation from cohabitation, or bereavement, alongside usage trends before and after subsequent repartnering.

Background

Unlike earlier generations, older people are today more likely to divorce and remarry or pick up new partners. However, such relationships typically do not last as long as marital unions and repeated re-partnering is common in this subgroup.

About 10-15% of people above the age of 55 years have symptoms of clinical depression. Correlates of poor mental health have been identified, including divorce, non-marital separation, and partner death, but not much research deals with these factors in this population.

Existing studies indicate that older adults show increased signs of depression, clinical or otherwise, after a divorce. However, a US study showed that depressive symptoms began before the divorce, peaking with the divorce and slowly subsiding to pre-divorce levels over the next four years.

Other research indicates similar trends, though recovery in a UK study appeared to be considerably faster than in several US studies. However, all these did not separately examine depression and antidepressant use among couples who broke up while cohabiting. The effect of new relationships is also unclear, though some research in the US indicates that depressive symptoms are reduced with the formation of new partnerships, mostly among men.

The study is based on Finnish population registry data from 1996 to 2018. It included nearly 230,000 people between 50 and 70 years old in the years 2000-2014. The focus was on the use of antidepressants over a period extending four years before to four years after the end of any relationship, including by death and the subsequent formation of a new relationship.

What did the study show?

Of the large group, approximately a third each was bereaved, divorced, or separated from cohabiting partners between the ages of 50 and 70 years. Separations were likely to occur at earlier ages compared to bereavements, leading to differences in socioeconomic characteristics between these categories.

That is, separated people were more often employed, had more income, and lived with children compared to bereaved individuals. The latter were more likely to own their homes.

Following bereavement, less than 8% formed new relationships, vs. one in five after divorce. In contrast, almost half of those who left their cohabiting partners found new partners. Men were more likely to find new partners after bereavement or losing their live-in partners, a difference not so marked among divorcees. A larger income was correlated with a higher rate of finding new partners.

Both men and women had similar mean ages at the point of marital dissolution or forming new relationships.

After adjusting for potential confounders, the scientists found that both males and females used antidepressants significantly more during the four years preceding and succeeding relationship breakups.

When calculated as percentage points, the increase in divorce was five for men vs seven for women. With non-marital relationships, it was smaller, by three and four, respectively. Men who lost their partners increased antidepressant use by five, and women by six percentage points.

People were most likely to up their antidepressant use just before the end of the relationship, with a slow fall after that. The final extent of use was, however, on a sustained higher level compared to that before the event.

Even after forming new relationships, antidepressant use failed to return to the original level, with the fall by 0.1-1.5 percentage points being temporary. Women showed a larger increase in their antidepressant use than men and showed an extremely transient partial recovery after finding new partners.

While men showed a modest rise in use during the four years preceding separation from live-in partners, this declined to the level recorded one year before the event and stabilized. Women showed larger increases, but hardly any recovery following such separation, and use rates began to climb at a slower rate from year one onwards.

After a live-in partner breakup, antidepressant use declined slightly during the four years before re-partnering for both sexes. It began to rise again one year after re-partnering, for men, but in 6 months, for women.

Among bereaved couples, antidepressant use began to climb within the four years preceding the event, but especially fast among women. Men and women showed a steep rise in antidepressant use three months after losing their partners to death compared to 3 months before. A small decline in use occurred later, but it never returned to baseline.

After finding new partners post-bereavement, both sexes showed a drop in antidepressant use over the six months before to 6 months after this event. For women, this continued to rise thereafter.

With divorce, men and women began using more antidepressants over the four years before, peaking in the preceding six months. This was followed by a fall associated with divorce, though use rates remained higher than before divorce. With re-partnering, the trend continued to rise over the eight years before and after, with a break in the one year just before re-partnering for women. For men, this break lasted one year before and after re-partnering (the “honeymoon effect”).

What are the implications?

Both men and women suffered equal rates of depression, as reflected by antidepressant use following bereavement in later life. However, when separating from live-in partners, women showed twice as high increases in antidepressant use as men.

The authors suggest that losing one’s life partner may trigger a cascade of detrimental effects, including loss of income and social support that build up over time, and this appears particularly relevant to women who experience separation from their live-in partners relative to men in the same situation.

“The greater increases in [antidepressant] use associated with union dissolution among women in our study may indeed relate to the fact that the costs of union dissolution on mental health fall more heavily on women than men.”

More research is required to understand why forming new partnerships is helpful in reducing antidepressant use only among bereaved and separated live-in couples but not divorcees.