The Association Between Marital Transitions and the Onset of Major Depressive Disorder in a South Asian General Population

Background: Marriage in general is associated with better mental health in high-income industrialized countries, but it is unknown to what extent this is also the case in South Asia.

Methods: The Chitwan Valley Family Study (CVFS) in Nepal is a 24-year family panel study with a recent representative survey to investigate the association between sociodemographic changes and mental health (N = 10,516). We investigated timing of marital transitions and timing of onset of MDD in both male and female respondents, controlling for key confounders.

Results: In this setting the transition to marriage is associated with increased odds of subsequent MDD first onset (median OR=2.28). For female respondents, divorce (OR=2.68), early widowed (OR=11.25), and even getting married significantly increased the odds of subsequent MDD onset (OR=3.03). For male respondents, only becoming widowed increased the odds of subsequent MDD (OR=16.32), but marriage did not reduce the odds of MDD.

Limitations: Limitations of the study include large-scale protocol that may have resulted in underreporting of MDD and the exclusion of sub-threshold cases that may otherwise have qualified as a case in a clinical setting.

Conclusions: In the Nepalese general population, marital transitions increase the odds of subsequent depression, especially among the female population. Results provide basic but essential vital health data that can guide clinicians to proactively plan sustainable healthcare both within South Asia and among many South Asians living in other places.