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Abstract

Getting divorced directly and indirectly affects men's biological, psychological, social, and even spiritual health. For example, divorced men have higher rates of mortality, substance abuse, depression, and lack of social support. In this case report we review current literature on the sequelae of divorce on men's health, and highlight key features of divorce from a multi-disciplinary lens using the example of a 45-year-old male from the authors’ clinical practice. We provide assessment and treatment recommendations for care providers according to current clinical guidelines, and conclude with a detailed discussion of the case resolution.

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... For example, men in this situation are twice as likely to experience depression compared to women, possibly in part due to men's greater reliance on their spouse's network for social support than vice versa (Rotermann, 2007). Compared to married men, divorced men are significantly more prone to depression, suicide, substance abuse and heart disease (Felix et al., 2013). An estimate based on a large US database is that divorced men are at nine times higher risk of suicide than divorced women, even after taking into account age, education and income (Kposowa, 2003). ...
... Previous research has found that individuals who are divorced or separated are more prone to health problems related to chronic stress (Chen et al., 2014). Divorced men are significantly more prone to depression, suicide, substance abuse and heart disease than married men (Felix et al., 2013). In the present study, physical health problems were moderately correlated (rs between .3 and .5) ...
Article
It is known that family breakdown and divorce are stressful for all parties. There is evidence these can even lead to suicide, especially in men. However it is not known how much various factors – such as child access restrictions and family court issues – cause stress, and whether the levels of stress change over time. The present study surveyed the experiences of 29 men who had separated from their partners. Participants submitted multiple reports (n = 408 for the whole sample) over a 12-month period. It was found that these reports included 358 stressful experiences related to child access problems, and 229 stressful experiences related to family court issues. Men’s mental well-being, measured using the Positive Mindset Index, was continuously low – just above clinical levels on average – throughout the 12-month period. Mental well-being was strongly negatively correlated to problems with child access (rs = –.571) and family court issues (rs = –.448). These correlations can be interpreted in the context of free text responses, which indicate that child access issues and family court issues had a negative impact on men’s mental well-being. Physical health problems were frequently reported too. Implications of these findings for the long-term mental health and physical health of men experiencing family breakdown are discussed in relation to the need for the family courts, and associated services, to recognise the chronic stress experienced by many men who find themselves in this predicament, and to ensure that court processes are resolved as swiftly as possible.
... Numerous studies shows that, in this transition, people may experience significant difficulties and diverse symptomatology, one of the most reported being depression (Akter and Begum 2012;Breslau et al. 2011;Faye et al. 2013;Felix et al. 2013;Simó-Noguera et al. 2015;Stack and Scourfield 2015;Symoens et al. 2014;Taylor and Andrews 2009;Wang et al. 2015). Even in general population research, divorce/ separation has been reported as a risk factor for depression (Dillard et al. 2012;Kaji et al. 2010;Leiderman et al. 2012;Lucht et al. 2003;Rancans et al. 2014;Szádóczky et al. 1998;Taylor et al. 2012;Wilhelm et al. 2003) and for the use of antidepressant, anxiolytic and hypnotic drugs (Colman et al. 2008;Monden et al. 2015). ...
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Previous studies have described the increase in depressive symptoms in divorced and separated individuals. However, the factors associated with depression have been little explored in this particular context. The aim of the present study was to assess the degree to which difficulties in emotional regulation are associated with depressive symptomatology in divorced and separated individuals. A sample of 1189 Chilean individuals, separated or divorced, completed self-reported measures of difficulties in emotional regulation and depression. The results obtained allow us to conclude that difficulties in emotional regulation, over other individual factors, such as early risk situations or circumstances of separation, are associated with higher rates of depression in men and women, explaining 41% of the variance of the depressive symptomatology. Emotional regulation difficulties are associated with greater depressive symptomatology in divorced/separated individuals. We discuss the clinical implications of these results, as well as future lines of research.
... 50 Evidence suggests that loss of custody and a negative experience in family court are some of the most stressful aspects of divorce for men and have been implicated in both substance abuse and suicide. 51 Like employment loss, loss of custody can leave many men feeling bereft of purpose and meaning in life. ...
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Numerous scholars have stated that there is a silent crisis in men’s mental health. In this article, we aim to provide an overview of core issues in the field of men’s mental health, including a discussion of key social determinants as well as implications for mental health services. Firstly, we review the basic epidemiology of mental disorders with a high incidence and prevalence in men, including suicide and substance use disorder. Secondly, we examine controversies around the low reported rates of depression in men, discussing possible measurement and reporting biases. Thirdly, we explore common risk factors and social determinants that may explain higher rates of certain mental health outcomes in men. This includes a discussion of 1) occupational and employment issues; 2) family issues and divorce; 3) adverse childhood experience; and 4) other life transitions, notably parenthood. Fourthly, we document and analyze low rates of mental health service utilization in men. This includes a consideration of the role of dominant notions of masculinity (such as stubbornness and self-reliance) in deterring service utilization. Fifthly, we note that some discourse on the role of masculinity contains much “victim blaming,” often adopting a reproachful deficit-based model. We argue that this can deflect attention away from social determinants as well as issues within the mental health system, such as claims that it is “feminized” and unresponsive to men’s needs. We conclude by calling for a multipronged public health–inspired approach to improve men’s mental health, involving concerted action at the individual, health services, and societal levels.
... Even though divorce is more accepted than it used to be, it is among life crises that entail major losses and grief. Many feelings divorced people have are shared by those who experience the death of a loved one, in addition to social crises, such as a sharp decline in self-esteem, which makes it more difficult for them 45 to adjust to their new social, marital, and economic status ( Amato, 2014;Felix, Robinson, & Jarzynka, 2013). Divorce and separation are severe life crises that an individual might encounter and can cause many psychological, social, and physical consequences, as well as emotional changes ( Pledge, 1992). ...
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This study was an attempt to determine the factor structure, reliability, validity, and adaptation of the Fisher Divorce Adjustment Scale (FDAS) for Iranian divorced individuals. The primary rationale for this study was the lack of such an instrument in an Iranian context to help researchers and therapists determine postdivorce adjustment and distinguish those in need of receiving psychological help. Participants of this study were 486 individuals (49.5% men, 50.5% women) who were divorced and were selected from the available population. Participants were asked to complete a sociodemographic questionnaire, the FDAS (Fisher, 1978), the Satisfaction With Life Scale (SWLS; Diener, Emmons, Larsen, & Griffin, 1985), and the General Health Questionnaire (GHQ; Ghanbarnejad & Turki, 2013). The results showed that the internal consistency of FDAS using Cronbach’s alpha was .93 and the split-half coefficient was .89, indicating fine consistency. Also, the internal consistency of FDAS subscales measuring self-worth, disentanglement from the ex-partner, anger, grief, social trust, and social self-worth was .81, .86, .89, .88, .86, and .69, respectively, using Cronbach’s alpha. Data analysis shows an adequate convergent validity with the SWLS and GHQ. It can be concluded that the FDAS has an acceptable factor structure, reliability, and validity, and can be used in Iran and other Persian-speaking countries.
... Divorced men have higher rates of mortality, substance abuse, depression, and lack of social support. (5) Many reported that there is no help for men facing domestic violence from their female partner as there is no law to protect them. If they sought to complain it to the police, they were ridiculed and sent back or much worse harassed by a counter complaint, and the male victim is arrested instead of the female perpetrator. ...
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Using ecosystemic theory, we evaluated marital satisfaction among 501 married individuals living in Northern Cyprus by analyzing socio-economic, attitudinal, psychological, contextual, and relationship-specific factors. In addition, we tested whether the correlates of marital satisfaction vary between men and women. Using ordered logistic regression analysis, we found that relationship-specific indicators are the most important correlates of marital satisfaction. Specifically, higher levels of marital interaction and sexual satisfaction, no presence of physical and verbal aggression, higher satisfaction with the division of household labor, and better communication with one’s spouse are significantly and positively correlated with higher marital satisfaction. In addition, respondents who were born in Northern Cyprus report higher marital satisfaction compared to immigrants, whereas those who have been married at least once before and those with poor mental health report significantly lower marital satisfaction. When we test differences in the correlates of marital satisfaction between males and females, the results suggest that among women only, native North Cypriots report higher marital satisfaction than immigrants do.
Article
The research dealt with adjustment to divorce among men who immigrated to Israel from Ethiopia versus Israeli-born men. In addition, we examined whether there were differences between the two groups of divorcés with regard to coping resources that explain adjustment to divorce. Three types of resources were examined: personal resources (level of education, and self-assessed income); interpersonal resources (quality of the relationship with the ex-spouse, the existence of a new romantic relationship, and the fathers’ involvement in their children's lives); and environmental resources (formal and informal social support). Adjustment in the dimension of self-acceptance of divorce was lower among the Ethiopian immigrant men than among their Israeli-born counterparts. The Israeli-born men were found to be more involved in their children's lives than the Ethiopian immigrants.
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Using panel data from the National Survey of Families and Households (n = 844), we examine the impact of divorce on father-child relationship quality and fathers' psychological well-being, the extent to which the residence of a focal child moderates these associations, and how changes in the quality of the father-child relationship over time affect fathers ' psychological well-being. Results indicate that the effect of divorce on the quality of the father-child relationship and fathers ' psychological well-being is moderated by the residence of children. Divorce is associated with lower relationship quality only for nonresident fathers and is associated with a decline in happiness for coresident fathers. Divorced fathers are more depressed than their married counterparts, regardless of child residence. Changes in relationship quality do not significantly influence fathers' psychological well-being.
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This study examined the effects of marital dissolution on two potential outcomes, relapse into and recovery from major depression, within a sample that explicitly faces the recurring risk of depression. Among subjects who were depressed at the time of marital dissolution, Cox proportional hazards models revealed a five-fold increased probability of recovering from major depression for subjects who experienced a separation/ divorce relative to subjects who did not separate/divorce. Among subjects who were remitted/recovered at the time of marital dissolution, analyses did not reveal a significant prob- ability of relapsing into major depression following a separ- ation/divorce. These findings suggest that among individuals with a history of major depression and marital stressors, experiencing a separation/divorce may function to alleviate rather than precipitate depression.
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Most adults in a community sample (N = 150; ages 25-56) perceived their top 10 strivings as being connected to God (theistic sanctification) and having sacred, transcendent qualities (nontheistic sanctification), with highest ratings given to religious goals, family relationships, altruistic endeavors, and existential concerns. Greater sanctification of strivings correlated positively with the importance, commitment, longevity, social support, confidence, and internal locus of control of strivings. Based on 5 phone interviews about the prior 48 hr, people invested more time and energy in their 2 most highly sanctified strivings than their 2 least sanctified strivings. Greater sanctification of strivings related to a greater sense of life purpose and meaning and joy yielded by strivings but not fewer psychological or physical health difficulties.
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This article develops a series of hypotheses about the long-term effects of one's history of marriage, divorce, and widowhood on health, and it tests those hypotheses using data from the Health and Retirement Study. We examine four dimensions of health at mid-life: chronic conditions, mobility limitations, self-rated health, and depressive symptoms. We find that the experience of marital disruption damages health, with the effects still evident years later; among the currently married, those who have ever been divorced show worse health on all dimensions. Both the divorced and widowed who do not remarry show worse health than the currently married on all dimensions. Dimensions of health that seem to develop slowly, such as chronic conditions and mobility limitations, show strong effects of past marital disruption, whereas others, such as depressive symptoms, seem more sensitive to current marital status. Those who spent more years divorced or widowed show more chronic conditions and mobility limitations.
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Although the meanings and rates of being married, divorced, separated, never-married, and widowed have changed significantly over the past several decades, we know very little about historical trends in the relationship between marital status and health. Our analysis of pooled data from the National Health Interview Survey from 1972 to 2003 shows that the self-rated health of the never-married has improved over the past three decades. Moreover, the gap between the married and the never married has steadily converged over time for men but not for women. In contrast, the self-rated health of the widowed, divorced, and separated worsened over time relative to the married, and the adverse effects of marital dissolution have increased more for women than for men. Our findings highlight the importance of social change in shaping the impact of marital status on self-reported health and challenge long-held assumptions about gender, marital status, and health.
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When politicians point to the high social costs and taxpayer burden imposed by disintegrating `family values they overlook the fact that individuals do not simply make the decisions that lead to unwed parenthood marriage or divorce on the basis of what is good for society. They weigh the costs and benefits of each of these choices to themselves--and sometimes their children. But how much do individuals know about these costs and benefits? I think that we as demographers have something to contribute here. As individual researchers we investigate the relationship between marriage and longevity wealth earnings or childrens achievements but we rarely try to pull all this evidence together. I would like to argue that we have an opportunity and an obligation to do that and to tell people what their decisions about marriage and family potentially mean for them as individuals. That is my objective here. (EXCERPT)
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The purpose of this study was to determine prospectively the optimal length of therapy in a long-term, placebo-controlled continuation study of patients who responded to acute fluoxetine treatment for major depression (defined by DSM-III-R). The study was conducted at five outpatient psychiatric clinics in the United States. Patients who met criteria for remission after 12 or 14 weeks of open-label acute fluoxetine therapy, 20 mg/day (N=395 of 839 patients), were randomly assigned to one of four arms of a double-blind treatment study (50 weeks of placebo, 14 weeks of fluoxetine and then 36 weeks of placebo, 38 weeks of fluoxetine and then 12 weeks of placebo, or 50 weeks of fluoxetine). Relapse rate was the primary outcome measure. Both Kaplan-Meier estimates and observed relapse rates were assessed in three fixed 12-week intervals after double-blind transfers from fluoxetine to placebo at the start of the double-blind period and after 14 and 38 weeks of continued fluoxetine treatment. Relapse rates (Kaplan-Meier estimates) were lower among the patients who continued to take fluoxetine compared with those transferred to placebo in both the first interval, after 24 total weeks of treatment (fluoxetine, 26.4%; placebo, 48.6%), and the second interval, after 38 total weeks of treatment (fluoxetine, 9.0%; placebo, 23.2%). In the third interval, after 62 total weeks of treatment, rates were not significantly different between the groups (fluoxetine, 10.7%; placebo, 16.2%). Patients treated with fluoxetine for 12 weeks whose depressive symptoms remit should continue treatment with fluoxetine for at least an additional 26 weeks to minimize the risk of relapse.
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Depression is one of the most common mental disorders in Western countries and is related to increased morbidity and mortality from medical conditions and decreased quality of life. The sociodemographic factors of age, gender, marital status, education, immigrant status, and income have consistently been identified as important factors in explaining the variability in depression prevalence rates. This study evaluates the relationship between depression and these sociodemographic factors in the province of Ontario in Canada using the Canadian Community Health Survey, Cycle 1.2 (CCHS-1.2) dataset. The CCHS-1.2 survey classified depression into lifetime depression and 12-month depression. The data were collected based on unequal sampling probabilities to ensure adequate representation of young persons (15 to 24) and seniors (65 and over). The sampling weights were used to estimate the prevalence of depression in each subgroup of the population. The multiple logistic regression technique was used to estimate the odds ratio of depression for each sociodemographic factor. The odds ratio of depression for men compared with women is about 0.60. The lowest and highest rates of depression are seen among people living with their married partners and divorced individuals, respectively. Prevalence of depression among people who live with common-law partners is similar to rates of depression among separated and divorced individuals. The lowest and highest rates of depression based on the level of education is seen among individuals with less than secondary school and those with "other post-secondary" education, respectively. Prevalence of 12-month and lifetime depression among individuals who were born in Canada is higher compared to Canadian residents who immigrated to Canada irrespective of gender. There is an inverse relation between income and the prevalence of depression (p < 0.0001). The patterns uncovered in this dataset are consistent with previously reported prevalence rates for Canada and other Western countries. The negative relation between age and depression after adjusting for some sociodemographic factors is consistent with some previous findings and contrasts with some older findings that the relation between age and depression is U-shaped. The rate of depression among individuals living common-law is similar to that of separated and divorced individuals, not married individuals, with whom they are most often grouped in other studies.
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The latest theory and research on understanding posttraumatic stressand its treatment, providing evidence-based clinical interventionsusing techniques drawn from positive psychology It is known that exposure to stressful and traumatic events can have severe and chronic psychological consequences. At the same time-mindful of the suffering often caused by trauma-there is also a growing body of evidence testifying to posttraumatic growth: the positive psychological changes that can result for survivors of trauma. Blending these two areas of research and exploring the relevance of positive psychology to trauma practice, Trauma, Recovery, and Growth: Positive Psychological Perspectives on Posttraumatic Stress provides clinicians with the resources they need to implement positive psychology interventions in their trauma treatment across a spectrum of?therapeutic perspectives, including cognitive-behavioral, psychodynamic, humanistic, existential, and group therapies. Featuring contributions by internationally renowned researchers and practitioners and edited by experts in the field of positive psychology who have worked with survivors of trauma in the facilitation of their resilience, recovery, and growth, this timely book is divided into four parts: • Toward an Integrative Positive Psychology of Posttraumatic Experience • Growth and Distress in Social, Community, and Interpersonal Contexts • Clinical Approaches and Therapeutic Experiences of Managing Distress and Facilitating Growth • Beyond the Stress-Growth Distinction: Issues at the Cutting Edge of Theory and Practice.
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We examined the impact of parental death and divorce prior to age 17 on physical and mental wellbeing in a national probability sample of middle-aged adults. The results suggest that, for men, parental divorce was associated with less positive relations with others, less self-acceptance, lower environmental mastery, and greater depression. Parental divorce predicted higher levels of physical health problems for both men and women. This relationship was mediated by income, education, drug use, and family support and was greater for men than women. Parental death predicted more autonomy for men and a higher likelihood of depression for women. The results contribute to understanding the developmental pathways involved in linking early life experiences to adulthood outcomes.
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How does the family affect the health of its adult members? It is in the family that the macro-level social and economic order affects individual physical and emotional well-being. This review presents a general model of understanding family and health that describes patterns of well-being, and then asks, "what explains these patterns?" Explanations are found in causal chains, conditional effects, and "structural amplification." The review summarizes and synthesizes ideas and findings about four factors: marriage and parenthood (which define the family), and the wife's or mother's employment and the family's social status (which connect it to the larger social order). Overall, the married are in better health than the nonmarried, but parents are not better off than nonparents. Women's employment and high family socioeconomic status tend to be associated with good physical and psychological health. Under what circumstances are these basic patterns found, and what explains these patterns—what links structure to individual health? Economic well-being and social support are considered as the basic explanations. Concluding comments point to the need for more studies of the impact of family on the sense of control, which could be an important link to health.
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This study investigates the relationship between health and marital status, focusing particularly on older persons, using data on reported long-term illness rates from the Samples of Anonymised Records (SARs) drawn from the British Census. Until about age 70, long-term illness rates are generally lowest for those in first marriage, followed by the remarried, with intermediate values for the widowed and divorced, and highest for the single. Beyond age 75 for both sexes, single people in the private household population report the lowest illness rates, but when the institutionalized population is included single people at older ages no longer appear to be the healthiest group. This is because at older ages increasingly high proportions of those with long-term illness are in institutions, disproportionately so for single people, explaining why such cross-overs have been found in analyses of private household populations. The health status of co-habiters is generally closer to the married than to other groups for both sexes.
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The impact of divorce on children has been well documented over the past 30 years. Divorcing parents who are also experiencing clinical depression often have a compromised ability to parent well and to give the children needed support. Children are then impacted both by the divorce itself and the effects of parental depression. They are at higher risk of numerous problems including poorer physical health, deficits in academic performance not attributable to intellectual limitations, poor social functioning, conduct disorder and other disruptive behavior problems, phobias, and other anxiety disorders. Because children of depressed parents are at higher risk for depression themselves, they should be monitored for depressive symptoms. If there are concerns, the child should be assessed by a mental health professional.
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Major stressful life events, particularly those that have chronic hardships, create a crisis for families that often leads to reorganization in the family's style of functioning. A major factor in this reorganization is the meaning the family gives to the stressful event. Often the meaning extends beyond the event itself and leads to a changed view of the family system and even to a changed view of the world. Building on other family stress models, we elaborate the family's definition of the stressor into three levels of family meanings: (1) situational meanings, (2) family identity, and (3) family world view. Examples from clinical work and studies of families adapting to chronic illness are used to illustrate the relationship between these three levels of meaning, particularly as they change in response to crisis. Implications for clinical and empirical work are discussed.
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This study examined the role of three spiritual responses to divorce for psychological adjustment: appraising the event as a sacred loss/desecration, engaging in adaptive spiritual coping, and experiencing spiritual struggles. A sample of 100 adults (55% female) was recruited through public divorce records. Most appraised their divorce as a sacred loss/desecration (74%), experienced spiritual struggles (78%), and engaged in adaptive spiritual coping (88%). Appraisals of sacred loss/desecration and spiritual struggles were tied to higher levels of depression. Adaptive spiritual coping was tied to greater posttraumatic growth. Spiritual coping and struggles each contributed uniquely to adjustment beyond parallel forms of nonspiritual coping and struggles and mediated links between viewing the divorce as a sacred loss/desecration and depression.
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I use a divorce-stress-adjustment perspective to summarize and organize the empirical literature on the consequences of divorce for adults and children. My review draws on research in the 1990s to answer five questions: How do individuals from married and divorced families differ in well-being? Are these differences due to divorce or to selection? Do these differences reflect a temporary crisis to which most people gradually adapt or stable life strains that persist more or less indefinitely? What factors mediate the effects of divorce on individual adjustment? And finally, what are the moderators (protective factors) that account for individual variability in adjustment to divorce? In general, the accumulated research suggests that marital dissolution has the potential to create considerable turmoil in people's lives. But people vary greatly in their reactions. Divorce benefits some individuals, leads others to experience temporary decrements in well-being, and forces others on a downward trajectory from which they might never recover fully. Understanding the contingencies under which divorce leads to these diverse outcomes is a priority for future research.
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Based on the literature on divorce, this paper explores the distinct ways in which men mourn the losses inherent in the breakup of a marriage. It argues that men have a distinct way of mourning that differs from that of women. They start the mourning process later than women, mourn the loss of their home and children more than the loss of their wives, and tend to express their mourning through actions rather than in words or obvious emotional manifestations of grief. The paper considers possible reasons for these behaviors and their implications for practitioners.
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Objective. This article addresses the relationship between suicide mortality and family structure and socioeconomic status for U.S. adult men and women. Methods. We use Cox proportional hazard models and individual-level, prospective data from the National Health Interview Survey Linked Mortality File (1986–2002) to examine adult suicide mortality. Results. Larger families and employment are associated with lower risks of suicide for both men and women. Low levels of education or being divorced or separated, widowed, or never married are associated with increased risks of suicide among men, but not among women. Conclusions. We find important sex differences in the relationship between suicide mortality and marital status and education. Future suicide research should use both aggregate and individual-level data and recognize important sex differences in the relationship between risk factors and suicide mortality—a central cause of preventable death in the United States.
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( This reprinted article originally appeared in Science, 1977, Vol 196[4286], 129–236. The following abstract of the original article appeared in PA, Vol 59:1423. ) Although it seems that acceptance of the medical model by psychiatry would finally end confusion about its goals, methods, and outcomes, the present article argues that current crises in both psychiatry and medicine as a whole stem from their adherence to a model of disease that is no longer adequate for the work and responsibilities of either field. It is noted that psychiatrists have responded to their crisis by endorsing 2 apparently contradictory positions, one that would exclude psychiatry from the field of medicine and one that would strictly adhere to the medical model and limit the work of psychiatry to behavioral disorders of an organic nature. Characteristics of the dominant biomedical model of disease are identified, and historical origins and limitations of this reductionistic view are examined. A biopsychosocial model is proposed that would encompass all factors related to both illness and patienthood. Implications for teaching and health care delivery are considered.
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Major stressful life events, particularly those that have chronic hardships, create a crisis for families that often leads to reorganization in the family's style of functioning. A major factor in this reorganization is the meaning the family gives to the stressful event. Often the meaning extends beyond the event itself and leads to a changed view of the family system and even to a changed view of the world. Building on other family stress models, we elaborate the family's definition of the stressor into three levels of family meanings: (1) situational meanings, (2) family identity, and (3) family world view. Examples from clinical work and studies of families adapting to chronic illness are used to illustrate the relationship between these three levels of meaning, particularly as they change in response to crisis. Implications for clinical and empirical work are discussed.
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The authors examined the effect of patients' style of clinical presentation on primary care physicians' recognition of depression and anxiety. The subjects were 685 patients attending family medicine clinics on self-initiated visits. They completed structured interviews assessing presenting complaints, self-report measures of symptoms and hypochondriacal worry, the Diagnostic Interview Schedule (DIS), and the Center for Epidemiologic Studies Depression Scale (CES-D). Physician recognition was determined by notation of any psychiatric condition in the medical chart over the ensuing 12 months. The authors identified three progressively more persistent forms of somatic presentations, labeled "initial," "facultative," and "true" somatization. Of 215 patients with CES-D scores of 16 or higher, 80% made somatized presentations; of 75 patients with DIS-diagnosed major depression or anxiety disorder, 76% made somatic presentations. Among patients with DIS major depression or anxiety disorder, somatization reduced physician recognition from 77%, for psychosocial presenters, to 22%, for true somatizers. The same pattern was found for patients with high CES-D scores. In logistic regression models education, seriousness of concurrent medical illness, hypochondriacal worry, and number of lifetime medically unexplained symptoms each increased the likelihood of recognition, while somatized presentations decreased the rate of recognition. While physician recognition of psychiatric distress in primary care varied widely with different criteria for recognition, the same pattern of reduction of recognition with increasing level of somatization was found for all criteria. In contrast, hypochondriacal worry and medically unexplained somatic symptoms increased the rate of recognition.
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An observational study of 648 routine medical visits with 69 physicians examined patient gender in relation to patient and physician communication, patient preference for the physician's communication style, patient satisfaction, and the physician's awareness of the patient's satisfaction. Data consisted of audiotapes as well as patient and physician questionnaires. Women appeared to be more actively engaged in the talk of medical visits--they sent and received more emotionally charged talk and were judged by independent raters as more anxious and interested both globally and in terms of voice quality than men. Consistent with the more emotional talk, women reported preferring a more "feeling-oriented" physician than male patients did. Mean levels of satisfaction with communication did not differ by gender, and communication predictors of satisfaction were similar for male and female patients, although they were stronger for male patients. Physicians were significantly less aware of some aspects of female patients' satisfaction compared to male patients' satisfaction. In light of the weaker correlations between patients' communication and their satisfaction for women, we suggest that women provided fewer obvious cues to their satisfaction. Training in communication skills may increase open discussion about feelings and emotions and may also produce greater physician sensitivity to patients' satisfaction, particularly with female patients.
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In this paper, we examine whether people's beliefs about the permanence, desirability, and importance of marriage moderate the impact of marital transitions--including marital losses and gains--on depression, a disorder associated with both marital status and role transitions. Using two waves of panel data from the National Survey of Families and Households (N = 10,005), we find that a marital loss results in increased symptoms, whereas a marital gain results in decreased symptoms. We also find, however, that the negative effects of a marital loss are greater for people who believe in the permanence of marriage than they are for those who do not. Conversely, the positive effects of a marital gain are greater for people who believe in the desirability and importance of marriage than they are for those who do not. Our results highlight the potential utility of more systematically incorporating people's beliefs--and sociocultural factors more generally--into theory and research on the impact of stressors on mental health.
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This review focuses on the pathway leading from the marital relationship to physical health. Evidence from 64 articles published in the past decade, particularly marital interaction studies, suggests that marital functioning is consequential for health; negative dimensions of marital functioning have indirect influences on health outcomes through depression and health habits, and direct influences on cardiovascular, endocrine, immune, neurosensory, and other physiological mechanisms. Moreover, individual difference variables such as trait hostility augment the impact of marital processes on biological systems. Emerging themes in the past decade include the importance of differentiating positive and negative dimensions of marital functioning, the explanatory power of behavioral data, and gender differences in the pathways from the marital relationship to physiological functioning. Contemporary models of gender that emphasize self-processes, traits, and roles furnish alternative perspectives on the differential costs and benefits of marriage for men's and women's health.
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From the viewpoint of quality of care, doctor-patient communication has become more and more important. Gender is an important factor in communication. Besides, cultural norms and values are likely to influence doctor-patient communication as well. This study examined (1). whether or not communication patterns of gender-dyads in general practice consultations differ across and between Western-European countries, and (2). if so, whether these differences continue to exist when controlling for patient, GP and consultation characteristics. Doctor-patient communication was assessed in six Western-European countries by coding video taped consultations of 190 GPs and 2812 patients. Cluster analysis revealed three communication patterns: a biomedical, a biopsychosocial and a psychosocial pattern. Across countries, communication patterns of the female/female dyad differed from that of the other gender-dyads. Differences in communication patterns between countries could especially be explained by differences in consultations of male doctors, irrespective of the patients' gender. It is important to take into consideration differences between gender-dyads and between countries when studying gender effects on communication across countries or when comparing studies performed in different countries.
Article
This study examines the relationship between the dissolution of a marital or cohabitating relationship and subsequent depression among Canadians aged 20 to 64. Data are from the longitudinal component of the National Population Health Survey (1994/1995 through 2004/2005) and include the household population only. Cross-tabulations were used to examine the association of marital dissolution with change in household income, social support, presence and number of children in the household and employment status over a two-year period. Multiple logistic regression was used to examine associations between marital dissolution and depression over a two-year period among those who had not been depressed two years earlier, while controlling for these changes. To maximize sample size, pooling of repeated observations was used. For both sexes, dissolution of a marriage or co-habiting relationship was associated with higher odds of a new episode of depression, compared with those who remained with a spouse over the two-year period. When the influences of possible confounders were considered, the association between a break-up and depression was weakened, but persisted. Marital dissolution was more strongly associated with depression among men than among women.
Article
Divorce has been established as an adverse social consequence of mental illness. There is, however, little research that has considered how the mental health of both spouses may interact to predict relationship disruption. The aim of the current study was to use data from a large population-based survey to examine whether the combination of spouses' mental health problems predicts subsequent marital dissolution. Prospective analysis of data from a longitudinal national household survey. 3,230 couples were tracked over 36 months, with logistic regression models used to determine whether the mental health problems of both spouses at wave 1 (determined by the SF36 mental health subscale) predicted subsequent relationship dissolution. Couples in which either men or women reported mental health problems had higher rates of marital disruption than couples in which neither spouse experienced mental health problems. For couples in which both spouses reported mental health problems, rates of marital disruption reflected the additive combination of each spouse's separate risk. Importantly, these couples showed no evidence of a multiplicative effect of mental illness on rates of subsequent divorce or separation. The results do not support the notion that a combination of mental health problems in both spouses uniquely predicts marital dissolution. Rather, there is an additive effect of individual mental health problems on the risk of dissolution.
Australian Social Trends 2007: Lifetime Marriage and Divorce Trends. Can-berra: Australian Bureau of Statistics
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Linacre S. Australian Social Trends 2007: Lifetime Marriage and Divorce Trends. Can-berra: Australian Bureau of Statistics; 2008. Available at: http://www.ausstats.abs.gov. au/ausstats/subscriber.nsf/0/0B6F42BBA462 2404CA25732F001C93F1/$File/41020_ Lifetime%20marriage%20and%20divorce %20trends_2007.pdf.
The bio-psychosocial–spiritual interview method
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Hodgson J, Lamson A, Reese L. The bio-psychosocial–spiritual interview method.
International divorce. Chapter 10
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McKenry PC, Price SJ. International divorce. Chapter 10. In: Ingoldsby BB, Smith SD, editors. Families in Global and Multicultural Perspective. Thousand Oaks, CA: Sage Pub-lications, Inc; 2006. p. 168–89.
Beliefs: The Heart of Healing in Families and Illness
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Wright LM, Watson WL, Bell JM. Beliefs: The Heart of Healing in Families and Illness. New York: Basic Books; 1996.
The Case for Marriage: Why Married People are Happier, Healthier, and Better Off Financially
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Beliefs: The Heart of Healing in Families and Illness Basic Books
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Wright LM, Watson WL, Bell JM. Beliefs: The Heart of Healing in Families and Illness. New York: Basic Books; 1996.
Births, Marriages, Divorces, and Deaths: Provisional Data for
Centers for Disease Control Prevention. Births, Marriages, Divorces, and Deaths: Provisional Data for 2009. Nat Vital Stat Rep 2010;58(25):1–6: Available at: http://www. cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_25. pdf. (Accessed April 1, 2011).
Psychiatric morbidity among adults living in private households London: Office for National Statistics Available at: http://www.ons.gov.uk/ons/ rel/psychiatric-morbidity/psychiatric- morbidity-among-adults-living-in-private- households
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Singleton N, Lee A, Meltzer H. Psychiatric morbidity among adults living in private households, 2000: Technical Report. London: Office for National Statistics; 2002. Available at: http://www.ons.gov.uk/ons/ rel/psychiatric-morbidity/psychiatric- morbidity-among-adults-living-in-private- households/2000/index.html.
Institute for Clinical Systems Improvement (ICSI) Major Depression in Adults in Primary Care
Institute for Clinical Systems Improvement (ICSI). Major Depression in Adults in Primary Care. Bloomington, MN: ICSI; 2010; Available at: http://www.guideline.gov/ content.aspx?id=23857&search=depression +and+thyroid+screening+and+depression.
Marital disruption as a stressful life event. Chapter 11 Divorce and Separation: Context, Causes and Consequences Basic Books
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Bloom BR, White SW, Asher SJ. Marital disruption as a stressful life event. Chapter 11. In: Levinger G, Moles OC, editors. Divorce and Separation: Context, Causes and Consequences. New York: Basic Books; 1979.