The social consequences of psychiatric disorders, III: probability of marital stability.
OBJECTIVE
The associations of prior DSM-III-R disorders with probability and timing of subsequent divorce were examined.


METHODS
The data came from the part II subsample (N=5,877) of the National Comorbidity Survey. The respondents completed a structured diagnostic interview that retrospectively dated age at onset of each of 14 lifetime DSM-III-R disorders and recorded ages at first marriage and divorce. These data were used to estimate survival models describing the relationships between prior disorders and subsequent divorce. In addition, simulations were used to estimate the number of years spent out of marriage because of these causal relationships in the total U.S. population.


RESULTS
Prior psychiatric disorders were associated with a substantially higher risk of divorce. The simulations suggested that the effects of these associations in the U.S. population in the survey's age range are approximately 23 million lost years of marriage among men and 48 million lost years of marriage among women.


CONCLUSIONS
Psychiatric disorders have a number of adverse consequences for those who suffer from them and for their families and communities. The results reported here suggest that an increase in the number of people who divorce and a decrease in the number of years of marriage in the population may be among them. The debate over whether society can afford to provide universal treatment for psychiatric disorders needs to take these costs into consideration.
Department of Health Care Policy, Harvard Medical School, Boston, MA 02115-5899, USA. kessler@hcp.med.harvard.edu
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D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D015897:Comorbidity; D016001:Confidence Intervals; D004243:Divorce / Q000517:prevention & control / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008393:Marriage / Q000523:psychology* / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D008875:Middle Aged; D016017:Odds Ratio; D011336:Probability; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D012307:Risk Factors; D012847:Single Person / Q000706:statistics & numerical data; D016019:Survival Analysis; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D019472:Universal Health Insurance