title: Divorce and health: current trends and future directions.
abstract: OBJECTIVE
  Social relationships play a vital role in health and well-being, and it follows that loss experiences can be highly stressful for some people. This article reviews what is known about the association between marital separation, divorce, and health outcomes.
  
  
  METHODS
  Key findings in the area of divorce and health are discussed, and the review outlines a series of specific questions for future research. In particular, the article integrates research in social epidemiology with research in social psychophysiology. The former approach provides a broad-based estimate of the association between marital status and health outcomes, whereas the latter approach studies mechanisms of action and individual differences associated with increased risk for poor outcomes.
  
  
  RESULTS
  The experience of separation or divorce confers risk for poor health outcomes, including a 23% higher mortality rate. However, most people cope well and are resilient after their marriage or long-term relationship ends. Despite the fact that resilience is the most common response, a small percentage of people (approximately 10%-15%) struggle quite substantially, and it seems that the overall elevated adverse health risks are driven by the poor functioning of this group. Several candidate mechanisms and novel (ambulatory) assessment techniques that may elucidate the poor outcomes among people who adapt poorly to separation are discussed.
  
  
  CONCLUSIONS
  To increase knowledge on the association between divorce and health, three primary areas require more research: a) genetic and third variable explanations for divorce-related health outcomes, (b) better studies of objective social behavior after separation, and (c) increased attention to interventions targeting high-risk adults.
authors.affiliation: From the Department of Psychology, University of Arizona, Tucson, Arizona.
authors.forename: David A
authors.initials: DA
authors.lastname: Sbarra
mesh_terms: D000223:Adaptation, Psychological; D004243:Divorce / Q000523:psychology / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D009026:Mortality; D055500:Resilience, Psychological; D012307:Risk Factors
references.citation: Psychol Bull. 2000 Nov;126(6):844-72
references.pmid: 11107879
references.citation: Am J Cardiol. 2001 Sep 1;88(5):526-9
references.pmid: 11524062
references.citation: Behav Res Methods Instrum Comput. 2001 Nov;33(4):517-23
references.pmid: 11816455
references.citation: Psychol Sci. 2002 Jan;13(1):81-4
references.pmid: 11894851
references.citation: J Pers Soc Psychol. 2003 Apr;84(4):857-70
references.pmid: 12703653
references.citation: JAMA. 2003 Jun 18;289(23):3095-105
references.pmid: 12813115
references.citation: Science. 2003 Oct 10;302(5643):290-2
references.pmid: 14551436
references.citation: Pers Soc Psychol Bull. 2003 Jul;29(7):871-84
references.pmid: 15018675
references.citation: Psychol Bull. 2004 Jul;130(4):601-30
references.pmid: 15250815
references.citation: Dev Psychol. 2004 Sep;40(5):776-89
references.pmid: 15355165
references.citation: Psychol Sci. 2004 Oct;15(10):687-93
references.pmid: 15447640
references.citation: Soc Sci Med. 1992 Apr;34(8):907-17
references.pmid: 1604380
references.citation: Psychol Sci. 2005 Sep;16(9):709-15
references.pmid: 16137257
references.citation: J Consult Clin Psychol. 2005 Oct;73(5):880-92
references.pmid: 16287388
references.citation: Psychol Sci. 2005 Dec;16(12):945-50
references.pmid: 16313658
references.citation: Emotion. 2006 May;6(2):224-38
references.pmid: 16768555
references.citation: J Consult Clin Psychol. 2006 Aug;74(4):658-70
references.pmid: 16881773
references.citation: Psychol Assess. 2006 Sep;18(3):340-5
references.pmid: 16953737
references.citation: Dev Psychol. 2007 Jan;43(1):39-53
references.pmid: 17201507
references.citation: Psychol Sci. 2006 Dec;17(12):1032-9
references.pmid: 17201784
references.citation: Psychol Bull. 1991 Nov;110(3):406-25
references.pmid: 1758917
references.citation: Psychosom Med. 2008 Apr;70(3):269-75
references.pmid: 18256340
references.citation: J Fam Psychol. 2008 Feb;22(1):144-52
references.pmid: 18266541
references.citation: Pers Soc Psychol Rev. 2008 May;12(2):141-67
references.pmid: 18453476
references.citation: Psychosom Med. 2008 May;70(4):482-7
references.pmid: 18480194
references.citation: Am J Public Health. 2008 Nov;98(11):2092-8
references.pmid: 18511733
references.citation: Annu Rev Psychol. 2009;60:501-24
references.pmid: 19035829
references.citation: Psychol Sci. 2009 Jan;20(1):107-13
references.pmid: 19076315
references.citation: Demography. 2008 Nov;45(4):851-73
references.pmid: 19110901
references.citation: Neurosci Biobehav Rev. 2010 Sep;35(1):33-8
references.pmid: 19751761
references.citation: Neurosci Biobehav Rev. 2010 Sep;35(1):115-21
references.pmid: 20026349
references.citation: Perspect Psychol Sci. 2009 Jul;4(4):375-8
references.pmid: 20161087
references.citation: Hypertension. 2010 Apr;55(4):1026-32
references.pmid: 20194301
references.citation: Psychol Sci. 2010 Apr;21(4):539-41
references.pmid: 20424097
references.citation: PLoS Med. 2010 Jul 27;7(7):e1000316
references.pmid: 20668659
references.citation: Pers Soc Psychol Rev. 2011 Aug;15(3):219-66
references.pmid: 20716644
references.citation: Curr Dir Psychol Sci. 2009 Jun 1;18(3):132-137
references.pmid: 21243077
references.citation: Perspect Psychol Sci. 2010 Sep;5(5):546-56
references.pmid: 21593989
references.citation: Pers Relatsh. 2011 Jun;18(2):285-301
references.pmid: 21647240
references.citation: Psychol Sci. 2012 Mar;23(3):261-9
references.pmid: 22282874
references.citation: Soc Sci Med. 2012 Jul;75(1):46-59
references.pmid: 22534377
references.citation: J Abnorm Psychol. 2012 Aug;121(3):559-69
references.pmid: 22708885
references.citation: Health Psychol. 2013 Apr;32(4):409-17
references.pmid: 22823067
references.citation: J Fam Psychol. 2013 Feb;27(1):30-41
references.pmid: 23088795
references.citation: Soc Personal Psychol Compass. 2012 Dec 1;6(12):905-919
references.pmid: 23284588
references.citation: Psychol Sci. 2013 Mar 1;24(3):272-9
references.pmid: 23307944
references.citation: Psychol Bull. 2014 Jan;140(1):140-187
references.pmid: 23527470
references.citation: Int J Psychophysiol. 2013 Jun;88(3):219-23
references.pmid: 23768883
references.citation: Psychosom Med. 2014 Jun;76(5):347-54
references.pmid: 24915293
references.citation: Brain Behav Immun. 2014 Oct;41:232-8
references.pmid: 24945717
references.citation: Health Psychol. 2014 Oct;33(10):1204-13
references.pmid: 25020156
references.citation: Clin Psychol Sci. 2013 Mar 18;1(2):120-134
references.pmid: 25606351
references.citation: Perspect Psychol Sci. 2008 Sep;3(5):400-24
references.pmid: 26158958
references.citation: Pers Relatsh. 2012 Sep;19(3):551-568
references.pmid: 26167126
references.citation: Perspect Psychol Sci. 2011 Sep;6(5):454-74
references.pmid: 26168197
references.citation: Behav Ther. 2016 Nov;47(6):869-885
references.pmid: 27993338
references.citation: Clin Psychol Sci. 2014 May;2(3):249-257
references.pmid: 29619285
references.citation: Psychosom Med. 1987 Jan-Feb;49(1):13-34
references.pmid: 3029796
references.citation: J Psychosom Res. 1967 Aug;11(2):213-8
references.pmid: 6059863
references.citation: Psychosom Med. 1984 May-Jun;46(3):183-97
references.pmid: 6739679
references.citation: Dev Neurosci. 1996;18(1-2):49-72
references.pmid: 8840086
references.citation: Science. 1997 Sep 12;277(5332):1659-62
references.pmid: 9287218
references.citation: N Engl J Med. 1998 Jan 15;338(3):171-9
references.pmid: 9428819