title: Divorce and the Onset of Alcohol Use Disorder: A Swedish Population-Based Longitudinal Cohort and Co-Relative Study.
abstract: The purpose of this study was to clarify the magnitude and nature of the relationship between divorce and risk for alcohol use disorder (AUD).
  
  
  
  In a population-based Swedish sample of married individuals (N=942,366), the authors examined the association between divorce or widowhood and risk for first registration for AUD. AUD was assessed using medical, criminal, and pharmacy registries.
  
  
  
  Divorce was strongly associated with risk for first AUD onset in both men (hazard ratio=5.98, 95% CI=5.65-6.33) and women (hazard ratio=7.29, 95% CI=6.72-7.91). The hazard ratio was estimated for AUD onset given divorce among discordant monozygotic twins to equal 3.45 and 3.62 in men and women, respectively. Divorce was also associated with an AUD recurrence in those with AUD registrations before marriage. Furthermore, widowhood increased risk for AUD in men (hazard ratio=3.85, 95% CI=2.81-5.28) and women (hazard ratio=4.10, 95% CI=2.98-5.64). Among divorced individuals, remarriage was associated with a large decline in AUD in both sexes (men: hazard ratio=0.56, 95% CI=0.52-0.64; women: hazard ratio=0.61, 95% CI=0.55-0.69). Divorce produced a greater increase in first AUD onset in those with a family history of AUD or with prior externalizing behaviors.
  
  
  
  Spousal loss through divorce or bereavement is associated with a large enduring increased AUD risk. This association likely reflects both causal and noncausal processes. That the AUD status of the spouse alters this association highlights the importance of spouse characteristics for the behavioral health consequences of spousal loss. The pronounced elevation in AUD risk following divorce or widowhood, and the protective effect of remarriage against subsequent AUD, speaks to the profound impact of marriage on problematic alcohol use.
authors.affiliation: From the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Va.; the Department of Psychiatry, Virginia Commonwealth University, Richmond, Va.; the Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, Va.; the Center for Primary Health Care Research, Lund University, Malmö, Sweden; and the Department of Psychology, Virginia Commonwealth University, Richmond, Va.
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Kendler
authors.affiliation: From the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Va.; the Department of Psychiatry, Virginia Commonwealth University, Richmond, Va.; the Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, Va.; the Center for Primary Health Care Research, Lund University, Malmö, Sweden; and the Department of Psychology, Virginia Commonwealth University, Richmond, Va.
authors.forename: Sara Larsson
authors.initials: SL
authors.lastname: Lönn
authors.affiliation: From the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Va.; the Department of Psychiatry, Virginia Commonwealth University, Richmond, Va.; the Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, Va.; the Center for Primary Health Care Research, Lund University, Malmö, Sweden; and the Department of Psychology, Virginia Commonwealth University, Richmond, Va.
authors.forename: Jessica
authors.initials: J
authors.lastname: Salvatore
authors.affiliation: From the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Va.; the Department of Psychiatry, Virginia Commonwealth University, Richmond, Va.; the Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, Va.; the Center for Primary Health Care Research, Lund University, Malmö, Sweden; and the Department of Psychology, Virginia Commonwealth University, Richmond, Va.
authors.forename: Jan
authors.initials: J
authors.lastname: Sundquist
authors.affiliation: From the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Va.; the Department of Psychiatry, Virginia Commonwealth University, Richmond, Va.; the Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, Va.; the Center for Primary Health Care Research, Lund University, Malmö, Sweden; and the Department of Psychology, Virginia Commonwealth University, Richmond, Va.
authors.forename: Kristina
authors.initials: K
authors.lastname: Sundquist
mesh_terms: D000328:Adult; D019973:Alcohol-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000235:genetics / Q000523:psychology*; D015331:Cohort Studies; D004243:Divorce / Q000523:psychology* / Q000706:statistics & numerical data*; D005260:Female; D020022:Genetic Predisposition to Disease / Q000235:genetics; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008393:Marriage / Q000523:psychology / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012042:Registries; D012306:Risk; D012737:Sex Factors; D013223:Statistics as Topic; D013548:Sweden; D017805:Widowhood / Q000523:psychology / Q000706:statistics & numerical data
keywords: Alcohol Abuse; Epidemiology