Association and causal mediation between marital status and depression in seven countries

Xiaobing Zhai, Henry H. Y. Tong, Chi Kin Lam, Abao Xing, Yuyang Sha, Gang Luo, Weiyu Meng, Junfeng Li, Miao Zhou, Yangxi Huang, Ling Shing Wong, Cuicui Wang () and Kefeng Li ()
Additional contact information
Xiaobing Zhai: Macao Polytechnic University
Henry H. Y. Tong: Macao Polytechnic University
Chi Kin Lam: Macao Polytechnic University
Abao Xing: Macao Polytechnic University
Yuyang Sha: Macao Polytechnic University
Gang Luo: Macao Polytechnic University
Weiyu Meng: Macao Polytechnic University
Junfeng Li: Changzhi Medical College
Miao Zhou: Tsinghua University
Yangxi Huang: University of Hong Kong
Ling Shing Wong: INTI International University
Cuicui Wang: Harvard T.H. Chan School of Public Health
Kefeng Li: Macao Polytechnic University

Nature Human Behaviour, 2024, vol. 8, issue 12, 2392-2405

Abstract: Abstract Depression represents a significant global public health challenge, and marital status has been recognized as a potential risk factor. However, previous investigations of this association have primarily focused on Western samples with substantial heterogeneity. Our study aimed to examine the association between marital status and depressive symptoms across countries with diverse cultural backgrounds using a large-scale, two-stage, cross-country analysis. We used nationally representative, de-identified individual-level data from seven countries, including the USA, the UK, Mexico, Ireland, Korea, China and Indonesia (106,556 cross-sectional and 20,865 longitudinal participants), representing approximately 541 million adults. The follow-up duration ranged from 4 to 18 years. Our analysis revealed that unmarried individuals had a higher risk of depressive symptoms than their married counterparts across all countries (pooled odds ratio, 1.86; 95% confidence interval (CI), 1.61–2.14). However, the magnitude of this risk was influenced by country, sex and education level, with greater risk in Western versus Eastern countries (β = 0.36; 95% CI, 0.16–0.56; P

Date: 2024
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DOI: 10.1038/s41562-024-02033-0

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