Marital separation and contact with primary healthcare services for mental health problems: a register-based study
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RESEARCH ARTICLE
Marital separation and contact with primary healthcare services for mental health problems: a register‑based study Anne Reneflot* , Carine Øien‑Ødegaard and Lars Johan Hauge
Abstract Background: Marital separation is associated with mental health problems, but little is known about how this trans‑ lates into healthcare use. In this study, we examine the relationship between marital separation and primary health‑ care use for mental health problems. Methods: We used data covering the period from 2005 to 2015 from the Norwegian Population Register, Statistics Norway’s Educational Registration System and the Norwegian Health Economics Database. Data were analyzed using logistic regression analysis. To control for time invariant characteristics, we estimated fixed-effect models. Results: Marital separation was associated with increased contact with primary healthcare services for mental health problems (MH-consultations). The prevalence of MH-consultations peaked during the year of marital separation. MHconsultations were more common following marital separation than prior to the separation. This pattern remained significant in the fixed-effect models. Conclusions: Men and women who experienced marital separation were more likely to consult primary healthcare services for mental health problems than those who remained married. Our study suggests that several mechanisms are in play. The prevalence of MH-consultations of those who eventually separated were higher several years prior to the separation. This lends support to selection mechanisms, whereas the sharp rise in the prevalence of MH-con‑ sultations around the time of marital separation coupled to higher levels several years after separation, indicate that marital separation induces both transient stress and leads to more lasting strain. Keywords: Health services, Primary healthcare, Mental health, Marital status, Marital separation, Registry data Background Marital separation is associated with a wide array of adverse outcomes including a deterioration in mental health [1]. Numerous studies have demonstrated that men and women who separate are more likely to report symptoms of anxiety and depression and to experience reduced life quality than those who remain married [2–9].
*Correspondence: [email protected] Mental and Physical Health, Norwegian Institute of Public Health, Nydalen, PO Box 4404, 0403 Oslo, Norway
In contrast, only few studies have examined the relationship between marital separation and healthcare service use for mental health problems [10–12]. Studies focusing on contact with primary healthcare services are particularly sparse. All people registered living in Norway are entitled to a GP, and a consultation with a GP is only subject to a small fee-for-service. General practitioners (GPs) play an important role in diagnosing and managing mental health care and are often gatekeepers to accessing specialized mental health services. In order to understand how mental health problems in association with marital
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