Introduction:

Marital disruption is a life event with dangerous potential health implications. Despite the rise in the standard of living of the population, the condition of widows and divorced women face challenges in terms of poor mental and physical health along with poor socioeconomic status, particularly in developing countries like India because of their unique social, cultural, and economic environment. ¹

Death of the spouse or divorce (legal or otherwise) affects both sexes in different ways. Divorced or widowed women suffer more. The Social Readjustment Rating Scale (SRRS) by Holmes and Rahe (1967) for identifying major stressful life events has identified the Death of a spouse, Divorce, and Separation as the top 3 Stressful events of life with a mean value of 100, 75 & 63. ^{2, 3}

Psychological distress is an important immediate outcome of the death of a spouse or divorce, which may arise because of financial and emotional challenges and can lead to adverse health outcomes with more stress, anxiety, depression, and social isolation than the general population. ² Emotional liability in divorced or widowed women is a predominant characteristic with a high level of depression and anxiety associated with loneliness, loss, and the uncertainty about future. ^{4, 5}

In the study of gender differences, the stain of divorce for men is transient but for women’s is chronic. ⁶ It is found that recent divorce or widowhood is associated with an increase in poor health and the harmful mental impact of depression and anxiety. ^{7, 8}

India has 34 million (10% of the female population, compared to only 3% of men) widows which is the highest number in the world ⁹ and this number has been increasing because of double pandemics of communicable and non-communicable diseases in India e.g., HIV/AIDS and DM. ¹⁰ Furthermore 54% of women aged 60 and over and 12% of women aged 35- 39 are widows. Remarriage is the exception rather than the rule; only about 10 per cent of widows marry again.” ^{9, 10}

Apart from associated health problems, widowhood and divorce have social stigmatization and isolation issues in India, particularly in rural areas. ¹¹ They may not be in a position to consult for their physical and mental health. Behavioural changes are often observed in women after divorce or separation. These changes are often overlooked and assumed to be a normal reaction to an adverse life event. It is now known that the changes may be due to an underlying psychiatric disorder. ^{12, 13, 14} This issue needs to be highlighted so that the suffering women may receive appropriate care and treatment. Considering these pertinent issues, this study was conducted with the objective of finding the prevalence and severity of depression and anxiety in separated, divorced, and widowed females.

Methodology

Study Design and Setting: Community-based, Cross-sectional study among separated, divorced and widowed females from two rural villages near JIIUs Indian Institute of Medical Science and Research, at. Warudi. Written Informed Consent was taken from study participants.

The inclusion criteria were 1. Females above 21 years of age residing in the selected villages. 2. All divorced and widowed females. 3. Separated females: Females living separately from husbands but not legally divorced for at least 2 years. The exclusion criteria were 1. Females who are separated from their partners due to personal reasons but communicate with each other regularly and 2. Presence of chronic physical illness (neurological illness, CVA, head injury) MR, organic mental disorder or active medical condition that could confound the diagnosis of clinical characterization of psychopathology.

Sample collection: Door-to-door survey was done in two villages of Badnapur tehsil i.e., Devgaon and Kasturwadi in the Jalna district of Maharashtra. The total number of widowed, divorced and separated females was interviewed for the study. Those participants who consented to the study and met the inclusion and exclusion criteria were enrolled in the study.

Data was collected using a sociodemographic proforma. All eligible participants were screened for depression and anxiety using DSM 5 criteria. The severity of depression was assessed using the Hamilton depression rating scale (HDRS) and for anxiety, the Hamilton anxiety scale (HAM-A) was used.

Statistical Analysis: The results are expressed as mean ± standard deviation for all continuous variables and percentages for qualitative variables. Logistic regression analysis was used to find out significant independent variables of depression and anxiety.

Result

A total of 162 women were enrolled in the study and of them, 76, 37, and 49 were widowed, separated, and divorced respectively. All of them got married at above 18 years of age. The average duration of married life for widowed women was approximately 30 years with mean age of 52.7 years at the time of widowhood. Whereas for separated and divorced, it is eight years and 12 years respectively. Duration since widowhood was less than 2 years in 30% of widows compared to 55.2% of widows with 2 to 5 years duration. Duration since separation was less than two years in the majority (78.4%) of separated women whereas it is 2 to 5 years in 63.2% of divorced women. The majority of widow women (71%) were self-earning compared to only around 27% to 35% among separated and divorced respectively. [SeeTable 1]

Prevalence of severity of Depression and Anxiety: Less than 10% of women had a normal score of depression in all three groups. Around 30% had mild depression whereas around 42% of widow and divorced women had moderate levels of depression but it is in 50% of separated women. Severe and very severe level of depression was in around 20% of widowed and divorced women compared to 16% of separated women. There was no anxiety in around 80% of divorced and widowed women whereas 24.3% of separated women had a severe level of anxiety on the HAM-A score. [SeeTable 1]

Regression Analysis: The source of earnings, duration of separation since widowhood/separated/divorced, and their status were found to be significant on univariate analysis. Logistic regression was used to analyze the relationship between these variables and the probability of depression (converted in binary variable i.e. No depression (Normal and Mild Score) and Depression present (Moderate to Severe Score). It was found that other factors are constant, the odds ratios of depression were 2.1 times for separated women compared to widowed and divorced women, 3.4 for dependent women, and 4.3 for women with less than two years of duration of separation,Table 2. Similarly, separated women, dependent women, and those with less than two years of duration of separation had higher levels of anxiety on regression analysis.Table 3

Discussion

Our study result shows significant levels of depression and anxiety in all three groups. Separated and divorced women had more levels of depression compared to widowed women. These findings are consistent with the results of Trivedi JK et al. ¹¹ Study of psychological aspects of widowhood and divorce and Sharma I et al. ¹⁵

Our study shows significant anxiety in separated females, especially during the early years of separation. Similar findings were reported by Boora S, Jain A ¹⁶ and press release of APA ⁷ , and Wade T ¹⁴ showing that the level of psychological distress was significantly higher for individuals immediately after divorce than in the following years. Ubaidi B ⁵ found no difference in psychological distress between the early and late phases of the divorce and concludes that divorce implies “permanent strain” in the individual ⁴ . But in our study depression and anxiety were much more in during 2 to 5 years and decreased after 5 years. Our study shows that widow females are more independent as compared to divorced and separated women. The reason may be better social support and age as most of widowed females are older. The prevalence of anxiety was also high reciprocating the results of Joung I ² and Trivedi J ¹¹ and Shrivastava S et al. ¹⁷

Conclusion: The prevalence of Depression and Anxiety is more common in all three groups. Moderate to severe Depression is around 75% among divorced/separated and widowed females but moderate to severe anxiety was more in separated women compared to widowed women. Depression and Anxiety are more common during the first 2 years of Separation in all three groups. Our study also implies that marital dissolution happens during the early years of marriage. These women are usually having one or no children. The study underscores the need of providing psychological support to this vulnerable group, especially at its inception.

Limitation: A larger sample would have yielded both greater statistical power, thereby allowing for observation of more subtle effects, and would increase the representativeness of the sample group to the greater population for better comparison.

Sources of Support

Nil

Conflict of Interest

None Declared