Ending a marriage is often a stressful experience, but the level of hostility between partners can have a lasting impact on physical and mental health. A recent study published in the British Journal of Health Psychology followed individuals over a 10-year period and found that those who experienced a high-conflict divorce often used more health services before and after the divorce. By tracking patterns in health outcomes, this study suggests that relationship dissolution is not just an isolated event, but a long-term process that begins to negatively impact health long before the marriage officially ends.
The end of a marriage involves emotional tension, financial changes, and changes in family relationships. Past research has linked this transition to increased anxiety, depressive symptoms, and increased risk of physical health problems. A prominent factor contributing to these health problems is the amount of hostility between ex-partners. Although most people report some level of discord when they break up, up to a quarter of divorcing couples experience persistent and intense friction.
This intense hostility includes pervasive negative interactions and a tense and distrustful emotional environment. The friction that arises when resolving disagreements over custody, financial, and emotional boundaries can create a toxic atmosphere. Such severe conflicts often exacerbate psychological distress, which manifests itself in measurable physical symptoms.
Historically, researchers have viewed divorce as a functionally discrete event, focusing on what happens immediately after the legal documents are signed. However, relationship experts are increasingly drawing on conceptual models that view marital breakdown as an evolving process. This framework proposes that stress factors leading to separation begin to accumulate years before the union’s legal dissolution. Emotional distancing or changes in living conditions can increase tensions well in advance of official declarations.
To better understand this timeline, researchers wanted to look beyond the immediate effects of legal separation. The study was led by researcher Andreas Nielsen-Hart from the School of Public Health at Aarhus University in Denmark. He and his colleagues sought to measure how health trajectories unfold across the entire timeline of divorce, from the early signs of marital breakdown to years after the legal documents are completed.
Researchers analyzed data from 1,784 adults who divorced in Denmark between 2015 and 2017. The researchers used objective medical data, rather than relying solely on self-reported health status, which can be biased by memory or mood. Participants first completed the survey immediately after their legal divorce and assessed their level of conflict using a validated psychological tool. Validated tools are standardized questionnaires that are repeatedly tested by researchers to ensure that they are accurately measuring what they are intended to measure.
In this particular study, three aspects of breakup were assessed. First, they considered areas of disagreement, such as how to approach childcare and economic issues. We then assessed the tactics used to solve these problems, ranging from cooperative attempts to adversarial strategies such as threats. Finally, we measured general attitudes between ex-spouses to understand the extent of persistent negativity and mistrust.
The research team then linked these survey responses to national health registries. These centralized databases record the medical history of every citizen. This access allowed the researchers to track each person’s health over 10 consecutive years, specifically the five years before and after the date of divorce.
The research team focused on three key measures of health status: number of prescriptions filled, number of visits to primary care providers, and overnight hospitalizations. They selectively sought out specific categories of medications, focusing on treating depression, anxiety, and sleep disorders.
The data revealed a stable correlation between the intensity of divorce disputes and the frequency of health service utilization. People who reported higher levels of hostility consistently required more doctor visits. For example, in the five years following a legal divorce, the standard increase in reported disputes was associated with a 28 percent increase in fully filled prescriptions.
This increase in drug use was primarily driven by a category of drugs known as psychotropic drugs, such as sleep aids, sedatives, and anxiolytics. The researchers noted that the sustained stress of a hostile breakup likely contributes to sleep disturbances and lingering anxiety after a breakup. In contrast, antidepressant use showed a different trend, increasing primarily in the years leading up to divorce.
This increase in pre-divorce antidepressant prescriptions is consistent with the notion that marital deterioration is a long-term ordeal. Those heading toward a frictional separation were already experiencing increased distress long before their marriage was legally consummated. Baseline drug use for those categorized in the highest conflict group was consistently higher than for others who experienced an amicable breakup throughout the decade.
Similar trends emerged when researchers looked at visits to general practitioners, medical professionals and psychologists. Doctor visits, which had remained relatively stable in the past for most couples, increased sharply starting about two years before legal divorce. This tendency to seek help was especially pronounced for people caught up in ongoing and violent conflicts.
After the divorce was finalized, doctor visits eventually began to decline in all groups. However, the high-conflict group had a higher total number of primary care appointments over the 10-year period.
The researchers also observed that people who were dealing with severe marital conflicts were more likely to be hospitalized. A uniform increase in relational hostility corresponds to a 13 percent higher likelihood of spending at least one night in the hospital in the five years following divorce. This particular association is most pronounced in the years before separation, suggesting that prior health vulnerabilities may increase the likelihood of a stressful divorce or place unusual strain on the body during the early stages of marital breakdown.
Although the study allows for a broad look at the timeline of marital dissolution, the observational design means it cannot prove that relationship friction directly caused the health problems. Observational studies analyze patterns in data without researchers intervening or running experiments. This means that other unmeasured factors may influence the results. Some people may already have underlying physical or psychological vulnerabilities that make them more susceptible to conflict in relationships.
Moreover, increased healthcare utilization is not inherently negative. In some cases, more doctor visits may reflect positive coping behaviors as individuals seek appropriate professional help to manage distress during turbulent transitions in life.
The cultural and structural context of the study should also be considered. Denmark offers universal health insurance and has relatively lenient divorce laws, allowing couples to separate without lengthy legal battles. These social characteristics may to some extent buffer against the worst health effects seen in countries with exorbitant health care systems and strict legal requirements for marriage dissolution.
Moreover, the last years of the observation period overlapped with the beginning of the viral pandemic. This global health crisis has led to widespread curtailment of normal medical practices as people avoid public clinics and hospitals to reduce the risk of infection. As a result, the decline in primary care visits in the later stages of the study likely reflected disruptions caused by the pandemic rather than a sudden improvement in participants’ health status.
In the future, the researchers hope to explore more direct measures of health, such as repeated self-reports of physical symptoms and biological markers of stress. Regular screening for relationship strains in primary care settings may help physicians provide timely support. By identifying high-conflict individuals early in the process, health care professionals may be able to connect them to mediation and counseling resources before physical and emotional harm becomes too severe.
The study, “Divorce disputes and health during the divorce process: A 10-year observational study of medication prescriptions, primary care visits, and hospitalization”, is authored by Andreas Nielsen-Hald, Gert Martin-Hald, and Peter Volsen.
