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March 13, 1997
A Johns Hopkins study finds that physicians in some specialties -- chiefly psychiatry and surgery -- are at higher risk for divorce than their medical brethren in other fields. But the results do not support the common view that job-related anxiety and depression are linked to marital breakup.
Alerting medical students to the risks of divorce in some specialties may influence their career choices and strengthen their marriages whatever field they choose, says Michael J. Klag, M.D., senior author and an associate professor of medicine.
"Marital counseling during residency training appears to be a good idea for family and career satisfaction in the long term," Klag says. The study, supported by the National Institutes of Health, is published in the March 13 issue of The New England Journal of Medicine.
Results also strongly suggest that the high divorce risk in some specialties may result from the inherent demands of the job as well as the emotional experiences of physicians who enter those fields.
. The Hopkins team assessed the specialty choices, marriage histories, psychological characteristics, and other career and personal factors of 1,118 physicians who graduated from The Johns Hopkins University School of Medicine from 1948 through 1964.
Over 30 years of follow-up, the divorce rate was 51 percent for psychiatrists, 33 percent for surgeons, 24 percent for internists, 22 percent for pediatricians and pathologists, and 31 percent for other specialties. The overall divorce rate was 29 percent after three decades of follow-up and 32 percent after nearly four decades of follow-up.
Physicians who married before medical school graduation had a higher divorce rate than those who waited until after graduation (33 percent versus 23 percent). The year of first marriage was linked with divorce rates: 11 percent for marriages before 1953, 17 percent for those from 1953 to 1957, 24 percent for those from 1958 to 1962 and 21 percent for those after 1962. Those who had a parent die before medical school graduation had a lower divorce rate.
Female physicians had a higher divorce rate (37 percent) than their male colleagues (28 percent). Physicians who were members of an academic honor society in medical school had a lower divorce rate, although there was no difference in divorce rates according to class rank. Religious affiliation, being an only child, having a parent who was a physician and having a divorced parent were not associated with divorce rates.
Physicians who reported themselves to be less emotionally close to their parents and who expressed more anger under stress also had a significantly higher divorce rate, but anxiety and depression levels were not associated with divorce rate.
"Healthy marriages have deep affection, compatibility, expressiveness and conflict resolution, so the higher risk of divorce in those less emotionally close to their parents could be telling," says Klag. "Feeling distant from your parents may indicate a decreased ability to form an intimate relationship with your spouse. Also, marriage after medical school may allow the relationship to develop in a less stressful environment."
Researchers cautioned that the study, which looked at marital histories through 1987, did not address quality of marriage and that physicians may be more likely to stay in poor marriages for financial and social reasons. Also, most physicians in the study were white males first married in the 1940s and 1950s when divorce was less socially acceptable, so the risks may vary for contemporary physicians, who include more women and minorities, say researchers.
Future studies should examine the quality of marriage, physicians' and spouses' views of their relationship, society's changing expectations of marriage, more women and minority physicians, and the effect of medical school debt and other stresses on divorce risks, the researchers say.
Co-authors of the study, which was part of the Johns Hopkins Precursors Study, an ongoing, prospective study of physicians from the Hopkins medical school graduating classes of 1948 through 1964, were lead author Bruce L. Rollman, M.D., Lucy A. Mead, Sc.M., and Nae-Yuh Wang, M.S.
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