The association between early marriage and mental disorder among young migrant and non-migrant women: a Norwegian register-based study | BMC Women’s Health

Entering a marital union is, for many, one of the most important decisions in life and a step into adulthood. Age upon first marriage differs largely across countries. However, during the past decades the average age at first marriage has increased all around the world, among men and women alike [1]. Similarly, the age at which young people start to establish their position in the labour market, finish their education, move out of the parental home, and enter marital union, has moved from the early 20s to the late 20s and early 30s [2, 3]. Postponement of marriage to a later age can be advantageous, especially for women, due to an extended time for gaining more education and a stable income prior to marriage [4]. In many Western countries, marriage during the early 20s has therefore become unusual and can be seen as something unsound or non-normative [5, 6].

Older age at first marriage may also be a result of the increasing popularity of cohabitation, rather than marriage, as a preferred form of first union in several Western countries [2]. In Norway for instance, large differences between the non-migrant and migrant population in the preferred form of first union have, however, been documented. According to Wiik [7], cohabitation as first union was chosen by 94% of individuals without migrant background, while the numbers were 64% and 75% for descendants of migrants and migrants who migrated prior to the age of 18, respectively. Thus, marriage as a first union has become unusual in Norway and age at first marriage has been postponed from an average age of 25.8 years for women in 1989 to 33.1 years in 2019 [8].

Marriage at a later age is associated with greater relationship stability due to maturity of the spouses, and may be beneficial for mental health [9]. Early marriages, on the other hand, are less stable and at greater risk of divorce [10]. Thus, early marriage may not be beneficial or could even be detrimental to mental health, certainly compared to marriage at later ages [11]. However, it is unclear whether early marriage is associated with poorer mental health among migrant women in a European context. As migrant women are at increased risk of mental disorder [12] and some migrant groups tend to marry earlier than the general population [13, 14], it is of interest to examine whether the association between early marriage and risk of mental disorder differs between migrant and non-migrant women.

Marital union and mental health

On average, entering a marriage can have a protective effect on one’s mental health, compared to remaining unmarried, however, it is not universally beneficial for all [15]. Stable and established marriages are found advantageous for mental health and well-being, relative to other, less committed relationship forms such as cohabitation [9, 16]. The positive effect of marriage on mental health is attributed to the social, emotional and financial support gained when entering a union, suggesting a causation effect [17]. Thus, married individuals are better able to cope with stress and other psychological challenges [18]. Yet, some evidence points in the direction of a selection effect; those who are happier and healthier are more likely to marry [16, 19]. Those with, or who are vulnerable to developing, mental disorders are at increased risk of either entering marriage at an early age or not entering marriage at all, and they have lower probability of marrying on-time or late [20,21,22]. However, stronger associations are found for causation rather than selection [16].

Whether marriage is beneficial for one’s mental health or not may depend on the timing of marriage. There is evidence suggesting that women who marry early (defined as before the age of 18 [23] and before the age of 26 [24]) report higher levels of depressive symptoms and more partner violence than those who marry later [23, 24]. Further, individuals marrying at earlier ages report more distress as compared to those marrying at later ages, but differences between the groups are mainly explained by the selection of more distressed individuals into early marriage [6]. There are, however, other studies suggesting that being in any kind of romantic relationship, both non-marital and marital is beneficial for mental health, regardless of age of entering such unions [6, 25], when compared to remaining single. Furthermore, Uecker [6] found no differences in life satisfaction between those entering marriage in their mid-20s compared to those entering marriage in their early 20s or as teenagers. Nevertheless, these studies come from non-European countries, and to the best of our knowledge, there is lack of European studies that investigated the association between marital timing and mental health.

However, it is not necessarily early marriage itself that is a risk factor for mental health, but also other aspects associated with early marriage. Economic hardship, lower educational attainment of spouses or less social support may increase the risk of mental disorders [26]. For instance, early marriages are more common among those from lower socioeconomic backgrounds and among those with low educational attainment [27, 28]. The timing of union formation and the preferred form of it can also depend on parental education. Individuals with highly educated parents are more likely to enter marriage or other union forms later than those with lower-educated parents [29]. Parental influence on partner choice and union type in some migrant groups may be present but it is greatest in families with poorly educated parents [30]. Increasing educational attainment of the child also results in more independent choices and later age at first marriage. The low socioeconomic status of the early married can play a role in the development of mental disorders, as low education, poor workforce participation–mainly unemployment–, and low household income are risk factors for mental disorder [31]. It is therefore plausible to assume that early marriage is less beneficial than on-time marriage because those entering early marriages are more likely to have lower levels of education, and that it could even be less beneficial than not being married during young adulthood.

To what extent the beneficial effect of marriage on mental health is generalizable to all groups in a society has been questioned by Roxburgh [32]. Findings in her study showed that for affluent Black American women, marriage has a detrimental effect on mental health (depression), while for White American women, marriage has a positive effect on mental health when compared to their non-married counterparts [32]. This study shows that differences in the relationship between marriage and mental health exist across sub-groups of women within a society. Thus, although the ethnic composition of the European population differs, it is possible that there could be differences in the association between early marriage and mental disorder by different migrant sub-groups in Europe. There are several possible reasons why the association could differ by migrant background.

One argument can be found in the life course perspective. The life course perspective suggests that psychological or social exposures during the different phases of life may have a long term impact on the risk of disease and other life outcomes in the future [33]. Furthermore, it is not only an event itself that is associated with positive or negative consequences but also its timing. Non-normative transitions has been found to negatively affect health [34]. Its timing may therefore be crucial for whether marriage will have positive or negative consequences for one’s mental health and well-being. However, what is considered as normative in some migrant groups, may be non-normative in the general population. A study conducted by Wiik [35] showed that individuals born in Norway to migrant parents (descendants) marry earlier than their non-migrant counterparts. Furthermore, there are large differences within the migrant group regarding the type of union and its timing [7]. Several European studies found that migrants, and migrant women in particular from South Asia, Eastern Europe and Middle East and North Africa, including Turkey marry directly and at earlier ages than the majority population [e.g., 7, 13, 14, 36]. Migrants who marry at a younger age have more ethnically homogamous unions, while individuals who marry later in life are more likely to have a partner with a different ethnic background than themselves [7, 35, 37, 38]. Wiik [7] suggested that more religious migrants, originating from Non-Western countries are more likely to follow the marital pathways and traditions from the country of origin, even if they were born in, or migrated to Norway as children or teens. This may result in less stigma and more acceptance of early marriage among some migrant groups, reducing the risk of poor mental health among those who marry early. For groups where marriage is postponed into the early 30s, such as for many Western migrants and Norwegians, there may be less acceptance of early marriages, since they deviate from the norm. This could increase the risk of poor mental health among those who marry early.

An alternative argument for why the association may differ by migrant background may relate to differing expectations about married women’s roles. Many migrant women originate from countries where a patriarchal structure dominates with men being the breadwinners and women being the homemakers. This may result in, for instance, poorer labour market participation of migrant women [39] particularly from African- and Asian countries [40], and increased risk of social isolation. Social isolation as a result of marriage, and perhaps early marriage in particular, may thus result in poor mental health among migrant women [41].

Current study

Whilst marriage can have a protective effect on one’s mental health [42], early, non-normative marriage may be associated with poorer health among women [11]. Based on the presented evidence from the literature, we aim to investigate whether early marriage is associated with increased risk of mental disorder, defined by use of outpatient mental healthcare (OPMH) services, when compared to women who marry on-time and those who remain unmarried. We hypothesise that:

Hypothesis 1

Early marriage may be less protective of mental disorder than on-time marriage, but still more protective than remaining unmarried.

Furthermore, as previous research pointed at the increased possibility of early marriage and the increased risk of mental disorders among lower educated individuals, we hypothesize that:

Hypothesis 2

The potential differences between the early married and the on-time married will be partially explained by educational level.

There is also evidence suggesting that migrant women differ from majority women both in terms of marital timing, marital patterns and the risk of mental disorder development. Therefore, the second aim of this study is to investigate whether there are differences between migrant and non-migrant women in the association between marital status and mental disorder. We hypothesise that:

Hypothesis 3

There will be a difference in the strength of the association between marital timing and mental disorder across different migrant groups compared with majority women.

It can be (a) weaker among groups where early marriage is more normative but on the other hand (b) stronger among groups with traditional gender roles and increased risk of social isolation. Differences in the association may be largest for women from Asian- and African countries compared with majority women.