Spousal separation and depression: a study of wives of labor migrants in Nepal

Purpose Understanding the factors associated with first onset of major depressive disorder (MDD) is important for identifying population at increased risk and informing preventive interventions. This study examined whether husbands’ migration was associated with the first onset of MDD among married women in rural Nepal and whether associations differed between international and internal migration. Design/methodology/approach The authors analyzed data from 1,899 married women enrolled in the Chitwan Valley Family Study (CVFS), a 20-year prospective panel survey with details on migration and mental health histories. The outcome, MDD, was assessed using a locally validated Nepali version of the World Mental Health Composite International Diagnostic Interview (CIDI 3.0) paired with a life-history calendar. Cox proportional hazards models estimated the association between husbands’ migration (international or internal) and their wives’ first MDD onset, adjusting for individual, household and community characteristics. Findings Women whose husbands accumulated 1–24 months of international (HR = 1.41, 95% CI: 1.18–1.69) or internal migration (HR = 1.32, 95% CI: 1.06–1.64) during the preceding five years had higher hazards of first onset MDD than women whose husbands did not migrate. Associations reversed among women whose husbands accumulated longer durations of migration. The magnitude and direction of the associations were similar for international and internal migration. Higher education, having more children and community group membership were associated with lower hazard, while larger household size increased the hazard. Practical implications Wives of migrants represent an important population for depression prevention, early identification and psychosocial support in communities with high levels of labor migration. Integrating preventive mental health services into existing community and primary healthcare programs may help reduce the burden of depression among migration-affected families. Originality/value To the best of the authors’ knowledge, this is one of the first population-based longitudinal studies to examine the association between husbands’ migration and the first onset of MDD among married women using a 20-year prospective cohort. By demonstrating similar associations for internal and international migration, this study suggests that cumulative spousal separation may be a more important factor associated with first onset MDD than migration destination.