Reviews The Influence of Divorce on Men’s Health Daniel S. Felix, PhD, 1,2 W. David Robinson, PhD, 3 and Kimberly J. Jarzynka, MD 4 Abstract Getting divorced directly and indirectly affects men’s biological, psychological, social, and even spiritual health. For example, divorced men have higher rates of mortality, substance abuse, depression, and lack of social support. In this case report we review current literature on the sequelae of divorce on men’s health, and highlight key features of divorce from a multi-disciplinary lens using the example of a 45-year-old male from the authors’ clinical practice. We provide assessment and treatment recommendations for care providers according to current clinical guidelines, and conclude with a detailed discussion of the case resolution. Key words: divorce; men’s health Case Presentation A 45-year-old Caucasian male presented to his family physician with the complaints of sleep disturbance and moderate, persistent, burning upper abdominal pain that had been increasing in severity over recent months. He often awakened several times each night for no apparent reason. This was his initial visit with this physician, as he had not seen any physician in over 10 years, and his past medical history was significant only for mild hypertension. When asked about alcohol use, he reported that he drinks ‘‘about a six pack of beer a day.’’ At the time of his visit he was employed as a mid- level manager at a local bank and stated that he used to like his job, but has become irritated with his co-workers and has lost respect for his boss. The thought of changing jobs was ap- pealing, but he did not want to put forth the necessary effort to find other employment. This patient told his boss he ‘‘was fine,’’ but admitted to his physician that he was often so tired and late to work in the mornings due to poor sleep. He com- plained of endless worries and cyclical thoughts at bedtime, and very seldom felt fully rested upon waking. Nearly 2 years prior, this patient had endured a very dif- ficult divorce. During his first visit to his primary care phy- sician he reported having very limited access to his children and was paying a significant amount of child support. He reported having very limited social support at home because his family lived over 1000 miles away and his ex-wife ‘‘took all our friends with her after the divorce.’’ His physical examination revealed an overweight, well- groomed, quiet male who appeared mildly lethargic, but was in no acute distress. His vital signs were stable with a mildly elevated blood pressure, and a body mass index of 32. He was cooperative but not very talkative with seemingly depressed mood and mildly blunted affect. On abdominal examination, he had mild epigastric tenderness to palpation and a slightly enlarged liver. The remainder of his physical exam was un- remarkable. Literature Review Although divorce rates and rituals vary from society to so- ciety, 1 getting divorced is a common occurrence facing men of many nationalities and cultures. Nearly one third of marriages end in divorce for Australian, English, and Welsh couples. 2,3 One quarter of Japanese marriages 4 and more than one half of United States marriages terminate in divorce. 5 As seen in the case of this patient, divorcing one’s partner not only alters the status of a relationship, but can also have widespread negative effects on men’s physical, psychological, and social health. In 1977, George Engel published a seminal article in which he encouraged healthcare providers to consider and include in their practice the systemic relationships between the bio- logical, psychological and social aspects of the lives of their patients. 6 The influence of his biopsychosocial model on medical and mental health care continues to grow, and has recently been expanded to include the spiritual or existential 1 Medical Family Therapy Program, University of Nebraska-Lincoln, Lincoln, Nebraska. 2 Methodist Family Medicine Residency, Department of Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana. 3 Marriage and Family Therapy Program, Utah State University, Logan, Utah. 4 Family Medicine Residency Program, Department of Family Medicine, University of Nebraska Medical Center, Omaha, Nebraska. JOURNAL OF MEN’S HEALTH Volume 10, Number 1, 2013 ª Mary Ann Liebert, Inc. DOI: 10.1016/j.jomh.2012.09.002 3