JMIR Publications

ABSTRACT

Background:

Divorce is a significant life event that often adversely affects mental and physical health. Digital health technologies, such as online therapy, digital platforms, and divorce education programs, may provide scalable, affordable, and accessible support to address these well-documented effects. However, most evidence comes from small studies (N<1000) focusing on self-reported and short-term outcomes (less than 12 months), such as improved mental health, co-parenting, and children’s health. To our knowledge, no studies have thus examined both short- and long-term (beyond 12 months) health effects of these technologies for divorcees using a large sample and objective, non-self-reported data, such as national registers. This information is crucial for evaluating the long-term efficacy of digital health technologies in supporting recently divorced individuals.

Objective:

This study assessed the long-term health effects of a digital health platform, SES One, on divorcees. Specifically, it examined mental health medication use, primary care visits, and hospitalizations over a five-year follow-up using Danish national health registers.

Methods:

Participants (n=1,856) from a previous randomized controlled trial of SES One were observed for five years post-divorce. Outcomes included mental health medication prescriptions (antipsychotics, anxiolytics, hypnotics, sedatives, and antidepressants), primary care visits (general practitioners, specialist practitioners, and psychologists), and hospitalizations. Odds ratios and incidence rate ratios were calculated to compare outcomes between SES One participants and the control group.

Results:

Over five years, SES One participants had 16% lower odds of filling any mental health medication prescription (OR 0.836, 95% CI 0.681-1.025, p=0.085) and a 28% reduction in the expected number of filled prescriptions (IRR 0.720, 95% CI 0.522-0.993, p=0.045) compared to controls. These effects were most pronounced in years one, four, and five post-divorce. No significant differences were observed in overall primary care visits or hospitalizations across the study period. However, SES One participants had 39% (p=0.003) and 28% (p=0.001) lower odds of visiting a general practitioner in years two and three, respectively, and 32% (p=0.046) lower odds of hospitalization in year four compared to the control group.

Conclusions:

This study indicates that SES One has sustained mental health benefits for divorcees over the long term, reducing the reliance on mental health prescriptions. This "reduce not remove" effect highlights how digital health technology may mitigate the adverse health impacts of divorce rather than eliminating them entirely. Further, although no significant differences were observed in overall primary care visits or hospitalizations, SES One showed potential delayed physical health benefits in reducing GP visits and hospitalizations in specific years. Clinical Trial: This observational study uses a cohort from a randomized controlled trial. The preregistration for the current study is available at [1]. Detailed information on the design, methods, analyses, and results of the randomized controlled trial can be found in [2,12,23].