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Sociodemographic Variables andDepression in Turkish Women FromPolygamous Versus Monogamous FamiliesAli Özer a , Fatma Özlem Orhan b & Hasan Çetin Ekerbiçer ca Department of Public Health, Faculty of Medicine, Malatya InonuUniversity, Malatya, Turkeyb Department of Psychiatry, Faculty of Medicine, KahramanmarasSutcuimam University, Kahramanmaras, Turkeyc Department of Public Health, Faculty of Medicine, KahramanmarasSutcuimam University, Kahramanmaras, TurkeyAccepted author version posted online: 01 Aug 2012.Publishedonline: 27 Feb 2013.

To cite this article: Health Care for Women International (2012): Sociodemographic Variables andDepression in Turkish Women From Polygamous Versus Monogamous Families, Health Care for WomenInternational, DOI: 10.1080/07399332.2012.692414

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Health Care for Women International, 00:1–11, 2013Copyright © Taylor & Francis Group, LLCISSN: 0739-9332 print / 1096-4665 onlineDOI: 10.1080/07399332.2012.692414

Sociodemographic Variables and Depressionin Turkish Women From Polygamous Versus

Monogamous Families

ALI OZER

Department of Public Health, Faculty of Medicine, Malatya Inonu University, Malatya, Turkey

FATMA OZLEM ORHAN

Department of Psychiatry, Faculty of Medicine, Kahramanmaras Sutcuimam University,Kahramanmaras, Turkey

HASAN CETIN EKERBICER

Department of Public Health, Faculty of Medicine, Kahramanmaras Sutcuimam University,Kahramanmaras, Turkey

In this study, we aimed to determine the different sociodemographicvariables of polygamous and monogamous wives, and the relation-ship between depression and polygamous marriage. Seventy-ninepolygamous wives and 73 monogamous wives from Kahraman-maras, located in southern Turkey, were interviewed. After re-viewing the data, we suggest that there is a statistically significantdifference between polygamous wives and monogamous wives interms of Beck Depression Inventory (BDI) scores. The results high-lighted many implications for clinical practice and for futureresearch. Additional research needs to be conducted in order toinvestigate the effects of polygamy on women’s mental health.

Our purpose in this study was to compare the sociodemographic vari-ables and depression scores of Turkish women in polygamous and monog-amous marriages and to explore the role polygamous marriage plays indepression.

Received 15 August 2011; accepted 7 May 2012.Address correspondence to Fatma Ozlem Orhan, Department of Psychiatry, Faculty

of Medicine, Kahramanmaras Sutcuimam University, Kahramanmaras 46100, Turkey. E-mail:fozlemorhan@yahoo.com

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Polygamy has been defined as “a marital relationship involving multiplewives” (Low, 1988). The practice of polygamy is widespread in many areas ofthe world and is most common in the Middle East, Africa, Asia, and the PacificIslands, but it has also been known to occur in Europe, North America, andother Western societies (Broude, 1994). The prevalence and distribution ofpolygamy within individual cultures vary according to social class, education,and geographic location (Hamdan, Auerbach, & Apter, 2009). Up-to-datestatistics for the prevalence of polygamy in particular cultures are difficult toobtain (Hamdan et al., 2009). In some practicing societies, polygamy mayconstitute up to 50% of all marriages (Caldwell & Caldwell, 1993). Althoughpolygamy is illegal in Turkey, the practice is common in rural villagers inthe southeastern region. In urban areas, however, polygamy is practicedless frequently; according to official data, the proportion of polygamousmarriages in Turkey is about 2% (State Institute of Statistics of Turkey, 1999).

A “senior wife” is defined as any married woman “who was followedby another wife in the polygamous marriage.” A “junior wife” is “the mostrecent wife joining a marriage” (Chaleby, 1985). Polygamous wives may livetogether, or each may have her own household (Hassouneh-Phillips, 2001).Although, as Al-Krenawi and colleagues (1997) have noted, “there is animperative to treat co-wives equally regarding the provision of economic re-sources, social support, and attention” among most practicing societies, this isnot always the case in practice. The scholars have indicated that differencesexist between senior and junior wives in a polygamous marriage. Subse-quent marriages are associated with love and a greater possibility of choice;hence, second and subsequent wives often experience favored status withrespect to economic resources, social support, and attention (Al-Krenawi,1998; Al-Krenawi et al., 1997). Inversely, many societies assign high statusto senior wives: they may have power over the other wives, enjoy specialprivileges within the family, and, in some societies, arrange and consent tothe husband’s next marriage (Altman & Ginat, 1996).

Polygamous marriage is often associated with stress, tension, conflict,and disequilibrium in the family structure (Al-Krenawi, 1998; Al-Krenawiet al., 1997; Al-Krenawi & Lightman, 2000; Chaleby, 1988). Women in polyg-amous marriages often experience various degrees of emotional difficulties,including anger, jealousy, pain, emotional distress, competition, loneliness,emptiness, unhappiness, and a lack of intimacy with their spouse. For themajority of these women, infertility and fear of divorce were the reasons citedfor allowing cowives into the marriage (Madhavan 2002; Meekers & Franklin,1995). Al-Issa (1990) has identified polygamous marriage as a marker of in-creased family stress that may contribute to mental illness in mothers andchildren in polygamous families. Women in polygamous families demon-strated more mental health problems than women in monogamous fami-lies (Al-Krenawi & Slonim-Nevo, 2002). Among psychiatric patients, polyga-mous marriage is associated with depressive disorders, anxiety, depression,

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Depression in Polygamous Versus Monogamous Wives 3

somatization disorders, and a loss of self-esteem (Camara, 1978; El-Islam,1975, cited in Chaleby, 1985). Only one study has compared the mentalhealth aspects of Turkish women from polygamous and monogamous fami-lies (Ozkan, Altindag, Oto, & Sentunali, 2006).

The article begins with a review of existing literature on polygamy,followed by a brief description of the study sample and methods. Next, areview of study findings related to polygamy is offered. The article thenconcludes by considering the implications of study findings for both practiceand research in this area.

MATERIAL AND METHODS

We conducted the study in Kahramanmaras, located in southern Turkey.Kahramanmaras consists of 412,252 people. We employed a snowball sam-pling method. The study was conducted over a 1-year period. This is acase-control study and we compared polygamous wives (senior and juniorwives) with women in monogamous marriages.

Participants

Women at least 18 years old who consented to be interviewed were in-cluded as participants. Seventy-nine (43 senior wives and 36 junior wives)women from polygamous families and 73 women from monogamous fam-ilies participated in this research. Women were randomly chosen from themonogamous families, who were matched with women from polygamousfamilies for age, education, and economic status.

The respondents were told that their participation was voluntary, thatthey could withdraw at any time, that confidentiality and anonymity wouldbe preserved at all times, that they could obtain access to the researchfindings, and that the decision to participate or not participate would haveno bearing on any received social or medical services.

Research Instruments

The participants’ sociodemographic characteristics (age, age at time of mar-riage, education, economic status, etc.) were investigated using a semistruc-tured, open-ended questionnaire.

Beck Depression Inventory

The BDI was developed by Beck and colleagues (1979) and adapted toTurkish by Hisli (1988). The BDI is a self-report scale of 21 items measuringthe emotional, somatic, cognitive, and motivational symptoms exhibited in

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depression. The scale is not designed to diagnose depression but to objec-tively determine the severity of depressive symptoms. Correlation coefficientsbetween the English and Turkish versions of the scale were calculated as0.81 and 0.73 (language validity); split half reliability was 0.74, and criterion-related validity with MMPI-D was 0.63. The BDI scores ≥17 were reportedto discriminate depression that might require treatment with more than 90%accuracy. The score of each item ranges from 0 to 3, and the depressionscore is obtained by adding the score of each item. The highest obtainablescore is 63 (Savasır & Sahin, 1997).

Data Analysis

Data were computerized using the Statistical Packages for the Social Sci-ences (SPSS v.15.0; SPSS Inc., Chicago, IL, USA). Chi-square analysis wasused for categorical data, and analysis of variance (ANOVA) and a post hoctest (Bonferroni) were used to determine significant differences in the meanvalues of numerical data. Values are presented as mean ± SD (standarddeviation) and as percentages. p values < .05 (two-tailed) were consideredstatistically significant. Logistic regression was used to determine the inde-pendent effects of the associations between depression by estimating theadjusted odds ratio and confidence intervals (95%). A multivariable logis-tic regression model included variables whose associations with depressionwere statistically significant (defined as p < .05).

Ethical Considerations

This study was approved by the ethics committee of KahramanmarasSutcuimam University, Faculty of Medicine. Furthermore, all eligible patientsgave their informed consent orally and in writing before being included inthe study.

RESULTS

Seventy-nine women from polygamous families and 73 women from monog-amous families were included in the study. The polygamous group wascomposed of 43 senior wives and 36 junior wives. Table 1 displays thesociodemographic variables of the three groups. Among the groups, therewere no statistically significant differences with regard to age, occupation,economic status, number of pregnancies, husband’s education, or husband’soccupation (p > .05). The participants’ mean age was 40.3 ± 10.4 years.The mean ages (±SD) of the senior wives, junior wives, and monogamouswives were 42.5 ± (9.8) years, 40.7 ± (10.5) years, and 38.8 ± (10.6) years,

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Depression in Polygamous Versus Monogamous Wives 5

TABLE 1 Sociodemographic Characteristics of the Participants

Marriage status

Monogamous Senior Juniorwives wives wives Total

(n = 73) (n = 43) (n = 36) (n = 152)

Sociodemographicvariable Mean (SD) Mean (SD) Mean (SD) Mean (SD) p

Age 38.8 (10.6) 42.5 (9.8) 40.7 (10.5) 40.3 (10.4) .177Husband’s age 44.1 (11.1)∗ 47.1 (9.4) 50.9 (10.2)∗ 46.5 (10.7) .007Economic status 1484 (1245) 1820 (2415) 1547 (1137) 1594 (1638) .558Number of

pregnancies3.5 (1.8) 4.0 (2.5) 2.9 (2.2) 3.5 (2.1) .098

Age at time ofmarriage

21.3 (6.1) 18.4 (3.3)∗∗ 23.3 (6.1) 21.0 (5.7) .001

Husband’s age at timeof marriage

26.5 (7.5)∗ 22.7 (3.8)∗ 33.1 (9.7)∗ 27.0 (8.2) <.001

n (%) n (%) n (%) n (%)

OccupationHousewife 52 (71.2) 35 (81.4) 23 (63.9) 110 (72.4) .213Employed 21 (28.8) 8 (18.6) 13 (36.1) 42 (27.6)

EducationIlliterate 15 (20.5) 20 (46.5)∗∗ 8 (22.2) 43 (28.3) .001Primary 27 (37.0) 15 (34.9) 15 (41.7) 57 (37.5)Secondary schooland higher

31 (42.5) 8 (18.6) 13 (36.1) 52 (34.2)

Husband’s occupationLaborer 18 (24.7) 12 (27.9) 5 (13.9) 35 (23.0) .131Officer 21 (28.8) 5 (11.6) 7 (19.4) 33 (21.7)Tradesman 28 (38.4) 20 (46.5) 22 (61.1) 70 (46.1)Other 6 (8.2) 6 (14.0) 2 (5.6) 14 (9.2)

Husband’s educationPrimary school andbelow

30 (41.1) 25 (58.1) 17 (47.2) 72 (47.4) .121

Secondary school 17 (23.3) 11 (25.6) 12 (33.3) 40 (26.3)High school orabove

26 (35.6) 7 (16.3) 7 (19.4) 40 (26.3)

Legal marriageYes 73 (100.0)∗ 36 (83.7)∗ 11 (30.6)∗ 120 (78.9) <.001No 0 (0.0) 7 (16.3) 25 (69.4) 32 (21.1)

First marriageYes 66 (90.4) 39 (90.7) 15 (41.7)∗∗ 120 (78.9) <.001No 7 (9.6) 4 (9.3) 21 (58.3) 32 (21.1)

Related to the husbandYes 11 (15.1) 21 (48.8) 6 (16.7) 38 (25.0) <.001No 62 (84.9) 22 (51.2)∗∗ 30 (83.3) 114 (75.0)

Living placeApartment block 41 (56.2)∗∗ 13 (30.2) 12 (33.3) 66 (43.4) .009Detached house 32 (43.8) 30 (69.8) 24 (66.7) 86 (56.6)

Chronic diseaseYes 22 (30.1)∗ 33 (76.7)∗ 19 (52.8)∗ 74 (48.7) <.001No 51 (69.9) 10 (23.3) 17 (47.2) 78 (51.3)

∗Items are different from each other.

∗∗Items are different from other items.

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respectively (p > .05). The husbands’ ages and husbands’ ages at time ofmarriage among the junior wives were higher than for the other two groups( p < .05). The ages at time of marriage among the senior wives were lowerthan those of the other two groups ( p < .05). Of the enrolled partici-pants, 75% were housewives, 50% of the husbands were tradesmen, andnearly 50% of the husbands’ education was at the primary school level andbelow.

One-fifth of the monogamous wives’ and junior wives’ education levelwas lower than primary school, and half of the senior wives’ educationlevel was lower than primary school—the highest rate between the othertwo groups. Regarding their educational level, 15 (20.5%) of the monoga-mous and 8 (22.2%) of the junior wives had less than primary education;in addition, 20 (46.5%) of the senior wives were below the primary schoollevel—higher than the other groups.

Almost all of the monogamous marriages were legal: four-fifths of thesenior wives and one-third of the junior wives had legal marriages, and thedifferences between the groups were statistically significant (p < .05). For90% of women from monogamous families and senior wives, the marriagewas their first; however, only 41.7% of the junior wives—lower than theother two groups—were in their first marriage (p < .05). More senior wiveswere relatives of the husband than in other groups (p < .05). Senior wiveshad higher rates of chronic diseases than junior wives, and junior wives hadhigher rates of chronic diseases than women from monogamous marriages(p < .05; Table 1).

As shown in Table 2, the BDI scores were above 17 in one-third ofthe participants. About 8.2% of women from monogamous families, 58.1%of senior wives, and 41.7% of junior wives, had BDI scores above 17; thescores were statistically lower in women from monogamous families thanthe scores for the other two groups (p < .05).

As shown in Table 3, women from polygamous families were 2.23 timesmore likely to have BDI scores of 17 or more than women from monogamousfamilies (OR = 2.23, p < .05). Additionally, women with a chronic diseasewere 1.25 times more likely to have BDI scores of 17 or more (OR = 1.25,p < .05).

TABLE 2 Beck Depression Scores of Women, According to Marriage Status

Beck Depression scores

Marriage status <17 n (%) ≥17 n (%) Total n (%) p

Monogamous wives∗ 67 (91.8) 6 (8.2) 73 (100.0) <.001Senior wives 18 (41.9) 25 (58.1) 43 (100.0)Junior wives 21 (58.3) 15 (41.7) 36 (100.0)Total 106 (69.7) 46 (30.3) 152 (100.0)

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Depression in Polygamous Versus Monogamous Wives 7

TABLE 3 Multiple Logistic Regression Analysis of the Independent Variables Affecting theDepression Scores

95% ConfidenceFactors Odds ratio interval p

Marriage statusMonogamous 1.00Polygamous 2.23 3.40–25.37 <.001

Age −0.31 0.92–1.02 .210

EducationSecondary school and higher 1Primary school −0.70 0.15–1.55 .226Less than primary school −0.08 0.26–3.34 .903

OccupationEmployed 1.00Housewife 0.28 0.46–3.77 .600

Chronic diseaseNo 1.00Yes 1.25 1.42–8.71 .007

DISCUSSION

The authors found significant differences in the BDI scores between wivesin polygamous marriages and wives in monogamous marriages. Women inpolygamous marriages are often unhappy, and the addition of a second orthird wife is typically very distressing to “senior wives.” This change in thefamily organization can even be perceived as an abusive or traumatic ex-perience (Hassouneh-Phillips, 2001). Furthermore, the researchers from theUnited Arab Emirates (UAE), Kuwait, Egypt, Jordan, the Gaza Strip (BedouinArabs in Israel), and Turkey showed that senior wives in polygamous mar-riages report more psychosocial, familial, and economic problems comparedwith monogamous family counterparts (Al Darmeki, 2001; Al-Krenawi &Slonim-Nevo, 2008; Al-Shamsi & Fulcher, 2005; Chaleby, 1985). Authorsfound that after the husbands’ second marriage, senior wives in polyga-mous families experienced a major psychological crisis that manifested itselfin somatic complaints and psychological symptoms, such as anxiety, depres-sion, and irritability in the study conducted in Egypt (Al-Sherbiny, 2005). Ina study conducted in Kuwait, Chaleby (1987) found a high proportion ofpolygamous women among a sample of psychiatric outpatients comparedwith their numbers in the general population. Chaleby also found that moresenior wives were receiving treatment than junior wives. In another study,Chaleby (1985) found that the percentage of wives in polygamous marriageswas also significantly greater in the inpatient psychiatric population thanthe general population of Kuwait. In a recent Turkish study Ozkan and col-leagues (2006) found that participants from polygamous families, especially

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senior wives, reported more psychological distress. Different from the pre-vious studies, our findings indicate that senior and junior wives have higherBDI scores than monogamous wives.

There was an inconsistent relationship between education and the fre-quency of polygamy at the research (Elbedour, Onwuegbuzie, Caridine, &Abu-Saad, 2002). Al-Krenawi (2001) found no significant difference betweenthe educational levels of two groups of Bedouin Arab women that werecomposed of senior wives in polygamous marriages and wives in monoga-mous marriages. In addition, Peterson (1999) found no significant differencein literacy rates between monogamous and polygamous women. Inversely,better-educated, urban women are less likely to favor polygamy than moretraditional women in many studies (D’Hondt & Vandewiele, 1980; Ferraro,1991; Pool, 1972; Ware, 1979). Klomegah (1997) reported that the majorityof women in polygamous marriages have no formal education, fewer haveprimary education, and an even smaller number have secondary educationor higher. Within polygamous areas, Agadjanian and Ezeh (2000) found that71% of wives had no education, and only 2% had at least secondary educa-tion. In monogamous areas, 35% of wives had no education, and 17% hadat least some secondary education. Similarly, in our study, half of the se-nior wives’ education levels were lower than primary school—a higher ratethan the other two groups. This finding is consistent with previous reportsthat correlate lower education with a higher prevalence of polygamous mar-riages for both genders (Al-Krenawi et al., 2002; Chamie, 1986). In addition,husbands in polygamous marriages were more likely to have a lower levelof education than monogamous husbands (Peterson, 1999). Al-Krenawi andLightman (2000) reported that the educational levels of monogamous hus-bands were significantly higher than those of polygamous husbands. Ourstudy, however, found no difference in education level between husbandsin polygamous and monogamous marriages.

We found that for senior wives, the age at time of marriage was lowerthan for the other two groups. This finding is consistent with previous re-ports that demonstrate that wives in polygamous unions are prone to beingyounger at the time of their first marital cohabitation (Al-Krenawi et al., 1997;Johnson & Elmi, 1989).

Finally, Al-Krenawi (2001) documented in his study that none of thepolygamous wives, and only a small fraction of the monogamous wives,worked outside the home. In Peterson’s study, (1999) the wives in polyga-mous marriages were also less likely to work outside the home. Similarly,none of the women in Al-Krenawi and Lightman’s (2000) study worked out-side the home. Lev-Wiesel and Al-Krenawi (2000) found that 25% of womenfrom polygamous households worked part time outside the home. In addi-tion, Agadjanian and Ezeh (2000) found that more wives from areas witha lower incidence of polygamy worked outside the home and earned cashfor their work compared with wives from areas with a higher incidence

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Depression in Polygamous Versus Monogamous Wives 9

of polygamy. In our study, 18.6% of senior wives, 36.1% of junior wives,and 28.8% of monogamous wives worked outside the home; the differenceamong the groups was not significant.

CONCLUSION

Because there is no research on the depression scores of Turkish women inpolygamous and monogamous marriages and the role polygamous marriageplays in depression, the results highlighted many implications for clinicalpractice for future research. It is essential to increase awareness of the sig-nificance of polygamous family structures among psychiatrists and othertherapists. A first step in improving the ability to address these problemsis to transfer knowledge regarding the difficulties with which polygamy isassociated. Future studies are needed for transferring this knowledge to thecommunity and for establishing and monitoring reciprocal processes of col-laboration between researchers and practitioners. The findings in the presentstudy are therefore potentially powerful.

LIMITATIONS

Several limitations of this study warrant mention. First, data were obtainedfrom self-reports. Second, the sample was small, and data collection wascross sectional; therefore, these findings warrant replication with largersamples.

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