Exploring effects of severe mental illnesses on marriages: A qualitative study from Karachi, Pakistan.

Marriage is a central institution in South Asia, carrying deep social, cultural, and moral significance. In Pakistan, where psychiatric illness and divorce are both heavily stigmatized, the interaction between serious mental illness and marital life is complex and under-examined. Given the paucity of literature on this topic, our study explores how severe mental illnesses (Bipolar Disorder, Schizophrenia and Obsessive-Compulsive Disorder) affect marital quality, caregiving roles, and marriage outcomes within this sociocultural context. Using an exploratory qualitative design, we conducted in-depth interviews with 40 + participants recruited from a tertiary care hospital in Karachi. Participants were purposively sampled across 6 scenarios varying by disclosure timing and marriage outcome. Data were thematically analyzed using an interpretive approach grounded in family systems theory. Findings revealed that the presence of children, prior knowledge of the illness and the prevalent stigma of divorce were major influences in keeping the marriage intact. Spouse-participants reported significant caregiving strain, marked by role reversals, emotional exhaustion and health deterioration. Given the sociocultural and religious importance of marriage in Pakistan coupled with widespread stigma of mental illness, our findings call for culturally grounded mental health strategies that promote early disclosure, especially in the South Asian context.