“Assessing association of societal pressure to get married with anxiety and depression among unmarried women (25-49 years) in Pakistan”: a mixed method study

Background: Mental wellbeing is defined as the ability to realize one’s potential, cope with life’s stresses, work productively, and contribute to society. Globally, mental health conditions have increased by 13% over the last decade, accounting for 1 in 5 years lived with disability. In Pakistan, mental illness contributes over 4% to the national disease burden, with women disproportionately affected. Key risk factors include low education, adverse childhood experiences, lack of social support, and stressful life events. In the Pakistani context, cultural expectations around marriage place significant psychological strain on women, often without adequate social support. Methods: An explanatory sequential mixed methods design was used. In the quantitative phase, 241 unmarried women aged 25–49 were recruited through snowball sampling. Anxiety and depression (outcome) were assessed using the AKUADS, while societal pressure (exposure) was measured via the Perceived Sociocultural Pressure Scale (PSPS). In the qualitative phase, 12 in-depth interviews were conducted using purposive sampling to explore personal experiences of societal pressure. Quantitative data were analyzed in Stata v15; thematic analysis of qualitative data was done using NVivo 12. Results: Among participants, 62.7% held graduate degrees, and 59.8% were employed. Of those reporting societal pressure, 74.69% experienced anxiety/depression. Logistic regression showed women facing societal pressure had 2.56 times higher odds of anxiety/depression (OR = 2.56; 95% CI: 1.29–5.10). Low-income women (below PKR 50,000/month) had 2.31 times the odds compared to those earning above PKR 200,000. Qualitative findings echoed the quantitative results, revealing that societal and religious norms drive marriage pressure, with marriage seen as a source of financial security. High income and professional identity (particularly in healthcare) provided a protective buffer against poor mental health. Conclusion: Societal pressure to marry is significantly associated with anxiety and depression in unmarried Pakistani women. Higher income and skilled professions appear to mitigate this risk.