Original Research
Women’s Health / Psychometrics

Validation of a New Questionnaire Assessing the Health Impact of Divorce on Women: An Exploratory Factor Analysis

Last reviewed: March 2026

Background and Rationale

Divorce is increasingly recognised as a significant public health concern, with well-documented consequences extending far beyond the legal dissolution of marriage. Research from multiple countries has established that divorce is associated with increased risks of depression, anxiety, cardiovascular disease, and reduced immune function. For women specifically, the health toll can be particularly severe, encompassing not only psychological distress but also economic hardship, social stigma, and disrupted social support networks.

In Malaysia, divorce rates among Muslim couples have shown a concerning upward trend over recent decades, prompting growing interest among public health researchers in understanding the health ramifications for affected women. The Malaysian context presents unique considerations: the intersection of Islamic family law, Malay cultural norms regarding family honour, and the practical challenges of single motherhood in a society where extended family support structures are undergoing transformation due to urbanisation.

Despite the growing prevalence of divorce and accumulating evidence of its health impacts, the field lacked a validated psychometric tool specifically designed to capture the breadth of health consequences experienced by divorced women in Malaysian or broader Southeast Asian settings. Existing instruments, predominantly developed in Western contexts, may fail to capture culturally specific stressors such as community stigma, religious guilt, and changes in family standing that are particularly salient in Malaysian society.

Study Design and Methodology

This study employed a rigorous instrument development methodology following established psychometric principles. The research unfolded across several phases. The initial phase involved an extensive literature review to identify existing measures of divorce-related health impacts, complemented by qualitative interviews with divorced women and expert consultations with psychologists, public health practitioners, and family counsellors familiar with the Malaysian context. This process generated an initial pool of candidate items intended to capture the full spectrum of health effects reported in both the scientific literature and lived experience.

Item refinement involved expert panel review to assess content validity, ensuring that each item was relevant, clearly worded, and culturally appropriate. Face validity was evaluated through pilot testing with a small sample of divorced women who provided feedback on comprehensibility and relevance. Items judged to be redundant, ambiguous, or culturally inappropriate were revised or eliminated.

The refined questionnaire was then administered to a larger sample of divorced women recruited from relevant community settings. The data collected were subjected to exploratory factor analysis (EFA) using principal axis factoring with varimax rotation. This statistical procedure identifies the underlying latent constructs (factors) that explain the pattern of correlations among the questionnaire items. The Kaiser-Meyer-Olkin measure and Bartlett’s test of sphericity were used to confirm the appropriateness of the data for factor analysis. Factor retention decisions were guided by eigenvalue criteria and scree plot inspection.

Internal consistency reliability was assessed using Cronbach’s alpha for each extracted factor, with values of 0.70 or above considered acceptable. Item-total correlations were examined to ensure each item contributed meaningfully to its respective factor.

Results and Factor Structure

The exploratory factor analysis revealed a multidimensional structure, confirming the theoretical expectation that divorce affects women’s health through multiple distinct pathways. The extracted factors aligned with domains that have been identified in the broader divorce-health literature, but with additional culturally specific elements that justified the development of a new instrument rather than relying solely on adapted Western measures.

Key domains identified through the factor analysis included psychological wellbeing (encompassing symptoms of depression, anxiety, loneliness, and loss of self-esteem), physical health complaints (including somatic symptoms such as sleep disturbance, appetite changes, fatigue, and musculoskeletal pain), social functioning (capturing disruptions in social networks, perceived stigma, and difficulties in social interactions), and economic strain-related health effects (reflecting the health consequences of financial hardship that often accompanies divorce).

Factor loadings for retained items exceeded the conventional minimum threshold, indicating that each item had a sufficiently strong relationship with its designated factor. The total variance explained by the extracted factors was within the range typically reported for health questionnaires of this type. Cross-loading items—those that loaded substantially on more than one factor—were either removed or reassigned based on theoretical considerations.

Cronbach’s alpha coefficients for the extracted factors ranged within acceptable to good levels, supporting the internal consistency reliability of the subscales. Item-total correlations confirmed that individual items were appropriately associated with their respective factor scores.

The Malaysian Context: Divorce and Women’s Health

Understanding divorce-related health impacts in Malaysia requires consideration of several distinctive contextual factors. Malaysia’s dual legal system, in which Islamic family law governs matters of marriage and divorce for Muslim citizens while civil law applies to non-Muslims, creates a legal landscape that influences the divorce process and its aftermath differently for different populations.

For Malay Muslim women, who constitute the majority of divorce cases handled by Syariah courts, the process may involve specific stressors related to navigating religious court procedures, potential disputes over mahr (dower) and iddah (waiting period) provisions, and the interplay between religious obligations and personal wellbeing. The concept of fasakh (judicial divorce initiated by the wife) and khuluk (divorce by mutual consent with compensation) reflect particular legal pathways that carry their own psychological dimensions.

Socially, divorced women in Malaysia may face stigma that manifests differently across ethnic and religious communities but is broadly present across Malaysian society. Research has documented that divorced Malay women often report feelings of shame, social exclusion from community and religious gatherings, and pressure from family members to remarry. These social stressors compound the direct psychological effects of marital dissolution.

Economically, the consequences of divorce for Malaysian women often include reduced household income, loss of shared assets, and the challenge of balancing employment with single parenthood in a labour market that may not adequately accommodate these needs. The financial strain can directly affect health through reduced ability to access healthcare services, nutritional compromises, and the physiological effects of chronic economic stress.

Public Health Implications and Significance

The validated questionnaire offers public health practitioners and researchers a culturally appropriate tool for assessing the health consequences of divorce among Malaysian women. Such an instrument has multiple practical applications. In clinical settings, it can facilitate early identification of divorced women at heightened risk of health deterioration, enabling targeted preventive interventions. In research contexts, it permits more accurate measurement of divorce-related health outcomes in population studies, improving the evidence base for policy development.

From a public health policy perspective, the findings underscore the need for Malaysia’s healthcare system to recognise divorce as a determinant of women’s health and to develop supportive services accordingly. This might include integrating mental health screening into primary care encounters for recently divorced women, establishing peer support programmes, and ensuring that health promotion messages reach this vulnerable population. The Department of Women’s Development (JPW) and related agencies could use such evidence to advocate for expanded support services.

Limitations

As an initial validation study employing exploratory factor analysis, the findings represent a foundational step that requires confirmation through subsequent confirmatory factor analysis with an independent sample. The cross-sectional design limits the ability to assess the instrument’s sensitivity to change over time, which would be important for evaluating intervention outcomes. The sample, while adequate for exploratory factor analysis, may not fully represent the diversity of divorced women across Malaysia’s varied ethnic, religious, and socioeconomic landscape. Future research should include larger, more heterogeneous samples and evaluate the instrument’s performance across different cultural subgroups within Malaysia. Test-retest reliability, convergent validity with established measures of related constructs, and known-groups validity (comparing women at different stages post-divorce) remain to be established.

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