The relationship between depression and marital maladjustment in a clinic population: A multitrait-multimethod study

The Dynamic Interplay Between Satisfaction With Intimate Relationship Functioning and Daily Mood in Low-Income Outpatients

Substantial research supports bidirectional links between intimate relationship discord and individual psychopathology, including depressive symptoms. However, few studies have utilized daily diary methods to capture the micro-level processes underlying the association between couple discord and depression, particularly among populations that are at elevated risk for both interpersonal and individual dysfunction. To address this gap, we examined whether daily changes in satisfaction with relationship functioning were associated with daily changes in negative affect and positive affect over the span of 2 weeks among mental health outpatients of low socioeconomic status. Participants were 53 low-income outpatients from community mental health clinics who completed a semi-structured interview about the quality of their intimate relationships followed by 14 daily reports of positive and negative mood and satisfaction with relationship functioning across several domains. Growth curve analytic techniques revealed the hypothesized bidirectional relations. Decline in satisfaction with relationship functioning predicted escalation in negative affect and deterioration in positive affect over 2 weeks, and deterioration of mood predicted declining satisfaction with relationship functioning. This study extends existing knowledge about couple dysfunction and individual psychopathology by highlighting the immediate nature of this dynamic process as it unfolds over time.

The moderating role of social support for marital adjustment, depression, anxiety, and stress: Evidence from Pakistani working and nonworking women

BACKGROUND

This study examined how social support moderates the prolongation of mental distress related to depression, anxiety, stress, and marital adjustment in working and nonworking women. The study aimed to reveal the relationship between social support and mental health issues associated with depression, anxiety, stress, and marital adjustment among females.

METHODS

This research study is among the few studies performed in a Pakistani context and was conducted in 2017 to measure affective disorders among nonworking and working married females. Questionnaires were distributed among 500 targeted women, and valid responses were received from married working women in hospitals, banks, and multinational companies, and married nonworking women from residential areas of Islamabad and Rawalpindi, Pakistan. A cross-sectional design with purposive sampling was adapted for this research, and three scales were used to measure stress, anxiety, depression, social support, and marital adjustment and its social and cultural implications among the sampled population.

RESULTS

Social support was positively and significantly associated with marital adjustment, although it showed a negative association with anxiety, depression, and stress in working and nonworking women; this finding reflects the better mental health of the study population. The findings proved that marital adjustment has a negative relation with depression and anxiety in married working and nonworking females. Social support acts as a moderator for marital cohesion, affection, stress, and depression, and the results reflected that nonworking women with higher marital cohesion and affection showed less stress and depression because of social support.

LIMITATIONS

The findings of this sample cannot be generalized to the whole population as they are specific to the targeted respondents only.

CONCLUSION

The study revealed that women's mental health is affected by psychological distress caused by depression, anxiety, stress, social and cultural norms, and their implications. Lower stress and depression lead to better mental health as ostensive social support may help to explain the relationship between depression, anxiety, and stress.

A comparative study of quality of life and marital satisfaction in patients with depression and their spouses

Spouses of patients suffering from depression experience various forms of burden. Present study assesses and compares the marital satisfaction and quality of life (QOL) of the patients and their spouses. Further it assesses these variables in terms of illness severity, duration of untreated illness (DUI) and other demographic parameters especially gender. In this cross sectional study, 50 patients diagnosed with Depressive Disorder along with their spouses were recruited. Both groups were assessed separately for marital satisfaction and QOL along with demographic details followed by appropriate statistical analysis. A high level of marital distress found amongst both patients and their spouses whereas only patients reported poor QOL. Increasing DUI worsens both marital satisfaction and QOL in spouses with no effects on patients. Illness severity worsens QOL in both groups with no effect on marital satisfaction. Gender was not found to have any impact on either of the groups. Small sample size and cross sectional study design were main limitations. Early and faster intervention will be helpful in patient's prognosis, and also the perception and QOL of spouses. A better treatment response may be expected if focus is at improvement in QOL rather than only symptom control. Further work will be needed with a larger population and in a longitudinal study design. Future research also needs to focus upon establishment of better norms for the DUI for depressive disorder.

Silencing The Self

Silencing the self theory (Jack, 1991) holds that women's depression is closely related to experiences in close relationships, especially if women conform with societal norms for feminine relationship roles. In conforming, Jack believes that women develop relationship schema that heighten vulnerability to loss of self-esteem and depressive symptomatology. An exploratory study addressed relationships among self-report measures of silencing the self, dyadic adjustment, demographic variables, and depressive symptomatology in a community sample of 155 cohabiting women and men, including 37 heterosexual couples from which both partners provided data. Although relationship adjustment was no more closely associated with depressive symptomatology for women than for men, silencing the self was. Demographic variables (number of children, employment status, and income) accounted for a significant proportion of variance in depressive symptomatology for men but not for women. Women's self-reported silencing was related to both their own and their partner's relationship adjustment.

Behavioural Marital Therapy in the Treatment of Psychological Disorders

There is a well established relationship between marital discord and individual psychopathology in family members. This paper reviews evidence relating to patterns of marital interaction related to the co-occurrence of marital discord and three common psychological disorders: depression, alcohol abuse, and childhood conduct disorders. The effects of behavioural marital therapy (BMT) on dysfunctional marital interaction in such cases, and the impact of BMT on individuals' psychological disorders, are evaluated. It is concluded that BMT is often a useful component of treatment in each disorder reviewed. Further it is argued that it is important routinely to assess the relationship context in which these disorders occur. Finally, some of the difficulties and limitations of the application of BMT in cases where the presenting problem is an individual psychopathology are considered.

Marital adjustment for patients with epilepsy in China

Marriage is a major source of social support and a predictor of health; however, marriages that involve people with epilepsy are more likely to fail. To explore this issue in China, we compared the marital adjustment of patients with epilepsy to control subjects using the Dyadic Adjustment Scale (DAS). A total of 136 married persons with epilepsy and 145 healthy control subjects were recruited. The DAS score was significantly lower in people with active epilepsy than in the controls (102.0±17.8 vs. 109.2±15.8, p<0.001). A hierarchical regression showed that depression and social support satisfaction were significant predictors for DAS. Psychosocial variables accounted for 24.0% of the variance in DAS after control for demographic and seizure-related factors in patients with active epilepsy. The result suggests that people with active epilepsy in our sample encountered more marital discord than controls. Treatment to control mood disorder and support intervention might be important for their marital adjustment.

Relative contributions of relationship distress and depression to communication patterns in couples

Researchers have long been interested in the relationship between marital distress and depression. Empirical findings from investigations into the relative contributions of marital distress and depression to marital communication have been inconsistent, and some communication behaviors, such as the demand/withdraw interaction pattern, have yet to be examined. The ability of depression to predict major types of communication (positive communication, negative communication, problem-solving, and demand/withdraw) was analyzed after controlling for the shared variance between marital distress and depression. Across two studies of couples beginning therapy and one study of couples beginning an enhancement program, results failed to provide support for a unique contribution of depression to couples' communication behaviors.

The effect of polygamous marital structure on behavioral, emotional, and academic adjustment in children: a comprehensive review of the literature

Polygamy represents expanded family structures that are based on marriages involving a husband with 2 or more wives. Interestingly, polygamy is legally and widely practiced in 850 societies across the globe. In the last 2 decades, polygamy has been the focus of a significant growth in public, political, and academic awareness. Indeed, several quantitative and qualitative research articles and theoretical papers have emerged during this period, particularly concerning the effects of this form of marital structure on behavioral, emotional, and academic adjustment of children. However, to date, no researcher has provided a summary of the extant literature. Thus, the purpose of this comprehensive literature review is to summarize findings and to discuss implications of empirical studies that have examined whether polygamous marital structures are beneficial or harmful to children in comparison with children raised in monogamous marital structures. This review includes a summary of the findings from all quantitative and qualitative studies in the extant literature that have examined the effect of polygamy on children's outcomes.

The role of marital interaction in chronic pain and depressive symptom severity

Several investigators have noted the moderating role of the spouse in determining the severity and disability associated with the experience of chronic pain. In this study, pain-contingent responses from spouses, but not global marital satisfaction, accounted for a significant proportion of the variance in reported pain severity. Global marital satisfaction predicted depressive symptom severity. The interaction between global marital satisfaction and the reported frequency of punishing responses to pain behavior added significantly to the prediction of depressive symptoms. Similarly, the interaction between marital satisfaction and degree of spouse solicitousness significantly predicted pain severity. These results are consistent with evolving literatures on the important relationship between marital distress, aversive communication and depression on the one hand, and the potentially deleterious role of the solicitous spouse in the maintenance of chronic pain on the other.

On the validity of the Beck Depression Inventory. A review

The present review discusses validity aspects of the Beck Depression Inventory (BDI) on the basis of meta-analyses of studies on the psychometric properties. Shortcomings of the BDI are its high item difficulty, lack of representative norms, and thus doubtful objectivity of interpretation, controversial factorial validity, instability of scores over short time intervals (over the course of 1 day), and poor discriminant validity against anxiety. Advantages of the inventory are its high internal consistency, high content validity, validity in differentiating between depressed and nondepressed subjects, sensitivity to change, and international propagation. The present paper outlines agreements and contradictions between the various studies on the BDI and discusses the potential factors (composition of the subject sample, statistical procedures, point in time of measurement) accounting for the variance in their results. The Beck Depression Inventory (BDI) is world-wide among the most used self-rating scales for measuring depression. Since the test construction in 1961, the test has been employed in numerous (more than 2,000) empirical studies. The present review will only consider those investigations which are primarily concerned with the validity or the psychometric properties of the BDI. Since most studies are oriented along the criteria of the classical test theory, our review will discuss to what extent the BDI meets these criteria.

Intrusiveness of rheumatoid arthritis on sexuality in male and female patients living with a spouse

OBJECTIVE

To determine whether physical disability, pain, depressive mood, and criticism by the spouse are differentially related to intrusiveness of rheumatoid arthritis (RA) on sexuality in male and female patients.

METHODS

Physical and psychological aspects of health were assessed in 102 male and 118 female RA patients who were living with a spouse. Patients were classified into 3 levels of intrusiveness of RA on sexuality. The data were analyzed by means of analysis of covariance and multiple regression analysis.

RESULTS

Greater intrusiveness of RA on sexuality was related to greater physical disability, pain, and depression in male and female RA patients. Female patients, compared with male patients, appeared to have lower levels of mobility and self-care. Male and female patients did not differ in their level of intrusiveness of RA on sexuality.

CONCLUSION

Physical disability, pain, and, to a lesser extent, depression were found to contribute to intrusiveness of RA on sexuality. It is suggested that differences in sexual motivation between men and women might have been influential in the absence of gender differences in intrusiveness.

Does recollection of exposure to poor maternal care in childhood affect later ability to relate?

The study tested Bowlby's hypothesis that experiencing the poor relating of parents in childhood predisposes the individual to poor relating in adult life. Data were drawn from two community samples: a younger sample of 25-34-year-old married women, and an older one of 40-49-year-old women. Data were also drawn from the husbands of the women in the younger sample. It focused on the single childhood variable of the recollection of poor maternal care. To avoid the effect of this on depression or other psychopathology, groups who were depressed and not depressed, or who were at different levels of psychopathology, were examined separately. Recollection of poor early care was associated with poor relating, lower age at marriage, poor-quality marriage and divorce from first marriage. There was a suggestion that the effects of the recollection of poor early care of marital partners summate.

Dependency conflict, marital threat, and alcohol consumption in a middle-aged sample

The hypothesis that dependency conflict is associated with higher levels of alcohol consumption when dependency needs are threatened or thwarted was tested with a sample of 672 middle-aged, married adults with college-age children. The subjects' current level of alcohol consumption was predicted based on the present level of threat to the marital relationship (assessed by reports from several family members) and on indices of dependency need and inhibition of dependent behavior estimated from sibship size, sibship density, and sibling position. A multiple regression analysis yielded a significant two-way interaction (p less than .05) between marital threat and subject sex, and a significant three-way interaction of dependency need, inhibition of dependent behavior, and marital threat. High marital threat was associated with higher levels of alcohol consumption in men and slightly lower levels of alcohol consumption in women. Additionally, when dependency need was high, alcohol consumption was generally low, except when both inhibition of dependent behavior and marital threat were high. However, when dependency need was low, the highest alcohol consumption score occurred when marital threat was low and inhibition was high.

Work stress, family stress and depression in professional and managerial employees

Detailed interviews were conducted with 1523 married professional and managerial employees of a major US corporation to test associations of acute and chronic occupational and domestic stress with DSM-III-R major depression and current depressive symptoms. After controlling for demographic and clinical risk factors, both sources of stress were significantly associated with the two measures of depression. On the other hand, neither the demographic and clinical risk factors, nor several psychosocial characteristics (social support, sense of mastery and organizational commitment) moderated the relationship between stress and depression.

Perceived interpersonal risk factors of non-endogenous depression

In a case-control study, two potential interpersonal risk factors of non-endogenous depression, namely a patient's perception of their current intimate partner as dysfunctional and a patient's recall of exposure to previous deprivational parenting, were quantified. The interpersonal characteristics of the partner were assessed principally by a brief self-report questionnaire, the Intimate Bond Measure (IBM). By cross-sectional and longitudinal comparison of this instrument with other interview-derived and self-report measures, the convergent, discriminant and predictive validity of the IBM in depressed patients was established. Further, little evidence of any distorting effect of depressed mood or neuroticism was detected. The perception of the current intimate partner as dysfunctional imparted a risk to non-endogenous depression of at least five times, while reported exposure to parental 'affectionless control' was quantified as a four times' risk. Importantly, IBM care scores predicted the course of the depressive disorder over a six-month period.

Negative modes of relating, marital quality and depression

Young married couples, with or without a depressed wife, were divided into three groups according to marital quality. Negative modes of relating were assessed by self-rating and partner-rating questionnaires. The intercorrelation of scores for different modes of relating was higher on partner-rating than on self-rating scales. There was a significant gradient of mean negative-relating scores across the three levels of marital quality. The partner-ratings of depressives and their husbands were higher on all negative-relating scales than those of non-depressed women and their husbands. The self-ratings of the depressives corresponded with these negative ratings while those of their husbands did not. The partner-rating scores differentiated between the depressives with poor marriages and those with better marriages.

Parental rearing behaviour, family atmosphere and adult depression: a pilot study with psychiatric inpatients

In a sample of 72 depressed inpatients the relationships between severity of depression, emotional family atmosphere and perceived parental rearing were studied at admission, discharge and follow-up. The results indicate that paternal rejection and overprotection might be of particular importance for developing social skills used to form close relationships, whereas maternal emotional warmth seems to have a preventive effect by promoting emotional stability.

Couples coping with chronic illness: women with rheumatoid arthritis and their healthy husbands

Effects of a chronic disease, rheumatoid arthritis, upon the psychological adjustment of 103 women and their healthy husbands were examined. Husbands completed scales assessing perceived vulnerability to illness and coping efficacy, burden of caring for their wives, and level of psychological adjustment. Wives completed the Ways of Coping scale, rated attributions about arthritis, and rated criticalness and supportiveness of their husbands. Husbands were also interviewed and their responses coded for critical remarks about the wife. The same variables were used to predict each partner's adjustment in order to compare factors associated with each. Hierarchical regression indicated that negative marital interaction surrounding the wife's illness was a determinant of both partners' psychological adjustment. Apart from this variable, different factors predicted husbands' and wives' mental health. Husbands were most affected by their own perceived vulnerability to disease and coping inefficacy. Wives were most affected by pain severity and how they coped with arthritis.

Social relationships reflected by depressive inpatients

In a study of 100 inpatients suffering from depressive symptoms, the influence of cognitive characteristics (negative automatic thoughts and dysfunctional attitudes) and of the severity of depression on the emotional reflections of social relationships were investigated at admission, discharge and 3 months follow-up. The reflections of strained relation and rejection in the family or partnership were significantly determined by negative cognitive patterns and severity of depression. The prognostic aspects of the assessed psychological characteristics and the psychotherapeutic implications of the results are discussed.

Depression and family relationships. A study of young, married women on a London housing estate

The study was carried out on 25-34-year-old, British-born, married women, living on a south-east London housing estate. The reported early and current family relationships of 50 depressed and 40 non-depressed women were compared. Significantly more of the depressed women reported a poor early relationship with their mothers, but not with their fathers. This finding was confirmed by corresponding low care and high overprotection scores (for mothers only) on the Parental Bonding Instrument. On the basis of what the women and their husbands said, the marriages of the depressed women were rated as much poorer. This was confirmed by the women's and their husbands' scores on a Partner Rating Questionnaire and the Ryle-Scott-Heyes Marital Patterns Questionnaire. The depressed women reported a poorer current relationship with their mothers and a much poorer relationship with their husbands' mothers and fathers. Significantly more depressed women reported four or more poor family relationships.

Life history factors associated with neurotic symptomatology in a rural community sample of 40-49-year-old women

Associations between a range of life history variables and neurotic pathology (measured by the Crown-Crisp Experiential Index) were examined in a rural community sample of 208 women aged 40-49. Significant childhood associations were a poor maternal relationship, parental discord, nervousness and not liking school. Significant later associations were a poor marital relationship and emotional and behavioural problems in children. There were significant intercorrelations between the significant childhood variables and between the later significant variables but not between the early and later variables. The predictor equations derived from multiple regression analysis fitted significantly a small replication patient sample.

Psychogenic pain: a study of marital adjustment

The marital adjustment of patients with psychogenic pain disorder was evaluated and compared with a matched group of patients with other neurotic disorders. Pain patients spouses were found to have better marital adjustment and less psychiatric morbidity than the spouses of neurotic patients. These findings are discussed in terms of the concepts of "sick role homeostasis" and "tertiary gain".

The Maudsley Marital Questionnaire (MMQ): an extension of its construct validity

In a successful attempt at extending the construct validity of the Dutch version of the Maudsley Marital Questionnaire (MMQ), its sub-scales were correlated with the Marital Deprivation Scale, the Sexuality Experiencing Scale, the Marital Communication Inventory, and the Hopkins Symptom Checklist.

Partnership problems as causes of endogenous and neurotic depressions

Content analysis of biographic interviews with endogenous and neurotic depressives shows that problems in a partnership carry particular weight as triggers of depression. In this respect, however, separations and the death of a partner play a comparatively less important role. Neurotic depressives become significantly more often depressive because of partnership-related events than endogenous depressives. Also in qualitative respects the causes for depression differ between the two groups: in endogenous depressives a threat of real loss often triggers depression, whereas neurotic depressives fall ill more frequently as a result of disappointments and injuries caused by the partner. Accompanying differences in the course of the partnership, the choice of partner and the premorbid personality are discussed.

The relationship of social setting to major depression

Sixty middle-aged women with a major depressive episode diagnosed in a community survey were compared with those 400 participants of the study who had no history of major depression. The husband's income and the family income were lower in the depressed group even when adjustment was made for age and marital status. The depressives were more often divorced or widowed than were controls. As a direct consequence of this, women with major depression lived in smaller residences and were more seldom owners of a summerhouse. The proportions of women working full-time, part-time or not working outside home were the same in those with major depression and the controls. The level of adversity (life events and long-term major difficulties) during the year preceding the study was increased in the depressed group when adjustment was made for age, marital status and social class differences. A larger proportion of the depressed women reported marital and job dissatisfaction. Variables reflecting social isolation did not differ between groups. There were no differences between depressed and undepressed regarding churchgoing, but fewer of the former stated that they believed in God.

Family environments of depressed outpatients

The present study assessed the family environments of 43 depressed patients treated in an outpatient clinic. All family members 11+ years of age were administered the Family Environment Scale. Results showed that perceptions of the family environment were not statistically different from a normative sample. Differences among unipolar, bipolar and secondary affective disorder groups also did not attain statistical significance. On the other hand, current symptomatology among patients was associated with negative perceptions of the family environment.

The depressed mother as a source of stimulation for her infant

Compared a group of 25 postpartum depressed mothers and 25 control mothers with respect to the level and quality of stimulation they provided for their newborn infants during a feeding session. Observer measures of maternal behavior included visual, auditory and kinesthetic stimulation and levels of unconditional positive regard. Results did not indicate any differences between the two groups in levels of stimulation. However, depressed mothers provided significantly lower levels of unconditional positive regard and exhibited less continuity of rocking behavior with their infants. A post hoc analysis that compared the extremes of the two S groups (N = 22) revealed significant differences in gazing behavior, with more depressed mothers gazing less at their infant's faces. Depressed mothers exhibited significantly lower levels of marital adjustment and had more extensive postpartum concerns. Contrary to expectations, no relationship was demonstrated between level of marital adjustment and maternal behavior toward the infant.

Marriage and mental illness

Two female psychiatric patient samples were examined--240 women, aged 20 or over, from North East Scotland; and 44, aged 40 to 49, from Chichester, West Sussex. There was also a Chichester community sample of 230 women of similar age-range. The N.E. Scotland psychiatric patients with poor marriages broke down significantly earlier, and the delay between marriage and first breakdown was significantly shorter. This group also tended to have a neurotic rather than an endogenous type of depression. The poor marriages of the Chichester psychiatric patients were, in the main, similar to those of the Chichester non-patients, but the patients demonstrated significantly more disturbance of sexual relationships, and their in-laws were significantly more disapproving.

Marital interaction in depression

The great majority of depressed patients are currently married or formerly married and depression is commonest at ages when marital satisfaction is least. Study of patterns of marital interaction in depression may provide useful leads for understanding the aetiology and therapy of depressive syndromes. Theoretical views of depression as loss, as coerced behaviour and as coercive behaviour suggest useful hypotheses. Both marital interaction and depression are complex variables to define and measure. A literature review suggests reduced general affective involvement, reduced expressions of affection, increased criticism, increased husband domination and a marked struggle for interpersonal control in the marriages of depressed persons. Marital therapy may be the most useful psychotherapeutic approach for depression.

Understanding and similarity in relation to marital satisfaction

This investigation assessed the relation of understanding and similarity of spouses to marital satisfaction by use of the MMPI. The satisfactorily married couples predicted significantly more of their spouses' responses than did the unsatisfactorily married couples. This significantly greater accuracy of prediction was not enhanced by the significantly greater similarity exhibited by the satisfactorily married couples. In fact, both groups accurately predicted a significantly greater number of items that were dissimilarly endorsed when compared with those items similarly endorsed. No relation was found for either group between assumed similarity and marital satisfaction.