Accounting for the physical and mental health benefits of entry into marriage: a genetically informed study of selection and causation

Divorce, genetic risk, and suicidal thoughts and behaviors in a sample with recurrent major depressive disorder

BACKGROUND

Theories of risk for suicidal thoughts and behaviors (STB) implicate both interpersonal and biological factors. Divorce/separation and aggregate genetic liability are robustly associated with STB, but have seldom been evaluated in conjunction with one another. Furthermore, whether these factors are effective predictors in high-risk populations is not clear.

METHODS

Analyses were conducted in a sample of Han Chinese women with severe recurrent major depressive disorder (maximum N = 4380). Logistic regressions were used to evaluate the associations between divorce/separation and polygenic scores (PGS) for suicidal ideation or behavior with STB. Where appropriate, additive interactions between divorce and PGS were tested.

RESULTS

Divorce/separation was significantly associated with increased risk of suicidal ideation, plans, and attempts (odds ratios = 1.28-1.61). PGS for suicidal ideation were not associated with STB, while PGS for suicidal behavior were associated with ideation and plans (odds ratios = 1.08-1.09). There were no significant interactions between divorce/separation and PGS.

CONCLUSIONS

Consistent with theories of suicidality, the disruption or end of an important interpersonal relationship is an indicator of risk for STB. Aggregate genetic liability for suicidal behavior more modestly contributes to risk, but does not exacerbate the negative impact of divorce. Thus, even within a high-risk sample, interpersonal and biological exposures distinguish between those who do and do not experience STB, and could motivate targeted screening. Further research is necessary to evaluate whether and how the context of divorce contributes to variation in its effect on STB risk.

Patterns of Singlehood, Cohabitation, and Marriage in Early Adulthood in Relation to Well-being in Established Adulthood

In a cohort followed from late adolescence until established adulthood, this study examined how singlehood, cohabitation, and marriage are related to well-being at different ages across early adulthood and into established adulthood.Participants (N = 585) from three U.S. sites reported their marital and residential status at ages 18, 23, 28, and 34, when they also reported on physical, psychological, and social indicators of well-being. Findings suggest that being married compared to single earlier in adulthood is related to several indicators of better age 34 well-being. Although single and married participants did not differ on all indicators of well-being, married participants across several ages had less problematic substance use, better health, more economic security, and fewer internalizing and externalizing problems at age 34. Cohabiting participants' well-being was more similar to the well-being of the single than married participants on most indicators (and on all indicators by age 34). Findings did not differ by gender. The findings suggest that despite normative increases in singlehood and cohabitation, the present cohort shows that marriage continued to be associated with well-being at age 34.

Recognizing and Appreciating the Partner's Support Protects Relationship Satisfaction during Cardiac Illness

BACKGROUND

This study aimed to examine whether dyadic coping (DC) is associated with relationship satisfaction (RS) among couples facing cardiac diseases. Furthermore, the moderating role of both partners' anxiety and depression was tested.

METHODS

One hundred cardiac patients (81.5% men) and their partners (81.5% women) completed a self-report questionnaire during hospitalization. The Actor-Partner Interdependence Model (APIM) and moderation analyses were used to assess the above associations.

RESULTS

Results showed that positive DC was significantly related to higher levels of RS, and negative DC was related to lower levels of RS. Furthermore, patient and partner psychological distress significantly moderated the link between DC and RS: patient-perceived positive DC was associated with higher partner RS when partner depression was high; partner-perceived positive DC was associated with higher patient RS when patient anxiety was low; patient-perceived negative DC has associated with lower patient RS when patient anxiety and depression were high.

CONCLUSION

This study showed that positive DC is associated with a more satisfying relationship and identified under what conditions of cardiac-related distress this can happen. Furthermore, this study underlined the importance of examining DC in addition to the individual coping skills as a process pertaining to personal well-being and couple's outcomes.

Lifetime years married held steady for men with a BA degree since 1960 but dropped to lowest level since 1880 for men without a BA

Trends in life expectancy and marriage patterns work together to determine expected lifetime years married. In 1880, adult life expectancy was short and marriages were more likely to end by death than divorce. Since then, although there have been substantial life expectancy gains in adulthood, marriage has been increasingly delayed or forgone and cohabitation and divorce are far more prevalent. Whether adults today can expect to spend more or fewer years married than in the past depends on the relative magnitude of changes in mortality and marriage. We estimate trends in men's expected lifetime years married (and in other marital statuses) from 1880 to 2019 and by bachelor's degree (BA) status from 1960 to 2019. Our results show a rise in men's expected lifetime years married between 1880 and the Baby Boom era and a subsequent fall. There are large and growing differences by BA status. Men with a BA have had high and relatively stable expected lifetime years married since 1960. For men without a BA, expected lifetime years married has plummeted to lows not seen among men since 1880. Cohabitation accounts for a substantial fraction, although not all, of these declines. Our results demonstrate how increasing inequality in both life expectancy and marriage patterns combine to amplify educational differences in lifetime experiences of coresidential partnerships.

Union Status and Disability Pension

A lot is known about the association between marital status and mortality, and some of these studies have included data on cohabitation. Studies on the association with health problems, rather than mortality, are often based on self-reported health outcomes, and results from these studies are mixed. As cohabitation is now widespread, more studies that include data on cohabitation are needed. We use Norwegian register data that include detailed information about union status and all cases of disability pensioning from 2005 to 2016. We employ Cox regression analysis and a within-family design in order to control for hard to measure childhood characteristics. Compared to the married, the cohabiting have a somewhat higher risk of receiving disability pension due to mental disorders, and for men also due to physical disorders. Receipt of disability pension is most common among the never married, especially for men. The association between union status and disability pensioning is stronger for mental than for physical disorders.

COVID-19-associated mental health impact on menstruation physiology: A survey study among medical students in Jordan

BACKGROUND

The coronavirus disease 2019 pandemic has been an extraordinarily stressful situation in recent years. Stress is a physiological reaction to negative stimuli that is regulated by different neuroendocrine pathways. The female reproductive function is maintained by the menstrual cycle, which is negatively affected by hyperstimulation of stress signals.

OBJECTIVES

This study evaluates the effect of the coronavirus disease 2019 outbreak on menstrual function and mental health, exploring the relationship between them.

DESIGN

The current study uses a cross-sectional, survey-based design.

METHODS

During this cross-sectional study, an online self-completion questionnaire was conducted among a sample of 385 Jordanian female medical students during the pandemic. The survey compared menstrual characteristics, depression, anxiety, and stress 10 months after the coronavirus disease 2019 pandemic with 10 months prior. Paired t-test, McNemar's test, Pearson's correlation, and multiple linear regression model were employed to analyze data using SPSS software.

RESULTS

The mean age of female medical student respondents was 19.89 years. Data showed that the menstrual cycle length significantly increased during the coronavirus disease 2019 pandemic compared with 10 months prior (32.23 days versus 30.02 days, p = 0.019). The average number of heavy bleeding days also increased during the coronavirus disease 2019 pandemic (2.82 days versus 2.42 days, p = 0.002). The proportion of females with heavy bleeding amount was more than doubled during the pandemic of coronavirus disease 2019 compared with before (27.3% versus 10.4%, p = 0.000). Unpleasant menstrual signs such as nausea and/or vomiting, breast pain, and urinary urgency were significantly increased during the pandemic (p = 0.000, p = 0.008, and p = 0.024, respectively). During coronavirus disease 2019, a positive association between total Depression, Anxiety, and Stress Scale-21 Questionnaire score and heavy bleeding was identified (p < 0.05). The findings also indicated that mental disorders and the incidence of amenorrhea, nausea and/or vomiting, and urinary urgency were positively correlated during the coronavirus disease 2019 pandemic. The multiple regression analysis revealed associations between several menstrual characteristics such as amenorrhea and severity of bleeding with coronavirus disease 2019-related depression, anxiety, and stress.

CONCLUSION

This study revealed that the stress related to the pandemic of coronavirus disease 2019 could affect the female menstrual cycle and hence the quality of women's life. Therefore, this study could serve as a baseline for planning and introducing stress mitigation interventions in crisis situations to improve the physiological and mental well-being of females and improve their quality of life.

Do married and/or cohabiting individuals fare better during the COVID-19 pandemic? Satisfaction with life and depression among adult twins in the United States

Due to social distancing measures implemented to mitigate the COVID-19 pandemic, individuals are spending more time isolated at home with limited physical social interactions. The current study investigated whether marriage and/or cohabitation is associated with satisfaction with life and depression among 732 adult same-sex twin pairs (monozygotic and dizygotic) in the US using online survey data. Twin analysis showed that married and/or cohabiting individuals were more satisfied with life and less depressed than those not married and/or cohabiting. The association between marriage and/or cohabiting and satisfaction with life was not confounded by between-family factors, whereas that between depression was mediated by familial factors. These findings suggest that being in a close relationship may mitigate some of the adverse consequences of the COVID-19 pandemic. Close relationships may be an essential source of support as individuals rely on their intimate partners when faced with the uncertainty and stress of the pandemic.

In Caring for Older People in Low- and Middle-Income Countries, Do Older Caregivers Have a High Level of Care Burden and Psychological Morbidity Compared to Younger Caregivers?

Caregivers have become older as longevity increases. Caregiving for older people can cause burdens and psychological morbidity, which are the chronic stresses perceived by informal caregivers. This study aimed to compare the levels of care burden and psychological morbidity between older and younger caregivers in low- and middle-income countries. A cross-sectional survey was conducted in Cuba, the Dominican Republic, Peru, Venezuela, Mexico, Puerto Rico, and China. Data were collected by the 10/66 Dementia Research Group. The Zarit Burden Inventory was used to measure the levels of burden on caregivers. Psychological morbidity was assessed through the Self-Reporting Questionnaire. Data from 1348 households in which informal caregivers provided home care for one older person were included in the analysis. Multivariable logistic regression was used to investigate the effects of caregiver age upon care burden and psychological morbidity. A fixed-effect meta-analysis model was used to obtain a pooled estimate of the overall odds ratios of each country. The unadjusted and the adjusted model for potential covariates revealed no significant difference in care burden and psychological morbidity between older caregivers and younger caregivers. The adjusted pooled estimates, however, indicated a lower psychological morbidity among older caregivers (OR = 0.61, 95% CI: 0.41-0.93, I2 = 0.0%). The demographic implications of caregiver age may suggest different policy responses across low- and middle-income countries.

Effect of Marital Status on Outcomes Following Total Joint Arthroplasty

INTRODUCTION

The purpose of this study is to investigate whether the specific socioeconomic factor such as marital status has any effect on clinical outcomes and patient-reported outcome measures (PROMs) after primary total hip (THA) and knee (TKA) arthroplasty.

MATERIALS AND METHODS

We retrospectively reviewed patients who underwent primary THA or TKA from January 2019 to August 2019 who answered all PROM questionnaires. Both THA and TKA patients were separated into two groups based on their marital status at the time of surgery (married vs. non-married). Demographics, clinical data, and PROMs (FJS-12, HOOS, JR, KOOS, JR, and VR-12 PCS&MCS) were collected at various time-periods. Demographic differences were assessed using chi-square and independent sample t tests. Clinical data and mean PROMs were compared using multilinear regressions while accounting for demographic differences.

RESULTS

This study included 389 patients who underwent primary THA and 193 that underwent primary TKA. In the THA cohort, 256 (66%) patients were married and 133 (34%) were non-married. In the TKA cohort, there were 117 (61%) married patients and 76 (39%) non-married patients. Length of stay was significantly shorter for married patients in both the THA (1.30 vs. 1.64; p = 0.002) and TKA (1.89 vs. 2.36; p = 0.024) cohorts. Surgical-time, all-cause emergency department visits, discharge disposition, and 90-day all-cause adverse events (readmissions/revisions) did not statistically differ between both cohorts. Both HOOS, JR and KOOS, JR score improvements from baseline to 1-year did not statistically differ for the THA and TKA cohorts, respectively. Although VR-12 PCS (p = 0.012) and MCS (p = 0.004) score improvement from baseline to 1-year statistically differed for the THA cohort, they did not for the TKA cohort.

CONCLUSION

Total joint arthroplasty may yield similar clinical benefits in all patients irrespective of their marital status. Although some PROMs statistically differed among married and non-married patients, the differences are likely not clinically significant. Surgeons should continue to assess levels of psychosocial support in their patients prior to undergoing TJA to optimize outcomes.

LEVEL OF EVIDENCE

III, Retrospective Cohort Study.

Risk Factors for Problematic Drinking in One's Thirties and Forties: A Longitudinal Analysis of the 1970 British Cohort Study

Alcohol drinking and risk factors for problematic drinking may vary across a lifespan. The objective of this study was to identify risk factors for problematic drinking in men and women in their thirties and forties. Alcohol drinking and potential risk factors for problematic drinking were assessed at ages 30, 34, 42, and 46 in the 1970 British Cohort Study. Multilevel models included 10,079 observations in 3880 men and 9241 observations in 3716 women. In men, formerly smoking, currently smoking, having a degree, having malaise, and having a mother who drank while pregnant were independently associated with increased risk of problematic drinking. In women, formerly smoking, currently smoking, being physically active in one's leisure time, having a degree, having a managerial or professional occupation, having malaise, and having a mother who drank while pregnant were independently associated with increased risk of problematic drinking. In men and women, cohabiting as a couple was associated with decreased risk of problematic drinking. This study suggests that several risk factors may be associated with problematic drinking in men and women in their thirties and forties. Policy makers should consider the role of modifiable risk factors in the prevention of problematic drinking.

Failure to Meet Same-Day Discharge is Not a Predictor of Adverse Outcomes

INTRODUCTION

As more centers introduce same-day discharge (SDD) total joint arthroplasty (TJA) programs, it is vital to understand the factors associated with successful outpatient TJA and whether outcomes vary for those that failed SDD. The purpose of this study is to compare outcomes of patients that are successfully discharged home the day of surgery to those that fail-to-launch (FTL) and require a longer in-hospital stay.

MATERIALS AND METHODS

We retrospectively reviewed all patients who enrolled in our institution's SDD TJA program from 2015 to 2020. Patients were stratified into two cohorts based on whether they were successfully SDD or FTL. Outcomes of interest included discharge disposition, 90-day readmissions, 90-day revisions, surgical time, and patient-reported outcome measures (PROMs) as assessed by the FJS-12 (3 months, 1 year, and 2 years), HOOS, JR, and KOOS, JR (preoperatively, 3 months, and 1 year). Demographic differences were assessed with chi-square and Mann-Whitney U tests. Outcomes were compared using multilinear regressions, controlling for demographic differences.

RESULTS

A total of 1491 patients were included. Of these, 1384 (93%) were successfully SDD while 107 (7%) FTL and required a longer length-of-stay. Patients who FTL were more likely to be non-married (p = 0.007) and ASA class III (p = 0.017) compared to those who were successfully SDD. Surgical time was significantly longer for those who FTL compared to those who were successfully SDD (100.86 vs. 83.42 min; p < 0.001). Discharge disposition (p = 0.100), 90-day readmissions (p = 0.897), 90-day revisions (p = 0.997), and all PROM scores both preoperatively and postoperatively did not significantly differ between the two cohorts.

CONCLUSION

Our results support the notion that FTL is not a predictor of adverse outcomes as patients who FTL achieved similar outcomes as those who were successfully SDD. The findings of this study can aid orthopedic surgeons to educate their patients who wish to participate in a similar program, as well as patients that have concerns after they failed to go home on the day of surgery.

LEVEL III EVIDENCE

Retrospective Cohort Study.

Using a developmental perspective to examine the moderating effects of marriage on heavy episodic drinking in a young adult sample enriched for risk

Many studies demonstrate that marriage protects against risky alcohol use and moderates genetic influences on alcohol outcomes; however, previous work has not considered these effects from a developmental perspective or in high-risk individuals. These represent important gaps, as it cannot be assumed that marriage has uniform effects across development or in high-risk samples. We took a longitudinal developmental approach to examine whether marital status was associated with heavy episodic drinking (HED), and whether marital status moderated polygenic influences on HED. Our sample included 937 individuals (53.25% female) from the Collaborative Study on the Genetics of Alcoholism who reported their HED and marital status biennially between the ages of 21 and 25. Polygenic risk scores (PRS) were derived from a genome-wide association study of alcohol consumption. Marital status was not associated with HED; however, we observed pathogenic gene-by-environment effects that changed across young adulthood. Among those who married young (age 21), individuals with higher PRS reported more HED; however, these effects decayed over time. The same pattern was found in supplementary analyses using parental history of alcohol use disorder as the index of genetic liability. Our findings indicate that early marriage may exacerbate risk for those with higher polygenic load.

Fear and depression linked to COVID-19 exposure A study of adult twins during the COVID-19 pandemic

Millions of people have been impacted by the novel coronavirus (COVID-19) pandemic worldwide. High infection rates and death tolls, combined with social distancing measures, may have unintended psychological consequences on individuals. The goal of this study was to examine the interrelations between COVID-19 exposure, fear of COVID-19, and depression among a community-based sample of adult twins. We further explored whether fear of COVID-19 mediated the association between COVID-19 exposure and depression. 732 same-sex adult twin pairs (78.1% MZ, 21.9% DZ) completed an online survey examining their feelings in May 2020. About one-fifth of the participants reported having any COVID-19 exposure. Most participants (>80%) were somewhat concerned about themselves or their household members being infected by COVID-19. The average depression level was relatively low (M = 0.9 out of 6). We found that COVID-19 exposure was related to increased fears of COVID-19 and depression, and that depressive feelings increased with fear of COVID-19. The correlation between COVID-19 exposure and depression was partially mediated by fear of COVID-19. However, these associations were confounded by familial influences. As society navigates through the pandemic, it is essential to implement public health strategies to help individuals cope with the concerns and fears about COVID-19.

Factors Influencing Residents' Psychological Status During Standardized Training in COVID-19

Objectives: To explore the influencing factors of residents' psychological status during standardized training in COVID-19 for finding ways to promote their mental health. Methods: A total of 760 residents were surveyed with a structured questionnaire. Correlation analysis was used to analyze the influencing factors of psychological status of the residents, and a mediation model was constructed to verify the mediating role of satisfaction. Results: Age, willingness to study medicine, and satisfaction were positively correlated with negative psychological status (P < 0.05). And gender, only child or not, and annual household income (RMB) were negatively correlated with negative psychological status (P < 0.01). Residents' satisfaction with standardized training mode plays a complete mediating role between annual household income and negative psychological status. Conclusions: Our findings emphasize the importance of concentrating on resident's psychological status and family economic situation. And relative departments should take action to optimize the standardized training mode to improve the satisfaction.

A Postcard From Italy: Challenges and Psychosocial Resources of Partners Living With and Without a Chronic Disease During COVID-19 Epidemic

The new Coronavirus (COVID-19) has been declared a global pandemic by the World Health Organization (WHO). The sudden outbreak of this new virus and the measure of lockdown adopted to contain the epidemic have profoundly changed the lifestyles of the Italian population, with an impact on people's quality of life and on their social relationships. In particular, due to forced and prolonged cohabitation, couples may be subject to specific stressors during the epidemic. In addition, living with a chronic health condition may add specific challenges to the ones posed by the epidemic itself. The present cross-sectional study aimed to provide a picture of the challenges as well as the resources for both individual and relational well-being of Italian individuals in a couple relationship (N = 1921), with a specific attention to the comparison between individuals living with and without a chronic disease. Results showed that people with a chronic disease had lower psychological well-being and more fears and worries about the COVID-19. People with a chronic disease perceived fewer resources than healthy people. Moreover, the challenges are shown to be associated with less psychological well-being and high pessimism about the future. Instead individual, relational, and social resources play a protective role during the pandemic for both healthy and chronically ill people.

Marriage and reductions in men's alcohol, tobacco, and cannabis use

BACKGROUND

Psychoactive substance use is lower among married compared to divorced or unmarried men; yet, the nature of this effect remains unclear because becoming and staying married is potentially confounded with substance-related background familial and individual factors, like parental divorce and personality. The authors investigated the associations between marital status and substance use; how substance use changed across the transition to marriage; and whether marriage effects were likely to be causal.

METHOD

The sample included 1790 adults from male-male twin pairs from a population-based registry. Measures of marital status and alcohol, tobacco, and cannabis use came from Life History Calendars. Data were analyzed using regression, co-twin comparison, and within-person models. The latter models are tools for quasi-causal inference that control for familial and individual-level confounders.

RESULTS

Married men used less alcohol, tobacco, and cannabis than men who were divorced/separated or single. In analyses of substance use across the transition to marriage, men reduced their alcohol and cannabis use both before and after marriage, but their tobacco use only after marriage. These effects were largely robust in co-twin and within-person analyses.

CONCLUSIONS

Marriage was associated with substantial reductions in substance use compared to being divorced/separated or single, and these reductions began prior to marriage. The co-twin comparison and within-person models ruled out the alternative explanation that marriage effects were due to confounding background familial and individual factors. These results provide strong evidence that the social role expectations associated with marriage reduce psychoactive substance use.

Does Neighborhood Alcohol Availability Moderate the Impact of Familial Liability and Marital Status on Risk for Alcohol Use Disorders? A Swedish National Study

OBJECTIVE

The purpose of this study was to determine whether ease of access to alcohol at the neighborhood level moderates the impact of familial liability and marital status on risk for alcohol use disorder (AUD).

METHOD

Individuals in Sweden were divided into those residing in a neighborhood with (n = 14.1%) versus without (n = 85.9%) an alcohol outlet (bars/nightclubs or government stores). AUD was detected through national medical, legal, and pharmacy registries. Using an additive model predicting AUD registration over 5 years in 1,624,814 individuals, we tested for interactions between the presence of outlets in the individuals' neighborhoods and familial risk for externalizing syndromes and marital status.

RESULTS

In both males and females, we found positive and significant interactions in the prediction of AUD between the presence versus absence of a nearby alcohol outlet with (a) familial risk and (b) single and divorced versus married status. Similar but nonsignificant interactions were seen between nearby outlets and widowed versus married status. These results changed little when all cases with prior AUD were removed from the sample. For males, most of the interaction arose from the proximity of bars/nightclubs, whereas for females the results varied across different kinds of outlets.

CONCLUSIONS

Environments that provide easy access to alcohol augment the impact of a range of risk factors for AUD, especially familial vulnerability and the reduced social constraints associated with single, divorced, and widowed marital status.

Revisiting the relationship between perceived discrimination and health: Evidence from sibling models with multiple health measures

Perceived discrimination (PD) is known to be significantly related to health outcomes. This link, however, warrants further scrutiny due to the possibility of unobserved family-level confounding. Using the Add Health and sibling fixed-effect approach, we examine whether the relationship between PD and health is confounded by family background characteristics such as genetics, family environment, and childhood social context (school and neighborhood effects). While the naive OLS models exhibit significant associations between PD and both physical and psychological health outcomes, our preferred sibling fixed-effect estimates reveal that the observed associations between PD and physical health outcomes are confounded by shared family background. In contrast, the observed associations for psychological health, self-reported health, and some of health behavior outcomes are robust to adjustment for sibling fixed-effects. Furthermore, we find similar overall patterns in the link between PD and health across races/ethnicities.

Risk Factors for Post-Acute Coronary Syndrome Depression: A Meta-analysis of Observational Studies

BACKGROUND

The incidence of depression is very common among patients with post-acute coronary syndrome (ACS) and leads to adverse outcomes.

AIMS

The aim of this meta-analysis was to detect risk factors for depression among patients with ACS and to provide clinical evidence for its prevention.

METHODS

The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline to search the PubMed, Web of Science, EMBASE, and EBSCO databases from January 1996 to March 2018. Data that met the inclusion criteria were extracted to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the risk factors of post-ACS depression.

RESULTS

A total of 30 articles met the inclusion criteria, and 25 risk factors were found to be associated with depression. The top 5 risk factors are as follows: antidepression treatment (OR, 4.25; 95% CI, 3.41-5.31), housewife status (OR, 4.17; 95% CI, 1.83-9.53), history of depressive disorders (OR, 3.52; 95% CI, 2.69-4.61), widow status (OR, 2.34; 95% CI, 1.05-5.21), and history of congestive heart failure (OR, 2.03; 95% CI, 1.04-3.97). The authors also found that a married status, high education level, and employment are protective factors.

CONCLUSION

Clinical personnel should be alerted with regard to the high risk factors of depression, including female gender, low education level, unmarried status, living alone, unemployed status, unhealthy lifestyle, and complications such as cardiovascular, respiratory, and metabolic diseases. In particular, staff should pay attention to a history of previous depression, be concerned with the psychological condition of the patient, and monitor and perform early interventions to reduce the incidence of depression.

Adolescent Peer Relationship Qualities as Predictors of Long-Term Romantic Life Satisfaction

Adolescent-era predictors of adult romantic life satisfaction were examined in a multimethod, prospective, longitudinal study of 165 adolescents followed from ages 13 to 30. Progress in key developmental tasks, including establishing positive expectations and capacity for assertiveness with peers at age 13, social competence at ages 15 and 16, and ability to form and maintain strong close friendships at ages 16-18, predicted romantic life satisfaction at ages 27-30. In contrast, several qualities linked to romantic experience during adolescence (i.e., sexual and dating experience, physical attractiveness) were unrelated to future satisfaction. Results suggest a central role of competence in nonromantic friendships as preparation for successful management of the future demands of adult romantic life.

Polygenic risk for alcohol misuse is moderated by romantic partnerships

BACKGROUND AND AIMS

Previous twin research suggests relationship status can moderate underlying genetic liability towards alcohol misuse. This paper examined: (1) whether genome-wide polygenic scores (GPS) for alcohol consumption are associated with alcohol misuse; (2) whether these GPS are moderated by romantic relationships (gene-environment interaction; G × E) and (3) whether G × E results are consistent across sex.

DESIGN

Linear mixed-effects models were used to test associations between genome-wide polygenic scores, relationship status and alcohol use/misuse.

SETTING

Finnish twins born between 1983 and 1987 identified through Finland's central population registry.

PARTICIPANTS

An intensively studied subset of Finnish Twin Study (FinnTwin12) during the young adult phase (aged 20-26 years). The analytical sample includes those with complete interview and genetic data (n = 1201).

MEASUREMENTS

Key measurements included involvement in a romantic partnership, drinking frequency, intoxication frequency and DSM-IV alcohol dependence (AD) symptoms. Genome-wide polygenic scores (GPS) were created from available summary statistics from a large genome-wide association study (GWAS) of drinks per week.

RESULTS

GPS predicted drinking frequency [b = 0.109; 95% confidence interval (CI) = 0.050, 0.168], intoxication frequency (b = 0.111; 95% CI = 0.054, 0.168) and AD symptoms (b = 0.123; 95% CI = 0.064, 0.182). Having a romantic relationship negatively influenced the association between GPS and drinking frequency (b = -0.105; 95% CI = -0.211, -0.001), intoxication frequency (b = -0.118; 95% CI = -0.220, -0.016) and AD symptoms (b = -0.119; 95% CI = -0.229, -0.009). There was a three-way interaction between sex, relationship status and GPS for intoxication frequency (b = 0.223; 95% CI = 0.013, 0.433), such that the reduced association between GPS and intoxication frequency for those in a relationship was only apparent in males. We found no evidence of three-way interactions for drinking frequency or AD symptoms.

CONCLUSIONS

Being in a romantic relationship reduced the association between genetic predisposition and drinking, high-risk drinking and alcohol problems. However, for high-risk drinking the protective effect was limited to males, mapping onto earlier findings suggesting that males benefit more from romantic partnerships.

A randomized controlled trial of a transdiagnostic cognitive-behavioral intervention for Afro-descendants' survivors of systemic violence in Colombia

BACKGROUND

Exposure to violence has negative consequences on mental health. Armed-conflict in Colombia has widely affected Afro-descendants in the Pacific region. Evidence regarding effectiveness of mental health interventions is lacking in low-income settings, especially in areas with active conflict. The objective of this study is to evaluate an individualized Common Elements Treatment Approach (CETA), a transdiagnostic psychotherapy model based on Cognitive-Behavioral Therapy, for adult trauma survivors.

METHODS AND FINDINGS

A referred sample of 521 adult Afro-descendants from Buenaventura and Quibdó, Colombia, experiencing significant sadness, suffering or fear (score>0.77 in Total Mental Health Symptoms), with history of traumatic experiences, and with associated functional impairment were randomly allocated to CETA intervention, standby group without intervention, but under monthly monitoring, or a Narrative Community-Based Group Therapy. CETA was provided by trained Lay Psychosocial Community Workers without previous mental health experience, supervised by psychologists, during 12-14 weekly, 1.5-hour sessions. Symptoms were assessed with a locally validated survey built based on the Hopkins Symptom Checklist, the Harvard Trauma Questionnaire, the PTSD CheckList-Civilian Version, a qualitative study for additional general symptoms and a gender-specific functional impairment scale. CETA was compared with the control group and the intervention effects were calculated with mixed models using intention to treat analysis. Participant completion of follow-up was 75.1% and 13.2% voluntarily withdrew. Reduction in post-traumatic stress symptoms was significant in both municipalities when comparing intervention and control groups (mean difference), with a with a moderate effect size in Buenaventura (Cohen's d  =  0.70) and a small effect size in Quibdó (d = 0.31). In Buenaventura, the intervention also had significant effects on depression (large effect size d = 1.03), anxiety (large effect size d = 0.80) and functional impairment (moderate effect size d = 0.70). In Quibdó, it had no significant effect on these outcomes. Changes in Total Mental Health Symptoms were not significant in neither city.

CONCLUSIONS

This trial suggests that CETA, can be effective in improving depression, anxiety, post-traumatic stress and function among victims of systematized violence in low-income and active conflict settings. Nonetheless, the difference of effectiveness between the two cities of intervention may indicate that we cannot assume that a mental health intervention known to be effective in one setting will be effective in another, even in similar circumstances and population. This may have special importance when implementing and reproducing these types of intervention in non-controlled circumstances. Further research should address these concerns. Results can be of use by governmental decision-makers when defining mental health programs for survivors.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01856673 (https://clinicaltrials.gov/ct2/show/NCT01856673).

A Twin Study on Perceived Stress, Depressive Symptoms, and Marriage

Marriage is associated with reductions in both perceived stress and depressive symptoms, two constructs found to be influenced by common genetic effects. A study of sibling twins was used to test whether marriage decreases the proportion of variance in depressive symptoms accounted for by genetic and environmental effects underlying perceived stress. The sample consisted of 1,612 male and female twin pairs from the University of Washington Twin Registry. The stress-buffering role of marriage was tested relative to two unmarried groups: the never married and the divorced. Multivariate twin models showed that marriage reduced genetic effects of perceived stress on depressive symptoms but did not reduce environmental effects. The findings suggest a potential marital trade-off for women: access to a spouse may decrease genetic effects of perceived stress on depressive symptoms, although marital and family demands may increase environmental effects of perceived stress on depressive symptoms.

The role of romantic relationship status in pathways of risk for emerging adult alcohol use

Dating several people in emerging adulthood has been associated with higher alcohol use compared with being single or being in an exclusive relationship. As a follow-up to that report, we examined whether romantic relationship status is part of a pathway of risk between antecedent alcohol use risk factors and subsequent alcohol outcomes. Participants were 4,410 emerging adults assessed at 2 time-points during their first year of college. We found that a parental history of alcohol problems was indirectly related to dating several people via 2 modestly correlated pathways. The first pathway was through conduct problems. The second pathway was through positive urgency (i.e., a positive emotion-based predisposition to rash action). In turn, dating several people was associated with higher alcohol use. Our results suggest that these familial and individual-level alcohol risk factors are related to emerging adults' selection into subsequent romantic relationship experiences that are associated with higher alcohol use. These findings have implications for how romantic relationship experiences may fit into developmental models of the etiology of alcohol use. (PsycINFO Database Record

Is marriage a buzzkill? A twin study of marital status and alcohol consumption

Married adults have consistently been found to drink less than their single or divorced counterparts. This correlation may not be causal, however, as people nonrandomly "select" into marriage and into alcohol use. The current study uses a sample of 2,425 same-sex twin pairs (1,703 MZ; 722 DZ) to control for genetic and shared environmental selection, thereby eliminating a great many third variable, alternative explanations to the hypothesis that marriage causes less drinking. Married twins were compared with their single, divorced, and cohabiting cotwins on drinking frequency and quantity. Married cotwins consumed fewer alcoholic beverages than their single or divorced cotwins, and drank less frequently than their single cotwins. Alcohol use patterns did not differ among married and cohabiting twins. These findings provide strong evidence that intimate relationships cause a decline in alcohol consumption. (PsycINFO Database Record

Effect of Marriage on Risk for Onset of Alcohol Use Disorder: A Longitudinal and Co-Relative Analysis in a Swedish National Sample

OBJECTIVE

The authors sought to clarify the relationship between marriage and risk for alcohol use disorder.

METHOD

The association between marital status and risk for first registration for alcohol use disorder in medical, criminal, and pharmacy registries was assessed in a population-based Swedish cohort (N=3,220,628) using longitudinal time-dependent survival and co-relative designs.

RESULTS

First marriage was associated with a substantial decline in risk for onset of alcohol use disorder in men (hazard ratio=0.41, 95% CI=0.40-0.42) and women (hazard ratio=0.27, 95% CI=0.26-0.28). This association was slightly stronger when the spouse had no lifetime alcohol use disorder, while marriage to a spouse with lifetime alcohol use disorder increased risk for subsequent alcohol use disorder registration in both men (hazard ratio=1.29, 95% CI=1.16-1.43) and women (hazard ratio=1.18, 95% CI=1.06-1.30). In both sexes, the protective effect of marriage was significantly stronger in those with than those without a family history of alcohol use disorder. In both men and women, the associations between marriage and risk for alcohol use disorder in cousins, half siblings, full siblings, and monozygotic twins discordant for marital status were as strong as that seen in the general population.

CONCLUSIONS

First marriage to a spouse with no lifetime alcohol use disorder is associated with a large reduction in risk for alcohol use disorder. This association cannot be explained by standard covariates or, as indicated by co-relative analyses, familial genetic or shared environmental confounders. These results are consistent with the hypothesis that the psychological and social aspects of marriage, and in particular health-monitoring spousal interactions, strongly protect against the development of alcohol use disorder. The protective effects of marriage on risk for alcohol use disorder are increased in those at high familial risk for alcoholism.

Voluntary and Involuntary Singlehood and Young Adults' Mental Health: an Investigation of Mediating Role of Romantic Loneliness

The present study tested the hypothesis that single young adults who perceive their singlehood as voluntary would report a higher level of positive mental health (i.e., emotional, psychological and social well-being), lower levels of mental health illness (i.e., somatic symptoms, anxiety, social dysfunction, severe depression) and romantic loneliness in comparison to young adults who perceive their singlehood as involuntary. This paper also investigated whether romantic loneliness mediates the relationship between voluntary and involuntary singlehood, positive mental health, and mental health illness. The study sample included 151 participants (86 females and 65 males) aged 20–26 (M = 22.48, SD = 2.01) from Poland. The main findings were that voluntarily single young adults reported a lower level of romantic loneliness compared to involuntarily single young adults. The two groups differed neither in regard to positive mental health nor in regard to mental health problems. In addition, gender differences were observed solely in the domain of romantic loneliness, with women reporting greater romantic loneliness than men. The mediation analysis revealed that romantic loneliness does not mediate the relationship between voluntary and involuntary singlehood, positive mental health, and mental health illness. Voluntary and involuntary singlehood was predictive of somatic symptoms, anxiety and insomnia, severe depression, and romantic loneliness.

Romantic relationships and mental health

This paper reviews the research on relationships and mental health. Individuals who are more mentally healthy are more likely to select into relationships, but relationships are also demonstrably associated with mental health. The type of relationship matters - evidence suggests that more established, committed relationships, such as marriage, are associated with greater benefits than less committed unions such as cohabitation. The association between relationships and mental health is clearly bidirectional, however, stronger effects are observed when mental health is the outcome and relationships are the predictor, suggesting that the causal arrow flows more strongly from relationships to mental health than vice versa. Moreover, improving relationships improves mental health, but improving mental health does not reliably improve relationships. Our review of research corroborates the view that relationships are a keystone component of human functioning that have the potential to influence a broad array of mental health outcomes.

A Sex-Positive Framework for Research on Adolescent Sexuality

In this article, I propose a sex-positive framework for research on adolescent sexuality in which I consider consensual sexual activities in adolescence as developmentally normative and potentially healthy. The sex-positive framework is contrasted with the predominant "risk" perspective that presumes that abstinence from sexual activity is the ideal behavioral outcome for teenagers. Evidence from longitudinal and behavioral genetic studies indicates that engaging in sexual intercourse in adolescence does not typically cause worse psychological functioning. The relationship context of sexual experience may be a critical moderator of its psychological impact. Moreover, cross-cultural data on adolescents' contraception usage, unintended pregnancy, and sexually transmitted infections suggest that, despite the unacceptably high rate of negative health consequences among U.S. teenagers, adolescents can have the developmental capacity to regulate the health risks inherent in sexual activity. Understanding adolescent sexuality can be fostered by considering sexual well-being, a multidimensional construct that incorporates an adolescent's sexual self-efficacy, sexual self-esteem, feelings of sexual pleasure and satisfaction, and freedom from pain and negative affect regarding sexuality. New research is necessary to understand the development of adolescent sexual well-being, including its normative age trends, its reciprocal links with sexual behavior, and its impact on psychological and physical health.

Differential Vulnerability to Early-Life Parental Death: The Moderating Effects of Family Suicide History on Risks for Major Depression and Substance Abuse in Later Life

Only a portion of those individuals exposed to parental death in early life (PDE) develop behavioral health disorders. We utilized demographic pedigree data from the Utah Population Database to test for differential vulnerability to PDE by creating a risk score of familial susceptibility to suicide (FS) at the population level. Using logistic panel regression models, we tested for multiplicative interactions between PDE and FS on the risks of major depressive disorder (MDD) and substance abuse (SA), measured using Medicare claims, after age 65. The final sample included 155,983 individuals (born 1886-1944), yielding 1,431,060 person-years at risk (1992-2009). Net of several potential confounders, including probability of survival to age 65, we found an FS × PDE interaction for females, in which PDE and FS as main effects had no impact but jointly increased MDD risk. No statistically significant main or interactive effects were found for SA among females or for either phenotype among males. Our findings are consistent with a differential vulnerability model for MDD in females, in which early-life stress increases the risk for poor behavioral health only among the vulnerable. Furthermore, we demonstrate how demographic and pedigree data might serve as tools for investigating differential vulnerability hypotheses.

The mental health benefits of relationship formalisation among lesbians and gay men in same-sex relationships

OBJECTIVES

To examine links between same-sex relationship formalisation - such as registered domestic partnerships and commitment ceremony unions - and mental health among lesbians and gay men, after controlling for differences in other relationship characteristics.

METHODS

Data were collected via an online survey of a national sample of Australian lesbians and gay men aged 16 years and older, with the sample for analysis confined to those in a same-sex relationship (n=1,420). The K10 Psychological Distress Scale was used as an indicator of mental health.

RESULTS

Being in a formalised relationship was associated with lower distress for those aged 16-39 years but not for those aged 40+ years; whereas, intending to formalise was associated with higher distress among the older group. These associations remained significant after controlling for cohabitation, feeling able to seek partner emotional support, relationship tenure and financial arrangements.

CONCLUSIONS AND IMPLICATIONS

Relationship formalisation appears to be an important protective factor for mental health among gay men and lesbians, especially among younger sexual minority individuals. These findings suggest that affording same-sex couples the opportunity to formalise their relationship is not only a civil rights issue but also a public health issue.

Divorce and health: current trends and future directions

OBJECTIVE

Social relationships play a vital role in health and well-being, and it follows that loss experiences can be highly stressful for some people. This article reviews what is known about the association between marital separation, divorce, and health outcomes.

METHODS

Key findings in the area of divorce and health are discussed, and the review outlines a series of specific questions for future research. In particular, the article integrates research in social epidemiology with research in social psychophysiology. The former approach provides a broad-based estimate of the association between marital status and health outcomes, whereas the latter approach studies mechanisms of action and individual differences associated with increased risk for poor outcomes.

RESULTS

The experience of separation or divorce confers risk for poor health outcomes, including a 23% higher mortality rate. However, most people cope well and are resilient after their marriage or long-term relationship ends. Despite the fact that resilience is the most common response, a small percentage of people (approximately 10%-15%) struggle quite substantially, and it seems that the overall elevated adverse health risks are driven by the poor functioning of this group. Several candidate mechanisms and novel (ambulatory) assessment techniques that may elucidate the poor outcomes among people who adapt poorly to separation are discussed.

CONCLUSIONS

To increase knowledge on the association between divorce and health, three primary areas require more research: a) genetic and third variable explanations for divorce-related health outcomes, (b) better studies of objective social behavior after separation, and (c) increased attention to interventions targeting high-risk adults.

Perceived Social Support and Mental Health Among Single vs. Partnered Polish Young Adults

The aim of this study was to examine whether young adults in nonmarital romantic relationships experience better mental health and lower levels of mental health problems compared to single young adults. In addition, the current study also tested the hypothesis that perceived social support mediates the association between relationship status (single vs. partnered) and mental health, and mental health problems. Five hundred fifty three participants (335 females and 218 males) aged 20-30 completed the Polish versions of General Health Questionnaire-28, Mental Health Continuum-Short Form, Social and Emotional Loneliness Scale for Adults-Short Form, and Multidimensional Scale of Perceived Social Support. Results indicated that single individuals reported lower emotional well-being than partnered individuals. No differences emerged between single and partnered individuals in regard to social and psychological well-being, as well in total well-being. Results also revealed no differences between single and partnered individuals in regard to somatic symptoms, anxiety and insomnia, social dysfunction, severe depression, and total mental health problems. Mediational analyses indicated the perceived social support mediates the association between partner status and mental health problems.

The association between relationship distress and psychopathology is consistent across racial and ethnic groups

The association between intimate relationship discord and DSM-IV Axis I psychiatric disorders has been described in studies that oversampled White participants; however, the racial and ethnic differences in marital distress and divorce as well as in prevalence rates of some forms of psychopathology led us to hypothesize that the association between relationship discord and psychopathology would vary across races and ethnicities. Relationship quality and psychopathology were assessed in three national surveys (the National Comorbidity Survey Replication, the National Latino and Asian American Study, and the National Survey of American Life), for a total sample size of 10,057. We found that the log odds of being diagnosed with both narrow-band (e.g., major depressive disorder) and broad-band disorders (e.g., mood disorder) were negatively associated with relationship quality consistently across 11 different racial and ethnic groups. We discuss the implications of the cross-cultural reliability of the association between relationship discord and psychopathology in the context of etiological models and culturally competent practices.