The longitudinal course of marital quality and stability: a review of theory, method, and research

Although much has been learned from cross-sectional research on marriage, an understanding of how marriages develop, succeed, and fail is best achieved with longitudinal data. In view of growing interest in longitudinal research on marriage, the authors reviewed and evaluated the literature on how the quality and stability of marriages change over time. First, prevailing theoretical perspectives are examined for their ability to explain change in marital quality and stability. Second, the methods and findings of 115 longitudinal studies--representing over 45,000 marriages--are summarized and evaluated, yielding specific suggestions for improving this research, Finally, a model is outlined that integrates the strengths of previous theories of marriage, accounts for established findings, and indicates new directions for research on how marriages change.

Intimacy and relationship processes in couples' psychosocial adaptation to cancer

The authors highlighted the importance of viewing cancer from a relationship perspective. This perspective not only considers the marital relationship as a resource that individual partners draw upon but also highlights the importance of focusing attention onto the relationship and engaging in communication behaviors aimed at sustaining and/or enhancing the relationship during stressful times. On the basis of existing conceptualizations, empiric research on couples and cancer, and the authors' perspective on the literature, they formulated the relationship intimacy model of couples' psychosocial adaptation to cancer as a first step toward building a framework for researchers and clinicians to inform their work in this area. The model proposes that patients and their partners engage in behaviors that either promote or undermine the level of closeness in their relationship and that the closeness of the marital relationship is an important determinant of patient and partner psychologic adaptation to cancer. Preliminary data from a couples' intimacy-enhancing intervention for breast cancer patients and their partners supported the model. Of the 25 couples who consented to participate in the intervention and completed the preintervention surveys, 15 couples completed all 5 sessions, and 12 couples completed the follow-up survey. The current results suggested that the intervention improved patient and partner perceptions of the closeness of their relationship and reduced their distress. The authors also discuss limitations of the relationship intimacy model as well as future directions for empiric and clinical research on couples' psychosocial adaptation to cancer.

Alcoholism: a controlled trial of "treatment" and "advice"

Two groups of alcoholics received either one counseling session or several months of in- and outpatient treatment. One year later there were no significant differences in outcome between the two groups.

Physical aggression in early marriage: prerelationship and relationship effects

Spousal physical aggression at 30 months after marriage was predicted for 393 young couples who were interviewed for a longitudinal study. The prerelationship predictor variables were history of violence in the family of origin, aggression against others during childhood and adolescence, and personality characteristics. Relationship predictor variables were marital discord and spouse-specific psychological aggression, both measured at 18 months after marriage. The findings suggest that predictive models are different for husbands and wives. For both sexes, there were direct paths to marital violence that were not mediated by characteristics of the relationship, as well as paths that originated in or flowed through indicators of the marital relationship. Implications for intervention through marital therapy, individual therapy, or both are discussed.

Power and violence: the relation between communication patterns, power discrepancies, and domestic violence

This study hypothesized that power discrepancies in the marital relationship, where the husband is subordinate, serve as risk factors for husband-to-wife violence. The construct of marital power was assessed from 3 power domains operationalized by discrepancies in economic status, decision-making power, communication patterns, and communication skill. Three groups of married couples (N = 95) were compared: domestically violent (DV), maritally distressed/nonviolent (DNV), and maritally happy/nonviolent (HNV). DV couples were more likely than the 2 nonviolent groups to engage in husband demand/wife withdraw interactions. Within the DV group, husbands who had less power were more physically abusive toward their wives. Thus, violence may be compensatory behavior to make up for husbands' lack of power in other arenas of marriage. Difficulties in assessing marital power and future direction for the study of power and violence are discussed.

The marital and family functioning of adults with ADHD and their spouses

Little is known about the family relationships of adults with Attention-Deficit/Hyperactivity Disorder (ADHD). Thus, the marital adjustment and family functioning of 33 married adults with ADHD and their spouses was compared to 26 non-ADHD control participants and their spouses. Results revealed that married adults with ADHD reported poorer overall marital adjustment on the Dyadic Adjustment Scale (DAS; Spanier, 1989) and more family dysfunction on the Family Assessment Device (FAD; Eptein, Baldwin, & Bishop, 1983) than control adults. The spouses of adults with ADHD did not differ from control spouses in reports of overall marital adjustment and family dysfunction. A greater proportion of their marital adjustment scores, however, fell within the maladjusted range. The ADHD adults' perceptions of the health of their marriages and families were more negative than their spouses' perceptions. The way in which spouses of ADHD adults compensated for their partners' difficulties were explored through clinical interviews. The findings in this study underscore the need for assessments and treatments to address marital and family functioning of adults with ADHD.

The Golombok-Rust Inventory of Sexual Satisfaction (GRISS)

The Golombok-Rust Inventory of Sexual Satisfaction (GRISS) is a short 28-item questionnaire for assessing the existence and severity of sexual problems. The design, construction and item analysis of the GRISS are described. It is shown to have high reliability and good validity for both the overall scales and the subscales.

Communication, conflict, and psychological distance in nondistressed, clinic, and divorcing couples

This study compared communication patterns and conflicts over psychological distance in 25 nondistressed couples, 15 clinic couples, and 22 divorcing couples. Data consisted of questionnaire reports completed independently by husbands and wives. The two distressed groups, compared with nondistressed couples, had less mutual constructive communication, more avoidance of communication, more demand/withdraw communication, and more conflict over psychological distance in their relationships. In addition, the divorcing group had less mutual constructive communication than the clinic group and evidenced a trend for more conflict over psychological distance than the clinic group. Consistent with past research, wife demand/husband withdraw communication was more likely across all groups than husband demand/wife withdraw communication. Results are discussed in terms of skills deficits and incompatability models of marital discord.

Social support, conflict, and the development of marital dysfunction

How spouses help each other contend with personal difficulties is an unexplored but potentially important domain for understanding how marital distress develops. Newly married couples participated in 2 interaction tasks: a problem-solving task in which spouses discussed a marital conflict and a social support task in which spouses discussed personal, nonmarital difficulties. Observational coding of these interactions showed that wives' support solicitation and provision behaviors predicted marital outcomes 2 years later, independent of negative behaviors during marital problem-solving discussions. In addition, couples who exhibited relatively poor skills in both behavioral domains were at particular risk for later marital dysfunction. These results suggest that social support exchanges should be incorporated into social learning analyses of marriage and into programs designed to prevent marital distress.

Psychosocial adjustment of female partners of men with prostate cancer: a review of the literature

Advances in prostate cancer treatments since the 1990s have led to a growing proportion of patients living with the effects of the cancer. Various challenges face the man and his partner from the point of learning of the diagnosis: deciding among numerous diverse treatment options, dealing with side-effects of treatment and possibly facing the terminal phase of the illness. This invariably has an impact on the patient's family and, in view of the older age group of men usually affected, the experience of a partner is particularly relevant. A thorough review of the research literature reporting directly from partners of prostate cancer patients has not been undertaken previously. For this review, five databases were searched for the decade 1994-2005, during which most of the work in this field has been done. Very few evaluations of psychosocial interventions involving the partner were found, but there was a preponderance of qualitative studies involving small numbers of participants and quantitative surveys with little consistency in the measures used. The literature suggests that partners report more distress than patients, yet believe that patients are the more distressed, and the focus of concern of patients on their sexual function is not shared to an equal degree by their partners.

Psychotherapy and medication in the treatment of adult and geriatric depression: which monotherapy or combined treatment?

OBJECTIVE

The authors reviewed the literature with respect to the relative efficacy of medications and psychotherapy alone and in combination in the treatment of depression.

DATA SOURCES AND STUDY SELECTION

Findings from empirical studies comparing medications and psychotherapy alone and in combination were synthesized and prognostic and prescriptive indices identified. We searched both MEDLINE and PsychINFO for items published from January 1980 to October 2004 using the following terms: treatment of depression, psychotherapy and depression, and pharmacotherapy and depression. Studies were selected that randomly assigned depressed patients to combined treatment versus monotherapy.

DATA SYNTHESIS

Medication typically has a rapid and robust effect and can prevent symptom return so long as it is continued or maintained, but does little to reduce risk once its use is terminated. Both interpersonal psychotherapy (IPT) and cognitive-behavioral therapy (CBT) can be as effective as medications in the acute treatment of depressed outpatients. Interpersonal psychotherapy may improve interpersonal functioning, whereas CBT appears to have an enduring effect that reduces subsequent risk following treatment termination. Ongoing treatment with either IPT or CBT appears to further reduce risk. Treatment with the combination of medication and IPT or CBT retains the specific benefits of each and may enhance the probability of response over either monotherapy, especially in chronic depressions.

CONCLUSION

Both medication and certain targeted psychotherapies appear to be effective in the treatment of depression. Although several prognostic indices have been identified that predict need for longer or more intensive treatment, few prescriptive indices have yet been established to select among the different treatments. Combined treatment can improve response with selected patients and enhance its breadth (IPT) or stability (CBT).

Family functioning and major depression: an overview

The authors review the evidence supporting the idea that the family plays a major role in the development and course of major depression. They find that the family pathology evident during an acute depressive episode continues after the patient's remission; that the course of depressive illness, relapse rates, and suicidal behavior are all affected by family functioning; and that children of depressed parents are at high risk for psychopathology. The authors explore unresolved issues regarding our understanding of the factors mediating the interaction between major depression and family functioning, concluding that there is evidence to support family and marital interventions, particularly in the treatment of depressed women.

Assessing attributions in marriage: The Relationship Attribution Measure

A brief, simple measure of different types of attributions for partner behavior was examined in 3 studies of married couples. Reliability was established by high internal consistency and test-retest correlations. Causal and responsibility attribution scores correlated with marital satisfaction, attributions for marital difficulties, and attributions for actual partner behaviors generated by spouses. Responsibility attributions were related to (a) reported anger in response to stimulus behaviors used in the measure and (b) the amount of anger displayed by wives during a problem-solving interaction with their partner. The extent to which husbands and wives whined during their discussion also correlated with their responsibility attributions. The results address several problems with existing assessments, and their implications for the measurement of attributions in marriage are discussed.

The effect of dyadic intervention on self-efficacy, social support, and depression for men with prostate cancer

Urinary and sexual dysfunctions are side effects of radical prostatectomy (RP) for prostate cancer (PC) that contribute to depression. Despite the effectiveness of support groups at reducing depression in cancer patients, men typically do not participate in them. The purpose of this pilot study was to test the effects of a dyadic intervention (one-to-one support) on social support (Modified Inventory of Socially Supportive Behaviors), self-efficacy (Stanford Inventory of Cancer Patient Adjustment), and depression (Geriatric Depression Scale). Subjects were randomized to group. Controls (N=15; Mage=59.7) received usual care. Experimentals were paired with long-term survivors (LTS) who had RP and who had treatment side effects in common. Experimentals (N=15; Mage=57.5) met with a LTS 8 times in 8 weeks to discuss concerns associated with survivorship. No significant differences were detected on social support, but after 4 weeks, significant differences were present on depression between controls and experimentals, however these differences were not seen at 8 weeks. After 8 weeks, there were also significant differences on self-efficacy between controls and experimentals. Weekly anecdotal data supported the feasibility and acceptance of the intervention that was a low cost strategy effective at reducing depression and increasing self-efficacy in men treated by RP. Future research directions and clinical application is presented.

Interaction of drug therapy with marital therapy in depressive patients

Comparative effects of the antidepressant drug, amitriptyline hydrochloride, marital therapy, and the drug-psychotherapy interaction effects were studied in a 12-week course of treatment of outpatient depressives. Patients were assigned randomly to four treatment groups, in a 2 times 2 factorial design: (1) drug-marital therapy; (2) drug-minimal contact; (3) placebo-marital therapy; and (4) placebo-minimal contact. Both drug and marital therapy showed substantial beneficial advantages over their control conditions, but drug therapy was faster and generally superior in symptom relief and clinical improvement. Marital therapy was superior in family role task performance and perception of the marital relationship. For reducing hostility and enhancing the perception of the marital relationship, drug therapy had a better early effect, but marital therapy had superior effects by the end of treatment.

Marital therapy: a viable treatment for depression and marital discord

Thirty-six maritally discordant couples with depressed wives were randomly assigned to marital therapy, cognitive therapy, or a waiting-list control condition. The women given marital or cognitive therapy showed significant and clinically meaningful reductions in their depression. The women given marital therapy showed greater increases in marital satisfaction than did those given cognitive therapy or no therapy; these differences were maintained at 1-year follow-up. These findings suggest that marital therapy may be the most effective and appropriate treatment for clinically significant marital discord with coexisting clinically significant depression.

The impact of partner support in the treatment of postpartum depression

OBJECTIVE

To determine the impact of partner support in the treatment of mothers suffering from postpartum depression (PPD).

METHOD

Patients underwent a comprehensive psychiatric assessment and were enrolled in the study only if they met the DSM-IV criteria for major depressive disorder with postpartum onset. Patients with PPD (n = 29) were assigned randomly to 2 treatment groups: group 1 (control group) consisted of patients only (n = 13), while group 2 (support group) consisted of patients (n = 16) and their partners. The patients in both groups were seen for 7 psychoeducational visits each. In group 2, partners participated in 4 of the 7 visits. Patients in both groups were administered a set of questionnaires that included the Edinburgh Postnatal Depression Scale (EPDS), the Kellner Symptom Questionnaire, the Dyadic Adjustment Scale (DAS), and the Parental Bonding Instrument (PBI). In addition, during visits 1 and 7, all patients underwent assessment using the Mini International Neuropsychiatric Instrument (MINI), section A (major depressive episode). The partners in both groups completed the DAS and the General Health Questionnaire (GHQ).

RESULTS

Relative to the control-group patients, the support-group patients displayed a significant decrease in depressive symptoms and other psychiatric conditions. Relative to the support group, the general health of the partners in the control group deteriorated.

CONCLUSION

Partner support has a measurable effect on women experiencing PPD.

Marital violence before and after alcoholism treatment

The prevalence and frequency of marital violence were assessed for 88 male alcoholics and their wives at entry to and 1 year after completing a behavioral marital therapy (BMT) program. In the year before BMT, both the alcoholics and their wives had a significantly and substantially higher prevalence and frequency of marital violence than reported by a demographically matched, nonalcoholic comparison sample. Although violence decreased significantly in prevalence and frequency in the year after BMT, it remained significantly elevated relative to the matched controls when the entire sample of alcoholics was considered. However, extent of violence after BMT was significantly associated with the alcoholics' drinking outcome status: After treatment, remitted alcoholics no longer had elevated marital violence levels whereas relapsed alcoholics did. Implications for understanding the marital violence and alcoholism connection and cautions that should be exercised in interpreting the results are discussed.

Effectiveness of three types of spouse-involved behavioral alcoholism treatment

Treatment was provided to 45 alcoholics and their spouses in one of three out-patient behavioral treatment conditions: (1) minimal spouse involvement (MSI) (n = 14), (2) alcohol-focused spouse involvement (AFSI) (n = 12), or (3) alcohol-focused spouse involvement plus behavioral marital therapy (ABMT) (n = 19). Subjects were followed for 18 months after treatment. Subjects in all conditions reported significant decreases in frequency of drinking and frequency of heavy drinking, and reported increased life satisfaction. This information was corroborated by independent reports of the spouses. Patterns of outcome varied across the three treatment conditions, with ABMT subjects showing gradual improvement in proportions of abstinent days and abstinent plus light drinking days over the last 9 months of follow-up. Subjects in the other two treatment conditions showed gradual deterioration in proportion of abstinent days and abstinent plus light drinking days. Subjects assigned to the ABMT condition were less likely to experience marital separations, and reported greater improvement in marital satisfaction and subjective well-being than the other experimental groups. Clinical and theoretical significance of these findings are discussed.

The psychological treatment of depression. Evidence for the efficacy of psychotherapy alone, in comparison with, and in combination with pharmacotherapy

Seventeen clinical trials are identified that test the efficacy of various psychological treatments (behavioral, cognitive, group, marital, interpersonal) alone, in comparison with, and in combination with pharmacotherapy in homogeneous samples of depressed outpatients. I describe the results of these studies, gaps in the evidence, and suggestions for future research directions.