STRATEGIC THERAPY WITH DEPRESSED MARRIED PERSONS: INITIAL AGENDA,THEMES AND INTERVENTIONS*

A strategic approach to depression is outlined. Reasons are given for initially working with each spouse separately. For the purpose of discussion, three interrelated aspects of depressive marital situations are distinguished: the unsatisfying marriage, the distress of the depressed person and the spouse's response. Interventions focus on dampening the marital conflict rather than solving the problems that are presented; reframing depression as an active, dignified practice; and blocking the spouse's tendency to become over-involved in well-meant but unhelpful efforts to assist the depressed person. A case example is provided.     

MARRIAGE, DEPRESSION, AND COGNITION: UNRAVELING THE GORDIAN KNOT-REPLY TO ETTINGER ET AL.

Heim and Snyder (1991) explicitly applied a multidimensional assessment and data-analytic strategy to predict husbands' and wives' depressive symptoms from measures of marital disaffection, overt marital conflict, appraisals of relationship prognosis, characterizations of the spouse, and causal attributions. For both genders, the best single predictor of depression was a measure of marital disaffection—accounting by itself for approximately one third of the variance in subjects' depressive symptoms. Additional attributional predictors of depression for married women indicated the need for therapists to support wives' assertive expression of relationship concerns and confrontation of husbands' behaviors contributing to their distress. We reiterate the complex and recursive relationships among marital difficulties, depression, congnitive processes, and their antecedents and consequences and encourage focused research on components of this intricate puzzle.     

Depression, marital satisfaction, and marital and personality measures of sex roles*

The present study examined the relationship between depression, marital satisfaction, and marital and personality measures of sex roles. Subjects included 50 couples in which the woman was clinically depressed (and of which 26 were maritally distressed), and 24 nondepressed, nondistressed control couples. Results indicated that compared to nondepressed couples, husbands and wives in relationships in which the wife was depressed showed greater inequality in decision making and dissatisfaction with the distribution of decision making and household tasks; wives additionally indicated greater dissatisfaction with distribution of childrearing responsibilities. The relationship between marital roles and depression was largely mediated by the impact of marital distress in the clinic couples. In addition, depressed wives were less masculine than nondepressed wives, and women with high levels of masculinity reported less depression than women with low levels.     

A RESPONSE TO HEIM AND SNYDER

This article comments on a recent study by Heim and Snyder (1991) which explores the interaction between marital distress and spouses' attributions in predicting depression. We suggest taht the attributional theory model may set up a reductionistic research stance that potentially separates what depressed people think from their circumstances and history, thus implying a linear relationship between thinking, depression, and, in this case, marital distress. We also question whether the authors' focus on women's attributional processes, combined with their reliance on a potentially unidimensional model of depression, might inadvertently support preexisting power imbalances in the marital relationship. Finally, we address research design issues regarding measurement, sampling, and statistical concerns.     

Marital Status and Depressive Symptoms

Marital status differences in depressive symptoms are examined in a random sample of 559 Anglos, 403 Blacks, and 822 Mexican American adults. Findings were generally consistent with a "crisis" model, with highest levels of depression observed among the separated, with lower distress levels among the divorced, although, marital differences remained significant after controls only among Anglo males. Differences were negligible among Blacks and Mexican Americans and lower levels of distress were found among never married than married Black females. Further analyses indicated that observed racial/ethnic differences can be partially explained by differences between groups in length of time since separation/divorce and likelihood of previous marriage, though significantly higher levels of depression and marital strain among married Black females relative to Anglo and Mexican American females-even among those in their first marriage-suggests differences between groups in the relative rewards or costs of marriage. These preliminary analyses underscore the need to examine alternative explanations of racial/ethnic and marital status differences in distress in a larger, prospective data base.     

PREDICTING DEPRESSION FROM MARITAL DISTRESS AND ATTRIBUTIONAL PROCESSES*

This study examined the interaction between marital distress and spouses' attributions and expectancies regarding the marital relationship in predicting depressive symptoms in a mixed sample of 59 clinic and nonclinic couples. The best single predictor of depression for both sexes was a measure of disaffection, reflecting emotional distance and alienation in the marriage. However, prediction of wives' depression in multiple regression analyses was enhanced by measures of overt marital disharmony, attribution of causality for relationship difficulties to their own behavior, and failure to attribute difficulties to their husbands' behavior. Regression analyses accounted for 55% of the variance in wives' depression, in contrast to only 32% for husbands. Treatment implications are discussed.     

The Case for Insurance Reimbursement of Couple Therapy

A case is made for why it may now be in the best interest of insurance companies to reimburse for marital therapy to treat marital distress. Relevant literature is reviewed with a considerable focus on the reasons that insurance companies would benefit from reimbursing marital therapy – the high costs of marital distress, the growing link between marital distress and a host of related physical and mental health problems, as well as the availability of empirically supported treatments for marital distress. This is followed by a focus on the major reasons insurance companies cite for not reimbursing marital therapy, along with a discussion of advances in several growing bodies of research to address these concerns. Main arguments include the direct medical offset costs of couple and family therapy (including for high utilizers of health insurance), and the fact that insurance companies already find it cost effective to reimburse for prevention of other health and psychological problems. This is followed by implications for practitioners and researchers.     

Marital Conflict, Depressive Symptoms, and Functional Impairment

Guided by a stress process perspective, we investigated (a) whether marital conflict might directly lead to changes in depression and functional impairment, (b) whether marital conflict might indirectly lead to changes in functional impairment via depression, and (c) whether marital conflict might indirectly lead to changes in depression via functional impairment. We estimated a latent variable causal model using 3 waves of data from the National Survey of Families and Households (N = 1,832). Results indicated that marital conflict directly led to increases in depression and functional impairment and indirectly led to a rise in depression via functional impairment. Overall, findings suggest marital conflict is a significant risk factor for psychological and physical health among midlife and older adults.     

Reciprocity Counseling: Practice and Research*

This paper reviews the literature on reciprocity counseling. Evidence is presented for the usefulness of reciprocity counseling with young, well educated, white clients with slight to moderate marital distress. Research into the effectiveness of several components of reciprocity counseling including contracting, problem solving training and feedback is reviewed. Findings suggest that contracting alone is an important positive influence in increasing couples' reciprocating reinforcement. The impact of problem solving training is unclear. Sex of the therapist may influence husband and wife outcomes in problem solving training differentially. Couples' performance of problem-solving behavior appears to be under the control of other as yet unspecified variables. Feedback as a single treatment has unpredictable and sometimes negative results. Therefore use of feedback alone or without careful supervision appears questionable at this time. Issues raised for further research include use of token economies for more severely distressed couples, use of multiple therapists, and the development of a classification scheme for the severity of marital distress.     

Clarifying the relationship between parenthood and depression

Unlike other major adult social roles in the United States, parenthood does not appear to confer a mental health advantage for individuals. However, while research has examined parental status differences in emotional well-being, relatively little is known about variations in emotional distress among parents. In this article, we clarify the relationship between parenthood and current symptoms of depression using data from the National Survey of Families and Households. The analyses provide support for our first hypothesis: Parenthood is not associated with enhanced mental health since there is no type of parent who reports less depression than nonparents. We also find support for our second hypothesis: Certain types of parenthood are associated with more depression than others. Additionally, although we find marital status differences in symptoms among parents, there are no gender differences in the association between parenthood and depression. We discuss the implications of our findings for ongoing theoretical debates about the advantages of social role involvement for mental health as well as the meaning of contemporary parenthood in the United States.     

DEPRESSION IN MATURE MARRIAGES: IMPACT AND IMPLICATIONS FOR MARITAL THERAPY

Recent reviews of MFT literature have shown a failure to address mental health issues of the aging. Chief among these issues is depression, one of the most common psychological disorders found in older people. Although the relationship between depression and aging is a well-researched topic, few studies approach this common problem from a systemic perspective. Using data from a national survey of preretirement- and retirement-aged couples, this paper discusses the association between depression and marital quality in mature marriages as well the possibility of mediating variables such as the personality construct hardiness. Implications for marital therapy with older couples experiencing depression and future research are discussed.     

Racial differences in depression trajectories among older women: socioeconomic, family, and health influences

Despite recent increases in life course research on mental illness, important questions remain about the social patterning of, and explanations for, depression trajectories among women in later life. The authors investigate competing theoretical frameworks for the age patterning of depressive symptoms and the physical health, socioeconomic, and family mechanisms differentiating black and white women. Using data from the National Longitudinal Survey of Mature Women, the authors use linear mixed (growth curve) models to estimate trajectories of distress for women aged 52 to 81 years (N = 3,182). The results demonstrate that: (1) there are persistently higher levels of depressive symptoms among black women relative to white women throughout later life; (2) physical health and socioeconomic status account for much of the racial gap in depressive symptoms; and (3) marital status moderates race differences in distress. The findings highlight the importance of physical health, family, and socioeconomic status in racial disparities in mental health.     

Pathways Among Marital Distress,Parental Symptomatology,and Child Adjustment

A community sample of 295 mothers, fathers, and children (M age = 11.14 years, SD = 2.32 years) rated marital distress, maternal and paternal psychological symptoms, and child adjustment. The predicted direct relations between these family and child variables were demonstrated for both fathers and mothers. Tests of pathways among these variables were conducted for separate but complementary mediation models. Maternal and paternal symptoms mediated the association between marital distress and child adjustment. Marital distress mediated the link between fathers’ symptoms and child adjustment, but the direct pathway between mothers’ symptoms and child adjustment remained. Pubertal status was modestly related to higher levels of family stressors. Joint implications of marital distress and parental symptoms for child adjustment are discussed.     

Marital Relationships Following the Korean Economic Crisis: Applying the Family Stress Model

In response to the recent economic crisis in Korea and its negative effects on families, the current study examined the interrelationships among economic pressure, emotional distress, marital conflict, and marital satisfaction for 236 Korean couples. The family stress model ( Conger & Elder, 1994 ; Conger, Rueter, & Conger, 2000 ; Conger, Rueter, & Elder, 1999 ) was tested using structural equation modeling. The results generally supported the theoretical model, showing that economic pressure negatively affects marital satisfaction via emotional distress and marital conflict. The results also implied cultural differences in the process of family stress. Korean husbands' emotional distress did not affect marital conflict or marital satisfaction, suggesting that Korean husbands may differ from their wives in their reaction to emotional distress from economic pressure.     

Role of Marital Quality in Explaining Depressive Symptoms After Marital Termination Among Older Adults

This study assesses whether prior marital quality moderates the impact of divorce or widowhood on subsequent depression. Poor marital quality may buffer depression associated with divorce/widowhood; conversely, the effect of divorce/widowhood on depression could be exacerbated by previous marital quality. Three waves from the National Survey of Families and Households based on respondents, ages 50 and older, (N?=?2,570) included eight marital quality measures. We find limited evidence suggesting higher marital quality elevates, while lower marital quality decreases, depression after divorce. No moderating effects were found for widowhood. Additionally, health condition is more important than current marital status for elders’ well-being after divorce or widowhood. Heterogeneity in the context of the marriage before divorce should be considered when examining marital termination effects on elders’ depression.     

Gender,the Marital Life Course,and Cardiovascular Disease in Late Midlife

Drawing on 5 waves of the Health and Retirement Study, we examine the influence of the marital life course on the prevalence and incidence of cardiovascular disease among 9,434 middle‐aged individuals. Results show that compared to continuously married persons, both men and women with a marital loss have significantly higher prevalence of cardiovascular disease at baseline. Men and women, however, differ in the effects of marital loss on the incidence of cardiovascular disease over the course of the study. Women with a marital loss have a higher risk of cardiovascular disease in late midlife compared to continuously married women, whereas marital loss is not associated with men’s risk of cardiovascular disease. Emotional distress and socioeconomic status account for the higher risk of cardiovascular disease among divorced women.     

Marital Status,Marital History,Body Weight,and Obesity

Marital status and marital history are associated with health. Marital history can be represented by the marital trajectory components of timing, transitions, sequence, and duration. We examined whether marital trajectory components add insights beyond marital status in predicting body weight in a retrospective analysis of 3,011 adults. Marital status findings revealed that married men were heavier than separated/divorced men, and never married women were heavier and more often obese than married women. Marital history findings showed that after adjusting for marital status, trajectory measures of age at first marriage, second marriage or second divorce, experiencing widowhood, and duration of separation/divorce were not clearly associated with body weight or obesity. Body weight and obesity appear to be associated with current marital status but not marital history.     

Predicting 2-year marital satisfaction from partners' discussion of their marriage checkup

This study tested whether the observed marital interactions of partners following a marriage checkup predicted marital satisfaction 2 years later. In addition, this study examined whether recommendations to pursue therapy predicted subsequent treatment seeking and whether changes in marital distress following the checkup remained stable over 2 years. Results suggest that the affective tone of a couple's interaction predicts later marital satisfaction. Further, receiving a treatment recommendation predicted subsequent treatment seeking for wives. Finally, support was found for the hypothesis that changes in marital distress are self-sustaining.     

Emotionally focused interventions for couples with chronically ill children: a 2-year follow-up

Couples with chronically ill children are particularly at risk for experiencing marital distress. The study presented here is a 2-year follow-up of a randomized control trial that assessed the efficacy of Emotionally Focused Therapy (EFT) in decreasing marital distress in a sample of couples with a chronically ill child. Thirteen couples with chronically ill children who received treatment were assessed to determine if the significant improvement in relationship distress observed at posttreatment and 5-month follow-up would be maintained at 2-year follow-up. Results demonstrated that improvements in marital functioning were not only maintained but, in some cases, enhanced at the 2-year follow-up. This uncontrolled follow-up study provides initial evidence of the longer-term benefits of EFT.     

Attitudes Toward Divorce,Commitment, and Divorce Proneness in First Marriages and Remarriages

A random multistate sample of married individuals (N = 1,931) was used to explore whether more positive attitudes toward divorce and weaker commitment to marriage may contribute to the greater instability of remarriages than first marriages. Remarried adults, whether or not they brought children from a previous union into the remarriage, reported marital quality (happiness and conflict) equal to those in first marriages. They also reported more positive attitudes toward divorce, which were associated with higher divorce proneness (i.e., thinking about and taking actions toward divorce). Marriage type interacted with marital quality to predict divorce proneness, such that the association between low marital quality and divorce proneness was stronger for remarried individuals than for those in first marriages. This suggests that remarried adults may be more likely than adults in first marriages to take steps toward divorce when experiencing marital distress, possibly reflecting a weaker commitment to marriage.