Depression,the Family,and Family Therapy

The potential contribution of family therapists to the treatment of depression remains underdeveloped. Family therapists need to articulate how changes in family functioning might benefit depressed persons, as well as how other problems in the families of depressed persons tend to go unrecognised. Furthermore, family therapists need to be alert to how undetected depression in adults and children may interfere with their ability to meet their goals with families who seek therapy for other persons. This article provides family therapists with (1) an overview of the nature and experience of depression; (2) an introduction to antidepressant medication; (3) a summary of research findings relating depression to its family context and (4) a brief overview of developments in the marital and family treatment of depression.     

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.     

The experience of divorce for the psychotherapy patient—A developmental perspective

In this article the dynamics of divorce are discussed from the perspective of psychoanalytic developmental psychology. This theoretical framework is used to highlight and to explain some typical internal and external responses of psychotherapy patients for whom divorce is an issue. A therapeutic stance is suggested that enables the patient to understand the connection between his or her marital situation, early life experience, and past developmental problems. The patient's preoccupation with the unsatisfactory marital relationship can serve as a catalyst for the strengthening of the patient's overall ego functioning. This article demonstrates Kris' (1951) concept that the material at the psychic surface-in this case divorce-needs to be explored in such a way that the patient's ego is enlisted in his or her total growth.     

Marital distress,co-occurring depression,and marital therapy: a review

This article reviews several factors that contribute to marital distress and co-occurring depression and also reviews empirically supported therapies. Gender contributes to marital distress and depression but does not appear to be the cause of either. Marital distress and depression appear to have bidirectional influence on each other. The depressed spouse's depression has a marked impact on the marital adjustment of the nondepressed spouse. Both marital distress and depression appear to be chronic. It is recommended that treatment be designed to help couples be supportive of each another, to adapt, and to cope with the depressive symptoms within the framework of their ongoing marital relations.     

Childhood parental loss and adult depression

Previous research demonstrates convincingly that childhood parental deaths and parental divorces have implications for adult well-being as defined by levels of depression, educational attainment, early age at marriage, and risk of divorce. What this research has failed to examine are the interconnections among these outcomes. Specifically, are the socioeconomic and marital outcomes of parental loss implicated in the observed higher levels of depression? This analysis takes a first step in answering this question. Using data from a sample of 1,755 married men and women, I estimated regression models which examine the extent to which adult socioeconomic status and current marital quality mediate and/or modify the loss-depression relationship. Parental divorce was strongly related to socioeconomic and marital outcomes. Furthermore, current marital quality contributed importantly to understanding the higher levels of depressed mood observed among persons from divorced homes. Parental death was much more weakly related to socioeconomic and marital outcomes, and these outcomes played little role in explaining its relationship to depression. Finally, all of these relationships were stronger among women than men. These findings support the utility of life-course approaches to understanding adult mental health.     

THE INTEGRATIVE PSYCHOTHERAPY ALLIANCE: FAMILY,COUPLE AND INDIVIDUAL THERAPY SCALES*

The therapeutic alliance concept has been confined primarily to the literature on individual psychotherapy. This paper formally introduces the concept into the family and marital therapy domain and presents various clinical hypotheses about the nature of the alliance and its role in familyand marital therapy. A systemic perspective is brought to bear on the concept within individual psychotherapy. A new, integrative definition of the alliance is presented that conceptualizes individual, couple and family therapy as occurring within the same systemic framework. The implications of this integrative-alliance concept for family, couple and individual therapy research are examined. Three new system-ically oriented scales to measure the alliance in individual, couple and family therapy are presented along with some preliminary data on their methodological characteristics.     

Integrative and Masking Emotion Work: Marital Outcomes Among Dual-Earner Couples

This study redresses a gap in the literature concerning the outcomes of emotion work by exploring how both integrative and masking emotion work relate to marital quality and marital conflict. Using data from a random sample of dual-earner couples in a northeastern city in an upper Midwestern state (n = 99 couples), this study explores the emotion-work performance of each partner. The findings show that men’s integrative emotion work is only significantly associated with men’s marital quality, whereas men’s masking emotion work significantly predicts their partner’s marital quality, men’s marital quality, and men’s marital conflict. Women’s integrative emotion work is significantly associated with women’s marital quality and their partner’s marital conflict, whereas women’s masking emotion work predicts women’s marital quality and marital conflict. Altogether, the findings suggest that considering both masking and integrative emotion work helps gain a fuller understanding of how emotion work shapes marital outcomes.     

Complex Families and Late‐Life Outcomes Among Elderly Persons: Disability,Institutionalization, and Longevity

The authors examined the effects of marital status and family structure on disability, institutionalization, and longevity for a nationally representative sample of elderly persons using Gompertz duration models applied to longitudinal data from 3 cohorts of the Health and Retirement Study (N = 11,481). They found that parents with only stepchildren have worse outcomes than parents with only biological children. Elderly mothers with only stepchildren become disabled and institutionalized sooner, and elderly men with only stepchildren have shorter longevity relative to their counterparts with only biological children. The effect of membership in a blended family differs by gender. Relative to those with only biological children, women in blended families have greater longevity and become disabled later, whereas men in blended families have reduced longevity. The findings indicate that changing marital patterns and increased complexity in family life have adverse effects on late‐life health outcomes.     

Love,Marriage and the Division of Labor*

In this questionnaire study young engaged men and women were asked about the importance of love in marriage and the meaning of the concept “love.” Marital goals and criteria for mate choice were also explored. A highly consistent image of marriage as an institution in which to realize a comprehensive companionship with a partner of compatible temperament and life goals emerged. These findings have demonstrable implications for existing theoretical formulations concerning the dysfunctional aspects of the love marriage in contemporary American society in which it is contended that “romantic idealization” during courtship leads to a high incidence of dissatisfaction and disruption. Findings from numerous studies are assimilated to present an alternative explanation for marital conflict in the context of the modern division of labor in which the spheres of work and the family are poorly integrated, particularly in view of sharp role segregation by sex.     

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.     

I've Got You Under My Skin: Marital Biography and Biological Risk

Social relationships shape adult health in profound ways. This study informs our understanding of this association by investigating how the transitions, timing, and exposures to marriage are associated with types of biological risk presumed to serve as pathways to disease and disability. Drawing on the 2005–2006 National Social Health and Aging Project (N = 1,062), the authors evaluated how marital biography was associated with cardiovascular, metabolic, and chronic inflammation risk. The results showed that the effects of marital biography were highly sensitive to gender, the dimension of marital biography, and type of biological risk. For example, marital exposure was protective of cardiovascular risk for women, but not men, whereas an earlier age at first marriage had a pernicious effect on chronic inflammation among men, but not women. Health behaviors did not explain these associations. The implications of these findings are discussed as they pertain to under‐the‐skin risk processes and chronic morbidity.     

Marital Conflict and Children's Emotional Security in the Context of Parental Depression

Evidence has emerged for emotional security as an explanatory variable linking marital conflict to children's adjustment. Further evidence suggests parental psychopathology is a key factor in child development. To advance understanding of the pathways by which these family risk factors impact children's development, the mediational role of emotional security for children with parents who have potentially clinical levels of depression compared to children whose parents have lower levels of symptomatology was examined (i.e., moderated mediation). Participants included 297 families assessed annually for 3 years. Paternal depression moderated pathways, such that marital conflict was associated with greater child emotional insecurity 2 years later in the context of paternal depression. Testing alternative pathways, emotional insecurity mediated relations between maternal depression and externalizing problems.     

Gender, social status, and emotional reliance

Past research has suggested the potential importance of considering emotional reliance, a dimension of interpersonal dependence, when addressing social and developmental risk factors for depression. Based on a probability sample of 1,393 adults aged 18-55 residing in Toronto, Canada, this paper addresses gender differences in emotional reliance and the relevance of emotional reliance in explaining the gender-depression association. We also explore link-ages between emotional reliance and status factors. Findings indicate that emotional reliance is significantly related to depression and that women report greater reliance than men, independent of social status factors like marital and parental status, education, income, and occupational prestige. Moreover, the positive association between emotional reliance and depression is greater for women. Several social status factors modify the relationship between gender and emotional reliance. Both education and occupational prestige reduce reliance, and are particularly beneficial in this regard for women. Marriage, on the other hand, increases emotional reliance, especially for men. We offer interpretations of this pattern of findings.     

The Impacts of Individual Development Accounts,Assets, and Debt on Future Orientation and Psychological Depression

Individual development accounts (IDAs) have been adopted in communities across the country as a way of helping lower-income individuals accrue financial assets. These programs match the savings of program participants if they invest them in the purchase of a home, the creation or expansion of a business, or additional education. Beyond the financial benefits of holding assets, scholars have argued that they should also result in psychological benefits such as enhanced future orientations and decreased depression. This study tests this argument with data from a randomized controlled experiment involving 1,103 applicants to an IDA program. The findings show that assignment to the IDA program was not associated with either future orientation or depression 10 years later. The value of assets held at that time, however, was found to be negatively associated with depression. In addition, self-reported financial stress was found to be negatively associated with future orientation and positively associated with depression.     

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.     

DTREE,The Electronic DSM-111-R

A study showing that student internet behavior differed significantly for students with high scores on a test of depression is thought to be the first to consider the relationship between internet use and depression that focuses on patterns of online behavior rather than content. Study findings have the potential for use in the human services as a way to assess and/or promote mental health. Although the data were collected anonymously with Institutional Review Board approval and participants' informed consent, objections have been raised suggesting this type of data collection represents “Big Brother” or the monitoring of individuals' behavior without their awareness as portrayed in George Orwell's famous novel, 1984. The importance of this type of research in furthering our understanding of the impact of Internet use on human behavior is emphasized. Additionally, the role of the university is stressed as a location for conducting ethical research which disseminates findings via publication to inform and spur policymakers to develop appropriate guidelines to prevent misuse of new knowledge and technology.     

THE EFFICACY AND EFFECTIVENESS OF MARITAL AND FAMILY THERAPY: A PERSPECTIVE FROM META-ANALYSIS

This article reviews the major findings from a multiproject meta-analysis of the effects of marital and family therapy (MFT). Across 163 randomized trials, MFT demonstrates moderate, statistically significant, and often clinically significant effects. No orientation is yet demonstrably superior to any other, nor is MFT superior to individual therapy. Cost effectiveness information is scant in these 163 studies, but supportive. Randomized experiments yield very different answers from nonrandomized experimental studies of the effects of MFT, calling into question whether we should mix the two in reviews. We have also found several new differences in the ways that marital therapy (MT) and family therapy (FT) studies are conducted, making them harder to compare. Finally, important questions still exist about whether any psychotherapy, including MFT, yet has sufficient information about how well research generalizes to everyday clinical practice.     

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.     

Culturally Relevant Psychotherapy for Perinatal Depression in Low-Income Ob/Gyn Patients

To minimize barriers to care, ameliorate antenatal depression, and prevent postpartum depression in low-income women, we propose that a culturally relevant version of brief interpersonal psychotherapy (IPT-B) may be an effective approach. IPT-B is a modified form of Interpersonal Psychotherapy (IPT), an efficacious treatment for depression that we have altered to address the needs of women who have difficulty adhering to longer courses of psychotherapy. Culturally relevant additions to IPT-B include (1) a pre-treatment engagement strategy consisting of an ethnographic interview accompanied by psychoeducation to engage women in treatment; (2) convenient delivery of IPT-B in a public care Ob/Gyn clinic where the women receive prenatal services; (3) flexible scheduling of treatment sessions at the clinic or on the phone; and 4) facilitation of access to social services.     

Marital Enqing and Depression in Taiwanese Couples: The Mediating Role of Active and Passive Sacrifice

Using social exchange and identity theory, the authors examined the association between marital enqing and depression in 372 Taiwanese couples, and the mediating effects of active and passive sacrifice on that association. Marital enqing is a unique form of affection toward the partner in Taiwanese couples. Data was analyzed by using the actor-partner interdependence model to test for actor and partner effects among study variables. Results indicated that husbands, who reported more marital enqing, tended to have lower levels of depression. Partner effects revealed that couples’ marital enqing decreased their spouse’s depressive symptoms. Husbands’ sacrifice behaviors mediated the association between his marital enqing and depression. However, Taiwanese wives’ sacrifice behavior did not mediate the association between her marital enqing and depression. Chinese cultural principles indeed impacted how couples in Taiwan conceptualized marital affection differently from couples in western cultures, and it provided insights into its relationships with couples’ sacrifices and relational and individual wellbeing.