Marital therapy: a viable treatment for depression and marital discord

The intertwined relationship between depression and marital distress: elements of marital therapy conductive to effective treatment outcome

Within the framework of the interpersonal view of depression, this article examines the linkage between depression and four aspects of marital relationship: stress, support, role expectations, and interactional dynamics. Acknowledging the intertwined relationship between depression and marital adjustment, existing models of martial therapy for married depressed patients are examined for the extent to which they address these four aspects. The empirical evidence for the efficacy of these models is also reviewed, suggesting elements of marital therapy that are conducive to effective treatment outcome.

Characteristics and treatment of women with antenatal and postpartum depression

OBJECTIVE

Investigations of the efficacy of treatment for non-psychotic pregnancy-related mood disorders are scarce. Thus, a prospective, longitudinal study of six months duration, involving ninety-six index cases and forty-five healthy women as a reference group, was implemented to determine the response of mood, parenting stress and dyadic adjustment to an eclectic management.

METHOD

In this naturalistic study, the index cases were offered treatment consistent with their symptoms, context, and level of compliance. All women received individual psychotherapy combining strategies from Interpersonal and Cognitive Behavioral Psychotherapy and/or Marital Interventions and Pharmacology. Rating scales (Dyadic Adjustment Scale, Hamilton Rating Scale for Depression, Edinburgh Postnatal Depression Scale, Child Stress Inventory) scored monthly, were used to measure the response to treatment over time.

RESULTS

Depressive symptoms are generally alleviated by the second to third month of treatment. Dyadic discord accentuated by traditional sex role expectations and child care stress exacerbated by low self-esteem persisted throughout the trial at levels significantly different from the untreated reference group.

CONCLUSIONS

Short-term interventions are cost-effective for the relief of mood disorders. However, creative solutions, during an era of economic restraints, are required to extend treatment sufficiently to address couple conflicts and facilitate the transition to parenthood for index cases.

Individual psychopathology and marital distress. Analyzing the association and implications for therapy

This article is a review of the association of individual and marital problems. The focus is on depression, alcohol abuse, anxiety disorders, and the functional psychoses, each of which interact with marital distress in important ways. Although the causal connections between these disorders and marital distress are complex and only particularly understood, the available evidence shows that individuals' and couples' problems often exacerbate each other. Consequently, regardless of whether the initial presentation is individual or couple focused, there is routinely a need to assess both individual and relationship functioning. Couples therapy, and in particular behavioral couples therapy (BCT), is an important element of effective treatment of depression, alcohol abuse, anxiety disorders, and the functional psychoses. The integration of couple and individual therapy presents a number of clinical challenges, and in concluding this article the authors provide guidelines for managing these challenges.

INTERVENTIONS FOR COUPLES

A substantial body of empirical research has documented both the promise and the shortcomings of psychological interventions for preventing or ameliorating marital distress. Couple therapy reduces relationship distress and may affect individual psychopathology, such as depression. However, some couples are unresponsive and others improve but relapse later. Interventions to prevent marital distress usually produce short-term changes in behavior and relationship satisfaction, but little evidence exists demonstrating a longer-term prevention effect. Furthermore, these interventions have yet to be examined on a diverse population of couples or with a diverse set of outcome criteria (e.g. effects on children). Concern about the negative impact of marital discord and divorce will continue to provide the impetus for research on more effective means of intervening with couples. Future research could benefit from a focus on a more diverse population of couples, treatment in natural settings, the development of more powerful interventions, and the examination of those interventions over longer periods of time and with more comprehensive outcome measures.

Combined medication and psychotherapy in the treatment of chronic mood disorders

This article discusses the use of combined treatments for patients with chronic mood disorders. Although very little research concerning the efficacy of combined treatments for patients with chronic depression exists, clinical experience and limited available research suggest that combined treatment may be the most effective treatment option available for this population. The use of combination treatment involving pharmacotherapy, individual psychotherapy, and marital/family therapy is recommended to address the complex biopsychosocial issues involved in chronic mood disorders. Other theoretical and pragmatic issues concerning the delivery of combined treatment also are discussed.

Summary of the DSM-IV mood disorders field trial and issue overview

The DSM-IV Mood Disorders Field Trial addressed several issues concerning the relationship among major depression, dysthymia, recurrent brief depression, minor depression, and depressive personality disorder. The Mood Disorders Field Trial is a naturalistic, multisite study that investigated the diagnostic criteria for dysthymia, the reliability and validity of longitudinal course modifiers, the nosology of minor and recurrent brief depression, and the relationship between depressive personality disorder and dysthymia. Research on the nosology of chronic depressive disorders will, it is hoped, contribute to a better understanding of pathophysiology, etiology, and treatment. This article presents findings from the Field Trial as well as brief reviews of the other nine articles in this issue.

The role of marital therapy in the treatment of depressed married women

The absence of a close, confiding relationship has been identified as a vulnerability factor to depression for women under adverse circumstances. Marital discord has also been identified as a risk factor in initiating and sustaining depression in women. Recent research has suggested that marriages with a depressed spouse are associated with lack of intimacy and decreased self-disclosure. This paper reviews three controlled outcome studies which demonstrate that marital therapy in combination with antidepressant medication is not indicated for hospitalized women with major affective disorder but either alone or in combination with antidepressants, marital therapy is a viable treatment for outpatient women who are suffering from depression.

Do depressed patients with higher pretreatment stress levels respond better to cognitive therapy than imipramine?

Forty-eight unipolar depressed patients were randomly assigned to 12 weeks of treatment with either imipramine (IMI) (n = 32) or cognitive therapy (CT) (n = 16). Prior to treatment assignment, all patients were rated for severity of a variety of psychosocial stressors. The interaction effect between pretreatment stress and type of treatment, CT or IMI, on symptom improvement was evaluated. We hypothesized that patients with greater pretreatment stress would respond better to cognitive therapy. Patients treated with either CT or IMI showed equivalent reductions of depressive symptoms. There was no interaction effect between pretreatment stress and type of treatment on improvement of depressive symptoms. Based on this preliminary study it does not appear that depressed patients with higher pretreatment levels of stress respond better to cognitive therapy than they do to imipramine.