Randomized Controlled Trial of the Marriage Checkup: Depression Outcomes

Improvements in depressive symptoms following a brief relationship intervention

In the United States, 21 million adults are diagnosed with depression. Couple therapy effectively treats depression, however, couples encounter access barriers. The Relationship Checkup is an assessment and feedback intervention delivered in participants' homes. The current study examines changes in relationship satisfaction and depressive symptoms, and moderators and mechanisms of change in a community sample (N = 85 couples). Changes in depressive symptoms and satisfaction, and the association between changes in satisfaction and depressive symptoms were examined with multilevel modeling. Depressive symptoms (Cohen's d = 0.36) and satisfaction (d = 1.43) improved from baseline to 1-month follow-up, with greater declines in depression (d = 0.44) for those with more severe symptoms. Increases in satisfaction were associated with decreases in depressive symptoms (d = 0.23), and decreases in depressive symptoms were associated with increases in satisfaction (d = 0.33). Individuals with depression and relationship distress may be well served by this intervention.

Brief relationship support as a selective suicide prevention intervention: Piloting the Relationship Checkup in veteran couples with relationship and mental health concerns

INTRODUCTION

Close relationship problems play a key role in many contemporary theories of suicide. However, the potential of relationship support in suicide prevention is understudied. This study explores the feasibility, safety, acceptability, and promise of utilizing the 3-session Relationship Checkup (RC) in veterans with mental health and romantic relationship concerns.

METHODS

We conducted a single-arm pilot of telehealth RC in veterans with a positive mental health screen and their romantic partners. Couples completed baseline and post-treatment assessments of study outcomes.

RESULTS

Feasibility analyses showed we were able to recruit an elevated-risk sample (30% history of attempts or interrupted attempts), take them through the service (90% treatment completion), and had minimal harm events (no suicidal behavior, no physical harm in arguments). Multimethod acceptability analyses suggested high satisfaction with the program, though some desired more intensive services. Couples reported improvements in relationship functioning, emotional intimacy, thwarted belongingness, depression, and posttraumatic stress. Perceived burdensomeness only improved for identified patients and drinking did not change for either partner.

CONCLUSION

The RC is a feasible, safe, and acceptable strategy for providing relationship support to couples at elevated risk. Although further randomized trials are needed, RC shows promise to reduce relationship-level and individual-level suicide risk factors.

Randomized controlled trial of the Marriage Checkup: Stress outcomes

Several couple interventions targeting relationship distress also show beneficial effects on individual mental health. Yet, strikingly few studies report effects on perceived stress. This study examined the effects of a brief couple intervention, the Marriage Checkup (MC), on perceived stress. We randomly assigned 231 couples to receive two MCs (Weeks 7 and 51) or to a waitlist control. Survey data were collected at seven time points over 2 years and analyzed using multilevel models. We found no significant between-group treatment effects on average stress at any time point. However, women, but not men, in the intervention group experienced decreased stress after the second MC (d = -0.23) and more women in the intervention group (26.5%) compared with the control group (14.9%) experienced reliable improvements in stress after the second MC. Overall, the MC did not result in main effects on stress but caused temporary reliable change in terms of stress relief for women.

A randomized controlled trial of a 5-year marriage checkup booster session for a subsample of responder couples

This study examined maintenance and booster effects of a brief couple intervention, the Marriage Checkup (MC), across 5 years. A subsample of 63 couples who benefitted from two previous MCs (responder couples), were randomly assigned to a third MC or control. Before randomization (at 4-years-9-months), the responder sample had maintained small to medium effects on two measures of relationship functioning. After randomization, we found no significant between-group effects. Yet, within-group analyses revealed that while control couples showed flat trajectories in all outcomes after the 4-year-9-months baseline, couples receiving a third MC (at Year 5) reported small to medium improvements in three measures of relationship functioning and maintained follow-up effect in one measure. Findings indicate that couples who initially improved from the MC can maintain some of their improvements over long periods. The potential of boosting such improvements with recurrent MCs is a relevant target for further investigation in larger samples.

Health benefits of physical activity for people with mental disorders: From the perspective of multidimensional subjective wellbeing

This paper uses a large scale and nationally representative dataset, Chinese General Social Survey, to empirically examine the role of physical activity in reducing the negative effects of depression among people with mental disorders. Empirical results demonstrate that physical exercise could help to alleviate depression's adverse consequences on work and life for depressed individuals. The impact mechanism is that physical activity may decrease the severity of depression, enhance life satisfaction, improve mood, and make people have a better sense of purpose and meaning in life. Therefore, from the perspective of multidimensional subjective wellbeing, evaluative wellbeing, experienced wellbeing and eudaimonic wellbeing all play mediating roles in the reduction of depression's adverse effects. Heterogeneity analysis shows that there are no significant gender differences in the health benefits of physical exercise, but its impact tends to be more prominent for depressed individuals who are younger and higher educated, with better health status, and live in urban areas. It is also found that socioeconomic status may play an important moderating role. The health benefits of physical activity seem to be greater for depressed people who have lower income, work in the secondary labor market, and have lower levels of social capital and assets. In addition, the instrumental variable approach is used to identify the causal impact of physical activity, which further proves a significant effect of it based on tackling the endogeneity problem. Meanwhile, this paper uses different explanatory and explained variables, different statistical models, as well as machine learning and placebo techniques to conduct robustness tests, all of which lend credence to above findings.

Inman C, Shahawy OE, Weitzman M, Schmidt AM, Sherman S, Abdulle A, Ahmad A, Ali R. Association between depression, happiness, and sleep duration: data from the UAE healthy future pilot study

BACKGROUND

The United Arab Emirates Healthy Future Study (UAEHFS) is one of the first large prospective cohort studies and one of the few studies in the region which examines causes and risk factors for chronic diseases among the nationals of the United Arab Emirates (UAE). The aim of this study is to investigate the eight-item Patient Health Questionnaire (PHQ-8) as a screening instrument for depression among the UAEHFS pilot participants.

METHODS

The UAEHFS pilot data were analyzed to examine the relationship between the PHQ-8 and possible confounding factors, such as self-reported happiness, and self-reported sleep duration (hours) after adjusting for age, body mass index (BMI), and gender.

RESULTS

Out of 517 participants who met the inclusion criteria, 487 (94.2%) participants filled out the questionnaire and were included in the statistical analysis using 100 multiple imputations. 231 (44.7%) were included in the primary statistical analysis after omitting the missing values. Participants' median age was 32.0 years (Interquartile Range: 24.0, 39.0). In total, 22 (9.5%) of the participant reported depression. Females have shown significantly higher odds of reporting depression than males with an odds ratio = 3.2 (95% CI:1.17, 8.88), and there were approximately 5-fold higher odds of reporting depression for unhappy than for happy individuals. For one interquartile-range increase in age and BMI, the odds ratio of reporting depression was 0.34 (95% CI: 0.1, 1.0) and 1.8 (95% CI: 0.97, 3.32) respectively.

CONCLUSION

Females are more likely to report depression compared to males. Increasing age may decrease the risk of reporting depression. Unhappy individuals have approximately 5-fold higher odds of reporting depression compared to happy individuals. A higher BMI was associated with a higher risk of reporting depression. In a sensitivity analysis, individuals who reported less than 6 h of sleep per 24 h were more likely to report depression than those who reported 7 h of sleep.

Predicting change through individual symptoms and relationship distress: A study of within- and between-person processes in couple therapy

OBJECTIVE

In couple therapy clients often suffer from a blend of individual psychiatric symptoms as well as severe relational distress. However, research is inconclusive on whether relational change predicts symptom change or vice versa. Because answers to this question could have important clinical implications on what to focus on in couple therapy at which time in treatment, more research is recommended.

METHOD

In this study, data collected before every therapy session were used to test whether changes in relational functioning predicted symptom functioning or vice versa. The study used a multilevel modelling approach, and the variables of interest were disaggregated into within- and between-person effects.

RESULTS

The results indicated that if an individual improved more than expected on relational functioning, this predicted more improvement than expected on individual symptoms. No significant reciprocal relationship was found between these variables.

CONCLUSIONS

The clinical implication is discussed, suggesting that an emphasis on relational improvement seems to be an important mechanism during couple therapy that may facilitate the change on individual symptoms in the long run.

Intimate Relationships and Depression: Searching for Causation in the Sea of Association

This article provides a critical review of existing research on intimate (marriage or marriage-like) relationship distress and risk for depression. Using the meta-framework of research triangulation, we seek to synthesize research evidence across several different methodologies and study designs and to draw the most reliable conclusion regarding a potential causal association between relationship distress and depression. Focusing on existing correlational (i.e., observational), genetically informed, and intervention (i.e., experimental) research on the association between relationship distress and depression, we conclude that the existing body of research evidence supports the claim that relationship distress is a causal risk factor for depression. A secondary aim of the article is to highlight a variety of effective methods that, when viewed from the perspective of triangulation, enhance the pursuit of causal inference, including propensity score matching, target trial emulation, directed acyclic graph approach, and Mendelian randomization.