Marital adjustment and depression

Does depression experienced by mothers leads to a decline in marital quality: a 21-year longitudinal study

PURPOSE

Marital conflict and/or marital breakdown are known pathways to the onset of depression. Few studies however have examined the possibility that depression can lead to a decrease in marital quality and an increase in marital breakdown. Depression may be an important pathway to a decline in martial quality.

METHODS

A birth cohort study with women (mothers) recruited early in pregnancy and followed for 21 years. Using repeated measures analysis for four waves of data collection we use GEE to examine the extent to which symptoms of depression predict subsequent poor martial quality in women and poor marital quality predicts subsequent depression.

RESULTS

A bidirectional association between poor marital quality and depression is observed. After removing those who had pre-existing poor marital quality we note that depression predicts subsequent poor martial quality. Similarly, we note that poor marital quality predicts subsequent depression. These associations are all statistically significant and of a similar magnitude.

CONCLUSION

Over the maternal reproductive life course there is a long-term trajectory of reduced marital quality and increased depression. Maternal depression is as likely to lead to a decline in marital quality as poor martial quality is likely to lead to increased levels of depression. There may be a need to develop intervention programmes to reduce this long-term pattern of change.

Improvement in social-interpersonal functioning after cognitive therapy for recurrent depression

BACKGROUND

Cognitive therapy reduces depressive symptoms of major depressive disorder, but little is known about concomitant reduction in social-interpersonal dysfunction.

METHOD

We evaluated social-interpersonal functioning (self-reported social adjustment, interpersonal problems and dyadic adjustment) and depressive symptoms (two self-report and two clinician scales) in adult outpatients (n=156) with recurrent major depressive disorder at several points during a 20-session course of acute phase cognitive therapy. Consenting acute phase responders (n=84) entered a 2-year follow-up phase, which included an 8-month experimental trial comparing continuation phase cognitive therapy to assessment-only control.

RESULTS

Social-interpersonal functioning improved after acute phase cognitive therapy (dyadic adjustment d=0.47; interpersonal problems d=0.91; social adjustment d=1.19), but less so than depressive symptoms (d=1.55). Improvement in depressive symptoms and social-interpersonal functioning were moderately to highly correlated (r=0.39-0.72). Improvement in depressive symptoms was partly independent of social-interpersonal functioning (r=0.55-0.81), but improvement in social-interpersonal functioning independent of change in depressive symptoms was not significant (r=0.01-0.06). In acute phase responders, continuation phase therapy did not further enhance social-interpersonal functioning, but improvements in social-interpersonal functioning were maintained through the follow-up.

CONCLUSIONS

Social-interpersonal functioning is improved after acute phase cognitive therapy and maintained in responders over 2 years. Improvement in social-interpersonal functioning is largely accounted for by decreases in depressive symptoms.

Dyadic adjustment in parents of schizophrenics

OBJECTIVE

To study the dyadic adjustment in couples with a schizophrenic offspring.

METHOD

140 married couples, 67 with children with schizophrenia, and two control groups: 41 couples without pathology and 32 couples with pathology, were assessed with the Dyadic Adjustment Scale, the Beck Depression Inventory and the Self-Rating Anxiety Scale.

RESULTS

The couples with a schizophrenic offspring evidenced significantly worse dyadic adjustment than did the normal controls, especially low consensus and cohesion in husbands, and low cohesion and satisfaction in wives. Anxiety and depression in mothers of schizophrenics is significantly higher than in mothers of controls.

DISCUSSION

These findings suggest that the poor dyadic adjustment of the parents with a schizophrenic offspring could be an effect of the burden.

CONCLUSION

The treatment on the schizophrenia should be supplemented by interventions aimed at parents' dyadic adjustment, and mothers' anxiety and depression, so that they can be in better conditions to help their child.