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FALL 2006
Depression and Marital Strife: Dealing with a Double Whammy
by Lindsey Scott

As the U.S. divorce rate of almost 50 percent attests, keeping a marriage together can be pretty tough even under normal circumstances. But depression can comp-licate ordinary marital problems and make marital success even more challenging, said University of Georgia psychology professor Steven Beach.

Depression affects more than 19 million Americans, said Beach, who is director of UGA’s Institute for Behavioral Research. “Although people tend to dismiss it because it’s such a commonly known and diagnosed problem, depression actually causes greater difficulties than many other disorders.” Causing patients to feel helpless, unable to perform some of the simplest everyday tasks and pessimistic about the future, depression can be debilitating for the individual and make it harder to deal with the ups and downs that occur in every marriage, Beach said.

Marriage is a natural arena in which to study the interpersonal aspects of depression because it is such a powerful inter-personal environment. Events that “pile up” on a person who becomes depressed often stem from interactions with family and close friends. Some of the most powerful interpersonal events are those that occur between a husband and a wife. Although troubles in close relationships may contribute to depression, improvement in marital relationships can also help with recovery. This may reflect the importance of marriage as a source of support and the fact that many traditional sources of support are less available than they used to be, Beach said.

While the increase in rates of depression over the past 100 years is not thoroughly understood, some cultural anthropologists believe it results from the lack of inter-personal networks in modern society. For example, people are more likely to move several times over their lives — repeatedly losing contact with potential support groups — at the same time that new forms of communication have tended to replace face-to-face interactions. In the midst of this change, “marriage remains a core interpersonal relationship in modern society,” Beach said. “That may be why marital quality so consistently correlates with depression.” The loss of other interpersonal networks and sources of support may also put marriage at risk in the context of depression.

While matrimony can be a port in the storm, such singular reliance can over-burden a relationship. As a result, couples may find themselves dealing with both depression and marital problems.

Beach completed a study involving couples experiencing that volatile combination of marital strife and at least one partner who was depressed. Each couple was randomly assigned to a treatment group: marital therapy, cognitive therapy for depression, or no treatment. Couples in marital therapy attended counseling together, while only the depressed partner was counseled in cognitive therapy. “I was interested in finding out whether improving the marital relationship could help someone who was depressed as much as the leading-individual approach to treatment,” said Beach.

In the end, “marital therapy indeed acted as an intervention for depression. Couples tended both to improve their level of marital satisfaction and recover from their depressive episode regardless of which came first,” he said. By contrast, cognitive therapy often was successful in relieving individuals’ depression but only helped the couples’ marital problems if they were a direct result of the depression.

One may naturally ask a modern version of the elusive chicken-and-egg question — which comes first: depression or marital strife? There is no unique answer.

“Depression is a recurrent problem,” Beach said, “so it depends on whether you ask people if they have ever had a depressive episode or if you are focused on a current depressive episode.” Because individuals are getting married at older ages and diagnoses of depression are becoming prevalent at younger ages, more people than ever now have had a diagnosed depressive disorder prior to marriage, which a therapist also must take into account when deciding how to address a problematic union.

Beach has found that therapists and couples generally accomplish the most by looking at a specific depressive episode. Under such circumstances, some individuals will first notice marital stress and then slide into depression, whereas others will first notice the depression and then the marital stress. This crucial difference can help predict what type of treatment will be most appropriate.

“For people whose depression came first, cognitive therapy was generally effective, and as they got better they also rated their marital satisfaction higher. For patients whose marital discord came first, cognitive therapy did not improve marital satisfaction at all, although in some cases it still helped in relieving depressive symptoms,” he said.

It is well known that serotonin — a brain chemical that controls mood, sleep, sex- uality and appetite — is associated with depression, or freedom from it, and researchers have recently discovered a number of genetic links that may help explain differences in the way people respond to marital distress and other difficulties.

“Some forms of the genes are associated with greater changes in this neurotransmitter system when an individual is confronted by a stressful set of circumstances,” Beach said. “If I have those forms of the genes, I’m going to be at an elevated risk for depression compared to someone facing the same set of stressful events but who has the other form of the gene.”

With this new information, Beach believes it will be possible to help people at genetic risk for depression become more resilient by building stronger relationships. “Teaching people different strategies for avoiding stress and developing supportive relationships,” according to Beach, “should protect them from toxic stress and create a context that doesn’t allow an underlying genetic predisposition toward depression to express itself.”

hese new genetic findings may also help confirm and extend old-fashioned common sense. By encouraging couples to build more supportive connections with each other as well as with other people and to acquire techniques for reducing the level and the intensity of certain stresses, perhaps it is possible to reverse the processes that are leading to higher rates of depression in all modern societies, Beach said.

Depression Symptom Checklist
Steven Beach, a psychologist at the University of Georgia, has provided a short checklist to help determine whether or not a person is suffering from depression. However, he notes that checklists are only screening tools and cannot diagnose depression.

Step 1:
Check off any symptoms you have experienced on a regular basis over at least the past two weeks:

• Constant sadness
• Lack of motivation
• Irritability
• Trouble concentrating
• Feelings of isolation, reduced involvement with family and friends
• Loss of interest in favorite activities
• Hopelessness
• Feelings of worthlessness or guilt for no particular reason
• Thoughts of death or suicide
• Fatigue
• Low energy
• Insomnia
• Significant weight change

Step 2:
Do your symptoms affect your ability to be yourself and function on a daily basis?
(For example, do they prevent you from interacting with family and friends or enjoying your favorite hobbies or activities?)

Yes, my symptoms affect my daily functioning.

No, my symptoms do not affect my daily functioning.

If you have four or more symptoms in Step One, and answered “yes” in Step Two, you may want to see a professional to be evaluated or share the results with your physician. But remember, this is just a screening tool and cannot diagnose depression. Because other medical conditions may cause similar symptoms, only a health care professional can diagnose depression.

For more information, access the Institute for Behavioral Research at www.ibr.uga.edu, or email Steven Beach at sbeach@egon.psy.uga.edu.