Psychiatric disorders and dissatisfaction with social relationships: does type of relationship matter?

The specificity of the association between 9 Axis I psychiatric disorders and quality of the relationship with spouse, relatives, and friends was evaluated for married participants who completed the Ontario Health Survey Mental Health Supplement (N = 4,933). When the authors controlled for the quality of other social relationships, not getting along with one's spouse was related to 6 disorders, with the strongest associations found for generalized anxiety disorder, major depression, panic, and alcohol problems; 4 associations remained significant when they controlled for comorbid disorders. Not getting along with relatives and friends was generally unrelated to psychiatric disorders when they controlled for the other social relationships. Results indicate that the association between marital quality and psychiatric disorders is not an artifact of general social dissatisfaction and that this association is significant for several disorders.     

Marital distress and DSM-IV psychiatric disorders in a population-based national survey

The associations between marital distress and Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) Axis I psychiatric disorders were evaluated in a United States population-based survey of married individuals in which there was no upper age exclusionary criterion (N = 2,213). Marital distress was associated with (a) broad-band classifications of anxiety, mood, and substance use disorders and (b) all narrow-band classifications of specific disorders except for panic disorder, with the strongest associations obtained between marital distress and bipolar disorder, alcohol use disorders, and generalized anxiety disorder. The association between marital distress and major depressive disorder increased in magnitude with increasing age; there was no evidence that the association between marital distress and other psychiatric disorders was moderated by gender or age. Results support continued research on the association between couple functioning and mental health.     

Marital dissatisfaction and incidence of major depressive episode in a community sample

The association between marital dissatisfaction at baseline and 12-month incidence of major depressive episode (MDE) was examined in a community sample of married individuals from the New Haven Epidemiologic Catchment Area program (N = 904) who did not meet criteria for MDE at baseline. Results indicate that marital dissatisfaction was associated with increased incidence of MDE, with a significant risk ratio of 2.7 and an attributable risk of 29.5%. Thus, dissatisfied spouses were nearly 3 times more likely than nondissatisfied spouses to develop an MDE during the year, and nearly 30% of the new occurrences of MDE were associated with marital dissatisfaction. The association between marital dissatisfaction and risk of MDE (a) remained significant when controlling for demographics and depression history and (b) was not moderated by sex or by depression history. Findings suggest that marital dissatisfaction may be etiologically related to major depression.     

Sex-specific clinical correlates of hoarding in obsessive-compulsive disorder

Little is known about whether the clinical correlates of hoarding behavior are different in men and women with obsessive-compulsive disorder (OCD). In the current study, we evaluated the association of hoarding with categories of obsessions and compulsions, psychiatric disorders, personality dimensions, and other clinical characteristics separately in 151 men and 358 women with OCD who were examined during the OCD Collaborative Genetics Study. We found that, among men but not women, hoarding was associated with aggressive, sexual, and religious obsessions and checking compulsions. In men, hoarding was associated with generalized anxiety disorder and tics whereas, among women, hoarding was associated with social phobia, post-traumatic stress disorder, body dysmorphic disorder, nail biting, and skin picking. In women but not men, hoarding was associated with schizotypal and dependent personality disorder dimensions, and with low conscientiousness. These findings indicate that specific clinical correlates of hoarding in OCD are different in men and women and may reflect sex-specific differences in the course, expression, and/or etiology of hoarding behavior in OCD.     

Understanding general and specific connections between psychopathology and marital distress: a model based approach

Marital distress is linked to many types of mental disorders; however, no study to date has examined this link in the context of empirically based hierarchical models of psychopathology. There may be general associations between low levels of marital quality and broad groups of comorbid psychiatric disorders as well as links between marital adjustment and specific types of mental disorders. The authors examined this issue in a sample (N = 929 couples) of currently married couples from the Minnesota Twin Family Study who completed self-report measures of relationship adjustment and were also assessed for common mental disorders. Structural equation modeling indicated that (a) higher standing on latent factors of internalizing (INT) and externalizing (EXT) psychopathology was associated with lower standing on latent factors of general marital adjustment for both husbands and wives, (b) the magnitude of these effects was similar across husbands and wives, and (c) there were no residual associations between any specific mental disorder and overall relationship adjustment after controlling for the INT and EXT factors. These findings point to the utility of hierarchical models in understanding psychopathology and its correlates. Much of the link between mental disorder and marital distress operated at the level of broad spectrums of psychopathological variation (i.e., higher levels of marital distress were associated with disorder comorbidity), suggesting that the temperamental core of these spectrums contributes not only to symptoms of mental illness but to the behaviors that lead to impaired marital quality in adulthood.     

Discovery of a Partner Affair and Major Depressive Episode in a Probability Sample of Married or Cohabiting Adults

Prior research has found that humiliating marital events are associated with depression. Building on this research, the current study investigated the association between one specific humiliating marital event—discovering that one's partner had an affair—and past‐year major depressive episode (MDE) in a probability sample of married or cohabiting men and women who were at high risk for depression based on the criterion that they scored below the midpoint on a measure of marital satisfaction (N = 227). Results indicate that (i) women were more likely than men to report discovering their partner had an affair in the prior 12 months; (ii) discovering a partner affair was associated with a higher prevalence of past‐year MDE and a lower level of marital adjustment; and (iii) the association between discovering a partner affair and MDE remained statistically significant when holding constant demographic variables and marital adjustment. These results support continued investigation into the impact that finding out about an affair has on the mental health of the person discovering a partner affair.     

Marital adjustment and interleukin-6 (IL-6)

Building on prior research that marital functioning is associated with a variety of health outcomes, we evaluated the association between marital adjustment and a marker of inflammation in a sample of married adults between the ages of 35 and 84 years old (N = 415) from the second wave of the population-based Survey of Midlife Development in the United States (MIDUS II). Specifically, we evaluated associations between positive (i.e., partner support) and negative (i.e., partner strain) dimensions of marital adjustment and interleukin-6 (IL-6) separately for men and women, and whether these associations were moderated by age. Results indicated that (a) marital adjustment was not associated with IL-6 in men, (b) age moderated the association between marital adjustment and IL-6 in women, (c) partner support and partner strain were associated with IL-6 in younger women, and (d) partner support but not partner strain was uniquely associated with IL-6 in younger women. The associations between marital adjustment and IL-6 in younger women were significant when controlling for demographic variables, health status indicators, health behaviors, depressive symptoms, and perceived stress. These findings suggest that IL-6 may be a useful biomarker for studying health-relevant biological responses within intimate relationships, and that young women, in particular, may exhibit increased inflammation when partner support is low.     

Couples in Therapy: Actor-Partner Analyses of the Relationships Between Adult Romantic Attachment and Marital Satisfaction

This study was the first to investigate the relationship between adult romantic attachment and marital satisfaction in a clinical sample of 172 distressed couples seeking therapy. Fifty-six therapy-seeking nondistressed couples were also assessed for comparison. Analyses of variance showed that attachment avoidance was a distinctive characteristic of distressed couples. Actor-partner analyses revealed that attachment avoidance (for men and women) and attachment anxiety (for women only) were predictive of marital dissatisfaction for distressed couples. Gender-stereotype discordant partner effects were also found. Results suggest that attachment orientations (especially avoidance) are relevant predictors of marital dissatisfaction in distressed couples seeking therapy, and that couple therapists can gain important information by assessing partners’ attachment orientations.     

Subjective Well-Being of Older African Americans with DSM IV Psychiatric Disorders

This study examined demographic and mental health correlates of subjective well-being (i.e., life satisfaction, happiness) using a national sample of older African Americans with psychiatric disorders. We used a subsample of 185 African Americans, 55 and older with at least one of thirteen lifetime psychiatric disorders from The National Survey of American Life: Coping with Stress in the Twenty-first Century. The findings indicated that among this population of older adults who had a lifetime psychiatric disorder, having a lifetime suicidal ideation was associated with life satisfaction but not happiness. Further, having a 12-month anxiety disorder or a lifetime suicidal ideation was not associated with happiness. Having a 12-month mood disorder, however, was negatively associated with an individual’s level of happiness, as well as their life satisfaction. Additionally, there were two significant interactions. Among men, employment was positively associated with life satisfaction, and marriage was associated with higher levels of happiness among men but not women. The overall pattern of findings reflects both similarities and departures from prior research confirming that well-being evaluations are associated with multiple factors.     

Do men find "bony" women attractive?: Consequences of misperceiving opposite sex perceptions of attractive body image

Due to its role in the development and maintenance of eating disorders, body image perceptions and dissatisfaction continue to be an important area of study. Perceptions of attractive body images held by members of the opposite sex are an important determinant of body image satisfaction among both men and women. This research shows that men are accurate in their perceptions of what women find attractive among men, but women believe men want women to be thinner than men actually report. Furthermore, this inaccurate perception is associated with eating disorder symptomatology. The role of contingent self-worth was also assessed. Results indicate that individuals whose self-worth is more contingent on appearance-related standards experience more negative consequences than those who misperceive what the opposite sex finds attractive, but whose self-worth is less contingent on appearance. Implications for intervention are discussed.     

Gender,Social Roles,and Mental Health: An Epidemiological Perspective

The social roles men and women occupy may account for gender differences in rates of psychiatric disorder. Women are thought to have poorer experiences within any given role (role strain theory), have more conflicts among their different roles (role-configuration theory), or have fewer role opportunities available to them (role accumulation hypothesis) compared to men. These theories are examined in a community sample (n = 4,745, 52% females and 48% males; Caucasian [84.2%], Hispanics [10.0%], African Americans [3.8%], Native American [1.4%], Asian [0.6%], and Pacific Islander [0.1%]). No gender differences in the overall rate of DSM, psychiatric disorders were found; however, differences were found for specific disorders. Although multiple roles were generally found to be associated with lower rates of disorders for both men and women, some role combinations were associated with a higher rate of disorders. The possibility that roles may be associated with both stressors and protective factors is discussed.     

Sexual Dissatisfaction in a Sample of Married Iranian Women

This article investigates the sexual relationships of dissatisfied couples from the viewpoint of the female spouse. There are two basic approaches toward sexual dissatisfaction: the first regards sexual dissatisfaction as the cause of marital dissatisfaction; the second asserts that marital dissatisfaction leads to sexual dissatisfaction. This study aims at an understanding of the causes and mechanisms of women’s sexual dissatisfaction and its relationship to marital dissatisfaction. The research was organized using the Grounded theory for a holistic and deep understanding of the phenomenon. Findings drawn from the interviews with 20 severely sexually dissatisfied women indicated a discrepancy between the attitudes of men and women toward sexual relationships. This difference builds a sense of sexual inequality amongst women. This is accompanied by an increased importance of sexual satisfaction compared to the past, or “sexualization” of marital relationships and the resulting sexual dissatisfaction within women. Our study suggests that marital dissatisfaction may precede and cause sexual dissatisfaction and that this link ultimately becomes reciprocal.     

Gender roles, eating pathology, and body dissatisfaction in men: a meta-analysis

The current study reviewed relationships between gender roles and (a) eating pathology, (b) body dissatisfaction, and (c) muscle dissatisfaction among men via meta-analysis. Moderators of sexual orientation and type of gender role measure were also investigated. Results revealed the relationship between femininity and eating and body-related variables did not significantly differ from zero. Sexual orientation moderated the relationship between femininity and muscle dissatisfaction (i.e., femininity was negatively related to muscle dissatisfaction for heterosexual but not gay men). Masculinity was negatively associated with eating pathology and body dissatisfaction. Type of masculinity measure moderated the relationship between masculinity and body dissatisfaction (i.e., trait-based measures produced a negative association, multidimensional measures yielded nonsignificant relationships). Type of masculinity measure produced a cross-over interaction when examining muscle dissatisfaction (i.e., trait-based instruments yielded a negative association and multidimensional instruments revealed a positive relationship). Findings highlight the salience of masculinity in men's eating and body concerns.     

Type A Behavior and Marital Dissatisfaction: Disentangling the Effects of Achievement Striving and Impatience-Irritability

Previous research has documented an association between overall Type A behavior and marital dissatisfaction. The present study examines the nature of this relationship when a two dimensional approach to Type A behavior is adopted, and impatience-irritability and achievement striving are assessed separately. Subjects were 134 medical practitioners and specialists and their wives in South Africa. As predicted, husbands' impatience-irritability was associated with their own and their wives' marital dissatisfaction. However, neither their achievement striving nor global Type A behavior correlated with their own or their wives' marital dissatisfaction. The results are discussed in terms of the need for isolating the specific component of Type A behavior that is associated with marital dissatisfaction.     

The association between depression and thyroid disorders in a regionally representative Canadian sample

A subsample of six provinces (n = 67,621) from the 2005 Canadian Community Health Survey was used to determine the gender-specific prevalence of depression among those with and without thyroid disorders. Information was not available on the type of thyroid disorder. Logistic regression analyses were conducted to determine the odds and socio-demographic correlates of depression among those with and without thyroid disorders. Women had a significantly higher prevalence of thyroid disorders (9.3%) and depression (6.6%) than men (2.4% and 3.7%, respectively). Thyroid disorders were associated with 22% higher odds of depression in women after adjusting for socio-demographic factors, but no association was found in men. Among women with and without thyroid disorders, younger age, lower income, and limitations in Activities in Daily Living (ADL) were associated with higher odds of depression. Results suggest that women with thyroid disorders are more vulnerable to depression, and socio-demographic correlates of depression are similar among women with and without thyroid disorders.     

Marital satisfaction, recovery from work, and diurnal cortisol among men and women.

DESIGN: Multilevel modeling was used to model relationships between salivary cortisol, daily diary ratings of work experiences, and Marital Adjustment Test scores (Locke & Wallace, 1959), in a sample of 60 adults who sampled saliva 4 times per day over 3 days. RESULTS: Among women but not men, marital satisfaction was significantly associated with a stronger basal cortisol cycle, with higher morning values and a steeper decline across the day. For women but not men, marital satisfaction moderated the within-subjects association between afternoon and evening cortisol level, such that marital quality appeared to bolster women's physiological recovery from work. For both men and women, evening cortisol was lower than usual on higher-workload days, and marital satisfaction augmented this association among women. Men showed higher evening cortisol after more distressing social experiences at work, an association that was strongest among men with higher marital satisfaction. CONCLUSION: This work has implications for the study of physiological recovery from work, and also suggests a pathway by which marital satisfaction influences allostatic load and physical health.     

Type A behavior and marital dissatisfaction: disentangling the effects of achievement striving and impatience-irritability

Previous research has documented an association between overall Type A behavior and marital dissatisfaction. The present study examines the nature of this relationship when a two dimensional approach to Type A behavior is adopted, and impatience-irritability and achievement striving are assessed separately. Subjects were 134 medical practitioners and specialists and their wives in South Africa. As predicted, husbands' impatience-irritability was associated with their own and their wives' marital dissatisfaction. However, neither their achievement striving nor global Type A behavior correlated with their own or their wives' marital dissatisfaction. The results are discussed in terms of the need for isolating the specific component of Type A behavior that is associated with marital dissatisfaction.     

Indirect pathways between depressive symptoms and marital distress: the role of conflict communication, attributions, and attachment style

Previous studies have focused on concomitants of depression and marital distress in order to help explain the relationship between the two, suggesting that several variables, such as conflict communication, attributions, and attachment style, are associated with depression, marital distress, or both. Our contention is that the selected variables may be important mediators (hypothesis 1) or moderators (hypothesis 2) of the concomitance between depression and marital adjustment, exploring the direct and indirect ways in which depressive symptoms and marital adjustment are related. In total, 415 heterosexual couples were recruited, and a series of regression analyses was conducted to test our hypotheses separately for men and women. Results indicated that demand-withdrawal, avoidance, causal attributions, and secure, ambivalent, and avoidant attachment mediated the relation between depressive symptoms and marital adjustment in the female sample, whereas constructive communication and causal and responsible attributions were significant mediators of men's levels of depressive symptoms and marital adjustment. In addition, avoidance and secure attachment moderated the association between depressive symptoms and marital adjustment in the female sample, and causal attributions were significant moderators of the association between depressive symptoms and marital adjustment for men. Several conclusions and implications for theory and future research are discussed.     

Gender differences in comorbid disorders among offenders in prison substance abuse treatment programs

This study examined gender differences in a range of lifetime psychiatric disorders in a sample of 272 offenders newly admitted to a prison substance abuse program. Although these men and women did not differ in severity of substance use in the six months prior to incarceration, women were significantly more likely than men to report a lifetime psychiatric disorder and a lifetime severe disorder. Furthermore, gender differences emerged in the pattern of lifetime psychiatric comorbidity. Women reported greater lifetime major depression, posttraumatic stress disorder, eating disorder, and borderline personality disorder; men were more likely than women to meet criteria for antisocial personality disorder. Additionally, female offenders were found to have a higher degree of internalizing disorders than male offenders, but there were no gender differences in degree of externalizing disorders. The study concluded that women offenders newly admitted to a prison substance abuse program present with a greater psychiatric vulnerability and a different pattern of psychiatric comorbidity than their male counterparts.     

Suicide ideation and attempts in Hispanics and non-Hispanic whites: demographic and psychiatric disorder issues

This study examined the lifetime prevalence of suicide ideation and attempts in a community sample of 1,425 Hispanics and 1,309 non-Hispanic whites. The relationship between psychiatric disorder (as assessed by the Diagnostic Interview Schedule, or DIS) and suicide ideation and attempts was also examined. Fewer Hispanics reported suicide ideation (8.8% vs. 18.9%; p less than .001) and suicide attempts (3.2% vs. 5.1%; p less than .001) than non-Hispanic whites. More women of both ethnic groups reported suicide attempts than men of either ethnic group (p less than .001). Disrupted marital bonds were typically associated with higher rates of ideation and attempts. Individuals with any DIS diagnosis were more than four times as likely to think about killing themselves (p less than .01) and more than seven times as likely to attempt suicide (p less than .01) as those without a psychiatric disorder.