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Research
SUMMARY OF RESULTS
IMPACT OF DEPRESSION ON INTIMATE RELATIONSHIPS

This study was conducted by:
Maria Ftanou and Professor Marita McCabe

Study 1 - A cross-sectional investigation of the intimate realtionships of people with depression

Study 2 - A longitudinal investigation of the factors that contribute to relationship satisfaction, sexual satisfaction and depression for people with depression and partners of people with depression

Study 3 - Couple-coping, relationship satisfaction sexual satisfaction and depressive symptomatology


Overview of studies

Three studies were conducted to gain an understanding of the impact that depression has on intimate relationships.

Study 1, entitled "A cross-sectional investigation of the intimate relationships of people with depression", was designed to obtain an understanding of how people with depression and partners of people with depression perceived their intimate relationship in terms of relationship satisfaction, engagement, communication, positive view of partner, sexual frequency, sexual dysfunction, relationship stressors, relationship supports and coping. The inter-relationship between these variables was also evaluated, as well as the predictors of relationship satisfaction, sexual satisfaction, and depression. These results were compared with respondents who did not experience clinical depression. This study also included a qualitative investigation that examined the diversity of stressors, supports and satisfaction with supports for people with depression and partners of people with depression, as well as a non-depressed comparison group.

Study 2, entitled "A longitudinal investigation of the factors that contribute to relationship satisfaction, sexual satisfaction and depression for people with depression and partners of people with depression", expanded on the findings of Study 1 by examining whether the relationships of people with depression, partners of people with depression and a non-depressed comparison group changed over a six-month period. In addition, Study 2 examined whether the relationship and coping factors that predicted relationship satisfaction, sexual satisfaction and depression at the beginning of the study continued to do so at six months follow-up.

Study 3, entitled "Couple-coping, relationship satisfaction sexual satisfaction and depressive symptomatology", examined the impact of individual coping, congruent couple-coping and overall couple-coping on relationship satisfaction, sexual satisfaction and depression, for people with depression, partners of people with depression and a non-depressed comparison group, and also evaluated the impact of congruent-coping and overall couple-coping on these variables.

STUDY 1

A CROSS-SECTIONAL INVESTIGATION OF THE INTIMATE
RELATIONSHIPS OF PEOPLE WITH DEPRESSION

Participants

A total of 172 participants took part in this study. Seventy-two people had a depressive disorder, 41 were partners of people with depression, and 59 were people from a non-depressed comparison group. The characteristics of the people with depression, partners of people with depression and of the non-depressed comparison group are summarised in Table 1.1.

Results

A summary of the quantitative results will be first discussed followed by the qualitative results.

Quantitative Results

Differences between groups

The analysis revealed that people with depression reported having less energy than the non-depressed comparison group, and experiencing more distress and depressive symptomatology than both the partners of people with depression and the non-depressed comparison group. In addition, partners of people with depression experienced more depressive symptomatology as compared to the non-depressed comparison group. However, partners of people with depression did not report more distress than the general population. The analysis revealed that the three groups did not differ in their reported frequency of using avoidant or problem-focused coping strategies. Lastly, the analysis revealed no gender differences on the mood and coping variables.

The analysis indicated that people with depression and partners of people with depression were less satisfied with their relationship, less positive about their partner, and less engaged with their partner than the non-depressed comparison group. In addition, people with depression and partners of people with depression reported lower levels of communication in their relationship compared with the non-depressed comparison group.

In addition the analysis revealed that people with depression had more stressors in their relationship when compared with the general population, but that they experienced less stressors than partners of people with depression. The three groups did not differ in terms of satisfaction with the support they received in their relationship, however, partners of people with depression reported having less supports than the non-depressed comparison group and people with depression.

The analysis revealed that people with depression and partners of people with depression were less sexually active, less sexually satisfied, and had more sexual dysfunctions than to the non-depressed comparison group. Partners of people with depression did not differ on any of the sexual variables from people with depression.

Table 1.1 Demographic characteristics of people with depression, partners of people with depression and the non-depressed comparison group

Predictors of relationship satisfaction, sexual satisfaction and depressive symptomatology

The factors that predicted relationship satisfaction, sexual satisfaction and depressive symptomatology differed for the three groups .

People with depression

For people with depression: communication positively contributed to relationship satisfaction; sexual frequency and communication positively contributed to sexual satisfaction; however, medication negatively impacted on sexual satisfaction. Although the combined variables significantly predicted depressive symptomatology, no independent variables uniquely contributed to the depressive symptomatology of people with depression (see Figure1.1).

Figure1.1 Predictors of relationship satisfaction, sexual satisfaction and depressive symptomatology for people with depression

Partners of people with depression

For partners of people with depression: communication positively contributed to relationship satisfaction; sexual frequency, avoidant coping and communication positively contributed sexual satisfaction; sexual dysfunction negatively contributed to sexual satisfaction; and avoidant coping was inversely related to depressive symptomatology (see Figure1.2).

Figure1.2 Predictors of relationship satisfaction, sexual satisfaction and depressive symptomatology for people with depression

Non-depressed comparison group

For the non-depressed comparison group: communication and sexual satisfaction positively contributed to relationship satisfaction; sexual dysfunction negatively contributed to relationship satisfaction; sexual frequency and relationship satisfaction positively contributed sexual satisfaction; and none of the variables predicted depressive symptomatology (see Figure1.3).

Figure 1.3 Predictors of relationship satisfaction, sexual satisfaction and depressive symptomatology for the non-depressed comparison group

Qualitative Results

The qualitative results illustrated that, although the majority of people with depression, partners of people with depression and people from the non-depressed comparison group did not differ in their reported experience of stressors in relation to finances, work, children, and sexual functioning; the types of stressors experienced in these relationship areas appeared to be different for the groups. In relation to finances, the qualitative quotes indicated that people from the non-depressed comparison group were strained financially because of future plans and previous expenditures, whereas for people with depression and partners of people with depression the responses indicated that they were having difficulties meeting current financial needs. In terms of work demands, people with depression had difficulties coping with the demands of work or finding employment because of their depression whereas partners of people with depression had difficulties because of the burdens of looking after their spouse while keeping up with work demands. For people from the non-depressed comparison group, work demands limited the time available to spend with their partner.

The results also indicated that people with depression had difficulties coping with the demands of their children when they were unwell. Some people with depression felt pressured by their partner to have children, but did not want to have children, due to the fear of passing on the pain of their illness to their child. On the other hand partners of people with depression felt stressed in their relationship because they had to meet the demands of their children on their own, or due to their partner's behaviour and attitude in relation to their children, while people from the non-depressed comparison group felt stressed because disagreeing with their partner with regards to parenting strategies.

The three groups reported different sexual stressors in their relationships. People with depression and partners of people with depression considered a lack of sexual contact as stressful in their relationship, whereas the non-depressed comparison group reported that their sexual behaviour was a stressor, because it lacked excitement and because they did not have time for sexual activity

The qualitative study indicated that, although more partners of people with depression reported experiencing unequal distribution of responsibility in their relationship, the types of stressor experienced did not differ for the three groups.

The qualitative investigation illustrated that people with depression and partners of people with depression experienced two types of stressors that the non-depressed comparison group did not experience. The first stressor was the impact of the depressed person's symptomatology. People with depression reported that they felt guilty because of their symptomatology, as they felt that this made it difficult for their partners to live with them but they did not know how to change. The second stressor that people with depression and partners of people with depression experienced that the non-depressed comparison group did not experience, was social isolation. The qualitative quotes illustrated that some people with depression and some partners of people with depression felt socially isolated.

The qualitative analysis indicated that people with depression and partners of people with depression had less support from friends and family, when compared with the non-depressed comparison group. Both the non-depressed comparison group and people with depression perceived that they received more support from their spouses than partners of people with depression. The three groups did not differ in the support that they received from reading resources and spiritual support. However, a smaller percentage of partners of people with depression reported that they received support from mental health professionals, compared to people with depression. The majority of people with depression and partners of people with depression who received professional support felt that this support was beneficial, as it provided them with emotional support, helped them cope with stressful situations and changed their life situation.

Common complaints reported by people with depression and partners of people with depression, in relation to professional support, included professionals: not listening to their concerns; making generalisations; not providing practical assistance; and blaming them for their partners condition.

STUDY 2

A LONGITUDINAL INVESTIGATION OF THE FACTORS THAT CONTRIBUTE TO RELATIONSHIP SATISFACTION, SEXUAL SATISFACTION AND DEPRESSION FOR PEOPLE WITH DEPRESSION AND PARTNERS OF PEOPLE WITH DEPRESSION

Participants

A total of 118 participants completed the questionnaire at Time 2: 47 people with depression, 30 partners of people with depression and 41 people from the non-depressed comparison group. Both the people with depression (30 females, 17 males) and the non-depressed comparison group (22 females, 19 males) were comprised more females than males, whereas partners of people with depression comprised more males than females (17 males, 13 females). The three groups did not significantly differ in age. The mean age for people with depression was 40.7 years. For partners of people with depression the mean age was 43.8 years, and the mean age of the non-depressed comparison group was 43.2 years.

The attrition of participants across time did not appear to introduce a bias in the study. This was evident by the lack of significant differences on any of the variables between the participants who provided data at both times and those who dropped out. Only the 118 participants who completed both Time 1 and Time 2 questionnaires were included in the analysis. For a further description of the sample characteristic see Table 2.1.

Results

In summary, the results of Study 2 illustrated a number of differences between people with depression, partners of people with depression and the non-depressed comparison group, and provided only limited support for the long-term applicability of the Intimate Sexual Functioning Model of Depression. Firstly, the differences between groups will be discussed, followed by a summary of the longitudinal factors that predicted relationship satisfaction, sexual satisfaction and depressive symptomatology for the three groups.

Differences between groups

The analysis revealed that, across time, people with depression reported more depressed and distressed symptomatology than both partners of people with depression and the non-depressed comparison group. In addition, partners of people with depression reported more depressive symptomatology than the non-depressed comparison group. Partners of people with depression did not report more distress than the non-depressed comparison group.

The analysis also revealed that, although avoidant coping decreased over time and problem-focused coping increased for all three groups, the three groups did not differ in the reported use of the coping strategies.

In addition the analysis revealed that people with depression and partners of people with depression were less satisfied with their relationship, less engaged, and less positive about their partner than the non-depressed comparison group. Although communication decreased across time for all three groups, people with depression reported significantly lower levels of communication, compared to the non-depressed comparison group.

Table 2.1 Sample descriptives for people with depression, partners of people with depression and the non-depressed comparison group

In terms of relationship stressors and supports, the study revealed that people with depression and partners of people with depression experienced more stressors than the non-depressed comparison group, and partners of people with depression had less supports than either of the other two groups. In addition, the interaction effect revealed that, while the number of supports for people with depression and partners of people with depression remained constant over time, the non-depressed comparison group experienced increases in supports. Partners of people with depression did not report less satisfaction with support than the non-depressed comparison group.

Furthermore the analysis revealed that, despite the non-depressed comparison group's sexual satisfaction decreasing at six months follow-up, people with depression and partners of people with depression were less sexually active, less sexually satisfied and had more sexual dysfunctions, than the non-depressed comparison group. People with depression did not differ on these variables when compared with partners of people with depression.

Predictors of relationship satisfaction, sexual satisfaction and depressive symptomatology

The factors that predicted relationship satisfaction, sexual satisfaction and depressive symptomatology over time were limited for the three groups, and for males and females with depression.

People with depression

For people with depression, the only variable that predicted relationship satisfaction at six months follow-up was communication. Sexual dysfunction, sexual satisfaction, relationship stressors, depression, avoidant coping, and problem-focused coping at Time 1 did not predict relationship satisfaction at Time 2. For people with depression, hypotheses seven and eight were not supported. That is, none of the variables on the Intimate Sexual Functioning Model of Depression predicted sexual satisfaction or depressive symptomatology for people with depression (see Figure 2.1).

Figure 2.1 Long-term predictors of relationship satisfaction, sexual satisfaction and depressive symptomatology for people with depression

Partners of people with depression

For partners of people with depression the analysis illustrated that none of the factors contributed to relationship satisfaction, sexual satisfaction or depressive symptomatology.

Non-depressed comparison group

For the non-depressed comparison group the finding indicated that communication and depressive symptomatology predicted relationship satisfaction (see Figure 2.2). Sexual dysfunction, sexual satisfaction, relationship stressors, depression, avoidant coping, and problem-focused coping, at Time 1 did not predict relationship satisfaction at Time 2.

Figure 2.2 Long-term predictors of relationship satisfaction, sexual satisfaction and depressive symptomatology for the non-depressed comparison group

STUDY 3

COUPLE-COPING, RELATIONSHIP SATISFACTION SEXUAL SATISFACTION
AND DEPRESSIVE SYMPTOMATOLOGY

Participants

The sample consisted of 24 couples in which one partner had a depressive disorder, and 20 couples from the general population in which neither partner had a depressive disorder.

Results

The analysis different variables contributed to relationship satisfaction, sexual satisfaction and depressive symptomatology for the three groups. In this section, a summary of the results in relation to the hypotheses will be presented separately for each group.

People with depression

Figure 3.1 illustrates the coping variables that impacted on relationship satisfaction, sexual satisfaction and depressive symptomatology for people with depression.

The analysis revealed that overall couple avoidant coping positively contributed to the relationship satisfaction of people with depression. This indicated that, the more avoidant coping was used in the relationship, the more satisfied people with depression were with their relationship. The analysis revealed that no other coping variables impacted on the relationship satisfaction, sexual satisfaction and depressive symptomatology of people with depression.

Figure 3.1 Predictors of relationship satisfaction, sexual satisfaction and depressive symptomatology for people with depression

Partners of people with depression

For partners of people with depression, the analysis revealed that congruent problem-focused coping strategies negatively contributed to relationship satisfaction. This finding indicated that, the more similar the problem-coping strategies used in a relationship where one partner is depressed, the less satisfied the partners of people with depression were with their relationship.

For partners of people with depression, the analysis revealed that individual avoidant coping and overall couple avoidant coping negatively contributed to sexual satisfaction. These findings indicate that, the more the individual partner engaged in avoidant coping, and the more the couple engaged in avoidant coping, the less sexually satisfied partners of people with depression were with their relationship. In addition, the analysis revealed that congruent avoidant coping negatively impacted on the sexual satisfaction of partners, indicating that similarities in avoidant coping negatively impacts on sexual satisfaction.

Contrary to expectations, the analysis revealed that none of the coping variables uniquely contributed to the depressive symptomatology of partners of people with depression. Figure 3.2 provides a visual summary of the coping factors that impacted on relationship satisfaction, sexual satisfaction and depressive symptomatology for partners of people with depression.

Figure 3.2 Predictors of relationship satisfaction, sexual satisfaction and depressive symptomatology for partners of people with depression

Non-depressed comparison group

For this group, individual avoidant coping and congruent problem-focused coping negatively impacted on relationship satisfaction, whereas individual problem-focused coping positively impacted on relationship satisfaction. Individual avoidant coping and overall couple problem-focused coping impacted on sexual satisfaction. Overall avoidant coping negatively impacted on depression (see Figure 3.3).

Figure 3.3 Predictors of relationship satisfaction, sexual satisfaction and depressive symptomatology for the non-depressed comparison group

Treatment Recommendations

The findings from these studies have clear implications for intervention. There are a number of areas in the relationships of people with depression and partners of people with depression that may require therapeutic interventions. These include communication, sexual functioning, stressors, and mood.

Communication

Communication is a main predictor of both relationship and sexual satisfaction. In order to assist with relationship communication, clinicians working with couples where one partner has a depressive disorder, may consider encouraging participants to attend communication seminars or, in couple therapy, teach participants to assertively ask to be listened to, or teach them paraphrasing, clarifying and listening skills. For partners of people with depression, it is essential to also provide psycho-education on depressive symptomatology, for example, that partners with depressive symptomatology may be withdrawn and not have the energy to engage in communication. Providing partners of people with depression with such education may assist them to not personalise their partner's behaviours and may allay any sense of rejection they may feel as a result of those behaviours.

Sexual functioning

Sexual functioning is important to both relationship satisfaction and sexual satisfaction for all three groups. In order to promote healthy sexual functioning for people with depression, partners of people with depression or people from the general population, it is recommended in the literature that clinicians be pro-active in enquiring about sexual dysfunction. The literature recommends specific questions about libido, erection, ejaculation, orgasm frequency and sexual satisfaction to give more accurate results than general questions about sexual difficulties.

For people with depression, it is also essential that a pre-treatment level of sexual functioning be established in order to determine whether sexual dysfunctions are an anti-depressant side effect, a neuro-physiological disturbance or a result of a psychosocial stressor. Determining the cause of the sexual dysfunction will help in establishing the most effective treatment intervention for that dysfunction. In situations where sexual dysfunctions are due to an anti-depressant side-effect, the dysfunctions can be lessened by reducing the dose of the anti-depressant medication or by having drug holidays, where the drug is withdrawn for a time. Sexual dysfunctions due to medication can also often be avoided by starting the client on new anti-depressants such as nefazodone, bupropion or mirtazapine, which do not have sexual dysfunctions associated with them. Other psychological tools to improve sexual functioning include sensate focus, stein clenched fist technique, the cloud metaphor, the squeeze technique, directed masturbation technique, and the coital alignment technique, among others.

Relationship stressors

The findings of this study indicate that relationship stressors may negatively impact on the satisfaction of partners of people with depression. This implies that partners of people with depression may require practical assistance such as respite, financial counselling, assistance with household chores and dealing with stigmatisation. Mental health professionals may consider linking partners of people with depression to services that may assist in providing practical support. In addition, mental health professionals may provide or recommend partners of people with depression educational programs looking at difficult behaviours and how to deal with them. Other resources, such as support groups, may provide both information and emotional support, and individual counselling for partners is also encouraged. In addition, to reduce the impact of relationship stressors among couples, clinicians may introduce relaxation training or stress management to assist partners of people with depression.

Mood

To improve the mood of people with depression, and alleviate some of the sub-clinical depressive symptoms experienced by partners of people with depression, the most effective psychological treatment intervention recommended in the literature is Cognitive Behavioural Therapy. This type of intervention provides people with cognitive tools that assist them to change cognitive distortions, and behavioural strategies such as individual and couple pleasant activity scheduling to improve their mood and prevent relapse.

Future Research

The results of the studies conducted have several implications for future research. Firstly, the results need to be replicated over a longer period of time, with a greater sample size, especially in relation to gender and partners of people with depression. More specifically, future research needs to examine whether males and females respond differently in their role as primary carers of people with depression. Secondly, further research needs to be conducted on a larger scale so that it assesses the long-term impact of couple-coping on relationship satisfaction, sexual satisfaction and depression, for both people with depression and partners of people with depression. Future research would benefit by investigating the impact that personality and cognitions have on relationship satisfaction, sexual satisfaction and depression for people with depression and partners of people with depression. Fourthly, future research may benefit from exploring whether specific sexual dysfunctions impact differently on relationship satisfaction, sexual satisfaction and depression.

Correspondence
Maria Ftanou & Professor Marita McCabe
School of Psychology
221 Burwood Highway
BURWOOD Vic 3125
Email: ftanou@deakin.edu.au
Phone: (03) 9244 6856

Page created 25/06/02


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