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Infidelity and separation precipitate major depressive episodes and symptoms of non-specific depression and anxiety

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This study examined whether humiliating marital events (HMEs; husbands' infidelity, threats of marital dissolution) precipitated Major Depressive Episodes (MDEs) when controlling for marital discord. Participants were 25 women who recently experienced an HME and 25 control women who did not experience an HME. Both groups reported similar levels of marital discord. Results indicated that HME participants were 6 times more likely to be diagnosed with an MDE than control participants. These results remained even after controlling for family and lifetime histories of depression. HME participants also reported significantly more symptoms of nonspecific depression and anxiety than control participants. However, HME and control participants did not report significantly different numbers of anhedonic depression and anxious arousal symptoms. The research and clinical implications of these findings are discussed.
Content may be subject to copyright.
Journal
of
Consulting
and
Clinical Psychology
2000,
Vol.
68, No. 5,
774-781
Copyright
2000
by the
American Psychological Association, Inc.
0022-006X/00/S5.00
DOI:
10.1037//0022-006X.68.5.774
Infidelity
and
Separations Precipitate
Major
Depressive Episodes
and
Symptoms
of
Nonspecific Depression
and
Anxiety
Annmarie
Cano
and K.
Daniel
O'Leary
State
University
of New
York
at
Stony
Brook
This
study
examined whether humiliating marital events (HMEs; husbands'
infidelity,
threats
of
marital
dissolution)
precipitated
Major
Depressive Episodes (MDEs) when controlling
for
marital discord.
Participants were
25
women
who
recently experienced
an HME and 25
control women
who did not
experience
an
HME. Both groups reported similar levels
of
marital discord. Results indicated that
HME
participants were
6
times more likely
to be
diagnosed with
an MDE
than control participants. These
results
remained even after controlling
for
family
and
lifetime
histories
of
depression.
HME
participants
also reported
significantly
more symptoms
of
nonspecific depression
and
anxiety than control partici-
pants.
However,
HME and
control participants
did not
report significantly
different
numbers
of
anhe-
donic depression
and
anxious arousal symptoms.
The
research
and
clinical implications
of
these
findings
are
discussed.
Research
has
shown that negative
life
events
are
strongly asso-
ciated with depression
in
women (Kendler,
Neale,
Kessler, Heath,
&
Eaves, 1992)
and
that these negative
life
events appear
to
influence
the
risk
of
Major Depressive Episodes (MDEs) indepen-
dent
of
genetic
predisposition
(Kendler
et
al.,
1995).
One
type
of
negative
life
event,
the
negative event
in
marriage,
has
received
an
increasing
amount
of
empirical support
as a
precipitator
of
depres-
sion
in
women (e.g., Brown, Harris,
&
Hepworth,
1995; Christian-
Herman, O'Leary,
&
Avery-Leaf,
in
press). However, questions
remain.
Few
researchers have examined whether negative marital
events such
as
infidelity
and
threats
of
marital dissolution precip-
itate depression when controlling
for the
impact
of
marital discord,
other
negative life events, lifetime history
of
depression,
and a
family
history
of
depression. Furthermore, little
is
known regard-
ing
the
types
of
depressive symptoms
that
are
precipitated
by
negative events
in
marriage.
Coyne
(1976)
was one of the first
researchers
to
view depression
as
a
functional
reaction
to a
disruption
in
one's social
and
inter-
personal relationships. According
to
Coyne (1976), depressive
behaviors
function
to
solicit support
and
comfort
from
close oth-
ers. More recently, Coyne
and
Downey (1991) stated that stressors
in
interpersonal relationships including marriage
may be the
most
common
precipitators
of
depression because they involve
in-
creased
conflict,
declining communication,
and a
lack
of
stability,
each
of
which results
in
reduced social support. Similarly, Beach,
Sandeen,
&
O'Leary's
(1990) Marital Discord Model
of
Depres-
Annmarie
Cano
and K.
Daniel
O'Leary,
Department
of
Psychology,
State University
of New
York
at
Stony Brook.
This research
was
conducted
in
partial
fulfillment
of
Annmarie
Cano's
doctoral degree
at the
State University
of New
York
at
Stony Brook.
We
thank
Shari
Feldbau-Kohn
and
Hope Nevala
for
their assistance
on
this
project.
Correspondence concerning this article should
be
addressed
to
Ann-
marie Cano,
who is now at the
Department
of
Psychology, Eastern Mich-
igan
University, Ypsilanti, Michigan
48197.
Electronic mail
may be
sent
to
acano
@
ONLINE.EMICH.EDU.
sion posits that marital discord
is
associated
with
a
lack
of
couple
cohesion, disruption
of
scripted routines between spouses,
and
loss
of
spousal support
and
coping assistance,
all of
which contribute
to
depression.
Self-in-relation
theory suggests that women
in
partic-
ular
may be
sensitive
to
marital
disruptions
or
dissolutions
because
they
derive
a
sense
of
well-being
from
their roles
in
intimate
relationships with others (Jordan, Kaplan, Miller, Stiver,
&
Surrey,
1991). According
to
this theory,
a
divorce
or
other negative events
centered
in the
marital relationship
are
likely
to
precipitate feelings
of
shame
and
depression (Kaplan,
1991).
Empirical research
has
provided support
for
these theories.
Paykel
et
al.'s
(1969)
seminal study
on
life
events
and
depression
demonstrated that marital separations
and
arguments were reported
more
frequently
by
depressed patients than
by
community control
participants
in the 6
months before interview. More recent research
has
continued
to
demonstrate
a
significant association between
marital problems
and
depression (e.g., Aseltine
&
Kessler, 1993;
Brown
&
Harris, 1978, 1989; Christian-Herman
et
al.,
in
press;
Coryell,
Endicott,
&
Keller, 1992; Weissman, 1987;
Whisman
&
Bruce,
1999).
For
instance,
a
large-scale community study dem-
onstrated that women
who
separated
or
divorced during
a
3-year
period reported more depressive symptoms than women
who re-
mained married, even when controlling
for
baseline depressive
symptoms
(Aseltine
&
Kessler, 1993). Another large study
involv-
ing
the
relatives
and
spouses
of
depressed individuals
as
well
as
controls
found
that participants
who
separated
or
divorced during
a
6-year period were three times more likely
to
report
a first
onset
of
major depression
within
the
same period than participants
who
remained married (Coryell
et
al.,
1992). This result
was
stronger
for
women
than
for
men; separated
or
divorced women were
approximately
four
times more likely
to be
depressed
than
women
who
remained married. Most
of
these onsets
of
depression
oc-
curred
at
approximately
the
time
of the
separation
or
divorce.
Until
recently, investigators have limited their conceptualization
of
negative marital events
to
separation
and
divorce.
However,
Christian-Herman
et al. (in
press) examined
the
relationship
be-
tween
a
variety
of
wife-
and
husband-initiated negative marital
774
INFIDELITY, SEPARATIONS,
AND
DEPRESSION
775
events
(e.g.,
infidelity, threats
of
divorce, discrete episodes
of
violence)
and the
incidence
of
MDEs within
a
sample
of
women.
None
of the
participants
had a
lifetime history
of
depression.
The
incidence
of
MDEs within
4
weeks following
the
negative marital
event
was
38%. This incidence rate
is
considerably higher than
the
1.80-2.09%
annual incidence rate
of
depression
in
similarly
aged women
in
epidemiological
samples (Eaton
et
al.,
1989;
Lewinsohn, Duncan, Stanton,
&
Hautzinger, 1986), demonstrating
the
significant
impact
of
diverse negative marital events.
Brown
et al.
(1995) examined
the
impact
of a
number
of
negative relationship-oriented events that were considered
to be
humiliating
in
nature. Humiliation events
are
life
events that
de-
value
the
individual
in
relation
to the
self
or
others. They
found
that
31%
of
humiliation events were followed
by an
onset
of
depression
in a
sample
of
community women. Most
of
these
humiliation events occurred within
the
marital relationship. Spe-
cifically,
the
discovery
of a
husband's
infidelity,
a
husband-
initiated
separation
or
divorce,
and a
wife-initiated separation
or
divorce
due to
infidelity,
marked violence
by the
husband,
or
both,
were among
the
life
events that were classified
as
humiliation
events
by
Brown
et
al.'s
life
event coding system. Brown
et al.
found
that humiliation events were more likely
to
precipitate
a
depressive
episode than
nonhumiliating
events that were initiated
by
the
participants
(e.g.,
a
wife-initiated separation
or
divorce that
did
not
follow
a
husband's infidelity
or
violence).
It
appears that
a
variety
of
negative marital events, especially
those involving humiliation
or
devaluation, precipitate MDEs.
However, several issues have continued
to be
sources
of
contro-
versy concerning
the
actual impact
of
negative marital events.
First,
we do not
know
if
negative events
in
marriage lead
to
depression over
and
above
the
effects
of
general marital discord.
Cross-sectional
and
longitudinal studies
of
community
and
marital
clinic husbands
and
wives have shown that marital discord
is
associated
with
or
predicts
depressive
symptoms (Christian,
O'Leary,
&
Vivian, 1994; Christian-Herman
et
al.,
in
press; Fin-
cham,
Beach, Harold,
&
Osborne,
1997;
O'Leary,
Christian,
&
Mendell, 1994). Whisman
and
Bruce (1999) also
found
that mar-
ital
distress
is
associated with
the
incidence
of
major
depression.
Evidence
from
the
treatment literature provides
further
support
for
the
association between marital discord
and
depression (Beach
&
O'Leary, 1992;
Emanuels-Zuurveen
&
Emmelkamp,
1996; Jacob-
son, Dobson,
Fruzzetti,
Schmaling,
&
Salusky, 1991; O'Leary
&
Beach,
1990). Specifically, marital therapy alleviates both marital
discord
and
depression
in
married women. Despite
the
strong
evidence
for a
significant
association between marital discord
and
depressive symptoms, studies examining negative marital events
as
precipitators
of
depression have
not
controlled
for the
effects
of
marital discord.
It is
possible that marital discord
is
associated with
MDEs
and
that
the
effect
of a
humiliating marital event
(HME)
over
and
above
the
marital discord
is
negligible.
The
current study
addresses this question
by
recruiting
an HME
group
and a
control
group with similar levels
of
marital discord. This methodology will
help determine whether HMEs precipitate depression over
and
above
the
effects
of
marital discord.
Second,
few
studies have controlled
for the
existence
of
other
life
events that
may
have precipitated depression
(e.g.,
Christian-
Herman
et
al.,
in
press; Kendler, Kessler,
Neale,
Heath,
&
Eaves,
1993; Kendler
et
al.,
1995).
The
current study will address this
potential limitation
by
excluding
from
the
study
those individuals
who
have experienced negative
life
events other than
the HME
within
6
months prior
to
contact.
A
6-month period
was
chosen
as
the
criterion because
researchers
have
found
that
the
adverse
impact
of
negative
life
events
on
psychological well-being appears
to
be
limited
to
this amount
of
time
(e.g.,
Brown
et
al.,
1995).
Similarly, most negative marital event researchers have
not
assessed
or
controlled
for the
participants' lifetime histories
of
depression, their
family
histories
of
depression
or
both (Aseltine
&
Kessler, 1993; Christian-Herman
et
al.,
in
press, Paykel
et
al.,
1969).
One
exception
is
Kendler
et al.
(1995),
who
found
signif-
icant main
effects
for
serious marital problems, divorce,
and for
genetic
liability
as
assessed
by the
twin's diagnosis
of
depression.
The
researchers also controlled
for
participants' lifetime history
of
depression. Brown
et al.
(1995)
also
examined lifetime history
of
depression
but
limited
then"
comparisons
to
patients
with
and
without certain types
of
symptoms
and a
previous
episode
of
depression, limiting conclusions regarding lifetime history alone.
Nonetheless, both groups experienced similar rates
of
negative
life
events prior
to
becoming
depressed.
Neglecting
to
control
for
lifetime
and
family
histories
of
depression leaves
the
impact
of
negative marital events open
to
question.
The
current
study
will
assess
and
statistically control
for
lifetime
and
family
histories
of
depression
in
order
to
strengthen
the
internal validity
of
this study.
Fourth, there have been inconsistencies across studies
in the
conceptualization
of
negative marital events.
For
instance,
re-
searchers have used terminology such
as
"serious
marital prob-
lems"
(e.g.,
Kendler
et
al.,
1995; Weissman,
1987),
implying
ongoing
or
chronic marital stressors. However,
life
events
re-
searchers (e.g.,
Wheaton,
1994) have argued that discrete
life
events
may
differ
from
daily hassles
or
chronic stressors
in
terms
of
quality
and
impact. Researchers have also restricted
the
defini-
tion
of
HMEs
to
instances
of
separation
and
divorce (e.g., Aseltine
&
Kessler, 1993;
Coryell
et
al.,
1992). However, Brown
et
al.'s
(1995) work suggests that specific negative marital events, namely
humiliation
events,
are
particularly robust
precipitators
of
depres-
sion.
Following these conceptualizations,
the
current study inves-
tigates
the
rates
of
major
depression
and
psychological symptoms
in
women
who
have
and
have
not
experienced negative
and
discrete marital stressors
that
are
devaluing
or
humiliating
in
nature.
Anhedonia
Versus General Distress
Although
researchers
hav