Intimate Relationships and Depression: Searching for Causation in the Sea of Association

Whisman, Mark A.; Sbarra, David A.; Beach, Steven R.H.

doi:10.1146/annurev-clinpsy-081219-103323

Cited by 104Attachment and Relationship DynamicsFamily Dynamics and RelationshipsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Intimate Relationships and Depression: Searching for Causation in the Sea of Association

Whisman, Mark A., Sbarra, David A., Beach, Steven R.H.·2021·Annual Review of Clinical Psychology

DOI 10.1146/annurev-clinpsy-081219-103323

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Abstract

This article provides a critical review of existing research on intimate (marriage or marriage-like) relationship distress and risk for depression. Using the meta-framework of research triangulation, we seek to synthesize research evidence across several different methodologies and study designs and to draw the most reliable conclusion regarding a potential causal association between relationship distress and depression. Focusing on existing correlational (i.e., observational), genetically informed, and intervention (i.e., experimental) research on the association between relationship distress and depression, we conclude that the existing body of research evidence supports the claim that relationship distress is a causal risk factor for depression. A secondary aim of the article is to highlight a variety of effective methods that, when viewed from the perspective of triangulation, enhance the pursuit of causal inference, including propensity score matching, target trial emulation, directed acyclic graph approach, and Mendelian randomization.

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Previous research has identified an association between depressive symptoms and reduced relationship satisfaction and increased relationship stress.
“Previous research has identified an association between depressive symptoms and reduced relationship satisfaction and increased relationship stress (Doyle et al. 2021; Whisman et al. 2021).”
From “I Felt Like a Burden”: An Exploration Into the Experience of Romantic Relationships for People With ADHD (2026) · cites this paper as Whisman et al. 2021
Discord in intimate relationships poses a significant risk for depression.
“discord in intimate relationships poses a significant risk for depression [58, 59] and, to some degree, anxiety [60].”
From Trajectories of Maternal and Paternal Internalizing Symptoms from Pregnancy to 2 Years Postpartum: Identifying Modifiable Risk and Protective Factors (2024) · cites this paper as [59]
Couple discord is associated with depression.
“This finding contrasts with a robust body of research demonstrating an association between couple discord and depression (refer to [59] for a review).”
From Trajectories of Maternal and Paternal Internalizing Symptoms from Pregnancy to 2 Years Postpartum: Identifying Modifiable Risk and Protective Factors (2024) · cites this paper as [59]
Couples-based interventions are efficacious for depression and relationship distress.
“These findings converge with existing research demonstrating the efficacy of couples-based interventions for depression and relationship distress [59] and suggest that, beyond reducing relationship distress, fostering emotional intimacy and enhancing the quality as opposed to the mere frequency of support are especially important for paternal wellbeing.”
From Trajectories of Maternal and Paternal Internalizing Symptoms from Pregnancy to 2 Years Postpartum: Identifying Modifiable Risk and Protective Factors (2024) · cites this paper as [59]

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Depressive Symptoms in New First‐Time Fathers: Associations with Age, Sociodemographic Characteristics, and Antenatal Psychological Well‐Being
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Marital Dissolution and Major Depression in Midlife
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The Taxometrics of Marriage: Is Marital Discord Categorical?
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Age, Marital Processes, and Depressed Affect
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Marital discord and well-being in older adults: Is the association confounded by personality?
Whisman, M. A., Uebelacker, L. A., Tolejko, N., Chatav, Y., & McKelvie, M. (2006) · Psychology and Aging · doi:10.1037/0882-7974.21.3.626 · Cited by 76 · see citing works
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Recent developments in the study of social relationships, stress responses, and physical health
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Marital Status and Twins’ Health and Behavior: An Analysis of Middle-Aged Danish Twins
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Couple discord and depression in couples during couple therapy and in depressed individuals during depression treatment.
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Depressive symptoms and marital satisfaction in the early years of marriage: Narrowing the gap between theory and research.
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Couple-based Intervention for Depression: An Effectiveness Study in the National Health Service in England.
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Accounting for depressive symptoms in women: a twin study of associations with interpersonal relationships
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The Impact of Relationship-Specific Support and Strain on Depressive Symptoms Across the Life Course
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Family‐to‐Work Spillover in Singapore: Marital Distress, Physical and Mental Health, and Work Satisfaction
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Moderators of the association between relationship discord and major depression in a national population-based sample.
Uebelacker, L. A., & Whisman, M. A. (2006) · Journal of Family Psychology · doi:10.1037/0893-3200.20.1.40 · Cited by 39 · see citing works
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Discovery of a Partner Affair and Major Depressive Episode in a Probability Sample of Married or Cohabiting Adults
Whisman, M. A. (2015) · Family Process · doi:10.1111/famp.12185 · Cited by 37 · see citing works
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ChroniC StreSS aS a Moderator of the aSSoCiation Between depreSSive SyMptoMS and Marital SatiSfaCtion
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The Findings of a Cochrane Meta‐Analysis of Couple Therapy in Adult Depression: Implications for Research and Clinical Practice
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The association between relationship distress and psychopathology is consistent across racial and ethnic groups.
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Marital well-being and depression in Chinese marriage: Going beyond satisfaction and ruling out critical confounders.
Cao, H., Zhou, N., Fang, X., & Fine, M. A. (2017) · Journal of Family Psychology · doi:10.1037/fam0000312 · Cited by 33 · see citing works
Perceived Criticism and Marital Adjustment Predict Depressive Symptoms in a Community Sample
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Specificity of the Association between Marital Discord and Longitudinal Changes in Symptoms of Depression and Generalized Anxiety Disorder in the Irish Longitudinal Study on Ageing
Whisman, M. A., Robustelli, B. L., & Labrecque, L. T. (2018) · Family Process · doi:10.1111/famp.12351 · Cited by 29 · see citing works
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Marital attributions in spouses of depressed patients
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Short-Term Consequences of Severe Marital Stressors
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Parental rearing and intimate relations in women's depression
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Dyadic Causal Sequencing of Depressive Symptoms and Relationship Satisfaction in Romantic Partners Across Four Years
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Concordance for Depressive Disorders and Marital Quality
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Causal Inference in Psychiatric Epidemiology
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Randomized Controlled Trial of the Marriage Checkup: Depression Outcomes
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Can We Uncouple Neighborhood Disadvantage and Delinquent Behaviors? An Experimental Test of Family Resilience Guided by the Social Disorganization Theory of Delinquent Behaviors
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A Categorical and Dimensional Perspective on Depression Within a Nonclinical Sample of Couples
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Revisiting the effect of marital support on depressive symptoms in mothers and fathers: A genetically informed study.
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Perceived relationship support moderates the association of contextual stress with inflammation among African Americans.
Beach, S. R. H., Lei, M., Simons, R. L., Barr, A. B., Simons, L. G., Cutrona, C. E., & Philibert, R. A. (2019) · Journal of Family Psychology · doi:10.1037/fam0000509 · Cited by 20 · see citing works
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Couples in arms: Marital distress, psychopathology, and suicidal ideation in active-duty Army personnel.
Whisman, M. A., Salinger, J. M., Labrecque, L. T., Gilmour, A. L., & Snyder, D. K. (2019) · Journal of Abnormal Psychology · doi:10.1037/abn0000492 · Cited by 19 · see citing works
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Preventive Effect Heterogeneity: Causal Inference in Personalized Prevention
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A genetically informative analysis of the association between dyadic adjustment, depressive symptoms, and anxiety symptoms
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Depressive moods and marital happiness: within-person synchrony, moderators, and meaning.
Smith, D. A., Breiding, M., & Papp, L. M. (2012) · Journal of family psychology · doi:10.1037/a0028404 · Cited by 17 · see citing works
Marital discord and depression in middle-aged and older couples
Whisman, M. A., Robustelli, B. L., Beach, S. R. H., Snyder, D. K., & Harper, J. M. (2014) · Journal of Social and Personal Relationships · doi:10.1177/0265407514554519 · Cited by 17 · see citing works
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Gene–environment interplay in the context of romantic relationships
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Longitudinal Associations Between Relationship Quality and Maternal Depression Among Low-Income African American and Hispanic Mothers
Thomas, A. L., Caughy, M. O. B., Anderson, L. A., & Owen, M. T. (2019) · Journal of family psychology · doi:10.1037/fam0000548 · Cited by 12 · see citing works
Associations Between Marital Discord and Depressive Symptoms: A Cross-Cultural Analysis.
Salinger, J. M., Whisman, M., Randall, A. K., & Hilpert, P. (2020) · Family Process · doi:10.1111/famp.12563 · Cited by 12 · see citing works
Self-citation
The Association Between Marital Discord and Depression in a Community-Based Sample of Couples Seeking Treatment
Atkins, D. C., Bortnik, K. E., Hahlweg, K., & Klann, N. (2011) · Journal of Couple & Relationship Therapy · doi:10.1080/15332691.2011.539172 · Cited by 10 · see citing works
Relationship discord and depressive symptoms in sexual minority individuals over time.
Gilmour, A. L., Whisman, M. A., & Randall, A. K. (2019) · Journal of Family Psychology · doi:10.1037/fam0000554 · Cited by 9 · see citing works
Self-citation
Love and war: Prospective associations between relationship distress and incidence of psychiatric disorders in active-duty Army personnel.
Whisman, M. A., Salinger, J. M., Gilmour, A. L., Steele, B. A., & Snyder, D. K. (2020) · Journal of Abnormal Psychology · doi:10.1037/abn0000642 · Cited by 8 · see citing works
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Till depression do us part? Examining the prospective associations between depression and marital adjustment in older adults
Goldfarb, M. R., Trudel, G. A., Boyer, R., & Préville, M. (2019) · European Review of Applied Psychology · doi:10.1016/j.erap.2019.02.001 · Cited by 3 · see citing works

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Dyadic coping and mental health in couples: A systematic review
Landolt, S. A., Weitkamp, K., Roth, M., Sisson, N. M., & Bodenmann, G. (2023) · Clinical Psychology Review · doi:10.1016/j.cpr.2023.102344 · Cited by 105 · see citing works
Loneliness and depression: bidirectional mendelian randomization analyses using data from three large genome-wide association studies
Sbarra, D. A., Ramadan, F. A., Choi, K. W., Treur, J. L., Levey, D. F., Wootton, R. E., Stein, M. B., Gelernter, J. E., & Klimentidis, Y. C. (2023) · Molecular Psychiatry · doi:10.1038/s41380-023-02259-w · Cited by 69 · see citing works
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Social support and depression during a global crisis
Choi, K. W., Lee, Y. A., Liu, Z., Fatori, D., Bauermeister, J. R., Luh, R. A., Clark, C. R., Brunoni, A. R., Bauermeister, S., & Smoller, J. W. (2023) · Nature Mental Health · doi:10.1038/s44220-023-00078-0 · Cited by 67 · see citing works
The Mating Psychology of Incels (Involuntary Celibates): Misfortunes, Misperceptions, and Misrepresentations
Costello, W., Rolón, V., Thomas, A. G., & Schmitt, D. P. (2023) · The Journal of Sex Research · doi:10.1080/00224499.2023.2248096 · Cited by 48 · see citing works
Trauma, adversity, and biological aging: behavioral mechanisms relevant to treatment and theory
Bourassa, K. J., & Sbarra, D. A. (2024) · Translational Psychiatry · doi:10.1038/s41398-024-03004-9 · Cited by 40 · see citing works
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Intimate Relationships and Coronary Heart Disease: Implications for Risk, Prevention, and Patient Management
Smith, T. W. (2022) · Current Cardiology Reports · doi:10.1007/s11886-022-01695-4 · Cited by 43 · see citing works
Causal effect of adiposity on the risk of 19 gastrointestinal diseases: a Mendelian randomization study
Kim, M. S., Song, M., Kim, S., Kim, B., Kang, W., Kim, J. Y., Myung, W., Lee, I., Do, R., Khera, A. V., et al. (2023) · Obesity · doi:10.1002/oby.23722 · Cited by 33 · see citing works
The association of vitamin D deficiency, age and depression in US adults: a cross-sectional analysis
Mo, H., Zhang, J., Huo, C., Zhang, M., Xiao, J., Peng, J., Wang, G., Wang, C., & Li, Y. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-04685-0 · Cited by 32 · see citing works
Self‐compassion mediates the link between attachment security and intimate relationship quality for couples navigating pregnancy
Huynh, T., Phillips, E., & Brock, R. L. (2022) · Family Process · doi:10.1111/famp.12692 · Cited by 25 · see citing works
Marital satisfaction as a potential moderator of the association between stress and depression
Shi, Y., & Whisman, M. A. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.01.093 · Cited by 23 · see citing works
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Pathology in Relationships
South, S. C. (2021) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-081219-115420 · Cited by 22 · see citing works
The Effect of Rejection Sensitivity on Fear of Intimacy in Emerging Adulthood
Giovazolias, T., & Paschalidi, E. (2022) · European Journal of Psychology Open · doi:10.1024/2673-8627/a000019 · Cited by 24 · see citing works
African Americans’ relationship quality and depressive symptoms: A longitudinal investigation of the Marital Discord Model.
Barton, A. W., Lavner, J. A., Sutton, N. C., Smith, S. M., & Beach, S. R. H. (2022) · Journal of Family Psychology · doi:10.1037/fam0000967 · Cited by 15 · see citing works
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The ENRICH Marital Satisfaction (EMS) Scale: A Psychometric Study in a Sample of Portuguese Parents
Nunes, C., Martins, C., Leal, A., Pechorro, P., Ferreira, L. I., & Ayala-Nunes, L. (2022) · The social science · doi:10.3390/socsci11030107 · Cited by 14 · see citing works
Good Theories in Need of Better Data: Combining Clinical and Social Psychological Approaches to Study the Mechanisms Linking Relationships and Health
Farrell, A. K., Stanton, S. C. E., & Sbarra, D. A. (2021) · Perspectives on Psychological Science · doi:10.1177/17456916211027563 · Cited by 15 · see citing works
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Relationship satisfaction during COVID ‐19: The role of partners' perceived support and attachment
Bar‐Shachar, Y., Lopata, S., & Bar‐Kalifa, E. (2022) · Family Relations · doi:10.1111/fare.12767 · Cited by 13 · see citing works
Positive Outcomes of Long-Term Relationship Satisfaction Trajectories in Stable Romantic Couples: A 10-Year Longitudinal Study
Roth, M., Landolt, S. A., Nussbeck, F. W., Weitkamp, K., & Bodenmann, G. (2024) · International Journal of Applied Positive Psychology · doi:10.1007/s41042-024-00201-1 · Cited by 18 · see citing works
Spousal concordance in adverse childhood experiences and the association with depressive symptoms in middle-aged and older adults: findings across China, the US, and Europe
Sun, W., Ren, Z., Zhu, S., Cheng, S., Liu, W., Li, W. H. C., Xia, W., Yuan, C., Adeloye, D., Rudan, I., et al. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1158590 · Cited by 13 · see citing works
Association between chronic disease status and transitions in depressive symptoms among middle-aged and older Chinese population: Insights from a Markov model-based cohort study
Wu, Y., Su, B., Zhong, P., Zhao, Y., Chen, C., & Zheng, X. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.07.116 · Cited by 12 · see citing works
Disentangling between‐ and within‐person variation in relationship science
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A longitudinal investigation of marital dissolution, marital quality, and generalized anxiety disorder in a national probability sample
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Effects of social support on depression risk during the COVID-19 pandemic: What support types and for whom?Preprint
Choi, K. W., Lee, Y. A., Liu, Z., Fatori, D., Bauermeister, J. R., Luh, R. A., Clark, C. R., Brunoni, A. R., Bauermeister, S., & Smoller, J. W. (2022) · medRxiv · doi:10.1101/2022.05.15.22274976 · Cited by 10 · see citing works
The Association Between Close Relationships and Happiness Among Older Adults
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Romantic Unions and Mental Health: The Role of Relationship Churning
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Mediating effect of mindfulness level on the relationship between marital quality and postpartum depression among primiparas
Yang, J., Lin, X.-Z., Guo, Q.-W., Wang, C., Yang, R.-Y., Zhang, J.-W., & Zeng, Y. (2023) · World Journal of Clinical Cases · doi:10.12998/wjcc.v11.i12.2729 · Cited by 8 · see citing works
Associations among financial well-being, daily relationship tension, and daily affect in two adult cohorts separated by the great recession
Jenkins, A. I. C., Le, Y., Surachman, A., Almeida, D. M., & Fredman, S. J. (2022) · Journal of Social and Personal Relationships · doi:10.1177/02654075221105611 · Cited by 9 · see citing works
Romantic relationship quality during the COVID‐19 pandemic: The longitudinal associations with relationship loneliness and depression
Charvat, E. J., Ogan, M. A., Kanter, J. B., Monk, J. K., & Proulx, C. M. (2023) · Social and Personality Psychology Compass · doi:10.1111/spc3.12823 · Cited by 7 · see citing works
Genetic influences on depression and selection into adverse life experiences
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Racial discrimination predicts subjective cognitive decline: Perceived relationship support buffers the association
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Mental health well-being and functional adjustment in colorectal cancer patients: a prospective cohort study
Antoniadis, D., Giakoustidis, A. E., Paramythiotis, D., Michalopoulos, A., Mandanas, Z. N., & Papadopoulos, V. N. (2022) · Acta chirurgica Belgica · doi:10.1080/00015458.2022.2145725 · Cited by 7 · see citing works
Relationship satisfaction and family routines of young parents before and during the first year of the COVID-19 pandemic: A latent growth curve analysis
Weise, V., Güttner, F., Staudt, A., Mack, J. T., & Garthus‐Niegel, S. (2024) · PLoS ONE · doi:10.1371/journal.pone.0297740 · Cited by 6 · see citing works
Gender Differences in Variability in Intimate Relationship Satisfaction: A Secondary Analysis and Meta-Analysis
Whisman, M., & Balzert, A. (2024) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-024-00499-y · Cited by 7 · see citing works
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New Media Use and Mental Health of Married Women: Mediating Effects of Marital Quality
Zhou, D., Xu, Y., & He, Q. (2023) · Healthcare · doi:10.3390/healthcare11212909 · Cited by 9 · see citing works
Predicting change in relationship distress and depressive symptoms among couples in Taiwan: The role of attachment, emotional expressivity, and gender roles in Emotionally Focused Therapy
Tseng, C., Morgan, P. C., & Wittenborn, A. K. (2024) · Journal of Marital and Family Therapy · doi:10.1111/jmft.12743 · Cited by 5 · see citing works
Integrating multiple time-scales to advance relationship science
Heshmati, S., Sbarra, D. A., & Benson, L. (2023) · Journal of Social and Personal Relationships · doi:10.1177/02654075231152562 · Cited by 5 · see citing works
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How Does Physical Activity Shape Adolescents’ Coping Skills? Unveiling the Chain Mediation of Friendship Quality and Psychological Resilience
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Additional file 2 of Relationship satisfaction and metabolic health parameters: a cross-sectional study in Burkinabe population of older adults
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Additional file 1 of Relationship satisfaction and metabolic health parameters: a cross-sectional study in Burkinabe population of older adults
Kurniawan, A. L., Schretzmann, J., Paramastri, R., Cho, A., Sié, A., Fischer, M. S., Bärnighausen, T., & Ditzen, B. (2024) · Figshare · doi:10.6084/m9.figshare.25422344
Additional file 3 of Relationship satisfaction and metabolic health parameters: a cross-sectional study in Burkinabe population of older adults
Kurniawan, A. L., Schretzmann, J., Paramastri, R., Cho, A., Sié, A., Fischer, M. S., Bärnighausen, T., & Ditzen, B. (2024) · Figshare · doi:10.6084/m9.figshare.26694069
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Authors: Whisman, M. A., Sbarra, D. A., & Beach, S. R. H.
Affiliations: University of Colorado Boulder (US)
University of Arizona (US)
University of Georgia (US)
ORCID: Whisman, Mark A.
Sbarra, David A.
Beach, Steven R.H.
Venue: Annual Review of Clinical Psychology
Publisher: Annual Reviews
Published: 2021-05-07
Volume: 17
Issue: 1
Pages: 233-258
ISSN: 1548-5943 (ISSN-L)
1548-5951
DOI: 10.1146/annurev-clinpsy-081219-103323
OpenAlex: W3128410192
Cited by: 104
References: 149
Citations by year: 2026: 7 · 2025: 27 · 2024: 26 · 2023: 26 · 2022: 14 · 2021: 4
FWCI: 2.75
Type: journal article
Language: en
Open access: closed
Locations: Annual Review of Clinical Psychology (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute on Aging (R01AG059260)
National Cancer Institute (R01CA220254)
Topics: Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
Social Sciences › Demography › Family Dynamics and Relationships
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: intimate relationships, relationship distress, depression, causal inference, marriage, causal risk factors, genetic research, intervention research, propensity score matching, target trial emulation, directed acyclic graphs, Mendelian randomization
MeSH terms: Depression, Humans, Interpersonal Relations, Marriage, Risk Factors

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Intimate Relationships and Depression: Searching for Causation in the Sea of Association

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