Depression Lowest in Women with Systemic Sclerosis Who Are Happily Married, Study Says

A marriage or near-marriage relationship that is satisfying can considerably help to ease depression in women with systemic sclerosis compared to single woman with disease-related symptoms of depression, according to a study by researchers in Canada.

But an unhappy marriage can amplify depressive symptoms in these women, reducing their ability to cope with serious illness, the study found. It suggests that marital status and satisfaction be included — and continuously measured — in assessments of mental health in patients with rheumatic diseases, like systemic sclerosis, lupus, rheumatoid arthritis, and chronic musculoskeletal pain.

Titled “Using Marital Status and Continuous Marital Satisfaction Ratings to Predict Depressive Symptoms in Married and Unmarried Women With Systemic Sclerosis: A Canadian Scleroderma Research Group Study,” the study was published in the journal Arthritis Care and Research.

On average, people who are married are known to have better mental health than those who are single. Studies associating mental health and marital status, however, usually do not integrate patients’ satisfaction with their marriage, choosing instead to categorize them as simply satisfied or unsatisfied. But, the researchers said, analyzing satisfaction as a spectrum rather than a ‘yes’ or ‘no’ variable can provide better insights on how satisfaction affects mental health.

Researchers at Jewish General Hospital and McGill University developed an approach that allowed them to evaluate mental health in married versus unmarried women, using marital satisfaction as a continuous variable. Depression was assessed with the Center for Epidemiologic Studies Depression Scale (CES-D), and marital satisfaction was evaluated with the Dyadic Adjustment Scale-7 (DAS-7).

Among the 725 women with systemic sclerosis enrolled in the study, 68 percent — or 494 — were married or living as married.

The investigators found that married women were, on average, two points lower in the CES-D depressive symptoms than unmarried women. However, the variability in depressive symptoms among married women was high: patients who were very satisfied with their marriages were up to 6.9 points higher on the CES-D scale than unmarried women, and those least satisfied with their marriages to 6.7 points lower.

In fact, “married women whose marital satisfaction scores were below the 19th percentile had greater predicted depressive symptoms than unmarried women,” the study reported.