[*Anya*]

July 23, 2012

Robin W. Simon, PhD

Professor of Sociology, Wake Forest University, Winston-Salem, NC

First published in Psychiatry Weekly, Volume 7, Issue 14, July 23, 2012

Introduction
The connection between social relationships and mental health is a fundamental component of both the sociological and psychiatric literatures. Robin W. Simon, PhD, is a sociologist whose work has focused on social relationships—especially marriage—and mental health for 25 years.

Why is Marriage Associated with Mental Health?
“Sociologists have long been interested in the link between social relationships and mental health,” explains Dr. Simon. “Let’s take marriage as an example. At this point, hundreds of studies document a robust relationship between marriage and improved mental health: married people report significantly fewer symptoms of depression and are significantly less likely to abuse substances than their non-married counterparts. This is because marriage provides social support—including emotional, financial, and instrumental support. Also, married people have greater psychosocial (or coping) resources than the non-married—higher self-esteem and greater mastery. Social support and psychosocial resources not only increase emotional well-being but also buffer the negative emotional effects of stressors that people experience during the life course.”

There are, of course, many nuances in this narrative. For instance, poor marital quality can lead to lower levels of well-being among the married than the non-married, because marital conflict is highly stressful. However, although it was believed for decades that men derive greater benefit from marriage than women, Dr. Simon’s 2002 study1 and other sociological research show that the mental health advantage of marriage is evident among both genders. At the same time, it appears that marriage is less beneficial for individuals with a mentally ill than an emotionally healthy spouse.2

The Direction of the Relationship Between Marriage and Mental Health
The psychiatric literature recognizes the protective effects of marriage for mental illness. For example, among adults with schizophrenia, being in a marital or cohabiting relationship is associated with a 5-year delay in experiencing a first episode of psychosis (FEP) and higher quality of life, and is a significant predictor of symptom remission within 1 year of FEP.3,4

There is a debate about whether a person’s depression increases the risk of marital loss through divorce, or whether a marital loss itself (including cases where a spouse dies) is largely responsible for depression onset.

The former scenario fits into the hypothesis known as social selection, which states—to summarize it roughly—that healthy individuals gravitate toward intimate relationships and are seen as desirable partners. This view assumes that people who marry are more likely to have better mental health, anyway, and that “the healthiest, most robust people select into marriage,” says Dr. Simon. The alternative hypothesis—the perspective that most sociologists embrace—is social causation, which holds that marriage wards off mental illness and improves mental health by virtue of its built-in support system.

In a 2002 study1 Dr. Simon analyzed longitudinal data from a large nationally representative sample to examine, among other things, both the social causation and selection hypotheses of the relationship between marital status and mental health.

“In this study I examined whether a change in marital status between study onset and endpoint caused a change in mental health,” explains Dr. Simon. “I found that people who became divorced and widowed during the study experienced a significant decline in mental health between data points, which supports the social causation hypothesis. But those who divorced also reported more symptoms before the actual divorce. This latter finding could be interpreted as evidence that people who experience mental health problems are more likely to get divorced (in agreement with the social selection hypothesis). I argued, however, that some of these people might have been experiencing marital conflict at study onset, increasing symptoms of depression and alcohol abuse. In terms of marital gain, people who got married during the study reported a significant decrease in symptoms of depression and alcohol abuse, but there was no evidence that mentally robust people are more likely to marry than their less healthy peers.”

In an era where cohabitation and state-sanctioned same-sex marriage are increasingly common, do the mental health benefits of marriage apply exclusively to heterosexual marriages?

Unfortunately, there are no existing national data sets that would allow us to answer this question. Studies addressing this issue are underway, however, and Dr. Simon predicts that there would be no difference in the mental health benefits of marriage between individuals in heterosexual and same-sex marriages. “If anything,” she says, “marriage may be even more protective for people in same-sex marriages, because they fought long and hard for their partnerships to be recognized by the state.” As for cohabitation, Dr. Simon says that studies show that cohabitation, too, is good for mental health, “though not as good as marriage.”

“We still have much to learn about why marriage in particular, and social relationships in general, improve mental health,” concludes Dr. Simon, “but sociological research on this topic is clear; having a deep emotional connection with another person provides individuals with social support and coping resources, a sense of purpose and meaning in life, an important social identity, and feelings of social integration and mattering—which are all important for both the development and maintenance of mental health.”Disclosure: Dr. Simon reports no affiliations with, or financial interests in, any organization that may pose a conflict of interest.

References:

1. Simon RW. Revisiting the relationships among gender, marital status, and mental health. AJS. 2002;107:1065-1096.

2. Lam D, Donaldson C, Brown Y, Malliaris Y. Burden and marital and sexual satisfaction in the partners of bipolar patients. Bipolar Disord. 2005;7:431-440.

3. Nyer M, Kasckow J, Fellows I, et al. The relationship of marital status and clinical characteristics in middle-aged and older patients with schizophrenia and depressive symptoms. Ann Clin Psychiatry. 2010;22:172-179.

4. Álvarez-Jiménez M, Gleeson JF, Henry LP, et al. Road to full recovery: longitudinal relationship between symptomatic remission and psychosocial recovery in first-episode psychosis over 7.5 years. Psychol Med. 2012;42:595-606.

5. Bulloch AG, Williams JV, Lavorato DH, Patten SB. The relationship between major depression and marital disruption is bidirectional. Depress Anxiety. 2009;26:1172-1177.