The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 60:P338-P341 (2005)
© 2005 The Gerontological Society of America
Moderating Role of Marital Quality in Older Adults' Depressed Affect: Beyond the Main-Effects Model
Jamila Bookwala1 and
Melissa M. Franks2
1 Department of Psychology, Lafayette College, Easton, Pennsylvania.
2 Karmanos Cancer Institute and Department of Family Medicine, Wayne State University, Detroit, Michigan.
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Abstract
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We examine the role of three indicators of marital quality (marital disagreement, marital happiness, and time spent together) as moderators of the association between physical disability and depressed affect among married older individuals (N = 1,044). We found support for the moderating role of marital disagreement wherein the detrimental effect of disability on depressed affect was significantly heightened among older adults with more disagreements with their spouse; a moderating effect was not detected for marital happiness or time spent together. We conclude that, in addition to its main effect on older adults' depressed affect, marital quality (as indicated by marital disagreement) plays a significant stress-moderating role in the physical disability–depressed affect link.
Being married in late life has been widely documented to protect mental health (e.g., Earle, Smith, Harris, & Longino, 1998
; Kim & McKenry, 2002). More recently, however, the role of the quality of marital relationships in older adults' mental health has begun to receive empirical attention. Our goal was to examine the potentially protective role of marital quality in mitigating the physical disability–depressed affect association among older adults. Physical disability (i.e., the level of difficulty in carrying out day-to-day tasks) is a common stressor in late life (Federal Interagency Forum on Aging-Related Statistics, 2000) and is an established precursor to poor mental health (see Williamson, Shaffer, & Parmelee, 2002).
Several studies indicate that the quality of marital relationships is important to mental health among older adults in general (e.g., Bookwala & Jacobs, 2004; Sandberg, Miller, & Harper, 2002), as well as specifically among those who are living with or caring for a disabled or ill spouse (e.g., Bookwala & Schulz, 2000; Northouse, Dorris, & Charron-Moore, 1995; Tower, Kasl, & Moritz, 1997). These studies typically have relied on the main-effects model, hypothesizing that whereas higher levels of negative aspects of marital quality (e.g., marital disagreement, marital distress) are correlated with poorer mental health, higher levels of positive marital characteristics (e.g., marital happiness, marital closeness) are associated with superior mental health. In general, the main-effects hypothesis has been confirmed. Although valuable, support for the main-effects hypothesis provides only a partial understanding of the potential role of marital quality in mental health. A small body of research suggests that, in the face of stressful circumstances in late life, the contribution of marital relationships to mental health may be a more complex one. Most notably, Tower and her colleagues have found that marital closeness can buffer the stressful impact of living with a cognitively impaired or depressed spouse on older adults' mental health (e.g., Tower & Kasl, 1995; Tower et al.).
Our goal in this study was to estimate the extent to which marital quality acts as a moderator for symptoms of depression in the presence of physical disability. In defining marital quality we adopted a multidimensional perspective (Fincham & Linfield, 1997), conceptualizing marital quality as incorporating both positive and negative aspects about one's marital relationship. We hypothesized that negative aspects of older adults' marital relationships (i.e., marital disagreement) will exacerbate the association between physical disability and depressed affect, whereas positive marital characteristics (i.e., marital happiness, time spent with one's spouse) will buffer this relationship. To test our hypotheses, we drew data from the National Survey of Families and Households (Sweet & Bumpass, 1996).
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METHODS
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Participants
We derived the sample for this study from The National Survey of Families and Households (NSFH). The NSFH interviewed a nationally representative sample of 13,017 individuals; one adult between the ages of 19 and 95 per household was randomly selected as the primary respondent (Sweet & Bumpass, 1996). The overall response rate was 74%. Data collection included an in-person interview with the primary respondent (average duration = 1 hr, 40 min), several portions of which were self-administered to facilitate the collection of sensitive information and the flow of the interview. In the present analyses, we included only married primary respondents who were 60 years of age or older and had complete data on the study variables described in the paragraphs that follow. Of the total NSFH sample that was eligible for the study (N = 1,258), 83% had complete data on the study variables, giving us a final sample of 1,044 individuals. Our sample consisted of independent observations, as each primary respondent in the NSFH was recruited from a unique household. On average, participants were married 1.3 times (SD = 0.59), with 95.1% of the final sample of individuals married once or twice in their lifetime. The mean age of our sample was 68.3 years (SD = 6.4, range = 60–90 years), with 10.3 as the mean number of years of formal education (SD = 2.6). In our sample, 53.2% were men (n = 555) and 46.8% were women; 85.2% were Caucasian (n = 890) and 14.8% were African American or other.
Measures
Marital quality
We used three indicators of marital quality in our study. Marital disagreement was measured on the basis of disagreements with one's spouse in seven different areas (household tasks, money, time spent together, sex, whether or not to have a[nother] child, in-laws, and the children). Respondents indicated how often in the previous year they had had open disagreements with their spouse about each of the areas. A 6-point response scale ranging from 1 (less than once a month), to 6 (almost every day) was used. We summed scores such that higher scores represented greater marital disagreement (M = 8.3, SD = 3.1; Cronbach's 
= 0.67). We measured marital happiness by using this item: "Taking things all together, how would you describe your marriage?" A 7-point response scale ranging from 1 (very unhappy) to 7 (very happy; M = 6.2, SD = 1.3) was used. Time spent with one's spouse was assessed by using a single item regarding the amount of time the respondent had spent with his or her spouse alone, talking, or sharing an activity in the preceding month. Responses were made on a 6-point scale ranging from 1 (never) to 6 (almost every day). The mean for this variable was 5.6 (SD = 1.1).
Physical disability
A six-item measure of functional limitations (limited ability to perform self-care, move about inside the house, work for pay, do household tasks, climb a flight of stairs, and walk six blocks) assessed physical disability. Respondents indicated whether or not they experienced any difficulty with the listed tasks. We summed the "yes" responses to the items to create a physical disability index with a range of 0–6 (M = 0.7, SD = 1.3; Cronbach's = 0.81).
Depressed affect
The NSFH included a 12-item version of the Center for Epidemiological Studies–Depression scale (CES-D). The CES-D is a widely used measure that assesses the severity of depressive symptoms over a 1-week recall period (Radloff, 1977). The NSFH used an eight-category set of response options to measure the number of days out of the past 7 days (0–7) that each depressive symptom occurred (M = 12.6, SD = 16.4; Cronbach's = 0.93).
Control variables
The control variables included measures of respondents' gender, race, educational level, age measured as a continuous variable, number of marriages, and perceived health (which was measured by using a standard single-item assessment of general health, with 1 = poor to 5 = excellent; M = 3.8, SD = 0.9).
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RESULTS
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We used stepped multiple regression analyses to test the moderator model linking marital quality, physical disability, and depressive symptoms (Baron & Kenny, 1986; bivariate correlations between study variables can be requested from J. Bookwala). To illustrate, for the marital-disagreement-as-moderator model, after entering the control variables on Step 1, we regressed depressed affect on centered scores of physical disability and marital disagreement, and then on Step 3 on their interaction (which we computed by using the centered variables). A significant Physical Disability x Marital Disagreement interaction indicates that marital disagreement alters the association between physical disability and depressed affect. We performed separate analyses for each indicator of marital quality and present them in Table 1. We used a more conservative alpha level in testing our models (p <.01) because of our large sample size.
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Table 1. Regression Analyses Predicting Depressed Affect: The Moderating Role of Marital Quality in the Physical Disability–Depressed Affect Link.
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After introducing the control variables, we found that marital disagreement and physical disability accounted for a significant increase in the proportion of explained variance in depressed affect; higher levels of marital disagreement and greater physical disability were uniquely associated with more symptoms of depression. On Step 3, the Marital Disagreement x Physical Disability interaction was statistically significant. A follow-up analysis of covariance, using median splits to divide participants into groups that were high and low on marital disagreement (Mdn = 7) and physical disability (Mdn = 0), also obtained a significant Marital Disagreement x Physical Disability interaction: F(1, 1034) = 7.52, p <.01. The high marital disagreement–high physical disability group experienced the most depressive symptoms (M = 24.65, SD = 21.07). In contrast, the low marital disagreement–high physical disability group obtained a mean of 15.61 (SD = 16.21) on the CES-D. In the low-disability group, the means were 7.83 (SD = 13.37) and 12.58 (SD = 15.27) for the low versus high marital disagreement groups, respectively. Post hoc comparisons indicated that individuals in the high marital disagreement–high disability group scored significantly higher on depressed affect than the other three groups combined, t(1,040) = 8.39, p <.001, as well as higher when compared specifically with their high-disability peers who reported lower marital disagreement, t(1,040) = 4.96, p <.001.
As Table 1 also indicates, greater marital happiness and more time spent with one's spouse were related to less depressed affect; the buffering hypotheses were not supported, however. Neither the Marital happiness x Physical disability interaction nor the Physical disability x Time spent with one's spouse interaction was significantly related to depressed affect (p >.01).
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DISCUSSION
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In this study, we moved beyond the main-effects model in studying the link between marital quality and depressed affect by investigating the stress moderating role of marital quality in depressed affect. Consistent with previous research, we found support for the direct association between marital quality and depressed affect that has been reported with the use of the main-effects model (Bookwala & Jacobs, 2004; Fincham, Beach, Harold, & Osborne, 1997; Levenson, Carstensen, & Gottman, 1994; Sandberg et al., 2002). Higher marital disagreement, less marital happiness, and less time spent with one's spouse were associated with more depressed affect. More importantly, however, we expected that negative marital characteristics would exacerbate and positive marital characteristics would buffer the negative effects of physical disability on symptoms of depression. Our hypotheses were partially supported; we found that marital disagreement exacerbates the physical disability–depressed affect link. Specifically, respondents with physical disability who were in marriages marked by higher marital disagreement reported significantly greater depressed affect than elders with similar levels of physical disability who were in less conflictual marriages as well as those with low levels of physical disability (regardless of marital disagreement levels). Consistent with Tower (Tower & Kasl, 1995; Tower et al., 1997), who reported that a close marriage (i.e., one in which the spouse is described as a confidante and source of emotional support) can protect older adults from the negative mental health outcomes of living with a cognitively impaired or depressed spouse, we found that a more conflictual marriage can exacerbate symptoms of depression among older adults who are living with physical disability.
Our results indicate that marital disagreement deserves attention in the area of older adults' well-being. Previous research has documented that such negative marital processes may contribute directly to poorer mental health (Bookwala & Jacobs, 2004) and physical health (Bookwala, 2005; Kiecolt-Glaser & Newton, 2001). The current findings indicate that marital disagreement also appears to play a stress-exacerbating role in the event of physical disability. Thus, more disagreement in marriage operates like greater conflict does in broader social relationships; such conflict has been found to exacerbate people's susceptibility to illness outcomes (e.g., developing a cold) when exposed to illness-causing agents (e.g., a cold virus; see Cohen, 2004). Conversely, a marital relationship marked by less disagreement may protect psychological well-being by increasing the disabled partner's confidence in the availability of a dedicated caregiver to meet their needs (e.g., Coyne et al., 2001), or it may allow both partners to focus their emotional resources on managing a stressful circumstance, such as physical disability, rather than on coping with an embattled relationship.
The strengths of our study include the examination of the role of marital quality in depressed affect beyond its established main effects and the utilization of a large and representative sample of married older adults. However, our study also is limited in specific ways. First, both marital happiness and time spent together were assessed by using single items. This measurement strategy may have limited our ability to detect expected moderating effects of these positive indicators of marital quality. We recommend that future research use multi-item validated scales of these marital characteristics to confirm our pattern of findings. Second, our analyses are based on self-report and cross-sectional data. We suggest that future research be directed toward identifying the short- and long-term relationships among our study variables with the use of multipanel data that include behavioral observations. Despite these limitations, our study is important because it offers preliminary data identifying a good marriage as a factor that can protect the emotional well-being of older adults as they confront the physical challenges associated with aging.
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Footnotes
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Decison Editor: Thomas M. Hess, PhD
Received for publication May 12, 2004.
Accepted for publication June 15, 2005.
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References
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Abstract
Methods
