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Intimate relationships and depression: is there a causal connection?

The causal pathways that link depression and dissatisfaction in intimate relationships were estimated in 115 patients during the first 12 weeks of treatment with cognitive-behavioral therapy for depression. Depression severity, as measured by the Beck Depression Inventory, was negatively correlated with relationship satisfaction at intake and at 12 weeks. However, structural equation modeling was not consistent with the hypothesis that depression severity has a causal effect on relationship satisfaction levels and suggested that relationship satisfaction may have only a weak reciprocal effect on depression severity. As predicted, married patients were substantially less depressed 12 weeks after the beginning of treatment, when controlling for initial depression severity. Contrary to expectations, marital status predicted improvement even when relationship satisfaction was controlled. Unexpectedly, dysthymia at intake was associated with low relationship satisfaction after 12 weeks, when initial relationship satisfaction was controlled, suggesting that chronic, low-level depression may have a stronger association with interpersonal problems than other forms of depression, such as major depressive episodes. The theoretical and clinical implications of the findings are discussed.