Infidelity, initiation, and the emotional climate of divorce: are there implications for mental health?

A large literature has examined the role of "secondary" stressors, such as problems with finances, social support, residential mobility, and children, in producing the well-documented association between divorce and a variety of psychopathological conditions. Much less attention, however, has been paid to variation in the "primary" disruption experience. We address this omission using data from the National Survey of Families and Households to investigate the interrelationships among depression, initiator status, and spousal infidelity. While we find little evidence of direct effects of initiator status or spousal infidelity on post-divorce depression, the importance of these characteristics emerges when they are considered in an interactive context. Specifically, while divorce initiation is associated with reduced depression among individuals with unfaithful spouses, initiation is associated with increased depression in the absence of spousal infidelity. Taken together, our findings suggest that characteristics of the divorce experience may interact in complex ways to produce variation in mental health outcomes.

The impact of childhood abuse and neglect on adult mental health: a prospective study.

This paper examines the impact of three types of victimization in childhood--sexual abuse, physical abuse, and neglect--on lifetime measures of mental health among adults. In contrast to research that relies on retrospective recall of childhood victimization, this work uses a prospective sample gathered from records of documented court cases of childhood abuse and neglect in a midwestern city around 1970. These subjects were interviewed about twenty years later. In addition, this research compares outcomes of the 641 members of the abuse and neglect group with a matched control group of 510 persons who did not have documented cases of abuse or neglect. The results indicate that men who were abused and neglected as children have more dysthymia and antisocial personality disorder as adults than matched controls, but they did not have more alcohol problems. Abused and neglected women report more symptoms of dysthymia, antisocial personality disorder, and alcohol problems than controls. After controlling for stressful life events, however, childhood victimization had little direct impact on any lifetime mental health outcome. This research indicates the importance of adopting an approach that places childhood victimization in the context of other life stressors and of prospective changes over the life course.

Negative and supportive social interactions and quality of life among persons diagnosed with severe mental illness.

This study examined the relative importance of negative and supportive social interactions in predicting different aspects of quality of life (QOL) in a sample of persons diagnosed with severe mental illness (n = 104). Controlling for other variables that might explain such a relationship, we found that negative social interactions were significantly related to lower QOL in three subjective domains, while supportive social interactions were related to higher QOL in four objective domains and one subjective domain. We found negative social interactions that are stigmatizing to be particularly important in predicting QOL; additional analyses suggested that perceived stigma partially mediated the relationship between negative social interactions and QOL. We discuss the implications of the present findings for the study of the link between social relationships and QOL among persons with mental illness.

Age and mental health services.

This paper examines how age is related to the use of formal and informal mental health services, adjustment to current life conditions, and expectations for improvement in future life conditions among a group of persons with serious mental illnesses. Interviews with 301 clients of 3 clinics at a public psychiatric facility serving West Brooklyn and Staten Island provide the data from the study. Outcome measures include nine sorts of help received from informal members of the social network and from mental health professionals; desires to improve current life conditions; and expectations for future improvements in life conditions. Through hierarchical regression procedures we examine the impact of age on these outcomes, with controls for self-reported symptoms and functioning, sex, and the presence of social network members. The results indicate that younger people receive more help from both informal social networks and from mental health professionals. In addition, younger people are more likely to want improvements in their current life conditions and to be optimistic about what the future holds for them. The decline in informal and formal support, optimism, and desire to improve their current life situations among older clients may be cause for concern among mental health professionals. Mental health service providers should give greater recognition to the impact of age on mental health service needs among persons with serious mental illnesses.

How the negative and positive aspects of partner relationships affect the mental health of young married people.

The relationship between marriage and positive mental health is one of the most established findings in the stress literature. Few studies, however, examine the problematic as well as the supportive impacts of marriage on mental health. This paper uses a cohort of young adults who were sampled at 18, 21, or 24 years of age and resampled seven years later when they were married at 25, 28, or 31. It examines what factors are associated with the quality of marital relationships, the relative impact of and balance between negative and positive partner relationships on mental health, and sex differences in the determinants and outcomes of marital quality. The results indicate that the structural strains of parenthood and financial need and their interaction predict problematic and supportive spousal relationships and the difference in the levels of these two relationships. Problematic relationships with spouses have considerably stronger impacts than supportive relationships on depression. However, the difference between the amounts of supportive and problematic relationships with spouses has a greater impact on mental health than levels of either considered separately. Finally, relational quality has a greater impact on the mental health of wives than husbands. These findings indicate the importance of considering how marriage affects mental health in complex, rather than in straightforward, ways.

Primary therapists' views of managed care.

To assess the system's comprehensiveness in provision of public managed mental health care South Beach Psychiatric Center surveyed a sample (n = 54) of its primary therapists employed in its outpatient departments which have recently been reconfigured as key components of the New York State Office of Mental Health Prepaid Mental Health Plan. They are intended to be comprehensive resource and treatment centers which optimize recovery in a deregulated, capitated environment. As key informants, the primary therapists were asked to rate the difficulty they experience in providing or arranging adequate services and support groups in 19 areas. They were also asked to indicate if the fundamental problem was one of access, information, quality, or supply. The five areas with the highest ratings of difficulty were housing or residential services, substance-abuse services, dental care, general health care, and employment or vocational services. The reason for difficulty most endorsed for these areas was supply. It is suggested that capitated managed care contracts can create incentives to increase the supply of such services.

The use of multiple outcomes in stress research: a case study of gender differences in responses to marital dissolution.

This study tests the hypothesis that the use of a single outcome variable distorts the mental health consequences of a stressor among different social groups. It uses the example of the impact of marital dissolution on the mental health of men and women to see whether rates of depression and alcohol problems rise disproportionately among women and men, respectively, who experience the same type of stressor. The sample compares 465 married subjects with 127 separated or divorced subjects drawn from a longitudinal study of 25-, 28-, and 31-year-olds. With controls for earlier rates of depression and alcohol problems, as well as for secondary stressors connected with separation and divorce, women undergoing marital dissolution show significantly greater increases in rates of depression compared to men who experience this stressor. Although men report far more alcohol problems than women, rates of these problems do not increase disproportionately among men, compared to women, during marital dissolution. The results indicate that the use of gender-typical mental health outcomes reduce, but do not eliminate,gender differences in the response to marital dissolution. They also indicate the need to use outcomes that typify how each group under study responds to stressful social conditions.

Caregiving as reciprocal exchange in families with seriously mentally ill members.

Caregiving for people with chronic illnesses, including serious mental illnesses, has generally been seen as support that a care provider gives to a dependent receiver. In contrast, this research views caregiving as a process of mutual exchange. It tests the hypothesis that how much support a mentally ill family member receives depends on how much support they provide to other family members. We also examine whether or not reciprocity depends on the role relationship between recipients and providers of care, the level of patient symptomatology, coresidence, and several sociodemographic characteristics. The sample includes 66 patients who have at least one sampled parent or sibling. The results indicate that the amount of support patients give parents and siblings is very strongly associated with how much support they receive from family members. In comparison to the other variables considered here, patient support provision is by far the best predictor of the amount of family support. These results indicate that it is worthwhile to examine caregiving in families with a member who is seriously mentally ill as a process of mutual exchange.

Ethnic differences in caregiving duties and burdens among parents and siblings of persons with severe mental illnesses.

The policy of community care for the seriously mentally ill increases the caregiving duties and resulting burden on families with members who have a mental illness. Ethnicity is one factor that might have an important impact on the caregiving duties family members perform and the burden that results from these duties. This study uses interviews with 78 parents and 70 siblings of patients scheduled for imminent release from a state mental hospital. The findings indicate that Black and White parents have equivalent caregiving duties, but White parents report substantially more caregiver burden. Black siblings report more caregiving duties than White siblings but report less caregiver burden. These ethnic differences remain after controls for income, gender, age, diagnosis, perceived stigma, and coresidence. The results indicate that ethnicity can be a critical factor affecting levels of informal caretaking for persons with serious mental illnesses.

Siblings as caregivers for the seriously mentally ill.

The majority of seriously mentally ill people are unmarried and cannot obtain support from spouses or children. Help from parents is time limited. In the absence of spouses and parents, siblings are often the closest relations for many seriously mentally ill people, but their potentially supportive role has rarely been examined. This article reports results from a pilot study of 108 siblings with seriously mentally ill brothers and sisters. The findings indicate that siblings had regular contact and positive relationships with their ill sibs. Furthermore, most were willing to increase their current amount of support. Sibling support was greater when both parents were not alive, resulting in the increased importance of siblings over the life course. Policy markers, mental health professionals, and researchers should pay more attention to the question of sibling support.

Becoming married, depression, and alcohol problems among young adults.

This paper examines three questions regarding the relationship between marriage and mental health, specifically depression and alcohol problems. First, does marriage lead to improved mental health compared to never marrying? Second, do any mental health benefits of marriage primarily accrue to men? Third, what qualitative aspects of marriage are related to psychological disorder? We explore these questions in a longitudinal sample of young adults sampled at age 21 and again at age 24. We find no indication that marriage reduces depression. Married people do report fewer alcohol problems than the never-married but this could be due to the selection of less problematic drinkers into marriage. We also fail to find that men receive disproportionate mental health benefits from marriage. Finally, we find that marital conflict is associated with problem drinking for men and depression for women. The results indicate the importance of considering stage in the life cycle and gender-sensitive indicators of psychological disorder in studies of marriage and mental health.