Marital adjustment, psychological distress, and Internet addiction among married couples in an urban community: A cross-sectional study

Abstract

Background:

Urbanization and modernization have led to increasing marital disputes, a major cause of stress affecting the mental health and quality of life among couples. Poor marital adjustment is commonly associated with psychological complaints. Internet addiction may function both as a maladaptive coping mechanism and as a factor contributing to marital discord. These difficulties not only affect the couple but can also have lasting implications for family dynamics and child functioning. These factors must be considered when designing effective interventions targeting intergenerational associations and improving psychosocial outcomes in an urban environment.

Aim:

To determine the marital adjustment, psychological distress, and Internet addiction among married couples in an urban community through cross-sectional design.

Materials and Methods:

106 married couples were studied for marital discord. A simple random sampling approach was employed for recruitment. Standardized questionnaires measuring marital adjustment, psychological wellbeing, and Internet addiction were used to collect self-reported data. Statistical analysis was undertaken to evaluate how psychosocial variables relate to the extent of marital discord.

Results:

22.6% females and 20.7% males experienced poor marital adjustment. Education and occupation were significantly associated with marital discord, particularly among men. Marital adjustment showed a significant inverse correlation with psychological distress, whereas no such association was found with Internet addiction.

Conclusion:

Marital discord was significantly associated with psychological distress, with women experiencing higher distress levels. Internet addiction showed no direct link with discord but correlated with psychological distress. These findings highlight the need for integrated interventions addressing marital, mental health and digital wellbeing among urban couples.

Marital satisfaction is the general perception or feeling an individual has about their marriage. It is theoretically important for scholars of relationships and practically relevant to couples in a marital therapy setting. Marital satisfaction is influenced by the disruption and everyday work of marriage, as well as how couples negotiate conflicts.[1] Conversely, marital discord involves ongoing conflicts and emotional disconnection that negatively impact the couple’s overall wellbeing. The extensive research on marital discord and related concepts such as conflict and dissatisfaction highlights the critical need to understand the challenges that may undermine the integrity of marriage.[2] Unresolved marital conflicts harm health and work performance, leading to absenteeism and reduced productivity.[3] Marital adjustment refers to the effectiveness with which spouses address each other’s needs and maintain mutual understanding, which is an essential foundation for a stable and fulfilling relationship. Insufficient adjustment can heighten tensions and may eventually contribute to marital dissolution.

Emotional suffering is known as psychological distress, characterized by anxiety, depression, irritability, and trouble with daily functioning. It reflects how a person responds to stressful life situations or mental health issues.[4] Internet addiction puts a significant strain on marriages. Individuals who prioritize their online interactions, similar to those with substance or gambling addictions, often lose meaningful in-person engagement with their spouse. This behavior diminishes the quality of time spent in the relationship.[5]

Marital adjustment issues have grown more prevalent in modern urban society, creating significant challenges for emotional and relational stability. Psychological distress, manifested as anxiety, depression, and chronic stress, can further compound these issues, resulting in a persistent cycle of relational and emotional challenges. The rising incidence of adjustment difficulties poses substantial concerns for individual wellbeing and the stability of family structures. At the same time, concerns about general health and Internet addiction have emerged, with technology affecting almost every part of daily life. The relationship between these factors creates a complex web of influences on individuals and relationships. A study on couples seeking divorce found that 91.6% reported poor marital adjustment, primarily due to interpersonal problems. Additionally, psychopathology was prevalent, with interpersonal issues being a significant factor in marital breakdown.[6] Likewise, another study from India in a hospital setting highlighted a high prevalence of marital discord, primarily driven by interpersonal issues among couples seeking psychiatric consultation.[7] However, findings from such clinical populations may not fully represent the general population. No study from India thoroughly examines all these factors. To fully understand marital discord and develop effective, evidence-based ways to reduce psychological distress, a nuanced and integrated approach is needed. Therefore, we conducted this cross-sectional study to explore levels of marital adjustment, psychological distress, and Internet addiction among married couples in an urban community to provide broader, population-level insights.

MATERIALS AND METHODS

Sample and procedure

We conducted a cross-sectional study on a target population in the community that consisted of legally married couples residing in an urban area of western Maharashtra.

The sample size for this cross-sectional study was calculated using the formula for estimating a single proportion. Based on previous literature, the prevalence of Internet addiction among married individuals was reported as 52.5%,[8] marital adjustment issues as 50%, and psychological distress ranging from 24% to 31%.[9,10] Using the highest reported prevalence (52.5%), a 95% confidence level, and an absolute precision of 10%, the minimum required sample size was calculated to be 96. After accounting for a 10% nonresponse rate, the final sample size was modified to 106 couples. The sample size was estimated through Epi Info software version 7.2 (Centers for Disease Control and Prevention, Atlanta, Georgia, USA) was used for sample size calculation..

Simple random sampling was used to choose the participants from a list of eligible couples obtained from local records available to the ASHA worker, ensuring each eligible couple had an equal chance of selection. The study received institutional ethical clearance, and the couples provided written informed consent. Eligibility criteria included married women and men more than 18 and 21 years, respectively. We excluded those unwilling, not conversant in Hindi/English, very ill, widowed, or those with dementia or psychosis/delusional disorders. However, those with major mental illnesses, including substance use disorders, and stable on medications were included in the study. Participants’ identities were kept confidential.

Self-rated questionnaires and in-person interviews were used to gather the data. Demographic data of all eligible participants were collected as per the devised proforma.

Measures

The following prevalidated questionnaires and scales were used to evaluate all couples who met the inclusion criteria.

Marital adjustment test

The Locke–Wallace Marital Adjustment Test (MAT), a 15-item self-reported questionnaire, was used to measure marital adjustment. The cutoff score, which indicated high marital adjustment, was 101 out of 158. Marriage discord was suggested by scores below 101.[11] The MAT has demonstrated good internal consistency (Cronbach’s alpha ≈ 0.90) and has been widely validated in both clinical and community settings.[12]

General Health Questionnaire-12

This 12-item measure was used to screen couples for psychological distress. In the current study, a cutoff score of 2 was used to evaluate mental health.[13] The General Health Questionnaire-12 (GHQ-12) is a well-established screening tool with high internal reliability (Cronbach’s alpha ranging from 0.82 to 0.90) and good validity across diverse populations, including India.[9,14]

Internet Addiction Diagnostic Questionnaire

Internet use was assessed using this brief, 8-item self-reported scale. Internet addiction was operationalized using the Internet Addiction Diagnostic Questionnaire (IADQ) cutoff (≥5), which has been validated in prior research.[5] The IADQ, based on the Internet Addiction Test (IAT), has shown acceptable reliability (Cronbach’s alpha ≈ 0.89) and face validity in studies examining behavioural addictions.[15]

Statistical analyses

Data analysis was done using IBM SPSS Statistics for Windows, Version 26.0 (IBM Corp., Armonk, New York, USA). Frequencies and percentages (%) were used for categorical variables, whereas mean, standard deviation (SD), and so on were used for continuous variables. Associations of GHQ, MAT, and IADQ scores with age (years), education, and years of marriage for males and females separately were assessed using the Chi-square test. The Wilcoxon signed rank test evaluated within-gender differences, while the Mann–Whitney U test compared scores between genders. Spearman’s correlation coefficient assessed relationships among GHQ scores, IADQ scores, and MAT scores. Statistical significance was set at a P < 0.05.

RESULTS

Although 220 people were approached for this study, we included 106 couples’ spouses who could be contacted and completed the questionnaire. Thus, the analysis included a total of 212 participants. The key study variables are described in Table 1.

Table 1.

Sociodemographic profile of study participants

Demographic characteristic	Numbers
Males
Minimum age	23
Maximum age	74
Median age	39.5
Females
Min age	20
Max age	69
Median age	35
Educational attainment: Male
Graduate and above	36
Intermediate and below	70
Educational attainment: Female
Graduate and above	29
Intermediate and below	77
Duration of marriage (years)
<5	16
5–10	28
>10	62

With a mean score of 116.4 and an SD of 21.9, the 212 participants’ MAT scores varied from 34 to 158. The distribution of MAT, GHQ, and IADQ scores is illustrated in Supplementary Figure S1 ^{(1.1MB, tif)} . Most participants scored between 110 and 130, indicating generally high levels of marital adjustment. Using a cutoff score of 101, 166 participants (78.3%) were categorized as having high marital adjustment, while 46 (21.7%) were classified as experiencing poor adjustment or marital discord.

The average GHQ score was 6.9 (SD = 5.76), with a range of 1 to 24. The distribution was positively skewed, with most scores falling between 0 and 10 [Supplementary Figure S1 ^{(1.1MB, tif)} b]. Using a cutoff score of ≥2, 150 participants (70.8%) were found to have psychological distress, while 62 participants (29.2%) were categorized as not distressed. Psychological distress was significantly associated with marital discord (P < 0.001), with 29.3% of participants experiencing psychological distress reporting discord, compared to 3.2% of those without distress.

Internet addiction was measured using the IADQ. 13 participants (6.1%) met the criteria for Internet addiction (score ≥ 5), while 199 (93.9%) did not. The scores were highly positively skewed, with a mean of 1.1 (SD = 1.57), and the majority scored zero [Supplementary Figure S1 ^{(1.1MB, tif)} c]. This population had a low prevalence of problematic Internet use.

Among males, age group (P = 0.010) and educational status (P = 0.023) showed significant associations with marital adjustment. In contrast, no significant association was observed between MAT scores and any sociodemographic variables among female participants [Table 2].

Table 2.

Comparison of marital adjustment test scores with sociodemographic variables

	Males					Females
	MAT score		Total	χ²	P	MAT score		Total	χ²	P
	≤101	>101				≤101	>101
Age group
<30		12	12	11.355	0.010*	8	28	36	0.146	0.986
31–40	8	41	49			8	29	37
41–49	3	16	19			4	14	18
50+	11	15	26			4	11	15
Education
Illiterate	1		1	14.688	0.023*	1		1	4.872	0.560
Primary school	3	5	8			3	6	9
Middle school	4	21	25			4	16	20
High school	9	20	29			7	32	39
Post high school diploma		7	7			2	6	8
Graduate	2	27	29			6	21	27
Professional degree/postgraduate	3	4	7			1	1	2
Years of marriage (years)
<5	1	15	16	3.125	0.207	4	12	16	0.084	0.959
5–10	5	23	28			6	22	28
>10	16	46	62			14	48	62

*Significant as P<0.05. MAT=Marital adjustment test

Gender differences in Marital Adjustment Test, General Health Questionnaire, and Internet Addiction Diagnostic Questionnaire scores

To examine gender differences, the Mann–Whitney U test was used. Marital Adjustment: Male participants had slightly higher MAT scores (mean rank = 109.58) than females (mean rank = 103.42), though the difference was not statistically significant (P = 0.465) [Figure 1].

Figure 1.

Comparison of marital adjustment test scores between male and female participants using the Mann–Whitney U-test

Psychological distress

Female participants had significantly higher GHQ scores (mean rank = 116.29) compared to males (mean rank = 96.71; P = 0.019), indicating greater psychological burden among women [Supplementary Figure S2 ^{(357KB, tif)} ].

Internet addiction

No significant difference was observed between females (mean rank = 106.95) and males (mean rank = 106.05; P = 0.897) [Supplementary Figure S3 ^{(355.4KB, tif)} ].

The Wilcoxon signed rank test was used to compare MAT, GHQ, and IADQ scores among husband–wife couples. There was no statistical significance between husbands and wives in MAT scores (P = 0.091) or IADQ scores (P = 0.892). However, GHQ scores differed significantly, with wives being more psychologically distressed than husbands (P = 0.001).

Chi-square test was used for associations, and Fisher’s exact test was used wherever appropriate for marital discord and sociodemographic variables [Table 3].

Table 3.

Association of various sociodemographic and psychosocial factors and Internet addiction with marital discord (n=212)

Variable	Category/levels	Marital discord present (%)	χ²	P
Education level	Graduate	14.3	14.778	0.022
	Illiterate	100
Occupation	Professional	12.5	13.427	0.037
	Unskilled/unemployed	66.7
Socioeconomic status	Upper	0	5.228	0.156
	Lower middle	34.2
Number of children	0	18.2	0.295	0.863
	<2	21.5
	>2	23.9
Psychological distress (GHQ)	Yes	29.3	17.599	<0.001
	No	3.2
Internet addiction	Yes	38.5	2.291	0.130
	No	20.6
Duration of marriage	<5 years	19.6	1.288	0.525
	5–10 years	24.2
	>10 years	24.2

GHQ=General Health Questionnaire

A scatterplot matrix was used to visualize bivariate relationships between age, duration of marriage, MAT, GHQ, and IADQ [Figure 2]. MAT was negatively correlated with age (ρ = –0.314) and duration of marriage (ρ = –0.319), suggesting a decline in marital adjustment over time. GHQ and IADQ were positively correlated (ρ =0.357), indicating that higher Internet use may be associated with poorer mental health. MAT scores were negatively correlated with both GHQ and IADQ, reflecting a higher psychological distress and Internet addiction with lower marital adjustment. No significant correlation was observed between IADQ and either age or marital duration.

Figure 2.

Scatterplot matrix showing relationships among age, duration of marriage, marital adjustment test, psychological distress, and Internet addiction

DISCUSSION

This study aimed to examine the psychosocial correlates of marital discord among urban married couples, with a focus on the roles of psychological distress and Internet addiction. Using standardized scales and robust statistical analysis, we observed that a significant proportion of participants experienced marital discord (21.7%), with psychological distress and educational and occupational factors being significantly associated with it.

In our study, age and education significantly influenced marital adjustment among males, with poorer outcomes in midlife and among less educated, whereas no such associations were found in females. This gender difference may be explained by variations in the determinants of marital satisfaction. Prior research suggests that men’s marital adjustment is closely tied to structural factors such as education, career stage, and financial stability.[16] In contrast, women’s marital satisfaction is more strongly shaped by relational and contextual aspects, including spousal support, emotional intimacy, and family dynamics, rather than demographic variables.[17] Among couples married for over 10 years, 24.2% reported marital discord, suggesting a decline in satisfaction over time. This aligns with studies showing a negative correlation between marriage duration and marital quality, potentially due to cumulative stress, routine, and unresolved conflicts. The trend was more evident in urban low-income settings, where age and longer marriage duration were associated with poorer adjustment.[18,19]

A few studies also report a U-shaped relationship, where satisfaction initially declines during middle years and improves in later years, particularly after children become independent or as couples readjust to a new phase in life.[20,21] These conflicting trends may be influenced by cultural context, gender roles, and life-stage transitions, which warrant further longitudinal exploration in the Indian setting.

Marital adjustment and psychosocial correlates

Marital adjustment, defined as the degree to which spouses feel satisfied and compatible with one another, has been extensively studied in the context of overall marital quality and stability. Locke–Wallace MAT remains one of the most widely used tools to measure marital adjustment. Research consistently shows that high levels of marital adjustment are associated with better psychological outcomes and lower levels of conflict within marriages.[22] However, most studies focus on general marital satisfaction without deeply exploring how modern challenges, such as Internet use, impact marital adjustment. Existing research primarily addresses traditional factors like communication, financial management, and child-rearing practices, leaving a gap in understanding how Internet use and potential addiction may influence marital dynamics.[23] Our finding of 21.7% poor marital adjustment aligns with previous Indian studies reporting discord rates of 18% to 27% among urban couples.[24]

Education level was significantly associated with marital discord. Interestingly, individuals who were illiterate or professionally highly educated had a higher prevalence of discord. This pattern might reflect the dual challenges faced by undereducated couples in managing daily stressors and by highly educated couples in negotiating modern marital expectations. Marriages with at least one highly educated spouse are less stable as these couples may face unrealistic expectations and pressures, contributing to discord.[25] While the U-shaped relationship between education and marital discord is evident, it is essential to consider that marital distress can arise from various factors beyond education, indicating a complex interplay of influences on marital stability.[26]

Occupational status also showed a statistically significant association, with higher discord among professionals and clerical/shop owners, possibly due to greater work-related stress and time constraints. This supports prior work wherein it was found that occupational stress among dual-career couples contributed to decreased marital satisfaction.[27]

Psychological distress and marital discord

A strong association was observed between psychological distress and marital discord (P < 0.001). Nearly 70.8% of participants were found to be psychologically distressed (GHQ ≥ 2), and those with distress were significantly more likely to report poor marital adjustment. This aligns with studies that emphasized the bidirectional relationship between psychological distress and relationship dissatisfaction. Chronic stress and unresolved emotional difficulties can erode communication and conflict resolution, which are essential to marital harmony. A significant portion of individuals in discordant relationships report psychological distress, with studies showing high rates of depression and anxiety among these couples.[28]

Internet addiction and marital discord

Although Internet addiction was measured and explored in this study, it was not significantly associated with marital discord (P = 0.130). Only 6.1% of respondents met the criteria for problematic Internet use (IADQ ≥ 5). In contrast, some earlier studies from Western contexts have identified Internet use—especially compulsive social media engagement—as a significant predictor of marital dissatisfaction. Nevertheless, the psychological effects of excessive Internet use—including social withdrawal, decreased spousal interaction, and emotional detachment—are well documented, emphasizing that Internet addiction contributes to depression, anxiety, and interpersonal dysfunction; however, most studies focus on individual outcomes rather than relational effects.[29] The subtle impact of Internet overuse on marital life, especially when it replaces shared time or intimacy, deserves further investigation. Many participants in our study came from low socioeconomic backgrounds, which limited their access to smartphones and the Internet.[5,30] This low prevalence may be attributed to socioeconomic factors, particularly in the Indian context. Internet addiction may function both as a maladaptive coping mechanism and as a factor contributing to relational difficulties, but in our study, it was evaluated as an associated variable, not as a causal factor. Future research could explore the impact of emerging digital access in India on marital dynamics.

However, a significant positive correlation was observed between Internet addiction and psychological distress (ρ =0.357), suggesting that excessive Internet use may be more strongly linked with mental health outcomes than directly with marital functioning. Future longitudinal research may establish the causal direction of these relationships.

Gender differences

Gender-wise analysis revealed that female participants reported significantly higher psychological distress than males (P = 0.019), indicating a disproportionate psychosocial burden on women within marital settings. This aligns with previous studies, including a hospital-based study in India reporting distress in 66% of women versus 36% of men,[7] and the National Mental Health Survey (2016), which attributed higher mental health burdens among urban women to role conflict, emotional labor, and limited support systems.[31,32]

Although male participants had higher median MAT scores than females, the difference was not statistically significant (P = 0.465). This is consistent with similar studies done using MAT.[33] While marital adjustment (MAT) and Internet addiction (IADQ) levels were comparable between spouses, the consistently higher distress scores among women suggest gender-based differences in emotional responses, with women more affected by internalizing disorders and social stressors. This aligns with prior findings suggesting that women tend to disproportionately carry the burden of emotional labor in relationships.[34]

This study is the first community-based investigation in India to examine the relationship between marital adjustment, psychological distress, and Internet addiction among married couples. Utilization of standardized tools (MAT, GHQ-12, IADQ) and involvement of both partners strengthen the validity of the findings. The urban setting offers context-specific insights relevant to modern marital dynamics.

However, causal inference is limited by the cross-sectional design. Self-reported data are susceptible to recall and social desirability bias. The sample was limited to one urban locality, affecting generalizability. Participants in our study came from low socioeconomic backgrounds, which limited their access to smartphones and the Internet. Other relevant variables, such as personality traits, substance use, and sexual satisfaction, were not assessed. Future research could delve deeper into causal mechanisms among the key variables, including diverse populations, preventive strategies, and interventions tailored to address these intertwined issues. Mixed-method approaches could offer deeper insights into underlying relational dynamics.

CONCLUSION

Marital discord is a serious problem requiring timely intervention; in such cases, women experience worse marital adjustment compared to men. Marital adjustment discord, general health deterioration, and Internet addiction form an intricate triad that impacts individuals and families profoundly. This study, based on questionnaire findings, reveals the interconnected nature of these challenges and emphasizes the importance of holistic solutions. Clinicians can help couples explore each partner’s expectations. Promoting awareness and fostering dialog among couples can pave the way for healthier and more fulfilling relationships, ultimately contributing to the overall wellbeing of urban communities. The study findings can help in the development of targeted interventions and support programs like marital counseling, reducing psychological distress and digital hygiene among urban couples.

Authors’ contributions

Concept, design, literature search: SPP, RJR. Data acquisition: RJR. Data analysis: VM, RJR. Manuscript preparation: RJR, SPP. Manuscript editing and manuscript review: KC, NS, PY.

Data availability statement

Data can be made available on reasonable request.

Ethical statement

Ethics clearance was obtained from the: Institutional. Ethics Committee, Armed Forces Medical College, Pune, IEC/2024/649, 28/OCT/2024. Written informed consent was taken from the participants.

Conflicts of interest

There are no conflicts of interest.

Supplementary Figure S1

Distribution of MAT Scores (a), GHQ Scores (b) and IADQ Scores (c) Among Study Participants (N = 212)

Supplementary Figure S2

Comparison of GHQ Scores between Male and Female Participants Using Mann-Whitney U Test

Supplementary Figure S3

Comparison of IADQ Scores between Male and Female Participants Using Mann-Whitney U Test

Funding Statement

Nil.