Introduction
The percentage of married adults in the United States has decreased dramatically over the past four decades. The decline in marriage has been particularly pronounced among African Americans (Harknett & McLanahan, 2004). African Americans are less likely than whites to be married or remarried, and are more likely to be separated, divorced and widowed (Taylor, Tucker, Chatters, & Jayakody, 1997). Consequently, African Americans spend less time in marriage than Whites. However, this lower rate of marriage does not mean that they are not involved in romantic relationships. For instance, Tucker and Taylor (1997) found that four out of 10 unmarried African American adults, and about half of those under 55 were involved in non-cohabiting romantic relationships. In the National Survey of American Life, 22.7% of African Americans were in a romantic relationship whereas only 33.2% were currently married. The average length of these non-marital, non-cohabiting romantic relationships was 4.5 years. It is critical that research on psychiatric disorders recognize the diversity of romantic relationships and not assume that the only long term romantic coupling is through marriage. This is especially true of African Americans (Lincoln et al., 2008).
There is an impressive literature on marriage and psychiatric disorders. This research indicates that among the total population (Kessler et al., 2005) and African Americans (Williams et al., 2007) married adults have lower rates of depression than their non-married counterparts. Our analysis investigates whether African Americans with depression are also less likely to be involved in a romantic relationship. We expect that African Americans who are depressed will not only be less likely to be married but will also be less likely to be in a romantic relationship. This is based on research which indicates that major depression as well as other mental disorders increases the odds of divorce in first marriages (Kessler et al., 1998).
Methods
Sample
The National Survey of American Life (NSAL) was collected by the Survey Research Center at the University of Michigan. A total of 6,082 face-to-face interviews were conducted with persons aged 18 or older, including 3,570 African Americans. The overall response rate is 72.3% which was computed using the American Association of Public Opinion Research guidelines (AAPOR, 2006). The data collection was conducted from February 2001 to June 2003 (see Jackson, Neighbors, Neese, Trierweiler, & Torres, 2004 for a more detailed discussion of the NSAL). The NSAL was approved by the University of Michigan Institutional Review Board.
Measures
The DSM-IV World Mental Health Composite International Diagnostic Interview (WMH-CIDI), a fully structured diagnostic interview, was used to assess the dependent variables, twelve month and lifetime major depressive disorder (Kessler and Ustun, 2004).
This analysis uses marital status and two measures of relationship status. Marital status was assessed using a single item that asked respondents if they are currently: married, living with a partner, separated, divorced, widowed, or never married. Analyses revealed small and non-significant differences between those who reported being married (n = 928; 33.2%) vs. those cohabiting with a partner (n = 253; 8.8%), and were therefore combined and classified as being “married/cohabiting”. Additionally, there were too few cohabiting respondents with 12 month MDD (n=17) to have cohabitation as a separate category. Respondents who were separated, divorced, or widowed, were classified as “previously married”.
Previously and never married respondents were additionally asked whether they were currently involved in a romantic relationship. The first romantic relationship status variable has three categories: 1) currently married or cohabiting, 2) unmarried and has a romantic relationship, 3) unmarried and does not have a romantic relationship. An expanded version of this measure has five categories: 1) currently married or cohabiting, 2) previously married and does not have a romantic relationship, 3) previously married and has a romantic relationship, 4) never married and does not have a romantic relationship, and 5) never married and has a romantic relationship. It is important to note that relationship status measures the respondents’ current status and that all of the categories are mutually exclusive.
Demographic variables examined are gender, age, and education in years. Poverty ratio was calculated as household income in relation to the poverty threshold based on household composition.
Analysis Strategy
One-hundred and sixty participants with missing data on any variables were excluded from analyses. The use of listwise deletion in cases where missing data represents less than 10% of the sample is considered to be acceptable, having little impact on the validity of statistical inferences. The percentages reported in Table 1 represent weighted proportions based on the distribution of African Americans in the population. The Rao-Scott χ2 represents a complex design-corrected measure of association. Logistic regression analysis was used and odds ratio estimates and 95% confidence intervals are presented along with the design-corrected F statistic. All analyses were conducted using SAS-callable SUDAAN (Version 9.0, RTI International) which uses the Taylor expansion approximation technique for calculating the complex design-based estimates of variance. To obtain results that are generalizable to the African American population standard error estimates are corrected for unequal probabilities of selection, nonresponse, poststratification, and the sample’s complex design.
Table 1.
Weighted descriptive characteristics of African American participants (n = 3410) in the National Survey of American Life (NSAL; 2002–2003) by lifetime and 12-month major depression.
| Total | 12-Month MDD | Lifetime MDD | |||
|---|---|---|---|---|---|
| No | Yes | No | Yes | ||
|
| |||||
| Lifetime MDD, n (%) | |||||
| No | 2993 (88.0) | ||||
| Yes | 417 (12.0) | ||||
| 12-month MDD, n (%) | |||||
| No | 3183 (93.3) | ||||
| Yes | 227 (6.7) | ||||
| Marital Status, n (%) **, ††† | |||||
| Married/Cohabiting | 1181 (42.0) | 1131 (95.7) | 50 (4.3) | 1069 (90.6) | 112 (9.4) |
| Previously Married | 1104 (26.4) | 1020 (92.0) | 84 (8.0) | 956 (85.7) | 148 (14.3) |
| Never Married | 1125 (31.6) | 1032 (91.1) | 93 (8.9) | 968 (86.4) | 157 (13.7) |
| Relationship Status, n (%) **, ††† | |||||
| Married/Cohabiting | 1181 (42.0) | 1131 (95.7) | 50 (4.3) | 1069 (90.6) | 112 (9.4) |
| Current Relationship | 850 (22.7) | 793 (92.6) | 57 (7.4) | 740 (86.4) | 110 (13.6) |
| No Relationship | 1379 (35.4) | 1259 (90.8) | 120 (9.2) | 1184 (85.8) | 195 (14.2) |
| Relationship/Marital Status, n (%) ***, †† | |||||
| Married/Cohabiting | 1181 (42.0) | 1131 (95.7) | 50 (4.3) | 1069 (90.6) | 112 (9.4) |
| Current Relationship/Previously Married | 327 (7.9) | 304 (92.6) | 23 (7.4) | 278 (83.0) | 49 (17.0) |
| Current Relationship/Never Married | 523 (14.7) | 489 (92.6) | 34 (7.4) | 462 (88.3) | 61 (11.7) |
| No Relationship/Previously Married | 777 (18.5) | 716 (91.8) | 61 (8.3) | 678 (86.9) | 99 (13.1) |
| No Relationship/Never Married | 602 (16.9) | 543 (89.8) | 59 (10.2) | 506 (84.7) | 96 (15.3) |
| Gender, n (%) ***, ††† | |||||
| Men | 1214 (44.2) | 1160 (95.3) | 54 (4.7) | 1110 (91.2) | 104 (8.8) |
| Women | 2196 (55.8) | 2023 (91.7) | 173 (8.3) | 1883 (85.4) | 313 (14.6) |
| Poverty Ratio, Mean (SE) † | 2.69 (0.11) | 2.72 (0.10) | 2.32 (0.23) | 2.70 (2.48) | 2.64 (2.32) |
| Education Years, Mean (SE) | 12.4 (0.09) | 12.5 (0.09) | 12.2 (0.21) | 12.4 (12.24) | 12.6 (0.16) |
Note:
p < 0.05;
p < 0.01;
p < 0.001 for Lifetime MDD
p < 0.05;
p < 0.01;
p < 0.001 for 12-Month MDD
Results
The distribution of variables is presented in Table 1. Marital and relationship status had significant bivariate associations with MDD; persons who were married/cohabiting consistently had the lowest prevalence of both 12-month and lifetime MDD. Results from the weighted logistic regression analyses are presented in Table 2 and indicate that each of the three marital and relationship status variables continued to have significant associations with both 12-month and lifetime MDD, even after controlling for demographic characteristics. An examination of the marital status variable indicated that previously married respondents had significantly higher levels of 12-month and lifetime MDD than their married/cohabiting counterparts. For the 3-category relationship status variable, respondents who were not in a current relationship had significantly greater odds of both 12-month and lifetime MDD, compared to those who were married or cohabiting.
Table 2.
Weighted logistic regressions predicting lifetime and 12-month major depression among African American participants (n = 3410) in the National Survey of American Life (NSAL; 2002–2003).
| 12-Month MDD OR (95% CI) | Lifetime MDD OR (95% CI) | |
|---|---|---|
| Marital Status | ||
| Married/Cohabiting (Ref) | 1.00 | 1.00 |
| Previously Married | 2.23 (1.28, 3.90) | 1.83 (1.22, 2.74) |
| Never Married | 1.47 (0.96, 2.25) | 1.20 (0.87, 1.66) |
|
| ||
| Relationship Status | ||
| Married/Cohabiting (Ref) | 1.00 | 1.00 |
| Current Relationship | 1.35 (0.84, 2.16) | 1.32 (0.92, 1.89) |
| No Relationship | 2.07 (1.31, 3.29) | 1.57 (1.15, 2.13) |
|
| ||
| Relationship/Marital Status | ||
| Married/Cohabiting (Ref) | 1.00 | 1.00 |
| Current Relationship/Previously Married | 1.90 (0.95, 3.82) | 2.11 (1.33, 3.37) |
| Current Relationship/Never Married | 1.09 (0.70, 1.70) | 0.95 (0.64, 1.39) |
| No Relationship/Previously Married | 2.43 (1.35, 4.38) | 1.70 (1.06, 2.71) |
| No Relationship/Never Married | 1.81 (1.09, 3.00) | 1.45 (1.02, 2.06) |
Note: Controlling for gender, age, poverty ratio, and years of education.
For the 5-category relationship status variable, those not currently in a relationship who were either previously married (OR = 2.43, 95% CI = 1.35, 4.38) or never married (OR = 1.81, 95% CI = 1.09, 3.00) had significantly greater odds of 12 month MDD than those who were married/cohabiting. These same associations were significant for lifetime depression; respondents who were not in a current romantic relationship and were previously married (OR = 1.70, 95% CI = 1.06, 2.71) or never married (OR = 1.45, 95% CI = 1.02, 2.06) had significantly greater odds of being depressed. Respondents who were previously married and in a current relationship also had significantly higher odds of 12-month (OR = 1.90 95% CI = 0.95, 3.82) and lifetime (OR = 2.11, 95% CI = 1.33, 3.37) MDD compared to those who were married/cohabiting. Lastly, respondents who were never married but in a current relationship most closely resembled persons who were married or cohabiting for both 12-month and lifetime MDD.
Discussion
The findings of this report indicate that African Americans who are depressed are not only less likely to be married; they are also significantly less likely to be involved in a romantic relationship. This holds for both twelve-month and lifetime major depressive disorder. Our results suggest that depression may impede the development and fostering of romantic relationships as well as marriage.
Kessler’s seminal research on marriage and psychiatric disorders (Forthofer et al., 1996; Kessler et al., 1998) argues that psychiatric disorders negatively impacts marriage. In particular, individuals with psychiatric disorders are more likely to marry early and have a substantially higher risk of divorce. Based upon this research we created the second romantic relationship status variable that incorporates both whether a person has been previously married as well as whether they are in a romantic relationship. An examination of these findings expands our understanding of the association between romantic involvement and depression. For twelvemonth depression, respondents who were previously married and do not have a romantic involvement were more likely to meet criteria for depression than their married/cohabiting counterparts. Similarly, never married respondents who did not have a current romantic involvement also had a greater likelihood of being depressed than married/cohabiting respondents. Collectively, these findings reaffirm that not only are depressed African Americans less likely to be married, they are also less likely to be involved in romantic relationships.
The findings for lifetime depression are similar to those for twelve month depression. Both previously married respondents who do not have a romantic relationship as well as never married respondents who do not have a romantic relationship are more likely to meet criteria for lifetime depression than their married/cohabiting counterparts. Respondents who were previously married and were involved in a romantic relationship were also more likely to meet criteria for lifetime depression than their married/cohabiting counterparts. This latter finding runs counter to our initial expectation, but may be characteristic of lifetime depression as opposed to twelve-month depression. Similar to Kessler’s work (Kessler et al., 1998) our finding may reflect individuals who had early onset depression, married early and then divorced; and at some point later in life, were involved in a romantic relationship.
The findings of our brief report both confirm and extend existing research. First, married and cohabiting African Americans have lower rates of both twelve-month and lifetime depression than their unmarried counterparts (Kessler et al., 2005; Williams et al., 1992). Second, previously married African Americans were more likely to meet criteria for 12-month or lifetime depression. This is consistent with other work (Forthofer et al., 1996; Kessler et al., 1998) indicating that depressed adults have both high rates of early marriage and high rates of divorce. This is also consistent with previous research indicating that grief associated with divorce, separation and widowhood may result in serious psychiatric difficulties for some African Americans (Williams et al., 1992). The dissolution of a marital union may result in grief, loneliness, diminished social support networks and, in the case of divorce and separation, a decline in religious service attendance (Chatters et al., 1999; Williams et al., 1992). Third, our findings extend previous research by also showing that depressed African Americans are not only less likely to be married, they are also less likely to be involved in romantic relationships. This is particularly the case for 12-month depression.
Our study provides evidence for a more nuanced approach to studying marital and relationship status and mental health in which examining marital and romantic relationship status together promotes a better understanding of major depression. Examining marital status or relationship status separately may overlook heterogeneity within these categories. For example, being never married appeared to be unrelated to either 12-month or lifetime MDD when examining marital status alone. However, examining it in conjunction with relationship status revealed that those who were never married and not in a current relationship had significantly greater odds of both of these outcomes compared to those who were married or cohabiting.
Limitations
Our analysis is limited by the fact that although we have a relatively large sample, the number of cohabiting respondents precluded having cohabitation as a separate category. Similarly, although outside of the limited scope of this brief report, future research should investigate these relationships separately for men and women as well as examining other disorders.
Research on depression and other psychiatric disorders must take into account the changing marital and relationship circumstances of the U.S. population. In the case of African American families, the decrease in marriage has resulted in more adult dating as well as numerous other demographic shifts including an increase in female-headed households, increases in cohabiting households, a higher proportion of births to unmarried mothers, and larger percentages of children living in female headed and cohabiting households (Hummer & Hamilton, 2010; Taylor et al., 1990; Taylor et al., 1997). Although the lower rates of marriage are more evident in African American families, this trend is seen among white families, as well as in many industrialized countries (Amato, 2010; Cherlin, 2010). Finally, in many cases, sample sizes preclude a full investigation of these demographic groups, however, it is important to be aware of how these issues may impact research and clinical practice.
Acknowledgments
The data collection on which this study is based was supported by the National Institute of Mental Health (NIMH; U01-MH57716) with supplemental support from the Office of Behavioral and Social Science Research at the National Institutes of Health (NIH) and the University of Michigan. The preparation of this manuscript was supported by a grant from the National Aging to Dr. Taylor (P30-AG15281) and from the National Institute of Mental Health to Dr. Lincoln, Chae, and Chatters (R01-MH084963).
Footnotes
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References
- Amato PR. Research on divorce: Continuing trends and new developments. J Marriage Fam. 2010;72:650–666. [Google Scholar]
- American Association for Public Opinion Research. Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys. 4. Lenexa, Kansas: AAPOR; 2006. [Google Scholar]
- Burton LM, Tucker MB. Romantic unions in an era of uncertainty: A post-Moynihan perspective on African American women and marriage. Ann Am Acad Polit SS. 2009;621:132–49. [Google Scholar]
- Chatters LM, Taylor RJ, Lincoln KD. African American religious participation: A multi-sample comparison. J Sci Stud Relig. 1999;38(1):132–145. [Google Scholar]
- Cherlin AJ. Demographic trends in the United States: A review of research in the 2000s. J Marriage Fam. 2010;72:403–419. doi: 10.1111/j.1741-3737.2010.00710.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Forthofer MS, Kessler RC, Story AL, Gotlib IH. The effects of psychiatric disorders on the probability and timing of first marriage. J Health Soc Behav. 1996;37:121–132. [PubMed] [Google Scholar]
- Harknett K, McLanahan SS. Racial and ethnic differences in marriage after the birth of a child. Am Soc Rev. 2004;69:790–811. [Google Scholar]
- Jackson JS, Torres M, Caldwell CH, Neighbors HW, Nesse RN, Taylor RJ, Trierweiler SJ, Williams DR. The National Survey of American Life: A study of racial, ethnic and cultural influences on mental disorders and mental health. Int J Meth Psych Res. 2004;13:196–207. doi: 10.1002/mpr.177. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kessler RC, Walters EE, Forthofer MS. The social consequences of psychiatric disorders, III: Probability of marital stability. Am J Psychiatry. 1998;155:1092–1096. doi: 10.1176/ajp.155.8.1092. [DOI] [PubMed] [Google Scholar]
- Kessler RC, Ustun TB. The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) Int J Meth Psych Res. 2004;13:93–121. doi: 10.1002/mpr.168. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiat. 2005;62:593–602. doi: 10.1001/archpsyc.62.6.593. [DOI] [PubMed] [Google Scholar]
- Lincoln KD, Taylor RJ, Jackson JS. Romantic relationships among unmarried African Americans and Caribbean Blacks. Fam Relat. 2008;57:253–265. doi: 10.1111/j.1741-3729.2008.00498.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hummer RA, Hamilton ER. Race and ethnicity in Fragile Families. The Future of Children. 2010;20(2):112–131. doi: 10.1353/foc.2010.0003. [DOI] [PubMed] [Google Scholar]
- Taylor RJ, Chatters LM, Tucker MB, Lewis E. Developments in research on Black families: A decade review. J Marriage Fam. 1990;52:993–1014. [Google Scholar]
- Taylor RJ, Chatters LM, Tucker MB, Jayakody R. Demographic changes in Black family structure. In: Taylor RJ, Jackson JS, Chatters LM, editors. Family Life in Black America. Newbury Park, CA: Sage; 1997. [Google Scholar]
- Tucker MB, Taylor RJ. Demographic correlates of relationship status among Black Americans. J Marriage Fam. 1989;51:655–666. [Google Scholar]
- Williams DR, Takeuchi DT, Adair RK. Marital status and psychiatric disorders among Blacks and Whites. J Health Soc Beh. 1992;33:140–157. [PubMed] [Google Scholar]
- Williams DR, Gonzalez HM, Neighbors H, Nesse R, Abelson JM, Sweetman J, Jackson JS. Prevalence and distribution of major depressive disorder in African Americans, Caribbean Blacks, and Non-Hispanic Whites: Results from the National Survey of American Life. Arch Gen Psychiat. 2007;64:305–315. doi: 10.1001/archpsyc.64.3.305. [DOI] [PubMed] [Google Scholar]