Anxiety, Depression as Shared Experience in Couples

Couples are at high risk for affective concordance, particularly with depression and anxiety.

Couples are at high risk for affective concordance, particularly depression and anxiety, according to a new British study.

Defined as “shared emotional states in partners,” affective concordance has garnered some research attention, but study findings have been inconsistent or have lacked rigor. J. Walker from the School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom, and colleagues conducted a 1-year cross-sectional study to “enable a better understanding of what components influence concordance” and to “highlight which of these may be targets for future interventions.”

The research used a primary care database consisting of 13,507 couples (aged 30-74 years) who lived at the same address, were of different sexes, had an age difference of no more than 15 years, and had no other adult between the ages of 30 and 74 years in the household.

The “outcome” was considered to be the presence of an anxiety or depression Read Code (in which the general practitioner recorded the reason for consultation) in the female partner, and the “exposure” was a recorded Read Code of anxiety or depression in the male partner.

Of the total population of 27,014 individuals (mean age, 52 years), 3.4% (n=927) patients recorded with an anxiety consultation, and 2.0% (n=538) recorded with a depression consultation. For both anxiety and depression, women recorded more than twice as many consultations as men (4.7% vs 2.2% and 2.8% vs 1.2%, respectively). More women than men consulted for both depression and anxiety (0.3% and 0.1%, respectively).

The researchers found no differences in these estimates when they adjusted for cardiovascular comorbidity or age. However, there were small reductions in the strength of association after adjustment for musculoskeletal consultations and psychiatric comorbidities. Increasing deprivation was significantly associated with female depression consultation, but not with anxiety. The greatest reduction in odds for both anxiety and depression took place when the researchers adjusted for healthcare engagement (ie, consultation frequency).

After adjustment for all factors, the odds ratio for the outcome of anxiety showed a small reduction from 2.98 (unadjusted model) to 2.48 (95% CI, 1.76-3.50) in the adjusted model, whereas the final depression multivariable model showed a more marked reduction from 4.45 (unadjusted model) to 3.39 (95% CI, 2.07-5.54).

The researchers conducted a sensitivity analysis that reversed exposure and outcome (ie, female partner consultation as exposure, male partner consultation as outcome). They found no marked difference from the original model.

“Female partners are more likely to have a consultation for anxiety or depression if their male partner has also consulted for the same condition,” the researchers comment, noting that these effects are “partially explained by the presence of comorbidity, healthcare engagement, and deprivation.”

The researchers state that their findings “support the affective concordance hypothesis of shared mental health state in couples and highlight the potential contextual influences on the rates of consultations for depression and anxiety in primary care.”

They indicate that their findings have important clinical relevance. For example, “social contextual factors” may be important to consider when patients present and consult for anxiety or depression in primary care. One issue to address is the “reaction or expressed emotion” that 1 member of the couple may have to the other member’s state (ie, increase in psychosocial stress in reaction to the partner’s anxiety/depression).

In addition, other negative shared life events, such as a death in the family, may contribute to concordance, and it “may be beneficial for clinicians to ask about the impact of such events at a partner or family level to give greater perspective on the context of the consultation.”

Clinicians should also inquire about the “level of relationship quality and marital discord present,” because depression and anxiety may well be a symptoms of discord and “may signify the need to access relationship counseling or couple therapy.”

On a public health level, the results can be extrapolated to the population at large and may “indicate the potential for taking a family level view on treatment.”

The authors conclude that their study “highlights the patients’ social context as a base for understanding consultations for anxiety and depression and gives support to the consideration of the patient’s household as an influence on patient’s mental health.”

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Walker J, Liddle J Jordan KP, Campbell P. Affective concordance in couples: a cross-sectional analysis of depression and anxiety consultations within a population of 13,507 couples in primary care. BMC Psychiatry. 2017;17:190. doi: 10.1186/s12888-017-1354-7.