Abstract
BackgroundDepression and anxiety are common and have a significant impact on the individual and wider society. One theory proposed to explain a heightened risk for depression and anxiety is affective concordance in couples (e.g. influence of shared mood states, shared health beliefs). Whilst research has shown concordance for severe psychiatric illnesses and general mood in couples, little attention has been given to concordance for common psychiatric conditions such as depression and anxiety. The aims of this study were to test affective concordance in couples and examine potential influences on concordance.MethodsStudy design is a 1-year cross-sectional study of anxiety and depression consultations in primary care. Data were obtained from a validated primary care database of recorded consultations. Outcome was the presence of an anxiety or depression Read Code (GP recorded reason for consultation) in the female (within the couple dyad), and exposure was a recorded Read Code of anxiety or depression in the male. Logistic regression was used to test associations with odds ratios (OR) and 95% confidence intervals (95% CI) reported. Statistical adjustment was carried out on potential influences of concordance; age, environment (deprivation), healthcare behaviour (consultation frequency), and comorbidity.ResultsA population of 13,507 couples were identified in which 927 people consulted for anxiety and 538 for depression. Logistic regression showed a 3 times increase in odds of an anxiety consultation in females if their male partner had also consulted OR 2.98 (95% CI 2.15 to 4.13). For depression females were over 4 times the odds of consulting if their male partner had also consulted OR 4.45 (95% CI 2.79 to 7.09). Adjustment within a multivariable model showed some reduction in odds; concordant anxiety was reduced to 2.5 times odds OR 2.48 (95%CI 1.76 to 3.50) and depression reduced to OR 3.39 (2.07 to 5.54).ConclusionResults show significant associations for affective concordance in couples. Factors influencing concordance are comorbidity and environmental factors, however reasons for deciding to consult (positive or negative) are unknown. This study highlights the patients’ social context as a factor in consultations for anxiety and depression and gives support to the consideration of the patient’s household as an influence on mental health.
Highlights
Depression and anxiety are common and have a significant impact on the individual and wider society
Overall there were 927 (3.4%) patients recorded with an anxiety consultation, and 538 (2.0%) patients recorded with a depression consultation
Females consulted more than twice as much for anxiety conditions (4.7%) as males (2.2%); a similar pattern was found for depression consultations (2.8% females, 1.2% males). 17 (0.1%) males had consulted for both depression and anxiety, and 38 (0.3%) females had consulted for both
Summary
Depression and anxiety are common and have a significant impact on the individual and wider society. Couples (i.e. married couple, partners living together) who live together are subjected to similar behavioural and environmental factors which may increase risk of disease concordance [23] These shared behavioural and environment influences can relate to external factors that the couple may have little control over, such as shared financial hardship, shared deprivation, or shared bereavement [24]. It may include lifestyle-orientated factors that couples may have more control over, such as a shared diet, shared health risk behaviour (e.g. smoking, alcohol intake), shared physical activity levels, or direct effects within the relationship such as marital discord [25,26,27,28]. There are positive reasons for concordance within a consultation population, it may be that one partner has received beneficial treatment for depression or anxiety and this encourages the other partner to seek healthcare
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