Marital Difficulties Research Articles

Vulvar vestibulitis: an integrated psychological and physical approach

Vulvar vestibulitis is a frequently occurring syndrome and a major cause of personal and marital difficulties. Effective management requires a thorough understanding of the mechanisms that lead to the disorder. We advocate taking in an integrated psychological and physical approach.

Vancouver’s newest Chinese diaspora: settlers or “immigrant prisoners”?

This study seeks to reground concepts of “diaspora” and “transnationalism” in the realities of everyday life through examining the lived experiences of immigrants. Based on in-depth household interviews and focus groups, it examines the newest Chinese diaspora in Vancouver—skilled immigrants from the People’s Republic of China. It explores the challenges that they face in an unfamiliar city, including employment and language barriers as well as domestic anxieties surrounding childcare, education and marital difficulties. The strategies that they adopt to counter these problems are at times transnational—in the form of astronaut families or transnational childcare—but almost always familial. Ultimately, the settlement challenges that they face, coupled with the available transnational possibilities, raise the question of whether they are settlers or “immigrant prisoners”, temporarily serving their time in Vancouver before a further relocation.

Humour, beauty, and culture as personal health resources: Experiences of elderly Swedish women

This paper explores how a group of elderly women used humour, beauty, and cultural activities to maintain physical and mental well-being. The paper reports on one aspect of a qualitative study on women's work and health in a lifetime perspective. Interviews with 20 strategically selected Swedish women, aged 63 to 83 years, were audiotaped and analysed according to a phenomenological approach. During the interview process, the researchers became increasingly aware that the women had clear ideas about what enabled them to feel well and healthy - even when actually quite diseased. Creating and enjoying humour, beauty, and culture formed part of such strategies. Joking with workmates made hard, low-status jobs easier, helped them endure pain, and helped balance marital difficulties. Creating a nice and comfortable home gave pleasure and a little luxury in a life filled with necessities. Making articles for everyday use more beautiful was regarded as worthwhile, because it gave delight to them and their families. Gains from cultural activities were social, aesthetic, and existential - the latter through a feeling of self-recognition and being heard. Humour, beauty, and culture formed a greater part of these women's survival strategies than expected. Making everyday life more aesthetic is an undervalued aspect of women's health-creating work in the family. Through their lifelong experience as carers and homemakers, elderly women possess special knowledge regarding what may promote health, a knowledge that should be tapped. When supplying elderly women with social care, their needs for humour, beauty, and culture should be respected.

Relationship Violence Among Couples Seeking Therapy: Common Couple Violence or Battering?

Relationship violence is highly prevalent among couples seeking therapy (Ehrensaft and Vivian, 1996; Jouriles and O'Leary, 1985), yet few couple therapists regularly assess for violence (Dimidjian, Berns, and Jacobson, 1999), and there is limited research on the type of violence most characteristic of couples in this population. The current study uses latent class analysis to examine types of violence in a sample of 273 therapy-seeking couples. The results support a three-class typology, with the groups labeled no violence, low-level violence, and moderate-to-severe violence. Comparisons between the classes support hypothesized differences between groups in degree of marital satisfaction and difficulties in communication, providing further validation of the typology among couples seeking treatment. Clinical and research implications are discussed.

Stray Wives: Marital Conflict in Early National New England (review)

Stray Wives: Marital Conflict in Early National New England By Mary Beth Sievens. (New York: New York University Press, 2005. Pp. 184. Cloth, $42.00.)Reviewed by Lucia McMahonStray Wives examines the hundreds of elopement notices that were published in New England newspapers between 1790 and 1830. Mary Beth Sievens's analysis of these documents provides fascinating insight on how early national men and women negotiated marital difficulties. Sievens carefully situates her study of marital conflict within legal, economic, and cultural transitions that emerged in the early Republic. Stray Wives focuses on Connecticut and Vermont, two New England states that had relatively similar and fairly lenient divorce statutes by late eighteenth-century standards (8). Yet only a fraction of New England couples chose divorce as a permanent solution to their marital problems. Between 1790 and 1830, the Vermont and Connecticut state courts heard 148 and 251 divorce petitions, respectively, yet during these same years, many hundreds of elopement notices were printed (317 and 461 in two sample counties). Sievens's sampling of these desertion notices indicates that only one-third of the couples who published notices actually went on to divorce. Instead, couples employed a variety of strategies to deal with marital problems. Printed elopement notices served as one strategy or one part of the negotiation process, typically on the part of men, to try and convince their spouses to return to unhappy or unsatisfying marriages.One of the most notable characteristics of these elopement petitions is that the vast majority were published by men. Sievens notes that no more than 4 percent of the petitions were written by women, and most of these were submitted as responses to their husbands' petitions. Only in a dozen or so instances did a woman initiate a petition-that is, a petition that was not a direct response to one previously submitted by her husband. Sievens interprets this overwhelming gender disproportion as evidence of a husband's position of power and privilege in marriage. In essence, the petitions allowed men to punish wives for their transgressions, to withhold economic support as a consequence of desertion. Typically, women did not enjoy this same type of economic leverage over their husbands, and thus their use of petitions served mainly to defend their reputations and honor against their husbands' charges. Familial, social, and community ties, rather than published desertion notices, were the more common strategies employed by women who sought to justify their desertions.Sievens argues that men used their elopement notices as patriarchal tools that emphasized married women's economic dependence (3). While she interprets these notices as male efforts to assert power and control in marriages, one could also read these petitions as evidence of a crisis in patriarchical authority. These petitions contained the published, admitted complaints of early national men who could not coerce their wives to perform household chores; men who could not curb their wives' consumer spending habits; men who could not even stop their wives from deserting them. One wonders how their Puritan forefathers would have reacted to these numerous and dramatic failures of male household authority. While early national men certainly continued to hold legal and economic advantages in marriage, increasingly such privileged positions were no guarantee that husbands could count on obedient, submissive wives.Culturally and emotionally, the dominant position of the male patriarch was under attack. The ideal of companionate marriage recast marriage as an egalitarian, affectionate union between equal partners. This new emotional standard softened the notion of patriarchy in marriage, stressing companionship and cooperation, rather than uncontested male authority and control. Wives were still expected to defer to their husbands' authority; but they also expected to exert a great deal of shared decision making, influence, and status within their marriages. …

Childhood trauma and marital outcomes in adulthood

AbstractAlthough existing research suggests that certain childhood traumas such as childhood sexual abuse are associated with interpersonal (e.g., marital) difficulties in adulthood, there has been limited research on interpersonal sequelae of other types of traumas. In addition, the association between childhood traumas and interpersonal outcomes has often been limited to a particular outcome such as divorce, and existing studies have rarely controlled for the co‐occurrence of other traumas when evaluating interpersonal outcomes. The current study sought to evaluate the associations between 7 childhood traumas and 2 marital outcomes—marital disruption (i.e., divorce and separation) and marital satisfaction—in a large, national probability sample. Results from univariate and multivariate analyses indicated that (a) probability of marital disruption was higher among people who during childhood had experienced physical abuse, rape, or serious physical attack or assault; and (b) current marital satisfaction was lower among people who during childhood had experienced rape or sexual molestation. Results support the importance of childhood traumas in predicting 2 important marital outcomes.

Controlled study of anxiety and depression in mothers of children with learning disability in Lagos, Nigeria

Parents of children with learning disability have been reported to suffer great stress and frustration due to increased burden of care. The manifestation of stigmatization by familial environment and the collective effect of the children with adverse impact on mothers predispose them to mental shock or a variety of neurotic symptoms and other psychiatric conditions including anxiety and depression. The objectives of the study were: to determine the general Health Questionnaire (GHQ) score of mothers of children with learning disability. To identify sociodemographic variables and to assess anxiety and depression in them. Using structured questionnaires between March and May 2002, 106 mothers of children with learning disability in a Mentally Handicapped Home for children in Lagos, Nigeria were assessed and compared with mothers of normal healthy children in Lagos. The mean age of the subjects was 40.0 +/- 6.6 years. More of the subjects (26.4%) compared with mothers of normal healthy children (9.9%) had a high GHQ score and high levels of anxiety (25.5%) and depression (10.4%). Marital difficulties were associated with learning disability. Mothers of children with learning disability are prone to emotional and psychological disorders. In order to improve the well-being of children with learning disability, there is need to look into the mental and physical health of mothers. Early and prompt treatment of associated anxiety and depression will no doubt help the children.

FATHERHOOD AND DEPRESSION: A REVIEW OF RISKS, EFFECTS, AND CLINICAL APPLICATION

This literature review attempted to compile a complete evaluation of the presentation, risks, and subsequent effects upon a family in relation to paternal depression. Clinical applications are reviewed as well. As with women, fathers will present with a dysphoric mood, but unlike their female counterparts, depressed men often experience a change in social behavior. Withdrawal from social situations, indecisiveness, cynicism, and an irritable mood are often found as hallmark signs of depression in the adult male. Life stress, or family stress and low social support, are risk factors associated with depression among fathers. Marital difficulties may be the most common trigger for first-time depression in husbands just as divorce amplifies depressive episodes, especially when children are involved. A variety of treatments have proven effective for depressed fathers including traditional psycho-dynamic, CBT, and group therapy. Therapy is effective when it can be initiated and continued but research repeatedly showed that men seek it out far less than women. Effective outreach programs to encourage treatment among depressed fathers are recommended.

Toward a Comprehensive Developmental Model for Major Depression in Women

Objective: Major depression is a multifactorial disorder with many etiologic variables that are interrelated through developmental pathways. The authors used structural equation modeling to generate a developmental model for the etiology of major depression in women. Method: Data from 1,942 adult female twins, interviewed up to four times over a 9-year period, were used to construct a developmental model to predict depressive episodes in the year before the most recent interview. Eighteen risk factors in five developmental tiers were considered: 1) childhood (genetic risk, disturbed family environment, childhood sexual abuse, and childhood parental loss), 2) early adolescence (neuroticism, self-esteem, and early-onset anxiety and conduct disorder), 3) late adolescence (educational attainment, lifetime traumas, social support, and substance misuse), 4) adulthood (history of divorce and past history of major depression), and 5) the last year (marital problems, difficulties, and stressful life events). Resul...

Power in relationships of women with depression

To identify marital power difficulties specifically associated with depression, twenty couples in which the female partner was depressed were compared on a range of interpersonal power variables with twenty healthy control couples and also with twenty couples in which the female partner had a disorder other than depression (specifically panic disorder with agoraphobia (PDA)). Couples in the depressed group had two features that distinguished them from couples in both the PDA and control groups and which were independent of relationship dissatisfaction. In the depressed group, both partners reported more physical assault in the year prior to the study and depressed women were more dissatisfied with their control of surplus spending money. Couples in the depressed group had a series of features that distinguished them from couples in both the PDA and control groups but which were due in part to relationship dissatisfaction. Depressed women were less committed to their relationships. Both partners in depressed couples reported more demand–withdraw transactions and less mutual constructive communication within their relationships. Depressed women reported more dissatisfaction with decision‐making and greater dissatisfaction in childcare task distribution.

Course and Short-Term Outcomes of Separation Anxiety Disorder in a Community Sample of Twins

To assess the course and short-term outcomes associated with separation anxiety disorder (SAD) in a community setting. The subjects were 161 of 2,061 8- to 17-year-old twins with SAD from a community-based twin study. Subjects were born between 1974 and 1983. Subjects and parents were personally interviewed about the subject's current psychiatric history between 1990 and 1993. A follow-up interview was conducted, on average, 18 months later. Logistic regression was used to identify predictors and outcomes of persistent SAD. Of the 161 subjects with SAD at time 1, 80% had remitted and 59% were free of any disorder at follow-up. Children with persistent SAD had a significantly higher prevalence of oppositional defiant disorder, significantly more impairment associated with symptoms of attention-deficit/hyperactivity disorder, and mothers who were less satisfied with their marriage at time 1 than children with transient episodes. Children with persistent SAD had a significantly higher prevalence of overanxious disorder or a new minor or major depressive disorder at time 2 than children with transient SAD. After controlling for comorbidity, only an elevated risk of new depressive disorders at time 2 distinguished children with persistent SAD. Many children with SAD in a community setting are well at follow-up, on average, 18 months later. A minority of children with persistent SAD are at significantly increased risk of a new depressive disorder, especially those with a history of oppositional defiant disorder, impairment associated with symptoms of attention deficit hyperactivity disorder, or parental marital difficulties.

Sexual dysfunction in Saudi depressed male patients

INTRODUCTIONSexual dysfunction is common among depressed male patients; however, its causes are complex and multifactorial. The aim of this study is to identify risk factors for sexual dysfunction associated with depression.METHODSOne hundred and twenty-five consecutive depressed male patients were interviewed at Jeddah Psychiatric Hospital. They were divided in to two groups, on the basis of whether they had sexual dysfunction or not. These two groups were then compared on a number of potential risk factors, using chi-square and odds ratio.RESULTSThe majority of patients had not previously been asked about sexual dysfunction. Seventy-seven (62%) presented with sexual dysfunction and 48 (38%) without. Marital difficulties, hypertension, diabetes, severity of depression and tricyclic antidepressants were significant risk factors. No association was found with demographic origin, occupation, education or marital status. These results are similar in some aspects to those reported in western studies.CONCLUSIONS(a) The majority of doctors do not take a sexual history despite its high prevalence. (b) Physical illness and overall severity of depression were important risk factors.

Making sense of informant disagreement for overanxious disorder

A community sample of 2798 8–17-year-old twins and their parents completed a personal interview about the child’s current psychiatric history on two occasions separated by an average of 18 months. Parents also completed a personal interview about their own lifetime psychiatric history at entry to the study. Results indicate that informant agreement for overanxious disorder (OAD) was no better than chance, and most cases of OAD were based on only one informant’s ratings. Disagreement about level of OAD symptoms or presence of another disorder (mostly phobias or depression) accounted for most cases of informant disagreement: 60% of cases based only on child interview, 67% of cases based only on maternal interview, and 100% of cases based only on paternal interview. OAD diagnosed only by maternal interview was also distinguished by an association with maternal alcoholism and increasingly discrepant parental reports of marital difficulties. Given the substantial overlap in case assignments for DSM-III-R OAD and DSM-IV GAD, these findings may identify sources of informant disagreement that generalize to juvenile GAD.

The efficacy of couples‐based interventions for panic disorder with agoraphobia

From this systematic literature review it was concluded that panic disorder with agoraphobia (PDA) can sometimes occur in conjunction with marital problems. Couples‐based treatments for PDA – partner‐assisted exposure and marital therapy – can be an effective treatment for the condition. It is as effective as individually based cognitive behaviour therapy. Involving partners of people with PDA in therapy may be appropriate in some cases, particularly those in which there are marital difficulties. Couple‐focused interventions may enhance the maintenance of treatment gains by facilitating interactions that positively reinforce and perpetuate attempts by people with PDA to enter feared situations and cope with these effectively. People with PDA who have good marital relationships show a better response to both individual and couples‐based treatment programmes. In some instances effective couples‐based treatment leads to improvement in marital adjustment as well as in PDA symptomatology.

Marital predictors of symptom severity in panic disorder with agoraphobia

Twenty-six to forty percent of individuals suffering from panic disorder with agoraphobia (PDA) do not benefit significantly from cognitive-behavior therapy. Marital problems are among risk factors that may explain this limited impact. Some studies suggest that PDA treatment outcome is related to the couple’s ability to communicate and solve problems during and after treatment. It may be also useful to further clarify the interplay of marital interpersonal variables with PDA severity before any intervention. This study aims at specifying the links between PDA symptom severity on the one hand and, on the other hand, marital adjustment, attachment style and personal problem-solving skills in both spouses. Results obtained from a group of 67 PDA patients (44 women and 23 men) and their partners showed that some PDA symptoms or comorbid depressive symptoms were more severe when both spouses independently scored low on problem-solving skills or marital adjustment, and when attachment style of PDA patients was insecure. Marital adjustment and difficulties in problem-solving, more specifically, avoidance of problem-solving activities in PDA patients, were the best predictors of PDA symptom severity. In light of these findings, a more complete program of problem-solving and acceptance strategies could be developed as part of a cognitive-behavior treatment of PDA. Other theoretical and clinical implications are discussed.

South Asian women in Britain: their mental health needs and views of services

This paper describes a survey carried out by a South Asian women's voluntary organisation to identify the physical and mental health needs of its users. The results confirm research findings that suggest a high proportion of South Asian women suffer from psychological and somatic symptoms that are commonly associated with anxiety and depression. A considerable number had experienced racial discrimination and several had suffered sexual discrimination. Problems reported by participants included eating disorders, marital difficulties and domestic violence. The majority did not know where to seek help for mental health problems. Respondents wanted confidential talking and complementary therapies to be provided in services run by South Asian staff, and for health education and health promotion to be provided in their own ethnic language. The paper ends with a consideration of the implications of these findings for the delivery of mainstream mental health services, from health promotion through primary care to specialist services.

Divorce, Patriarchal Authority, and Masculinity: A Case from Early National Vermont

In 1976, in a pathbreaking article on divorce in eighteenth-century Massachu? setts, Nancy Cott argued that the growing willingness of late eighteenth-century women to seek divorce implied that these wives were increasingly asserting con? trol over the direction of their lives and that wives who sought divorce in the Revolutionary era were, in part, responding to an enhanced sense of citizenship and legal rights. The fact that the success rate of women's divorce petitions also had improved suggested to Cott that wives' status within the family had risen in the eyes of authorities. Other scholars, such as Merril Smith, Glenda Riley, Steven Mintz, and Susan Kellogg, have portrayed the growing numbers of divorces and the increasingly liberal divorce laws ofthe late eighteenth and early nineteenth centuries as indicative of a gradual cultural shift away from tradi? tional notions of patriarchal authority within marriage, toward more egalitarian and companionate marital ideals. More liberal divorce laws and proceedings implicitly allowed wives to judge their husbands and to appeal to the courts to end their marriages when the women believed that their husbands had behaved inappropriately. Such laws provided married women with a way to challenge and possibly dissolve their husbands' authority over them. When viewed in this context, liberal divorce laws appear to have mounted a sustained challenge to marital patriarchy. However, not all historians have agreed with this assess? ment of late eighteenthand early nineteenth-century divorce law and practice. Michael Grossberg, in particular, has argued persuasively that increasingly lib? eral divorce laws did not truly undermine male authority within marriage, but rather substituted the authority ofa male judiciary for that of husbands. Other scholars who share this view also maintain that instead of challenging patri? archy, more liberal divorce laws merely provided a safety valve, a remedy for the worst abuses of patriarchal marriage, while upholding an ideal of benevolent patriarchal authority within marriage.1 The debate over the relationship between divorce and patriarchy has been invaluable to our understanding of the opportunities available for eighteenthand nineteenth-century husbands and wives to shape their marriages, as well as to our understanding of the larger cultural implications of individual marital conflicts. However, the debate has focused on divorce law and practice primarily from the point of view of legislators, jurists, and legal commentators. Very few scholars have attempted to assess the effects of divorce on patriarchal author? ity from the points of view of those husbands and wives who appeared before the courts to resolve their marital difficulties. To a certain degree, this lack of scholarship reflects the lack of sources detail ing the personal experiences and perceptions of couples who divorced. On occasion, however, the participants in

Profiles of impaired health professionals.

There are numerous studies that describe the characteristics of impaired health professionals and the types of professional misconduct leading to licensing board action. These studies have two fundamental limitations. The first is the sampling procedure, and the second is that they typically do not examine health professionals who are currently in treatment. This study describes the problems that lead health professionals--comprising psychiatrists, nonpsychiatric physicians, psychologists and social workers--to seek treatment and the sources of referral for treatment. A total of 334 health professionals were studied who sought out an evaluation or treatment at The Menninger Clinic between 1985 and 2000. The findings indicated that the participants' therapist was the largest referral source and that the most commonly cited problems leading to referral were marital and emotional difficulties rather than substance abuse, boundary violations, or prescribing problems. Licensing and regulatory agencies can take proactive steps to identify professionals with social and emotional vulnerabilities who may be at greater risk for unethical and negligent behavior.

The determinants of attempted suicide in a general hospital setting in Fiji Islands: a gender-specific study

The objective of the study was to examine the sociodemographic and clinical factors influencing gender-specific attempted suicide. Suicide attempters, 40 males and 88 females, seen on a consultation-liaison psychiatric service over a period of 42 months (from January 1, 1999 to June 30, 2002) were compared on sociodemographic and clinical variables. The female attempters [22.99 years (SD 8.1)] were younger than their male counterparts [25.15 years (SD 9.5)] [ P = 0.0002]. A higher proportion of the male attempters were engaged in outside occupations, compared with their female counterparts who were mainly full-time housewives or engaged in domestic duties [ P = 0.003]. Alcohol misuse was more associated with male suicide attempts [ P = 0.001]. Ninety percent of male attempters and 54.6% of the female attempters had the intention to die [ P = 0.001]. Although depressive episode was the most common psychiatric disorder in male attempters, followed by neurotic and stress-related disorders, while neurotic and stress-related disorders ranked first in female attempters followed closely by depressive episode, the difference was not significant. However, significantly more male attempters required pharmacotherapy and psychological intervention than their female counterparts [ P = 0.002]. More females had marital difficulties, although comparing the two groups on social difficulties did not yield a significant difference. Method used, personality disorders, previous attempt, repeat attempt, race, religion, and marital status were not significant distinguishing factors. Younger age, lack of employment outside home, marital problems, and nondeath motives were more influential in female attempted suicide, while alcohol misuse and severe psychiatric morbidity were more frequently associated with male attempted suicide. The findings support gender-specific preventive and interventional strategies.

Believing as Ourselves

This book represents the "female" side of a new genre in Islamic publishing.Jones, a white American convert, educated, well-read, and passionate abouther native tongue and its literature, writes of her experiences as a femaleconvert to Islam and, as the saying goes, ''tells it like it is." Like JeffreyLang, who provides the foreword, the author puts into words the confusion,hurt, bewilderment, and anguish that many converts feel after they comedown from the giddy heights of"saying their shahadah," - experiences thatmay all but extinguish the initial spark of excitement and enthusiasm.The book traces Jones' progress from initial conversion and communityinvolvement, to "burn-out'' and withdrawal, and on to her recoveryfrom depression and marital difficulties. In a pattern familiar to many converts,the initial spiritual delight - even euphoria - is soon swamped bylayer upon layer of community-induced confusion, rebuffs, snubs, dogmatism,and even racism. She speaks with reference to her interaction withthe Arab community, but the pattern will be familiar to many of those whoare either converts to Islam and/or partners in mixed marriages.Jones introduces the Muslim community to the idea of "personalauthenticity" and suggests that converts may suffer greatly when theylose their own ethnic or cultural identity in the effort to become more likethe born-Muslim community in which they find themselves. While this isan interesting idea, a brief search of such terms via my favorite websearch engine led to a host of gay and lesbian sites. Not knowing the pre ciseorigin of the notion of "personal authenticity," it wou Id appear to bea matter that should be handled with caution.The author frankly discusses depression, instead of accepting its beingswept under the carpet and dismissed as "madness" or the product of weakfaith ... and, therefore, one's own fault. This is another area that deserves theMuslim community's further attention, and in which Jones blazes a longoverduetrail. In addition to the spiritual approach, she provides some practicaltools for dealing with it, such as journaling and physical exercise. Thisbrings us back to the issue pertaining to the loss of identity and personalauthenticity, as she asks: How can you come to prayer without your heart?Jones also touches upon women's issues. The chapter on "TheAmerican Harlot," which makes for painful reading, highlights the ...