Relationship dissatisfaction, difficulty expressing emotions tied to depression

Relationship dissatisfaction, difficulty expressing emotions, and sexual dysfunction may lead to symptoms of depression in Asian women, according to a Singapore study.

“[The results show that] higher levels of depressive symptoms were predicted by lower relationship satisfaction, higher sexual dysfunction, and greater difficulty in emotional expressiveness,” said the researchers.

A total of 193 partnered women in Singapore (age ≥21 years; mean age 37.21 years, 56 percent Chinese) with no history of gynaecological cancer were recruited to participate in this cross-sectional study and asked to complete surveys. Participants provided demographic and comorbidity information. Depressive symptoms were assessed using the 7-point depression subscale of the Hospital Anxiety and Depression Scale (HADS), relationship satisfaction using the 4-item Dyadic Adjustment Scale-4 (DAS-4), sexual dysfunction using the 5-item Arizona Sexual Experience Scale, and emotional expressiveness using 2 items from the Ambivalence over Emotional Expressiveness Questionnaire (AEQ).

Of the study population, 15, 18, and 26 percent met the cut-off scores for depression, relationship dissatisfaction, and sexual dysfunction, respectively.

After adjusting for age and health status*, lower relationship satisfaction was associated with a higher risk of depressive symptoms (β, -0.213; p<0.001). [Ann Acad Med Singapore 2019;48:396-402]

Similarly, sexual dysfunction (β, 0.139; p=0.010) and increasing difficulty in emotional expression (β, 0.908; p<0.001) were linked to depressive symptoms. Difficulty in emotional expression was negatively associated with relationship satisfaction (β, -0.791; p=0.002).

The results also showed that relationship satisfaction at least partially mediated the association between difficulty in emotional expression and depressive symptoms (indirect effect, 0.169). In contrast, the association was not mediated by sexual dysfunction (indirect effect, 0.069), as noted through the lack of significant association between sexual dysfunction and difficulty in emotional expression (β, 0.492; p=0.162). Sexual dysfunction was also not associated with relationship satisfaction.

According to the Marital Discord Model of Depression (MDMD), “marital distress is a significant antecedent to depression for those who are married.” [Depression in Marriage: A Model for Etiology and Treatment. New York: Guilford Press; 1990] Prior research has reflected this, though it has focused primarily on the Western population, [J Soc Pers Relat 2003;20:355-371] with limited research among Asian populations which vary culturally from Western ones, said the researchers.

“Our data suggest that just like their Western counterparts, Asian women who have problems expressing themselves and their needs and who face marital or sexual difficulties have a higher risk of being distressed,” they said.

“[O]ur findings [also show] that the ability to express one’s self is important even in a society where open communication between spouses or romantic partners is stereotypically not always expected and may not be highly valued,” they added.

According to the researchers, the results highlight the importance of comprehensive assessment of individuals with depression, taking into consideration the elements examined in this study. Also crucial is identification of interventions that would work in populations that have “lingering societal taboo surrounding participation in psychological therapies or marital counselling.” However, they also noted that directionality could not be determined, and that depression may be leading to negative outcomes in relationships and not vice versa.