Psychological problems affect a substantial proportion of the general population and rates of depression are particularly high. However, the majority of people with psychological difficulties, including depression, do not receive professional treatment. Instead, it appears that people generally prefer to call upon informal helpers in their natural networks. Research suggests, on the one hand, that extensive training is not necessarily required in order to
provide effective psychological help, and, on the other, that everyday support attempts, while arguably beneficial to well-being, can also be experienced as unhelpful by those on the receiving end. People coping with a serious physical illness, for example, may find that others exaggerate or appear dismissive of their symptoms; while the bereaved may encounter forced cheerfulness from those around them, or receive unwanted advice, including exhortations to get over their loss. Moreover, there is some evidence to suggest that unhelpful social encounters may be detrimental to the well-being of both the person on the receiving end and the would-be helper.
Time and again, research findings have identified the spouse or partner as the most important informal helper for people facing stressful circumstances. However, there is also some evidence to suggest that people with depressive symptoms are less likely to look to their partners for support. The research reviewed above suggests there may be several reasons for this. Numerous studies have shown that people who interact with depressed persons, even briefly, are at risk of some level of psychological distress themselves. Moreover, people with depression are more likely to be rejected or criticised by those with whom they interact. Similar findings have emerged in respect of depressed persons’ more intimate relationships. Thus it is known that the partners of people with depression have elevated levels of depressed mood compared with population norms, and also may be critical of their depressed spouse. Importantly, there is some empirical support for the notion that people experiencing low mood themselves are less likely to provide support.
Other research findings are also relevant to the issue of people with depression seeking or receiving support from their partners. There is evidence that depressed marriages are characterised by negativity and conflict, that depression may trigger marital problems and vice versa, and that spousal criticism may predict relapse rates. There is also evidence that partners of people with depression experience significant psychological burdens. They may find themselves limited in social and leisure activities, experience strained marital
C h a p te r 1: In tr o d u c tio n - D e p r e s s io n p a g e 4 5
relationships, and feel at a loss to know how to go about helping the person with depression or improve matters generally. Furthermore, it would not be surprising if partners of depressed persons became more intolerant of the disruption and burden experienced as their own moods deteriorated (Benazon & Coyne, 2000). Thus it would seem that depression can have a detrimental impact on both partners in a relationship.
However, while there is a growing literature on the helping process in couples facing various forms of physical illness, this has not so far extended to couples in which one partner is suffering from depression. Indeed, the support process in couples coping with a partner’s psychological difficulties in general has received surprisingly little attention from researchers. Perhaps unsurprisingly, the focus has tended to be on the problematic and conflictual aspects of these relationships rather than how partners try to help each other. Thus considerable data has accumulated on the challenges and difficulties experienced by such couples but much less is known about how partners try to help and what the recipients of partner support find beneficial.
Given the prevalence of depression and its impact on family relationships, there would seem to be a good case for exploration of the support provided by partners to people with depression. That such informal helping relationships are perhaps even more likely than others to be problematic, or even break down entirely, further strengthens the case for their investigation. Research may suggest ways to improve the match between what depressed persons are offered by their partners and what they would actually find helpful. Moreover, improved helping is likely to lead to general improvements in the relationship, which may, in turn, have implications for recovery from depression and the likelihood of relapse.
The current paucity of data on the helping process in couples with a depressed member suggests the need, at this stage, for an exploratory study investigating the experience of giving and receiving support for depression in the context of an intimate relationship. A qualitative study, involving in-depth interviews with a limited number of couples with a
depressed member, would seem most appropriate for this purpose. The goal of the investigation would be to obtain a rich and detailed picture of the support process in a small sample of couples, from the perspective of both support provider and recipient, in a way that captures individual nuances and complexities yet, it is hoped, also speaks to the experience of giving and receiving support for depression at a more general level.
Specifically, this qualitative study addresses the following questions:
• What kinds of help and support are people with depression offered by their partners? • What things that partners say or do are perceived as helpful or unhelpful?
• What sort of help do people with depression want from their partners?
• How do the partners of people with depression experience the process of providing support?
• How do people with depression experience the process of being helped by their partners?
Chapter 2: Method
In this descriptive, qualitative study, nine people with depression and their partners were interviewed about their experiences of giving and receiving support for depression in the context of a close relationship. After a first interview, couples were sent a tentative summary of the themes and issues they had raised and invited to participate in a briefer follow-up interview. This was an opportunity for couples to give their views on the investigator’s summary and to explore some of the issues they had raised in more detail. Both interviews with each couple were tape recorded and transcribed; the interview data was analysed using Interpretative Phenomenological Analysis (IPA; Smith, 1996a). Participants also completed several questionnaire measures, to provide additional contextual information on their relationships, depressive symptoms, and attitudes towards expressing emotion.
Ethical approval
This study was reviewed and approved by three research ethics committees: The Joint UCLAJCLH Committees on the Ethics of Human Research; Camden and Islington Community Health Services NHS Trust Local Research Ethics Committee; and Riverside Research Ethics Committee. The letters of approval can be found in Appendix I.