Depression: Its impact upon the couple relationship
Depression is one of the most common psychological difficulties disorders affecting adults in the United Kingdom (UK). The Office for National Statistics (ONS) Measuring National Well-being program found that 20% of adults reported suffering from either anxiety or depression. While the ONS study found that being in a cohabiting or marital relationship was a protective factor against depression (with the rate of depression being higher amongst single and separated people than those in personal relationships) this article will focus on the impact of depression upon the couple relationship.
Depression is a complex condition with physical, cognitive, social and emotional consequences for people who suffer from this debilitating psychological difficulty. The physical effects of depression include changes in sleep patterns such as disturbed sleep and changes in eating habits which may cause weight loss or weight gain. Cognitive effects include difficulty concentrating, causing problems performing work, academic and other daily activities. There can often be changes in cognitive thought patterns with depressed people developing negative thought patterns about the world, other people and themselves.
A related issue is that depressed people often develop repetitive thought patterns known as ruminating, in which they repeatedly think about negative experiences in their life particularly if the depression developed in reaction to a negative life event such as bereavement. Becoming depressed also has negative impacts upon people’s social relationships. Individuals suffering from depression may be reluctant to socialise with others and may experience a reduction in their social network of family and friends as their interpersonal relationships with other people become strained.
The emotional effects of depression include low mood, tearfulness, mood swings and being particularly prone to anger. If you recognise that several of these symptoms apply to you, please seek the help you need from health professionals and your support network of family and friends. The positive news is that there is now a wealth of evidence based interventions which can be used to support people suffering from depression from anti-depressant medication to evidence based psychological therapies such as cognitive behavioural therapy, schema therapy and cognitive analytic therapy. Depression can vary in seriousness from mild, moderate to severe and often becomes worse if left untreated so seek support now.
Being in a relationship with a partner suffering from depression has important social and emotional implications for both the depressed person and their partner. This is especially the case when a loved one is suffering from moderate or severe depression which has more profound effects on their psychological state. When depression is moderate to severe this can particularly alter the dynamics of the couple’s personal relationship.
Partners of a depressed loved one often find themselves having to assume a caregiving role for their partner which was unnecessary prior to them becoming ill. Partners may have to assume responsibility for preparing and ensuring their loved one eats meals, supporting them by giving medication and, when the loved one is severely depressed, assuming responsibility for their partner’s self-care. It is often very challenging for both the depressed person and their partner to cope with the changes that depression has brought to the dynamics of their personal relationship.
Several couples describe feeling that the depression has resulted in their partner assuming the behaviour of an earlier developmental stage of their life such as childhood or adolescence. Partners have also often described difficulty in coping with the mood changes in their loved one that can accompany depression and have sometimes sadly described feeling that the person that they fell in love with has left and been replaced by someone who they are unable to recognise or relate to.
The partner of a person with depression may have to assume a protective role in ensuring that their loved one does not deliberately self-harm because of their illness. Self-harm takes several forms and can include a person self-destructively misusing alcohol or illegal drugs, cutting or attempting to end their life by over-dosing or hanging. Having to act as a caregiver for a depressed person to ensure that they do not self-harm is extremely stressful for both people within the couple relationship.
In some cases, the partner of a loved one suffering from depression has to constantly observe their loved one to ensure that they do not overdose or abuse alcohol. Partners of individuals with depression may find that because of their loved one’s illness they are unable to work, placing further economic strain on the couple and perhaps even damaging the partner’s self-esteem.
If you are a partner caring for a severely depressed loved one, it is important that you protect your emotional health to ensure that you do not become psychologically unwell and are able to continue caring for your depressed partner. If it is possible, please seek support for both your partner and yourself from your network of relatives, friends and healthcare professionals to ensure that your partner and you receive practical and emotional support.
Sadly this is not always possible as both members of the couple may find that their social support network has evaporated because people are unable to cope with their loved one’s depression. This can often sadly particularly seem to be the case for migrant couples who do not have any relatives in the United Kingdom (UK). There are often particularly severe social effects on migrant couples awaiting permission to settle permanently within the UK. Their insecure immigration status only serves to place further stress upon both partners in the relationship particularly when couples are experiencing significant economic stress when neither partner is able to work because of the loved one’s depressive illness.
When the loved one is experiencing a reactive depression as a consequence of miscarriage or death of a child, this can be particularly challenging for both partners within the couple relationship. For migrant couples seeking permission to remain permanently in the UK the stillbirth or death of a sole infant can be particularly cruel as they are aware that their case to remain in the UK would have been strengthened if their child had survived as they would have a legal argument for a right to family life.
However, for all couples coping with the loss of an unborn or born child there are major challenges. The depressed partner may feel hopeless about the loss of their child and the other partner may feel unable to share their feelings with the depressed loved one for fear of making their illness worse.
In my clinical experience it has been male partners who have been particularly inhibited in sharing their feelings of loss with a female partner who has miscarried or lost a child. The difficulties which male partners have experienced when it comes to sharing with their wives and girlfriends are often reinforced by their social and professional network which has focused most or all of the emotional support on their female partners. However, it is important that both partners in the relationship are able to share their feelings about the loss of a child.
Counselling and psychotherapy services have generally focused upon providing individual support to people experiencing depression with counselling or psychotherapy such as cognitive behavioural therapy. However, given the complex effects of depression on the couple relationship there is also a need for both couples and psychotherapists to be aware of the need to provide couple therapy or counselling which helps couples to cope with the significant impact of depression on the couple relationship.
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