Insight: Depression. A couples’ disease?

Medical sociologist Dr Susan McPherson supervised a research team who interviewed partners of people with long-term depression. Their findings have been published in a paper called Couples' Disease: The Experience of Living with a Partner with Chronic Depression.

“The impact on couples seemed incredibly important,” explains Dr McPherson. “So many adults with long-term depression are in a relationship or have been in the past, and that relationship (whether it survives or breaks down) is a key part of the context within which any individual experiences depression.”

The research found that people suffering from depression who are in a relationship are rarely – if ever – offered couples therapy, and partners of patients feel excluded from their care.

The research team is calling for greater awareness of the emotional impact on partners among frontline health service staff and for increased accessibility of couples therapy.

Partners’ experiences

One of the key findings was that the participants had all gone through a similar process as their partners became unwell.

Pre-diagnosis, people tried to explain the changes they could see in their partner’s behaviour. While diagnosis gave them a concrete explanation and a hope that it was ‘something we can fix together’, the realisation that there was no simple cure then sank in and the depression started to dominate their life. They then had to learn to navigate their new day-to-day reality.

The impact on relationships

Crucially, on top of the burden on partners as individuals, the relationship between the couple was affected at every stage.

• Participants felt they no longer received emotional support from their partner, leading to feelings of resentment and a struggle to reconcile those feelings with ones of loyalty.
• Pre-diagnosis, conflict about seeking professional help often placed strain on the relationship.
• As participants realised that depression may be a long term problem with an uncertain trajectory, they had to adjust the assumptions they’d previously made about what their futures would look like.

This is where couples therapy comes in. As partners find depression coming between them, joint therapy could help partners work as a team again. Couples therapy has the potential to prevent relationship breakdown which in turn could help avoid further depressive episodes induced by relationship loss and so save health service resources in the longer term.

Current UK provision

As of November 2017, current National Institute for Health and Care Excellence (NICE) guidelines say that couples therapy should be “considered” if a relationship might be contributing to an individual’s depression. Draft new guidelines propose that it should also be considered if involving the partner may help with the individual’s treatment.

“NICE judges treatments on a very narrow basis,” says Dr McPherson. “NICE focuses on short-term outcomes, looking only at symptoms in individuals, which doesn’t give the full picture of the wider and longer term burden on those individuals, couples, families and communities. NICE is failing to treat depression as a long-term condition on par with physical conditions – a supposed NHS principle known as ‘parity of esteem’.”

None of the people interviewed by our researchers had been offered couples therapy, and most felt excluded from their partner’s care and treatment. They felt medical professionals didn’t acknowledge the significant impact that living with a partner with depression can have.

Looking ahead

“We obviously want to see couples therapy offered more widely for depression, but it goes further than that,” says Dr McPherson.;

“We hope our research will highlight the link between past and present relationship difficulties and depression and show that couples therapy could also be used as a preventative measure – an intervention before depression develops.”