kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2016.16.1.11 kjhp-16-11 Original Article The Impact of a Spouse's Depression on Family Functioning and Communication YooSeung-Hyun 1 KwonHyuk-Ju 1 KimSun-Hee 1 LeeJung-Ah 1 SunwooSung 1 KimYoung-Sik 1 KimByung-Su 2 OhHan-Jin 3 KimChul-Min 4 ChoiHee-Jeong 5 HwangHee-Jin 6 OkSun-Wha 7 Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Family Medicine, Vievis Namuh Hospital, Seoul, Korea Department of Family Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine, Seoul, Korea Department of Family Medicine, Eulji University School of Medicine, Daejeon, Korea Department of Family Medicine, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Seoul, Korea Department of Child Development and Family Studies, Institute of Human Ecology, Seoul National University, Seoul, Korea Corresponding author: Young-Sik Kim, MD, MPH, PhD Departments of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3811, Fax: +82-2-3010-3815 E-mail: youngkim@amc.seoul.kr 01 2016 20 01 2016 16 1 11 19 16092015 06112015 Copyright © 2016 The Korean Society of Health Promotion and Disease Prevention 2016 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background

Depression is known to affect family function and communication. However, the distress experienced by those who have spouse with depression has not been properly assessed to date. This study attempted to examine the effect of depression on family function and communication as reported by the spouses of the depressed patients.

 Methods

The participants of this study were 445 couples who visited 28 family doctors from April 2009 to June 2011. The Family Adaptability and Cohesion Evaluation Scale III (FACES-III) was used to evaluate the family function, and the family communication scale in FACES-IV was used to evaluate communication among family members. A score of more than 21 points on the CES-D scale was used to indicate depression. The relationships between family type, family communication, and the depression of one's spouse were analyzed using the chi-square test and logistic regression.

 Results

The odds ratios, indicating how the family is heading towards an extreme level, were statistically significant in all male and female respondents (male: odds ratio [OR] 3.08, 95% confidence interval [CI] 1.73–5.48; female: OR 2.09, 95% CI 1.02–4.27). On the other hand, only female respondents with depressed spouses reported their family communication not to be good (male: OR 1.65, 95% CI 0.88–3.07; female: OR 2.48, 95% CI, 1.25–4.93).

 Conclusions

This study revealed people perceive their family function and communication not good when they have spouses with depression. There was no gender difference in the evaluation of their family function, but the perception on their family communication were different by gender.

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Demographic and clinical characteristics of the study participants

  Male Female
  Subjects with Subjects without   Subjects with Subjects without  
  spouse's depressiona spouse's depression P valueb spouse's depression spouse's depression P value
  (n＝71) (n＝374)   (n＝45) (n＝400)  
Age, years     0.01     0.57
Mean±SD 62.0±8.5 62.0±10.0   59.67±9.7 58.51±9.4  
＜50 3 (4.2) 57 (15.2)   6 (13.3) 79 (19.8)  
50–59 25 (35.2) 74 (19.8)   12 (26.7) 123 (30.8)  
60–69 30 (42.3) 150 (40.1)   20 (44.4) 149 (37.2)  
＞70 13 (18.3) 93 (87.7)   7 (15.6) 49 (87.5)  
Education (duration, years)     0.05     0.01
＜12 33 (46.5) 220 (58.8)   11 (24.4) 153 (38.2)  
12 22 (31.0) 107 (28.6)   14 (31.1) 149 (37.2)  
＞12 16 (22.5) 47 (12.6)   20 (44.4) 98 (24.5)  
Monthly income, 10,000 won/month     0.01     0.001
≥ 600 18 (25.4) 117 (31.3)   4 (8.9) 115 (28.7)  
400–599 14 (19.7) 83 (22.2)   6 (13.3) 95 (23.8)  
200–399 18 (25.4) 123 (32.9)   20 (44.4) 125 (31.2)  
＜200 21 (29.6) 51 (13.6)   15 (33.3) 65 (16.2)  
Smoking     1.00     1.00
Current smoker 19 (26.8) 100 (26.7)   6 (13.3) 53 (13.2)  
Ex/never smoker 52 (73.2) 274 (73.3)   39 (86.7) 347 (86.8)  
Physical activityc     0.05     0.45
High 26 (36.6) 139 (37.2)   9 (20.0) 115 (28.7)  
Moderate 16 (22.5) 130 (34.8)   16 (35.6) 132 (33.0)  
Low 29 (40.8) 105 (28.1)   20 (44.4) 153 (38.2)  
Diabetes mellitus     0.36     0.70
Yes 17 (25.0) 111 (30.5)   6 (13.6) 45 (11.6)  
No 51 (75.0) 253 (69.5)   38 (86.4) 342 (88.4)  
Hypertension     0.49     0.43
Yes 39 (57.4) 172 (47.3)   17 (38.6) 127 (32.7)  
No 29 (42.6) 192 (52.7)   27 (61.4) 261 (67.3)  

Values are presented as number (%) or mean±SD.

Depression: Center for Epidemiologic Studies Depression Scale CES-D) score ≥ 21.

P value was calculated using the chi-square test.

Categorized by International Physical Activity Questionnaire (IPAQ) short-form.

Comparison of adaptability and cohesion between subjects with spouse's depression and subjects without spouse's depression

    Subjects with spouse's depression Subjects without spouse's depression P valuea
Male
Adaptability Rigid 30 (42.3) 78 (20.9) 0.002
  Structured 17 (23.9) 122 (32.6)  
  Flexible 12 (16.9) 99 (26.5)  
  Chaotic 12 (16.9) 75 (20.1)  
Cohesion Disengaged 48 (67.6) 173 (46.3) 0.01
  Separated 12 (16.9) 105 (28.1)  
  Connected 9 (12.7) 75 (20.1)  
  Enmeshed 2 (2.8) 21 (5.6)  
Female
Adaptability Rigid 13 (28.9) 69 (17.2) 0.13
  Structured 12 (29.4) 119 (29.8)  
  Flexible 7 (15.6) 112 (28.0)  
  Chaotic 13 (28.9) 100 (25.0)  
Cohesion Disengaged 26 (57.8) 167 (41.8) 0.09
  Separated 13 (28.9) 115 (28.7)  
  Connected 5 (11.1) 82 (20.5)  
  Enmeshed 1 (2.2) 36 (9.0)  

P value was calculated using the chi-square test.

Comparison of family functioning and communication between subjects with spouse's depression and subjects withou spouse's depression

    Subjects with spouse's depression Subjects without spouse's depression P valuea
Male        
Family type Appropriate 41 (57.7) 300 (80.2) ＜0.001
　 Extreme 30 (42.3) 74 (19.8)  
Communication Good 48 (67.6) 300 (80.2) 0.02
　 Poor 23 (32.4) 74 (19.8)  
Female        
Family type Appropriate 30 (66.7) 317 (79.2) 0.05
　 Extreme 15 (33.3) 83 (20.8)  
Communication Good 27 (60.0) 324 (81.0) 0.001
　 Poor 18 (40.0) 76 (19.0)  

P value was calculated using the chi-square test.

Multivariate logistic regression to predict odds ratio of extreme family type and poor family communication according to presence of spouse's depressiona

    Appropriate Extreme Adjusted OR Good Poor Adjusted OR
    family type family type (95%CI) communication communication (95%CI)
Male
Spouse's depression No 300 (80.2) 74 (19.8) 1 (reference) 300 (80.2) 74 (19.8) 1 (reference)
  Yes 41 (57.7) 30 (42.3) 3.08 (1.73–5.48)b 48 (67.6) 23 (32.4) 1.65 (0.88–3.07)d
Female
Spouse's depression No 317 (79.2) 83 (20.8) 1 (reference) 324 (81.0) 76 (19.1) 1 (reference)
  Yes 30 (66.7) 15 (33.3) 2.09 (1.02–4.27)c 27 (60.0) 18 (40.0) 2.48 (1.25–4.93)e

Abbreviations: OR, odds ratio; CI, confidence interval. Extreme Families are those in the corners representing the extremes of Cohesion and Adaptability in Circumplex Model (sixteen types of marital and family systems). Family communication was investigated using Family Communication Scales (FCS) included in FACES-IV. Family communication is classified into 2 groups by total score. The good communication group was in the range of 36–50 points, and poor group was in the range of 10–35 points.

Values are presented as number (%) or adjusted OR

P value＜0.001. Adjusted for age, education, income, physical activity.

P value＝0.04. Adjusted for age, education, income.

P value＝0.17. Adjusted for age, education, income, physical activity.

P value＝0.009. Adjusted for age, education, income.