Category: Adult Anxiety - GAD
Background and Study
Aim: Historically, interpersonal theorists have conceptualized interpersonal distress to feature prominently in the etiology and maintenance of anxiety disorders (Ingraham & Wright, 1987; Sullivan, 1964). Indeed, empirical data from the Midlife Development in the United States (MIDUS) study illustrates that frequent spousal conflicts incur mental health costs to individuals (Grzywacz & Marks, 2000; Walen & Lachman, 2000). A wealth of literature also demonstrates that clinical depression manifests a strong prospective link to generalized anxiety disorder (GAD). However, no studies have tested whether various forms of interpersonal functioning, such as partner agreement, empathy, and strain, serve as mechanisms to explain the longitudinal depression-anxiety relationship. This study aimed to address this knowledge gap.
Method: Data was obtained from the MIDUS project. 4,963 community-dwelling middle-aged adults (M = 46.46 ± 12.51 years, 53% female, 85% college educated) participated in three waves of data collection over 18 years, with each wave approximately nine years apart from another. Mediation analyses using structural equation modelling were conducted to determine whether (a) time 1 depression predicted time 3 GAD and (b) time 2 agreement, empathy, and strain, mediated the proposed link. Time 1 GAD was controlled for in each step of the mediation analyses. The reliable and valid Spousal Support and Strain (Walen & Lachman, 2000) as well as Spousal Disagreement scales (Grzywacz & Marks, 2000) were used to assess for the three constructs.
Results: The overall pattern of practical fit indices suggested that the measurement model demonstrated good fit [Χ2(df = 690) = 9529.588, p < .001; CFI = .964; TLI = .961; RMSEA = .051]. Total effects analyses revealed that time 1 depression severity significantly predicted greater time 3 GAD severity 18 years later (b = 0.173, SE = 0.039, p < .001). Indirect effects analyses showed that time 2 partner disagreement (b = 0.019, 99% confidence interval (CI) [0.002, 0.035]), but not empathy (b = 0.011, 99% CI [-0.001, 0.018]) and strain (b = 0.041, 99% CI [-0.009, 0.012]), mediated the prospective link between depression and GAD severity. Higher baseline depression led to higher time 2 lower agreement (b = -0.101, SE = 0.022, p < .001), which in turn independently predicted greater time 3 GAD severity (b = -0.183, SE = 0.052, p < .001). Conclusion: Lack of consensus, but not empathy or tension, presents as a distal risk factor and mechanism through which clinical depression forecasts GAD 18 years later.