Journal of Genwwloay: I'SYCHOLOGICAL SCIENCES
1996. Vol 5IB. No. 3. PII5-PI29
Copyright 1996 by The Genmioliij-ical Soaetx of Aiiwriai
Gender, Marital Closeness, and Depressive
Symptoms in Elderly Couples
Roni Beth Tower1 and Stanislav V. Kasl1
'Department of Epidemiology and Public Health, Yale School of Medicine.
Data from the Established Populations for the Epidemiologic Study of the Elderly (EPESE) in New Haven include
independent interviews with husbands and wives in 317 community-dwelling older couples. Drawing on these data, we
(a) describe the prevalence of three aspects of marital closeness: having a confidant, perceived emotional support, and
reciprocity between spouses' reports of marital closeness; (b) evaluate their associations with depressive symptoms
according to both a respondent's own and his or her spouse's reports; and (c) examine gender similarities and
differences in the prevalence and the associations of the closeness variables. Both husbands and wives responded more
strongly to their spouse's responses than to their own. Different dynamics operate, with husbands having fewest
depressive symptoms when they have emotionally independent wives, and wives having low levels when they feel
important emotionally to their husbands. Dyadic closeness was associated with fewer symptoms in wives and more
symptoms in husbands.
THIS article we (a) describe the prevalence of three
INaspects
of marital closeness in community-dwelling older
couples: having one's spouse as a confidant, perceiving
one's spouse to be a source of emotional support, and
reciprocity between spouses' reports of marital closeness, a
measure that combines the responses of both spouses regarding both components; (b) evaluate the associations of the two
components with depressive symptoms according to both a
respondent's own and his or her spouse's reports; and (c)
examine gender similarities and differences in both the
prevalence and the associations of the closeness variables.
Substantial evidence documents that personal relationships affect the physical and psychological well-being of
older adults (Antonucci, 1985, 1990; George, 1990). One of
the most important of these relationships is marriage, with its
promise of longer life for men (House, Landis, & Umberson, 1988; Verbrugge, 1988) and better health (Renne,
1971; Verbrugge, 1985), higher subjective well-being
(Haring-Hidore, Stock, Okun, & Witter, 1985; Williams,
1988), and fewer depressive symptoms (Gove, Hughes, &
Style, 1983; Gove, Style, & Hughes, 1990; Ross, 1995;
Ross & Mirowsky, 1989; Ross, Mirowsky, & Goldsteen,
1990; Williams, 1988) for both men and women. Marriage
can bring with it improved health behaviors, the security of a
potential spousal caretaker, and increased financial resources, all of which facilitate physical and mental health
(Bengtson, Rosenthal, & Burton, 1990).
Early research on the benefits of marriage suggested two
explanations for the above findings: that physically and
psychologically healthier people select into marriage or that
the married experience fewer life strains. The former has
been documented by studies on assortative mating (Caspi &
Herbener, 1990; Mastekaasa, 1992), while Pearlin and
Johnson (1977) have shown evidence for the latter. Kessler
and Essex (1982) proposed a third hypothesis, one that did
not rule out contributions of assortative mating or of lessened
life stress: that "married people are less emotionally respon-
sive than nonmarried people . . . land thus] life strains have
less emotionally damaging effects on married than nonmarried people" (p. 485). They argued that the resilience in
married people stemmed from increased social resources of
integration and intimacy and enhanced intrapsychic resources of mastery and self-esteem. In testing their model,
Kessler and Essex (1982) found that intimacy did indeed
buffer the depressing impacts of financial strain and household demands and that it operated primarily through its
ability to increase feelings of mastery and self-esteem.
Apparently a capacity to develop and maintain a close
marital relationship was a source of pride and intrinsic worth
for both men and women.
But all marriages are not equal in the above dimensions,
and variations can be expected to have consequences. At a
global level, measures of marital satisfaction are associated
with physical and mental well-being (Glenn & Weaver,
1981; Hughes, Gove, & Style, 1983; Levenson, Carstensen,
& Gottman, 1993; Ross, 1995) while measures of marital
distress, conflict, or dissatisfaction are associated with
poorer immune functioning (Kiecolt-Glaser et al., 1987,
1988) and increased levels of depression and depressive
symptoms in both men and women (Brown & Harris, 1978;
Gove, Hughes, & Style, 1983; Renne, 1971; Ross, 1995;
Williams, 1988). Increased levels of depressive symptoms
in older adults in turn place them at greater risk for physical
decline (Aneshensel, Frerichs, & Huba, 1984) and even
death (Bruce & Leaf, 1989). The serious consequences of
depression in older adults have been detailed elsewhere by
both the National Institutes of Health (1991) and the American Psychological Association (1993).
Further, positive marriages are positive in terms of physical and psychological health for both husband and wife;
conflicted, unsatisfying, or distressed marriages negatively
impact both partners but affect the mental and emotional
well-being of the wife to a greater extent than the husband
(Acitelli & Antonucci, 1994; Gove et al., 1983; Levenson,
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TOWER AND KASL
Carstensen, & Gottman, 1993; Ross, 1995; Williams,
1988). In a cross-sectional study of upper-middle class
middle-aged (40-50) and older (60-70) couples (Levenson
et al., 1993), these associations held across the cohorts,
suggesting that the impact of the quality of the relationship is
not just a function of values that permeated the social
contexts in which the couples grew up. In other words, the
psychological health of women born earlier in this century
was not more affected by the social role of being a wife than
was that of women born 20 years later.
Global dimensions of marital happiness are not, however,
specific enough to clarify the mechanisms by which depression might be reduced. We are led back to Kessler and
Essex's (1982) examination of integration and intimacy as
qualities in marriage through which its protective influence
operates. In this study we focus in part on intimacy, or
marital closeness.
Marital Closeness: Confidants and Emotional Support
Feelings of closeness in marriage derive in part from
perceptions of the spouse as a friend (Grote & Frieze, 1994).
Liking, trust, and being able to rely on one's wife or husband
for emotional support are critical components of such intimacy (Sternberg, 1988), which Grote and Frieze (1994)
define as "friendship-based love." Substantial consequences stem from the presence or absence of these qualities
of closeness in the marriages of older adults.
Having a spouse who is a confidant or "special friend"
with whom one feels particularly close is a component of
marital adjustment and satisfaction (Kendig, Coles, Pittelkow, & Wilson, 1988; Merves-Okin, Amidon, & Bernt,
1991). It has also been associated with lower levels of
depression for women (Weissman & Paykel, 1974), especially in the context of increased life stress (Brown & Harris,
1978), although a study of 235 older British medical patients
did not find this to be so (Iliffe, Haines, Stein, & Gallivan,
1991). Lee (1988) found that older adults who confided in
their spouses had higher levels of well-being. Two possible
mechanisms by which having a confidant might contribute to
well-being would be permitting a person to talk through a
problem with a trusted person, and thus use them as a coping
resource in times of stress (Ross & Mirowsky, 1989), or
facilitating acknowledgment of one's deepest dreams and
secrets in a safe context. Such acts of verbal self-disclosure
may contribute to both physical and psychological health
(Pennebaker, 1990, 1995).
Married men and women have been found equally likely
to name the spouse as confidant (Iliffe et al., 1991; Peters,
Hoyt, Babchuk, Kaiser, & Iijima, 1987; Strain & Chappell,
1982) with a few exceptions, in which husbands named
wives more frequently than they were named (Gibson &
Mugford, 1986; Kendig et al., 1988; Lee, 1988). In most
studies, men were slightly more likely than women to report
having no confidant (17.1% of the men and 13.1% of the
women in Iliffe et al., 1991; 26% of the men and 19% of the
women in Lowenthal & Haven, 1968), while married
women were somewhat more likely to select other friends or
relatives as confidants. In addition, women have been found
to have lower morale than men if they lack a confidant (Lee,
1988).
These findings are usually attributed to the greater orientation toward and importance of relationships for women
compared to men. This difference in orientation has been
labeled a contrast between "masculine" or autonomyoriented thoughts and behaviors and "feminine" or
relationship-oriented foci (e.g., Bern, 1974; Spence &
Helmreich, 1978). Broader labels for these attributes of
human functioning are "agency" and "communion"
(Helgeson, 1994); "instrumental" and "affiliative" (Fultz
& Herzog, 1991) or the "separate self" and the "connected
self" (Pearson et al., 1994). They all make a distinction
between autonomy, mastery, and achievement on the one
hand, and interpersonal relationship competence on the
other, as a person's primary source of identity and of selfesteem. Theories explaining sources of this gender difference have emphasized perceptual and biological (Lewis,
1978), developmental (Franz & White, 1985), or social
processes (Gilligan, 1982; Miller, 1986), while those exploring its implications focus on identity, values, and motivation (McAdams, 1988; Tower & Scarr, 1985-1986). In
the United States, these gender-related differences remain
throughout the life span (Fultz & Herzog, 1991). One result
is the greater susceptibility in women compared to men to
depression from difficulties or disruptions in close relationships, and a greater susceptibility in men compared to
women to depression from perceived loss of autonomous
functioning (Beck, 1983; Blatt & Zuroff, 1992; Chevron,
Quinlan, & Blatt, 1978).
A second component of closeness is the perception of
emotional support (Sternberg, 1988). In contrast to trusting
someone else to listen to a concern or problem or to be a safe
repository of one's most private information, perceiving him
or her to be available for emotional support when needed
suggests a potential security or comfort with opportunities to
depend on a trusted other person in times of emotional
distress. As people age, they suffer increasing losses of
family and friends, sensory and motor functions, and perhaps
financial security; emotional support for dealing with these
losses can help ward off depression at these times of increasing dependency (Depner & Ingersoll-Dayton, 1985). In addition, fear of unmet dependency needs is a common source of
depressive symptoms (Blatt & Zuroff, 1992). Support may
reduce such fear and, therefore, its potentially depressive
impact. In a longitudinal study of 135 Canadian couples who
were 65 years of age or older, Ducharme (1994) found that
higher levels of emotional support contributed both directly
and indirectly to increased life satisfaction.
The above discussion suggests that perceiving someone to
be a confidant versus a source of emotional support are
separable both conceptually and in the possible mechanisms
through which they might regulate depressive symptoms.
Recent empirical evidence also suggests that they are distinct
empirically, though correlated. In a study of 298 older
married couples in whom the wife was or had been working,
Anderson and McCulloch (1993) found that a multidimensional model including instrumental support, emotional support, and confiding for both husbands and wives had an
adjusted LISREL goodness-of-fit index that was higher than
a unidimensional husband and wife model. Using a very
different population and methodology, Reis and Franks
GENDER, MARITAL CLOSENESS, AND DEPRESSION
(1994) found a correlation of .49 between dimensions representing confiding and emotional support. Their differential
patterns with the outcome variables of physical and mental
health support both the empirical distinction between the
constructs and the separate mechanisms through which they
operate.
Respondent and Spouse Reports of Marital Closeness
Few studies of the elderly have examined independent
reports concerning closeness obtained from both husbands
and wives. Those that did had limitations in addressing the
above questions, such as sampling restrictions (Anderson &
McCullough, 1993) or an interest in outcomes othei than
depressive symptoms (Acitelli & Antonucci, 1994). Three
related questions beg to be addressed: To what extent does
one's own experience of marital closeness contribute to
one's depressive symptoms? To what extent does a spouse's
experience of marital closeness contribute to a respondent's
depressive symptoms? Are these relationships the same for
men and women?
The first two questions are important because of their
differential implications concerning processes through
which closeness might operate. On the one hand, to the
extent that one's own perceptions are influential, one would
expect increased closeness to protect against depressive
symptoms through intrapsychic influences, presumably the
pathways of experiencing the benefits of self-disclosure or of
safe dependency. On the other hand, to the extent that a
spouse's reports are influential, interpersonal processes are
operating. One possibility is that the pathway of influence
involves two steps: the intrapsychic process in which a
spouse's report impacts on his or her own depressive symptoms, and then an interpersonal process in which a spouse's
level of depressive symptoms impacts on a respondent's own
symptoms. For example, the wife who feels that she lacks
emotional support may experience depressive symptoms
(Brown & Harris, 1978). In turn, her distress may exacerbate that of her husband (Tower & Kasl, 1995). Another
possibility is that the attitudes and feelings of a spouse
convey information that is, itself, protective. Perhaps the
message that one is trusted, relied upon, and dependable is a
source of self-esteem and mastery in a dynamic similar to
that proposed and examined by Kessler and Essex (1982).
The gender differences in agency and communion described above would suggest that gender influences in the
relative impact of a respondent's own reports versus his or
her spouse's reports might be found, with their own reports
more influential for husbands, whose lives are more organized around instrumentality, and those of their spouses
more important for wives, whose lives are oriented toward
relationships. This could also reflect different pathways to
depressive symptoms for men and women, with husbands
influenced more strongly by their own experiences and
wives by those of others who are close to them. If this is true,
a husband would be more likely to endorse a depressive
symptom item such as "felt my life was a failure" if he was
depressed while a wife would be more likely to endorse the
item if her husband was depressed. Similarly, a man would
be unlikely to link "failure" to lack of closeness to his
spouse, whereas a woman would be more likely to do so.
PI 17
Further, we repeat that gender differences in etiologies of
depression have been demonstrated, with men more likely to
suffer depressive symptoms from a loss of self-esteem based
on perceived failures of autonomous functioning or of
achievement (introjective depression) and women from a
vulnerability to fears of unmet dependency needs (anaclitic
depression) (Blatt & Zuroff, 1992; Chevron et al., 1978;
Lewis, 1985). We speculate that a husband's openness, as
indicated by his report that his wife is his confidant, would
suggest that his wife experiences an emotional closeness that
reassures her of her emotional connection to her husband and
thus lessens her fears of abandonment and thus risk of
anaclitic depression (Chevron et al., 1978). A wife's openness may be less important to a husband, although he might
be distressed if she finds no one she can talk to and he feels to
blame for an increase in her fears or loneliness. Experiencing
the spouse as a source of emotional support raises somewhat
different issues. Realizing that one's spouse feels that no one
is available or that the spouse feels that his or her needs are
unmet, may well be depressing to both men and women.
However, because of the greater likelihood of a dependencybased depression for women, a husband might feel greater
relief, with lower distress as a result, if his wife feels that her
needs are met.
Couple Closeness
A third conceptualization of marital closeness is both
emergent and dyadic. It encompasses the extent to which
perceptions and feelings of one spouse are positive and
reciprocated by the other. Couples in which spouses are
mutually close or mutually distant form a continuum of
marital closeness, with those in the residual asymmetric
category in the middle. By thus defining couple closeness
from the combined responses of both spouses on both variables, mutuality and congruence can be incorporated. Family systems theory considers this emergent property of joint
"distance regulation" to be the core dimension regulating
family dynamics (Kantor & Lehr, 1975).
In a prototype analysis of the concepts of interpersonal
closeness, consisting of love and commitment, Fehr (1988)
found "love" to include as central features qualities tapped
by our confidant item such as "trust," "honesty," "friendship," and "respect" while "commitment" included "loyalty," "responsibility," and "being there for the other in
good and bad times," definition features captured more
closely by our concept of emotional support. In a series of
studies examining the relationship between the two concepts, Fehr found both overlap and independence, with the
best theoretical fit being that of Kelley's (1983) interpersonal
interdependence based on social exchange theory. From that
perspective, the quid pro quo of marriage need not be an
exact trade-off of confiding for confiding or emotional support for emotional support. Rather, providing at least one of
these aspects of closeness and receiving at least one aspect in
return may be sufficient to achieving a general reciprocity
and sense of equity in marital closeness according to social
exchange theory (Kelley, 1983). Thus, while the viewing of
one's spouse as a confidant and as a source of emotional
support are related both conceptually and empirically, in the
aggregate they can form a global representation of closeness.
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TOWER AND KASL
According to a systems framework of marriage and family, agreement and reciprocity permit coherence. Moderate
levels of closeness point to a shared view of the relationship
and thus expectations concerning its role in one's life (Bell,
Ericksen, Cornwell, & Bell, 1991). Since confiding is
strongly associated with intimacy (Hoyt & Babchuk, 1983)
and intimacy in turn with better adaptation (Lowenthal &
Haven, 1968) as well as marital satisfaction (Lee, 1988;
Merves-Okin et al., 1991) and since emotional support
contributes directly, and through activating benefits of intimacy, to well-being (Reis & Franks, 1994), we expect
depressive symptoms in married older adults to decrease as
closeness in the marriage increases. While this expectation is
specific for those couples who are clearly not close (neither
names the other as either a confidant or a source of emotional
support) compared to those who clearly are close (each
spouse names the other at least once), we are not so certain of
the extent of linearity in the effect. Rather, assymetric
relationships, in which one spouse feels closer than the
other, remain to be explored empirically.
Depression and Gender
Women usually have higher levels of depression than
men, whether the measure is a continuum of depressive
symptoms, a cut-point on such a continuum, or meeting
criteria for a clinical diagnosis (McGrath, Keita, Strickland,
&Russo, 1990;Nolen-Hoeksema, 1987;Paykel, 1991). If a
meaningful pattern can be identified in which exceptions to
these findings occur, perhaps it can offer insight into circumstances that promote or minimize gender disparity. In this
report we examine the effects of closeness on depressive
symptoms and the extent to which they may vary by gender
in a community-dwelling sample of elderly married couples.
Research Questions
Based on the above theory and previous findings, we
asked the following questions:
1. Prevalence of a confidant and source of emotional
support. — Are husbands less likely to have a confidant than
are wives? Are husbands who do name a confidant equally or
more likely than their wives to name their spouse? Do
husbands and wives differ in perceiving their spouse to be a
source of emotional support?
2. Associations of respondent's sociodemographic and
health characteristics to their own and their spouse's reports
of closeness. — Do respondent characteristics that have been
associated with depressive symptoms (age, education, race,
financial distress, chronic illness, disability, cognitive impairment, hearing loss) vary significantly with the closeness
responses of the respondent and with those of the spouse?
Although we will adjust for these variables as potential
confounders of our findings in our analyses of depressive
symptomatology, examining their associations with the
closeness variables themselves permits a more precise grasp
of the closeness variables.
3. The impact of closeness on depression. — To what
extent are the two components of a respondent's own closeness responses associated with his or her level of depressive
symptoms? To what extent are the two components of a
spouse's responses associated with a respondent's level of
depressive symptoms? To what extent is the dyadic variable
of couple closeness associated with husbands' and wives'
depressive symptoms? Are these findings the same for husbands and wives?
4. Sub-scale variations. — Are the findings associating
marital closeness with depressive symptoms consistent
throughout the subscales of positive affect, negative affect,
somatic distress, and interpersonal distress, the four components usually found in factor analyses of the Center for
Epidemiological Studies-Depression (CES-D) Scale [e.g.,
Berkman et al. (1986), Kessler, Foster, Webster, & House
(1992) and Radloff( 1977)]?
We believe that our study has three distinct methodological advantages: (a) Our older couples came from a
community-based sample with no restrictions except that
they lived in the community and not in institutions, (b)
Independent data from both husbands and wives were collected; this eliminated the potential bias inherent in correlating a respondent's own perceptions of the spouse's imagined
responses, rather than the actual responses of the spouse,
with the respondent's own reports of depressive symptoms.
We believe ours is the first report of an older community
sample in which closeness based on responses of both
spouses has been examined in relation to their depressive
symptoms. And (c) extensive information on sociodemographic background and health status was collected, permitting these variables to be utilized as intrapersonal control
variables in analyses examining the impact of closeness on
depressive symptoms. The major limitation is that the data
are cross-sectional; therefore, the direction of causality cannot be securely inferred.
METHODS
Participants
Secondary analyses of extensive interview data permitted
us to address the above research questions. The data are from
the Yale Health and Aging Project (YHAP) in New Haven,
Connecticut, one of the four sites funded by the National
Institute on Aging as part of its Established Populations for
Epidemiologic Studies of the Elderly (EPESE) program
(Cornoni-Huntley et al., 1993). The full YHAP sample is a
probability sample of 2,812 noninstitutionalized men and
women, aged 65 years and older living in the city of New
Haven in 1982. A detailed description of the stratified
sample design for the full cohort is given elsewhere
(Berkman et al., 1986). Briefly, samples were drawn from
three housing strata reflecting the most common types of
housing for those 65 and older: (a) public elderly housing,
which is age- and income-restricted, (b) private elderly
housing, which is age-restricted, and (c) private community
houses and apartments.
There were different sampling frames in each of the three
housing strata. In public housing, all individuals aged 65 and
over were included in the sample. In private housing, the
sample consisted of all men over the age of 65 and 1 in 2.5
women. In the community, the sampling frame was a utilities listing. All men who were enumerated were included in
GENDER, MARITAL CLOSENESS, AND DEPRESSION
the sample, whereas 1 in 1.5 women were included. The
overall response rate was 82% and did not vary significantly
by marital status or by gender.
Respondents were included in the spouse-pair sample of
317 married couples (634 individuals) only when both partners participated in YHAP. This happened when both were
chosen independently as a result of the sampling frame. The
average age for husbands was 75.4 years; for wives it was
72.6. Husbands had a mean of 9.5 years of education; for
wives it was 9.3 years. Most husbands (84.9%) and wives
(85.1%) were in their first marriage; the average length of
marriage was 43.1 years. Of those who had been previously
married, 25 men and 13 women had been divorced while 22
men and 34 women had been widowed. In our subset of
married couples, 20.2% lived in public age-restricted housing, 23.3% in private age-restricted housing, and 56.5% in
the community. The sample was 84.2% White, with most of
the non-White respondents being Black. The average annual
income was $7,000-$9,999.
Participants were visited individually in their homes.
Trained interviewers followed a 75-page interview protocol.
No proxy interviews are included in our analyses. Information included the following:
Sociodemographic Variables
Respondents were questioned concerning their age, ethnic
identity, education (the highest grade completed), and both
income and financial strain. Because preliminary analyses
revealed that financial strain had a stronger association with
depressive symptoms than income (and thus was a more
powerful control variable; Mendes de Leon, Rapp, & Kasl,
1994) and because a number of respondents refused the
specific income question, the financial strain measure was
used in our analyses. It was based on four items: three queried
about the perceived adequacy of income for food, medical
care, and monthly bills while the fourth asked respondents if
they felt they had money left over at the end of the month, just
enough to make ends meet, or not enough to make ends meet.
Health Variables
Functional disability. — An index of physical functioning, the Functional Disability Index (FDI), was developed
by Berkman et al. (1986). The FDI is a Guttman-like scale
that combines scores of severe disability (Katz, Downs,
Cash, & Grotz, 1970; Katz, Ford, Moskowitz, Jackson, &
Jaffe, 1963), gross mobility (Rosow & Breslau, 1966), and
physical performance (Nagi, 1976). In our sample, 63% of
the husbands and 54% of the wives scored either as no
disability or in the mildest disabled category. These gender
differences are consistent with those found in other epidemiological studies of physical disability in the elderly (Merrill,
1993;Verbrugge, 1985).
Chronic health conditions. — Responses to questions
concerning whether a doctor had ever told the respondent
that he or she had each of 10 chronic disorders were
summed: heart disease (a heart attack, or coronary, or
myocardial infarction, or coronary thrombosis, or coronary
occlusion), a stroke or brain hemorrhage, cancer or malig-
PI 19
nancy or tumor of any type, diabetes, cirrhosis or liver
disease, fractured hip, other broken bones, high blood pressure, arthritis, or Parkinson's disease. The items were scored
3 to 1 for yes, possible, and no, and then summed to create a
total score. The mean total score for men was 12.8 (SD =
2.2) and for women was 13.5 (SD = 2.4). Of the men,
20.5% reported no chronic illness; the most common conditions reported were hypertension (40.7% yes or possible)
and arthritis (33.8% yes or possible). Of the women, 15.2%
had no chronic conditions; the most prevalent problems were
hypertension (53.3% yes or possible) and arthritis (54.9%
yes or possible). For both husbands and wives, the prevalence for each of the remaining eight conditions never
exceeded 18%.
Cognitive impairment. — Cognitive impairment was
measured by the Short Portable Mental Status Questionnaire
(SPMSQ; Pfeiffer, 1975), with the question "What is the
name of this place?" changed to "What is your address?"
because the respondents were interviewed in their homes
rather than in institutions. The 10 items were scored as
correct or incorrect, with refusals or missing responses
scored as incorrect. Since the resulting measure was heavily
skewed (33.1 % of the women and 39.0% of the men had no
errors), original scores were regrouped into a three-point
scale according to Moritz, Kasl, and Berkman (1989). Of
305 husbands who completed the SPMSQ, 68.2% had no
impairment (0 or 1 error), while 8.5% were in the most
impaired category (4 or more errors); for the 311 wives who
were able to complete the measure, the corresponding percentages were 63.0% and 7.4%. Those who were unable to
complete the SPMSQ were also unable to complete the
Center for Epidemiological Studies-Depression (CES-D)
Scale (see below) and so were not included in the analyses of
depressive symptoms.
Hearing. —The question "With or without a hearing aid,
can you usually hear and understand what a person says
without seeing his face if that person talks in a normal voice
to you in a quiet room?" was scored yes or no (as a binary
variable), and used as indicative of hearing impairment.
Some difficulty with hearing was reported by 11.4% of the
husbands and 9.8% of the wives.
Depressive Symptoms
The 20-item CES-D scale was used to measure depressive
symptoms. Berkman et al. (1986) and Radloff (1977) discuss the properties of the scale and its appropriateness for
use with community-dwelling adults in detail. The scale
includes 20 symptoms that are each rated for frequency in
the past week on a 4-point scale, 0 to 3. Prorated scores were
computed for all respondents who completed at least 17
items but not the full 20, with mean scores calculated based
on the number actually answered, and then this mean score
multiplied by 20. Of the 317 spouse-pairs who participated
in the study, 293 included both husbands (n = 301) and
wives (n = 307) who were willing and able to complete the
CES-D in independent interviews. Those who did not complete the measure were not included in our analyses of
depressive symptoms; these respondents tended to be inter-
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TOWER AND KASL
viewed by proxy. The range of actual scores obtained was 0
to 41, although the possible range was 0 to 60. The mean
score for husbands was 6.24 (SD = 7.02) and for wives it
was 8.83 (SD = 8.94).
CES-D subscales were computed based on factors identified by Berkman et al. (1986), Kessler, Foster, Webster,
and House (1992), and Radloff (1977): positive affect (as
good as others, hopeful, happy, enjoys life), negative affect
(feels blue, depressed, sad, lonely), somatic distress (poor
appetite, everything an effort, restless sleep, no energy),
and interpersonal discomfort (people unfriendly, feels disliked). Scores for these scales and for a fifth scale composed
of the remaining 6 CES-D items were computed by averaging the scores for items within each scale and multiplying
by the number of items in the scale. Missing data were
managed by prorating the scale score: the mean for items
answered was calculated and multiplied by the number of
items in the scale. Reliability coefficients were computed
specifically for this sample of older married adults, and
Cronbach's alphas were .66 (positive affect), .78 (negative
affect), .68 (somatic distress), .76 (interpersonal distress),
and .63 (the remaining items).
Marital Relationship Variables
The interviews included two items that reflect aspects of
emotional closeness. The first was "Is there any one special
person you know that you feel very close and intimate with
— someone you share confidences and feelings with, someone you feel you can depend on? What is this person's
relationship to you?" The respondent could spontaneously
mention the spouse, someone else, or identify no one.
The second item, which also permitted spontaneous responses, was "Can you count on anyone to provide you with
emotional support? (Talking over problems or helping you
make a difficult decision)." In response to this question, 66
husbands and 29 wives announced that they did not need
help or emotional support. All the other respondents were
asked the next question: "In the last year who has been most
helpful in providing you with emotional support?" Spontaneous mention of various individuals, including the spouse,
was possible as was a response of "no one."
Respondents who named their spouses as special person/
confidant were more likely to also name them as a source of
emotional support. The measure of association that we used
was Kappa (Cohen, 1960), which was .39 and .42, for men
and women, respectively. Cross-spouse analyses revealed
somewhat weaker associations: (a) for mutually being
named confidant, Kappa = .19; (b) for mutually being
named as a source of emotional support, Kappa = .26; and
(c) for mutually being named at least once, Kappa = .29.
In addition, a three-category index of Couple Closeness
was created by grouping (a) those couples in which neither
spouse named the other as emotional support or confidant,
(b) those in which one named the other on at least one
dimension but was not named in return, and (c) those in
which both spouses named each other on at least one dimension. We note that the couple closeness variable is potentially a complex one. While it represents a gradation on
involvement between the spouses (from neither naming the
other through one naming but not being named in return, to
each naming the other at least once), it does not form an
ordinal scale in terms of reciprocity.
Analytic Strategy
Data were analyzed in four steps. First, prevalence for
husband and wife on the confidant and emotional support
items were tabulated. They appear in Table 1, along with
relevant sociodemographic and background variables for the
respondents in each of the closeness response categories. We
then compared respondents in the various categories of
closeness on both their and their spouse's health status with
one-way ANOVAs, controlling for respondent's age.
Second, we analyzed the relationship of marital closeness
variables to depressive symptoms separately by sex. In order
to minimize confounding from known sociodemographic or
health status risk factors for depressive symptoms in older
adults, our multiple regression models included as covariates age (Kessler et al., 1992), education (Berkman et al.,
1986), financial strain (Krause, 1988; Mendez de Leon et
al., 1994), race (Krause, 1988), chronic illness, functional
disability (Aneshensel et al., 1984; Berkman et al. 1986;
Blazer, Burchett, Service, & George, 1991), cognitive impairment (Blazer et al., 1991), and hearing loss (Kivela &
Pahkala, 1989). We obtained the least squares CES-D
means and tested orthogonal planned comparisons of the
adjusted means for the two basic variables: for the special
person/confidant question, naming no one vs naming anyone
and naming the spouse vs naming someone else; for the
emotional support question, having no need vs some need,
having no one to provide it vs someone, and having the
spouse vs another person as the provider. Finally, we calculated two planned comparisons for the couple closeness
variable: between couples who were mutually close and
those who were mutually distant, and between those whose
responses were symmetrical (both spouses either did or did
not name each other) and those whose were not. In order to
control for possible influences of a spouse's health, we then
also adjusted for the spouse's chronic health conditions,
functional disability, cognitive impairment, hearing loss,
and depressive symptoms.
The adjusted means and standard errors of husbands' and
wives' CES-D scores that resulted from the regression
equations are shown in Tables 2 and 3. The first portion of
the tables reports adjusted mean CES-D scores for both
respondent and spouse responses to the confidant/special
person items, adjusted for respondent's variables only and
adjusted for both respondent and spouse variables. The
second section presents these data for the emotional support
items. Figure 1 shows means for depressive symptoms by
levels of couple closeness for both husbands and wives. Significance levels of planned comparisons are recorded in
footnotes.
Third, to test for gender differences in effects, differences
in CES-D scores across gender were assessed by computing
ANOVAs with sex, couple closeness, and their interaction
as independent variables, the CES-D score as the dependent
variable, and the control variables as covariates. The
planned comparisons for the main effects of closeness were
repeated. The interaction was tested for slopes differing in
amount and direction.
GENDER, MARITAL CLOSENESS, AND DEPRESSION
Fourth, to examine whether our overall results varied by
subscale, we repeated the multiple regression analyses with
the CES-D scale subscales as the dependent variable and the
control variables and closeness as predictors. Remaining
scales were included in each regression, in order to control
for the main effect of a general depressive experience. If a
scale continued to have its own main effect in the other scale,
further analysis examined the individual items in the scale as
predicted by the control and closeness variables. Spouse
variables that could possibly explain a portion of the effect
were included if a closeness variable continued to be significant in the presence of potential confounding effects, both of
respondent's own sociodemographic and background and
health status, and of a more generic depressive experience.
These analyses also permitted us to better understand gender
differences in the association between closeness and depressive symptoms.
RESULTS
Prevalence and Sociodemographic Correlates
Table 1 reports the responses of husbands and wives to the
closeness questions as well as the numbers of couples in each
of the dyadic levels of closeness. It also includes background
information on those in the various closeness categories.
First, we discuss prevalence and then we comment on any
significant differences in background variables.
For the Confidant variable, men were less likely to have
any confidant than were women, in a proportion markedly
similar to that found by Iliffe et al. (1991). They were also
more likely to name their spouses as confidant than were
their wives. Husbands named wives more frequently than
wives named husbands, while wives had a higher frequency
of turning to someone other than a spouse than did husbands.
The simple chi-square for independent samples across sex
was 12.51 (df = 2;p< .001) and thus was highly significant
(a paired analysis would have yielded even higher levels of
significance but the same percentages of difference). Thus, a
higher level of interpersonal intimacy for women compared
to men, consistent with differences in the literature on
agency and communion, was supported, but only outside of
marriage.
For the Emotional Support variable, as expected, husbands were more likely to report they had "no need" for
emotional support in response to the initial question, "Can
you count on anyone to provide you with emotional support?" than were women. Similar proportions of men and
women reported no one available for emotional support
while about 40% of both husbands and wives named their
spouses as a primary source of emotional support. Women
were far more likely than men to find support from someone
other than their spouses. The chi-square was 21.91 (df = 3;
p< .001).
For the couple closeness variable, in approximately onethird of the couples each spouse named the other at least
once (30.8%), one spouse named the other but was not
named in return (35.7%), and neither spouse named the
other (33.4%).
Of the 30 comparisons on background variables shown in
Table 1, only 2 were statistically significant: Husbands in
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marriages that were mutually close had the most education in
years (10.1); those in marriages with the least couple closeness had the least education (8.6); in addition, women in
marriages that were nonreciprocal in couple closeness were
less likely to be in their first marriage. We note that both
these findings were significant at less than a 5% level of
confidence and, given 30 comparisons, at least one was
likely to have occurred by chance.
Closeness Variables in Relation to Respondent Health Status
In order to examine possible systematic variations in the
control variables with closeness, a series of one-way
ANOVAs was calculated separately for husbands and wives.
Responses for both husbands and wives on both individual
closeness variables and couple closeness (that is, 5 closeness
variables) were used to examine differences in the four
health variables for both husbands and wives with respondent's age controlled. In these 40 analyses, 10 reached
statistical significance; 4 of those were at the .01 level. We
report (1) significant associations for the husband's closeness responses, first for the confidant variable as it related to
his own health and then to his wife's and next for the
emotional support variable, as it relates to his own health and
then to his wife's; (2) significant associations for the wife's
closeness responses, first for the confidant variable as it
relates to her own health and then to her husband's and next
for the emotional support variable, as it relates to her own
health and then to her husband's; (3) significant associations
for the couple closeness variable, first for husband's health
and then for that of wife.
For husbands, the confidant response was not related to
their own or their wife's health status. Their emotional
support response was associated with their own cognitive
impairment (means of 1.25, 1.62, 1.48, and 1.33, respectively, for no need, no one, someone other than spouse, and
spouse; F — 3.98;/? < .01) and hearing loss (means of 1.03,
1.21, 1.15, 1.09; F = 3.39; p < .05) and with their wife's
disability (means of 2.80, 3.23, 2.81, 2.41; F = 4.01;/? <
.01). For wives, the confidant response was associated with
their own hearing loss (means of 1.07, 1.07, 1.11 for none,
someone other than spouse and spouse, respectively; F =
3.59; p < .05) and their husband's cognitive impairment
(means of 1.54, 1.44, and 1.26; F = 3.18;/? < .05). Their
emotional support response was associated with their hearing loss (means of 1.10, 1.03, 1.06, and 1.16 for no need, no
one, someone other than spouse and spouse, respectively; F
= 3.40, p < .05) and with their husband's disability (means
of 2.22, 2.50, 2.64, 2.03; F = 3.67; p = .01). Couple
closeness was associated with a husband's disability (means
of 1.99, 2.52, and 2.37 for close, nonreciprocal and not
close, respectively; F = 3.43; p < .05) and cognitive
impairment (means of 1.24, 1.43, and 1.50; F = 4.50; p =
.01); none of the wife's health variables were significantly
associated with couple closeness. Overall, notable results
here are that (1) husbands report less availability of emotional support when they suffer cognitive impairment and
hearing loss, and when their wives are disabled; (2) wives
feel closer to their husbands as their hearing is impaired; and
(3) a husband's cognitive impairment and disability are
associated with less mutual closeness. We note that statisti-
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TOWER AND KASL
Table I. Sociodemographic Variables of Husbands and Wives by Marital Closeness Responses
Husband's Confidant Response
Husband Variable:
n (%)
Age (mean)
Education (mean years)
Race (% non-White)
Marital history (% first marriage)
Financial strain (mean)
None
Other
Spouse
54(17.3)
75.1
9.5
11.1
85.2
5.2
153(49.0)
75.4
9.3
14.4
86.9
5.1
105(33.7)
75.4
9.6
20.0
81.0
4.9
Husband 's Emotional Support Response
Husband Variable:
No Need
None
Other
Spouse
n (%)
Age (mean)
Education (mean years)
Race (% non-White)
Marital history (% first marriage)
Financial strain (mean)
66(21.1)
73.8
9.7
16.7
84.9
4.9
38(12.1)
75.1
9.5
13.2
81.6
5.3
85(27.2)
75.9
8.9
16.5
84.7
5.3
124(39.6)
75.8
9.7
15.3
85.5
4.9
Couple Closeness
Husband Variable:
n (%)
Age (mean)
Education (mean years)"
Race (% non-White)
Marital history (% first marriage)
Financial strain (mean)
Close
Nonreciprocal
Not Close
94 (30.8)
75.5
10.1
13.8
87.2
4.9
109(35.7)
75.5
9.8
16.5
78.9
5.0
102(33.4)
75.4
8.6
16.7
88.2
5.3
Wife's Confidant Response
Wife Variable:
M (%)
Age (mean)
Education (mean years)
Race (% non-White)
Marital history (% first marriage)
Financial strain (mean)
None
Other
36(11.5)
73.8
8.5
16.7
88.9
5.3
197(62.9)
72.4
9.5
13.8
83.5
4.9
Spouse
80(25.6)
72.6
9.0
18.8
87.5
5.2
Wife's Emotional Support Response
Wife Variable:
No Need
n (%)
Age (mean)
Education (mean years)
Race (% non-White)
Marital history (% first marriage)
Financial strain (mean)
29(9.3)
72.5
9.7
17.9
82.7
5.1
None
Other
Spouse
34(10.9)
73.0
9.3
11.7
85.3
5.5
124(39.9)
72.1
9.4
18.6
83.1
5.0
124(39.9)
72.7
9.1
12.9
87.1
5.0
Couple Closeness
Wife Variable:
n (%)
Age (mean)
Education (mean years)
Race (% non-White)
Marital history (% first marriage)6
Financial strain (mean)
a/r = 3 74 ; p
b
<
05.
Chi-square (4 df) = 10.
< .05.
Close
Nonreciprocal
Not Close
94 (30.8)
72.7
9.4
27.1
91.5
4.9
109(35.7)
72.4
9.3
37.5
76.2
5.2
102(33.4)
72.6
9.2
35.4
87.3
5.0
GENDER, MARITAL CLOSENESS, AND DEPRESSION
cal adjustments that are made for all these variables control
for whatever little confounding exists.
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depressive symptoms in the presence of a wife's health status
and her own depressive symptoms. This main effect for the
partner's depressive symptoms was expected (cf., Tower &
Kasl, 1995); however, we note that change in the impact of
the closeness variables was slight.
If his wife indicated that she had no confidant, her husband's least squares mean depression score was 8.51, compared to 5.50 or 6.02 for the presence of a confidant (F =
5.13; p < .05). If she said she did not need emotional
support, her husband's depression was lower (3.53) than for
the other three groups (F = 4.49; p < .05). The significance
of the first comparison, a wife's confidant response, decreased somewhat when the wife's control variables were
added; the significance of comparisons based on his emotional response remained the same. No interactions of the
wife's responses were significant.
A comparison of the couple closeness groups, as seen in
Figure 1, reveals a significant difference between couples
who are mutually close and those that are not (F = 3.99; p <
.05), in a direction opposite that which was expected: men
were more depressed with increased marital closeness.
When the means were adjusted for the wife's health status
and depressive symptoms, the comparison was even
stronger (F = 6.52; p < .01). The other planned comparison, that between those couples with reciprocal responses
and those without, was not significant.
Husbands' Depression and Closeness
As shown in Table 2, a husband's level of depressive
symptoms did not vary significantly according to his own
responses on either the confidant or the emotional variable.
Nor did it vary significantly when we adjusted these analyses
for his wife's chronic illness, disability, cognitive impairment, and hearing loss. We performed additional analyses,
not shown in Table 2, in which we grouped husbands
according to whether they named their wives confidant or not
and whether they named her emotional support or not, and
examined both main effects and the interaction of these two
variables. In the presence of the main effects, neither of
which was significant, the interaction was significant (F =
6.80; p< .01).
Specifically, a husband's adjusted depressive symptoms
were low if he named his wife on both variables (5.56) or on
neither (5.18), and higher if he named her confidant only
(7.48) or emotional support only (7.90). In other words,
consistency in his relationship to his wife, naming her both
confidant and emotional support or neither, protected him
from depressive symptoms, whereas naming her on only one
dimension increased his risk. We then added the wives'
health variables and depressive symptoms to the model.
They explained additional variance (from 16.3% to 21.5%),
with only her CES-D score significant in the presence of her
other health status variables (F = 6.66; p < .01). The
interaction in this full model highlighted the differences in
the interaction between the confidant and emotional support
variables: naming his wife neither was associated with the
lowest level of depressive symptoms (fully adjusted mean of
4.94); naming her on both variables was next (fully adjusted
mean of 6.10); naming her confidant only was higher still
(fully adjusted mean of 7.20); and naming her emotional
support only was highest (fully adjusted mean of 8.11). In
other words, naming her as emotional support and not
confidant was associated with particularly elevated levels of
Wives' Depression and Closeness
As shown in Table 3, a wife's depression level did not
vary significantly according to her own report concerning a
confidant.
When she indicated that she had no one to provide emotional support, her depression was much higher (least
squares mean of 14.89) than if she indicated she had someone (F = 20.05, p< .0001), confirming the expectation that
perceived emotional support would buffer depression.
Adding her husband's health status variables as controls
decreased the size of the latter association only slightly.
If her husband reported that he had no confidant, her
Table 2. Husbands' Adjusted Mean 1982 CES-D Scores According to Husbands' and Wives' Confidant and Emotional Support Responses
Husband's Response
His Wife 's Response
Mean (SE)
Wife Adjusted
Mean (SE)
Mean (SE)
Wife Adjusted
Mean (SE
Confidant/Special Person
None
Other
Spouse
6.17(0.95)
5.82(0.56)
6.21 (0.68)
6.18(0.98)
5.67(0.57)
6.45 (0.68)
8.51'(I.13)
5.50 (0.49)
6.02 (0.76)
8.26" (1.14)
5.51 (0.50)
6.28 (0.80)
Emotional Support
No Need
No One
Other
Spouse
5.39 (0.86)
6.20(1.17)
5.53(0.75)
6.60(0.62)
5.16(0.86)
5.77(1.20)
5.34(0.76)
6.99(0.62)
3.53"(1.24)
6.88 (1.21)
5.64 (0.63)
6.60 (0.61)
3.42" (1.25)
5.84 (1.26)
5.83 (0.63)
6.94 (0.63)
Notes. Means are adjusted for husband's age, education, race, financial strain, chronic health conditions, functional disability, cognitive impairment, and
hearing loss. Wife adjusted means are adjusted, in addition, for wife chronic health conditions, functional disability, cognitive impairment, hearing loss, and
depressive symptoms. Significant planned comparisons are reported in the footnotes.
"No one vs anyone is significant, F = 5.13;/; < .05. With wife variables, F = 3.58; p < .10.
b
No need vs any need is significant, F = 4.49; p < .05. With wife variables, F - 4.20; p < .05.
TOWER AND KASL
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Table 3. Wives' Adjusted Mean 1982 CES-D Scores According to Wives' and Husbands' Confidant and Emotional Support Responses
Wife's Response
Confidant/Special Person
None
Other
Spouse
Emotional Support
No Need
No One
Other
Spouse
Her Husband's Response
Mean (SE)
Husband Adjusted
Mean (SE)
Mean (SE)
Husband Adjusted
Mean (SE)
8.84 (1.42)
9.24 (0.60)
7.81 (0.98)
8.18 (1.47)
9.04 (0.63)
7.35 (1.01)
12.01^(1.15)
9.39 (0.67)
6.55 (0.80)
11.00* (1.22)
9.18 (0.07)
6.45 (0.83)
7.79* (1.54)
14.89 (1.42)
8.16 (0.73)
8.02 (0.75)
8.03" (1.56)
13.29 (1.49)
8.18 (0.78)
7.57 (0.78)
8.36d
11.66
8.79
8.11
8.43
11.01
8.80
7.73
(1.07)
(1.39)
(0.93)
(0.76)
(1.12)
(1.50)
(0.96)
(0.78)
Notes. Means are adjusted for wife's age. education, race, financial strain, chronic health conditions, functional disability, cognitive impairment, and
hearing loss. Husband adjusted means are adjusted, in addition, for husband chronic health conditions, functional disability, cognitive impairment, hearing
loss, and depressive symptoms. Significant planned comparisons are reported in the footnotes.
"No one vs anyone is significant. F = 20.05; p < .0001. With husband variables, F = 16.12; p < .0001.
b
None vs any is significant. F = 10.13; p < .01. With husband variables, F = 5.63; p < .05.
c
Someone else vs spouse is significant, F = 7.35; p< .01. With husband variables, F — 6.24; p< .01.
d
No one vs anyone is significant, F = 4.44: p < .05. With husband variables, F = 2.83; /; < . 10.
depression was higher (least squares mean of 12.01) than if
he named someone else (9.39) or if he named her (6.55).
Both preplanned contrasts were significant (F = 10.13, p <
.01 for no confidant vs any, and F = 7.35, p < .01 for
naming wife vs naming someone else confidant). Adding the
husband's health status variables as controls decreased the
significance of the contrast somewhat (from/? < .01 to p <
.05) for the confidant none vs any contrast but not for the
someone else vs spouse contrast. Our expectation, that
wives' depressive symptoms levels would have higher associations to husbands' responses than to those of the wives
themselves, was confirmed for the confidant variable.
If her husband answered "no one" to the emotional
support item, she was more depressed than if he named
someone (F = 4.44; p < .05). Adding the husband's health
status control variables to the model decreased the effect (F
= 2.83; p < .10) but it still tended toward significance.
Additional analyses designed to identify significant interactions between the closeness variables showed no interactions
to be significant.
A comparison of couple closeness categories in which
each spouse named the other and those in which neither
spouse named the other was significant, with heightened
closeness associated with lower levels of depression (F =
5.10, p < .05). (See Figure 1.) The comparison for reciprocal vs nonreciprocal naming was again not significant.
The sex X couple closeness ANOVA was significant for
both sex (F = 11.47,/? < .0001), reflecting the usual gender
difference overall, and for the sex x couple closeness
interaction (F = 5.67, p < .01), with women having higher
levels of depressive symptoms and responding somewhat
more strongly to closeness as well as responding in the
opposite direction.
Subscale Analyses
The two questions addressed by subscale analyses were: Is
the overall effect of couple closeness on depressive symp-
CES-D Means
Close
Non-Reciprocal
Not Close
Closeness Group
Husbands
I Wives
Figure 1. Adjusted CES-D means by closeness: husbands and wives.
CES-D means are adjusted for age, education, race, financial strain,
hearing, disability, cognitive impairment, and health. Husbands, close vs
not, F = 3.99, p < .05. Husbands, reciprocal vs not, F = .97, n.s. Wives,
close vs not, F = 5.10, p < .05. Wives, reciprocal vs not, F = .32, n.s.
toms seen for all the subscales of the CES-D? And do
closeness responses contribute to variations in means on any
individual subscales above and beyond that which is accounted for by the general effect of the CES-D?
Using the subscales as dependent variables, we repeated
our ANOVAs with the planned contrast between couples
who were mutually close and those who were not, again
controlling for a respondent's age, education, financial
strain, race, chronic illness, functional disability, cognitive
impairment, and hearing loss. We found that (a) for husbands, those in close relationships scored higher on the
positive and negative affect scales (F = 8.69; p < .01 and F
= 3.07; p < . 10, respectively), suggesting less positive and
more negative affect; and (b) for wives, those in close
relationships reported more positive affect, fewer somatic
symptoms, and fewer of the residual list of depressive
symptoms (F = 3.56,p < . 10; F = 4.81,/? < .05, and F =
5.24, p < .05, respectively).
GENDER, MARITAL CLOSENESS, AND DEPRESSION
Because the association of couple closeness with the
CES-D as a whole is significant, we next controlled for the
remaining CES-D items when examining the association of
couple closeness to the various subscales. In the presence of
the remaining CES-D scales, the positive affect scale continued to differentiate husbands in close marriages from
those not in close marriages (F = 8.69; p < .01), with
husbands in less close marriages reporting greater positive
affect than those couples who were mutually close. Since
this finding remained counter to prediction, we further decomposed the positive affect scale into its individual items.
"I felt that I was just as good as other people," "I felt
hopeful about the future," and "I was happy" were not significantly associated with couple closeness; however, "I
enjoyed life" was highly significant {p < .0001). As a final
examination, we controlled for a wife's chronic illness and
disability, which might contribute to the association, and
they only increased the association of couple closeness to the
"I enjoyed life" item (F = 9.97; p = .001).
SUMMARY AND DISCUSSION
We first summarize and discuss significant findings concerning the prevalence of confidants and of sources of
emotional support and their identities. We then review significant associations of a respondent's own closeness responses to his or her depressive symptoms, followed by
important influences of the reports of his or her spouse. Next
we discuss couple closeness as an influence on depressive
symptoms in general and subscale scores in particular. We
conclude with remarks concerning strengths and limitations
of the study, questions for future research, and implications
of the findings.
Prevalence: confidants. — Husbands were more likely
than wives to either name their spouse as "special person"
or to say they had "no one" to the special person question;
conversely, husbands were less likely to name someone
other than their wife as their special person/confidant (Table
1). This is consistent with specific previous findings regarding confidants (e.g., Iliffeetal., 1991; Lowenthal & Haven,
1968) as well as with more general findings on women's
higher levels of interpersonal involvement and of intimacy
with others outside of marriage (Gilligan, 1982; Miller,
1986).
Prevalence: emotional support. — Husbands were more
likely to say that they had "no need" for emotional support
than were women. This is consistent with a norm for this
generation of men that presumably values a "masculine"
ideal of self-reliance (Bern, 1974; Moore & Nuttall, 1981;
Spence & Helmreich, 1978; Thompson & Pleck, 1987).
Husbands were no more likely to believe that they received
emotional support from their spouses than were wives: about
40% of both husbands and wives named their spouses as a
source of emotional support (Table 1). Thus the argument
that men are more protected from depression by marriage
than are women because they receive more emotional support from their spouses (Depner & Ingersoll-Dayton, 1985;
Stinnett, Collins, & Montgomery, 1970) was not directly
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supported since they did not report higher levels of spousal
support. Perhaps the belief that men receive more social
support from marriage than do women resulted from a
confounding of emotional support and having a confidant.
Indeed, in the classic Depner and Ingersoll-Dayton (1985)
study, emotional support was defined as confiding, reassurance, and talking things over when upset.
Respondent's closeness reports and depressive symptoms.
— Husbands' responses concerning confidants and emotional support were not significantly associated with their
depressive symptoms when considered by themselves. However, when we examined the interaction between a husband's naming his wife as his confidant and as his emotional
support compared to not naming her, those who named her
both times or neither had the lowest levels of symptoms,
even when the wife's disability was controlled. Thus, for
husbands, their own consistency was associated with lower
levels of distress. This suggests that perhaps turning to a
wife for emotional support, especially in the absence of
sharing confidences with her, or regarding her as a close
friend but as not providing emotional support, are depressing
while a feeling of separation and autonomous functioning on
the one hand or firm attachment on the other are associated
with low reports of depressive symptoms.
Wives' confidant responses were not significantly associated with their depressive symptom levels. However, if they
experienced no one as being available for emotional support,
they were more depressed than if they had someone or
experienced "no need" for support. This suggests that
having no interpersonal connection was very painful for
women, consistent with women's reportedly high investment in relationships or communion (Helgeson, 1994), although independence, in the form of having "no need," was
as positive as having someone to rely on.
Spouses' closeness reports and respondents' depressive
symptoms. — Least squares mean depression levels were
highest and lowest for husbands in response to their wives'
reports rather than their own. Both husbands and wives were
more depressed if a spouse reported having no confidant than
if the spouse reported any confidant whether or not it was the
respondent. We note that husbands and wives were not
themselves more depressed if they lacked a confidant; the
fact that their spouses responded with increased depressive
symptoms to their reports is of interest. In addition, both
husbands' and wives' depressive symptoms were associated
with their spouses' reports concerning sources of emotional
support. Husbands showed decreased symptoms when their
wives expressed no need for support, perhaps reflecting the
effect of wives' independence. Wives showed increased
symptoms when their husbands reported "no one" to be
available. Since the husbands themselves were not more
depressed by having no one for emotional support, either
their wives projected their own experiences (increased distress with an absence of support) onto their husbands, or they
were depressed by (a) a husband's perceptions that she, the
wife, was unavailable, or (b) the husband's isolation that
resulted in a lack of support.
P126
TOWER AND KASL
Couple closeness and depressive symptoms. — Finally,
our most intriguing finding and the most striking difference
between husbands and wives was revealed by the couple
closeness measure: mutual closeness and mutual distance
brought different effects for husbands and wives. A closer
connection to a spouse was associated with decreased depressive symptoms for women but increased symptoms for
men. The finding of decreased depressive symptoms with
increased marital closeness for women is expected, in that it
is consistent with data linking wives' marital satisfaction
with feelings of closeness (Acitelli & Antonucci, 1994;
Merves-Okin et al., 1991) and their depressions to their
marital dissatisfaction or distress (Brown & Harris, 1978;
Gotlib & Hammen, 1992; Weissman & Paykel, 1974).
Wives' high level of symptoms when a couple was mutually
distant suggests that emotional distance in their marriages
was particularly painful for these older women. Explanations for women's higher levels of depression that stress
women's social or economic disadvantages relative to men
(Gove & Tudor, 1973; McGrath et al., 1990) would predict
the benefits of marital closeness «/the marriage is embedded
within a culture in which a close marriage defines successful
role performance for a wife and yields benefits of status and
security. The data may thus reflect the positive benefits of a
clear definition of a social role. Indeed, item analyses not
shown in this report revealed that wives were more likely to
report that their life was a failure when their marriages
lacked mutual closeness; this was not true for husbands. On
the other hand, post hoc additional analyses revealed that
mutual closeness was associated with significantly decreased
feelings of helplessness in wives but not in husbands.
The closeness results for men are more difficult to explain.
Possible explanations for less marital closeness being associated with fewer depressive symptoms are (a) men in close
marital relationships have learned to be more expressive of
affect in general and thus would report higher levels of all
affect including dysphoria than men who are not in a close
relationship (Fujita, Diener, & Sandvik, 1991); (b) old age is
more depressing to men who are close to their wives because
the perceived risk of loss through disease, disability, or
death is expected to increase with age and thus anticipatory
depression reactive to expected loss could result (Blatt &
Zuroff, 1992;Hobfoll, 1989); or (c) closer inspection of the
CES-D could shed light on the puzzle.
We used our subscale analyses to explore this possibility.
Older husbands in marriages with low levels of intimacy
reported enjoying life more than husbands in closer marriages. We speculate that men in the group in which neither
spouse named the other at all, where the wives were notably
more depressed, may have disengaged from the relationship
and found sources of enjoyment in other facets of their lives.
In his revised interpersonal theory of depression, Coyne
(1994) suggests that such disengagement is the only viable
resolution to living with a chronically unhappy partner and
feeling manipulated by the spouse's distress. In their studies
of gender differences in marital interaction, men withdraw
from conflict or distress while women become increasingly
affectively involved (Gottman, 1994; Gottman & Levenson,
1988). Our finding for men is consistent with both of these
interpretations. When we repeated these analyses for women
we found that no subscale contributed additional significant
variance beyond that explained by the overall effect of the
CES-D.
Finally, perhaps the couple closeness influencing depressive symptoms in opposite directions for the couples who
were not close supports a theory proposed by NolenHoeksema (1987). She suggested that women adapt to depressive experience by ruminating, especially about the
welfare of their close relationships, which makes symptoms
worse, while men respond to depressive experience by
engaging in increased activity. The activity serves to decrease
the symptoms. We suggest that it is also a coping strategy that
may take men further from their wives behaviorally and
emotionally while, at the same time, yielding an increase in
life enjoyment. We note that our data only clearly support
this theory for this particular subset of couples. Individual
and relationship characteristics that contribute to their lack
of closeness may, of course, also contribute to exaggerated
gender differences in both levels of depressive symptoms
and in coping strategies employed to deal with them.
Overall, aspects of marital closeness influenced depressive symptoms in elderly husbands and wives, and women
tended to be affected more strongly than men. Both gender
similarities and gender differences emerged in our analyses,
revealing different aspects of the dynamics of closeness.
Collectively, these findings offer compelling support for the
conclusion that, in general, men and women are affected by
and react to marital relationship issues differently. For the
wives, as long as they did not feel that they had no emotional
support at all, husbands' attitudes toward them were more
important than their own attitudes in influencing their level
of depression. These data lead us to speculate that husbands
are most affected by their wives' interpersonal comfort,
perhaps feeling responsible for it, while wives are more
influenced by their sense of connection to their husbands
and perhaps self-worth derived from having achieved it.
This interpretation could again reflect the well-documented
gender difference in instrumental and affiliative tendencies,
with men being more instrumentally oriented and women
more relationship oriented (Franz & White, 1985; Helgeson, 1994).
The most obvious limitation of our study comes from its
cross-sectional nature. Specifically, the cross-sectional data
leave room for reverse causation: one's own depression
could create a lack of emotional support from others (cf.,
Coyne, 1976), even though only the wives in our sample
showed this effect. Similarly, while a wife's report of no
need for emotional support is associated with low levels of
depression in her husband, perhaps low levels of depression
in a husband permit a wife to feel she does not need
emotional support. Longitudinal analysis can address these
questions as well as those that identify conditions under
which marital closeness changes.
In addition, we urge caution when extrapolating our
findings to other periods. Our sample necessarily includes
only those born before the 1920s. As is any cohort, they
were inevitably marked by their time; their perceptions of
themselves and of their options as married men and women
reflected those typical of their generation. In addition, it is
limited to those who were still alive and married in 1982.
GENDER, MARITAL CLOSENESS, AND DEPRESSION
Because of this, they are survivors of both life and marriage.
Some portion of seriously ill and possibly distressed adults
were already eliminated through death. Many who were
deeply unhappy with their marriages may have divorced.
These two realities — that (a) studies of the elderly cannot be
fully generalized to cohorts who grew up in later times with
their different cultures and (b) by definition the older adults
are survivors and so cannot be appropriately compared to
those unlikely to survive — underscore that we are not able
to infer the extent to which younger couples or those in
marriages of shorter duration might be similarly affected by
the quality of the marital relationship as were our couples.
In addition, our analyses of closeness are based on two
single items. They do not provide the more differentiated and
perhaps subtle information that would be available had a full
scale of self-disclosure, perceived support or closeness (e.g.,
Berscheid, Snyder, & Omoto, 1989) been administered.
Perhaps the strength of our findings from a large communitybased sample can support the more in-depth examination of
these constructs through fuller measures and experimental
research. In addition, the qualities and experiences that contribute to closeness and its disruption cannot be explored
within this study; they await longitudinal analysis.
Specific strengths of our study include independent reports from both spouses, the community basis of our sample
with its high response rate, and the availability of information concerning known risk factors for depression that permitted statistical control for them. Future research can address questions concerning the protective power of marital
closeness over time as other risk factors associated with
aging (such as disability, poor health, and financial strain)
increase.
ACKNOWLEDGMENTS
This research was supported by National Institute on Aging (NIA)
contract N01-AG-0-2I05 to Yale University as a research site for the
Established Populations for Epidemiologic Studies of the Elderly (EPESE)
and by an NIA-funded research training grant in epidemiology and aging,
5T32 AG-00153.
Address correspondence to Dr. Roni Beth Tower, Department of Epidemiology and Public Health, Yale University, P. O. Box 208034, 60 College
Street, New Haven, CT 06520-8034.
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Received June 21, 1995
Accepted January 4, 1996
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• Mary Harper
Tel (203) 281-4487 • Fax (203) 230-1186
• Paul K.H. Kim.
Toll-free (800) 627-6273
GARLAND