Mental Disorders in Married Couples (Assortative Mating)

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Abstract
A study of mental disorders in married couples has been made within the framework of the Samsø Project, a psychiatric demographic research project with an intensive psychiatric service in a geographically delimited area. In this island with a population over 15 of 4,987, approximately 2 per cent. of the population is referred to the psychiatric service every year. During the six-year investigation period a total of 543 patients aged 15 and over were referred as new cases; 234 were married women and 143 married men. Among the 377 married persons referred there were 29 married couples. At the midpoint of the six-year investigation period there were 1,634 married couples in the island. The expected frequency of married couples to be referred per year as new cases is 0.57, the observed is 2.8, which is 3.5 times the expected frequency. For the whole six-year period the expected number of married couples to be referred is 20.5. The observed is 29 or 1.4 times the expected number. There was diagnostic correlation in 11 of the 29 couples with endogenous, psychogenic or neurotic depression, and in 15 couples if psychogenic and endogenous psychoses are taken together and neuroses and character disorder together. In 13 out of the 29 couples there was a positive correlation between the professions of both husband's and wife's fathers. An attempt was made to analyse the relationship of the illness in the 29 couples. In 7 couples there was a pathological, interpersonal reaction pattern of relevance for the onset of the mental disorder. In one couple the same environmental stress was of relevance, and in 6 the disease of one spouse was of relevance in causing the disorder in the other spouse. It was the experience that there was a great variety of factors of relevance for the onset of the disorder. Constitutional predisposition and conflictual interaction with the spouse or with other family members was found to be of the greatest relevance for the onset of the disease. Environmental socio-economic conditions were of less relevance as causal factors, but were of importance for prognosis. From the data in this and previous investigations, it seems likely that a higher frequency of mental illness in the spouses of mental patients does exist. Such increased frequency may to a certain extent be due to a facilitated referral for the second spouse due to the contact of the first spouse with the psychiatric service. Other factors include assortative mating, with a tendency for persons of similar predisposition to marry and interact in a pathological manner. Cumulative and detrimental interaction without similar predisposition may, however, also take place if one partner has been mentally ill for a long time. Mental disorders, such as a depressive reaction, may also be caused in one spouse by the onset of mental illness in the other, especially if the spouse who develops a reactive depression has a biological or psychosocial predisposition to such depressive reaction. Similar environmental stress conditions are rarely of any great relevance for the development of mental illness in married couples.

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