Psychiatric Quarterly

, Volume 79, Issue 2, pp 121–132 | Cite as

Efficacy of Couple Therapy as a Treatment for Depression: A Meta-Analysis

  • Angelo BarbatoEmail author
  • Barbara D’Avanzo
Original Paper


Data from clinical trials of couple therapy for depression have never been subjected to systematic analyses. We performed a meta-analysis of eight controlled trials involving 567 subjects. No difference was found on depressive symptoms between couple therapy and individual psychotherapy. Relationship distress was significantly reduced in the couple therapy group. Too few data are available for comparisons with drug therapy and no treatment. The findings are weakened by small sample sizes, assessments at the end of treatment or short follow-up, unclear sample representativeness, heterogeneity among studies. The mediating role of improvement in quality of couple relationships is not supported by data. However, it has not been adequately tested. Evidence on efficacy of couple therapy as a treatment for depression is inconclusive. The evidence for improvement in couple relationships may favor the choice of couple therapy when relational distress is a major problem.


Unipolar depresssion Couple distress Couple therapy Controlled clinical trials Review 



The authors thank the Cochrane Collaboration Depression, Anxiety and Neurosis Review Group trials search coordinator Hugh McGuire, for assistance in developing the search strategy and Corrado Barbui, editor of the Cochrane Collaboration Depression, Anxiety and Neurosis Review Group for his helpful suggestions.


  1. 1.
    Chilvers C, Dewey M, Fielding C, Gretton V, Miller P, Palmer B, et al.: Antidepressant drugs and generic counselling for treatment of major depression in primary care: randomised trial with patient preference arms. BMJ 322:772–775, 2001PubMedCrossRefGoogle Scholar
  2. 2.
    Canadian Psychiatric Association and Canadian Network for Mood and Anxiety Treatment (CANMAT): Clinical guidelines for the treatment of depressive disorders. Canadian Journal of Psychiatry 46 Suppl:5S–90S, 2001Google Scholar
  3. 3.
    National Institute of Clinical Excellence. Clinical Guideline 23. Depression: management of depression in primary and secondary care. London, National Institute of Clinical Excellence, 2004Google Scholar
  4. 4.
    Beach SRH, Fincham FD: Marital processes and depression. In: L’Abate L (Ed) Family psychopathology. The relational roots of dysfunctional behavior. New York, Guilford Press, pp. 256–279, 1998Google Scholar
  5. 5.
    Whisman MA: The association between depression and marital dissatisfaction. In: Beach SRH (Ed) Marital and family processes in depression: A scientific foundation for clinical practice. Washington, American Psychological Association, pp. 3–24, 2001CrossRefGoogle Scholar
  6. 6.
    Paykel ES, Cooper Z: Life events and social stress. In: Paykel ES (Ed) Handbook of affective disorders. 2nd edition. New York, Guilford Press, pp. 149–170, 1992Google Scholar
  7. 7.
    Goering PN, Lancee WJ, Freeman SJ: Marital support and recovery from depression. British Journal of Psychiatry 160:76–82, 1992PubMedGoogle Scholar
  8. 8.
    Baucom DH, Shoham V, Mueser KT, Daiuto AD, Stickle TM: Empirically supported couple and family interventions for marital distress and adult mental health problems. Journal of Consulting and Clinical Psychology 66:53–88.1998PubMedCrossRefGoogle Scholar
  9. 9.
    Gupta M, Coyne JC, Beach SR: Couples treatment for major depression: critique of the literature and suggestions for some different directions. Journal of Family Therapy 25:317–346, 2003CrossRefGoogle Scholar
  10. 10.
    Denton WH, Golden RN, Walsh SR: Depression, marital discord and couple therapy. Current Opinion in Psychiatry 16: 29–34, 2003CrossRefGoogle Scholar
  11. 11.
    Barbato A, D’Avanzo B: Marital therapy for depression. Cochrane Database of Systematic Reviews Issue 2. Art. No: CD004188, doi:  10.1002/14651858.CD004188.pub2, 2006
  12. 12.
    Sabatelli RM: Measurement issues in marital research: a review and critique of contemporary survey instruments. Journal of Marriage and the Family 50:891–915, 1998CrossRefGoogle Scholar
  13. 13.
    DerSimonian R, Laird N: Meta-analysis in clinical trials. Controlled Clinical Trials 7:177–188, 1986PubMedCrossRefGoogle Scholar
  14. 14.
    Egger M, Davey SG, Altman DG: Systematic reviews in health care: meta-analysis in context. 2nd edition. London, BMJ Publishing Group, 2001Google Scholar
  15. 15.
    Moher D, Jadad AR, Tugwell P: Assessing the quality of randomized controlled trials. International Journal of Technology Assessment in Health Care 12: 195–208, 1996PubMedGoogle Scholar
  16. 16.
    Alderson P, Green S, Higgins JP: Assessment of study quality. In: Cochrane reviewers’ handbook 4.2.2 [updated March 2004]; Section 6. In: The Cochrane Library, Issue 1. Chichester, John Wiley & Sons, 2004Google Scholar
  17. 17.
    Waring EM, Chamberlaine CH, Carver CM, Stalker CA, Schaefer B: A pilot study of marital therapy as a treatment for depression. The American Journal of Family Therapy 23:3–9, 1995CrossRefGoogle Scholar
  18. 18.
    Waring EM: The role of marital therapy in the treatment of depressed married women. Canadian Journal of Psychiatry 39:568–571, 1994Google Scholar
  19. 19.
    Sanders MR, McFarland M: Treatment of depressed mothers with disruptive children: a controlled evaluation of cognitive behavioural family intervention. Behavior Therapy 31:89–112, 2001CrossRefGoogle Scholar
  20. 20.
    Jacobson NS, Fruzzetti AE, Dobson K, Whisman M, Hops H: Couple therapy as a treatment for depression: II. The effects of relationship quality and therapy on depressive relapse. Journal of Consulting and Clinical Psychology 61:516–519, 1993PubMedCrossRefGoogle Scholar
  21. 21.
    Friedman AS: Interaction of drug therapy with marital therapy in depressive patients. Archives of General Psychiatry 32:619–637, 1975PubMedGoogle Scholar
  22. 22.
    Beach SR, O’Leary K: Treating depression in the context of marital discord: outcome and predictors of response of marital therapy versus cognitive therapy. Behavior Therapy 23:507–528, 1992CrossRefGoogle Scholar
  23. 23.
    Dessaulles A, Jonson SM, Denton WH: Emotion focused therapy for couples in treatment of depression: a pilot study. The American Journal of Family Therapy 31:345–353, 2003CrossRefGoogle Scholar
  24. 24.
    Emanuels-Zuurveen L, Emmelkamp PM: Individual behavioural-cognitive therapy v. marital therapy for depression in marital distressed couples. The British Journal of Psychiatry 169:181–188, 1996PubMedCrossRefGoogle Scholar
  25. 25.
    Emanuels-Zuurveen L, Emmelkamp PM: Spouse-aided therapy with depressed patients. Behavior Modification 21:62–77, 1997PubMedCrossRefGoogle Scholar
  26. 26.
    Foley SH, Rounsaville BJ, Weissman MM, et al.: Individual versus conjoint interpersonal psychotherapy for depressed patients with marital disputes. International Journal of Family Psychiatry 10: 29–42, 1989Google Scholar
  27. 27.
    Jacobson NS, Dobson K, Fruzzetti AE, Schmaling KB: Marital therapy as a treatment for depression. Journal of Consulting and Clinical Psychology 59: 547–557, 1991PubMedCrossRefGoogle Scholar
  28. 28.
    Leff J, Vearnals S, Brewin CR, Wolff G, Alexander B, Asen E, et al.: The London depression intervention trial. Randomised controlled trial of antidepressants v. couple therapy in the treatment and maintenance of people with depression living with the partner: clinical outcome and costs. The British Journal of Psychiatry 177: 95–100, 2000PubMedCrossRefGoogle Scholar
  29. 29.
    Teichman Y, Bar-El Z, Shor H, Sirota P, Elizur A: A comparison of two modalities of cognitive therapy (individual and marital) in treating depression. Psychiatry 58:136–148, 1995PubMedGoogle Scholar
  30. 30.
    Hafner RJ, Badenoch A, Fisher J, Swift H: Spouse-aided versus individual therapy in persisting psychiatric disorders: a systematic comparison. Family Process 22:385–390, 1983PubMedCrossRefGoogle Scholar
  31. 31.
    Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J: An inventory for measuring depression. Archives of General Psychiatry 4:561–571, 1961PubMedGoogle Scholar
  32. 32.
    Hamilton M: A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry 23: 56–62, 1960PubMedGoogle Scholar
  33. 33.
    Zimmermann M, Coryell W, Corenthal C, Wilson S: A self-report scale to diagnose major depressive disorder. Archives of General Psychiatry 43: 1076–1081, 1986Google Scholar
  34. 34.
    Jones E, Asen E: Systemic couple therapy and depression. London, Karnac, 1999Google Scholar
  35. 35.
    Vaughn CE, Leff JP: The influence of family and social factors on the course of psychiatric illness: a comparison of schizophrenic and depressed neurotic patients The British Journal of Psychiatry 129:125–137, 1976PubMedGoogle Scholar
  36. 36.
    Spanier GB: Measuring dyadic adjustment: new scales for assessing the quality of marriages and similar dyads. Journal of Marriage and the Family 38:15–28, 1976CrossRefGoogle Scholar
  37. 37.
    Locke HJ, Wallace KM: Short-term marital adjustment and prediction tests: their reliability and validity. Marriage and Family Living 21: 251–255, 1959CrossRefGoogle Scholar
  38. 38.
    Arrindell WA, Boelens W, Lambert H: On the psychometric properties of the Maudsley Questionnaire (MMQ): evaluation of self-ratings in distressed and “normal” volunteer couples based on the Dutch version. Personality and Individual Differences 4:293–306, 1983CrossRefGoogle Scholar
  39. 39.
    Shadish WR, Bladwin SA: Meta-analysis of MFT interventions. Journal of Marital and Family Therapy 29:547–570, 2003PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Epidemiology and Social Psychiatry UnitMario Negri Institute for Pharmacological ResearchMilanItaly

Personalised recommendations