Original Research

Marital Status, Partner Satisfaction, and Depressive

Symptoms in Older Men and Women

Philip Donald St John, MD, MPH, FRCPC1; Patrick Roy Montgomery, MD, FRCPC2

Objectives: To determine if marital status is associated with depressive symptoms in men

and women, and to determine if partner satisfaction is associated with depressive
symptoms.
Methods: Community-dwelling adults (n = 1751) aged 65 years and older were sampled
from a representative population-based registry. Age, sex, education, and marital status
were self-reported. Satisfaction with living partner was assessed with an item from the
terrible–delightful scale. The Center for Epidemiologic Studies—Depression was used to
assess depressive symptoms, with a score of 15 or more indicating depressive symptoms.
Results: Only 3% of the sample were dissatisfied with their living partner, and those who
were dissatisfied with their living partner had higher levels of depressive symptoms.
Proportions of men with depressive symptoms were: 20.6% for never married; 19.2% for
separated or divorced; 17.3% for widowed; 7.3% for married (satisfied); and 38.1% for
married (dissatisfied) (c2 = 32.98, df = 4, P < 0.001). In women, the results were different:
11.8% for never married; 23.1% for separated or divorced; 15.4% for widowed; 14.4% for
married (satisfied); and 41.9% for married (dissatisfied) (c2 = 18.33, df = 4, P < 0.001). In
logistic regression models, a significant interaction term was seen for Marital status ´ Sex.
In stratified models, adjusting for age and education, an effect of marital status was seen in
men, but not in women.
Conclusions: The effects of marriage on depressive symptoms in men and women may be
different, with lower levels of depressive symptoms in married men, compared with
unmarried men, but similar rates in married women, compared with unmarried women.
Dissatisfaction with their partner was uncommon, but highly associated with depressive
symptoms.
Can J Psychiatry. 2009;54(7):487–492.

Clinical Implications
· Married men had lower rates of depressive symptoms than unmarried men, but married
women did not have lower rates of depressive symptoms than unmarried women.
· Men and women who were dissatisfied with their partner had high rates of depressive
symptoms.
· Clinicians should be alert to depressive symptoms in unmarried men, and researchers should
stratify analyses of depression on marital status and sex.

Limitations
· This was a cross-sectional survey, rather than prospective data, making causal inferences
difficult.
· It was not possible to adjust for some known confounding variables (such as functional status)
owing to small numbers in some categories.
· The measure of satisfaction with one’s partner was very crude.

The Canadian Journal of Psychiatry, Vol 54, No 7, July 2009 W 487

Original Research
Key Words: sex, gender, marital status, marriage,
depression, depressive symptoms
arriage may confer health benefits for people. Previous
M studies have shown that married people often have less
risky health behaviours1 and lower mortality rates than
unmarried people.2–4 Some attribute this protective effect to a
beneficial effect of marriage on mental health. Indeed, some
researchers go as far as to claim that unmarried people may die
of a broken heart.5 The effects of marital status on depression
have been studied in clinical samples and in population-based
studies. However, many previous reports of marital status and
depression have often not stratified on sex, and the effects of
marriage on mood may be different for men and women. This
is particularly relevant in older cohorts, where marital dura-
tion, roles, and responsibilities were different than in younger
cohorts. Married women in older cohorts may have had less
opportunity to pursue higher education and careers because
there was an expectation of maintaining a household and fam-
ily. For men, being married was unlikely to have resulted in
less educational or occupational opportunities. There are few
Canadian studies of marital status and depression. In one
recent population-based survey of depression in Canada,
Patten et al6 found that depression was more prevalent in
unmarried men than married men, while it was less prevalent
in unmarried women than married women. However, this
study was in adults of all ages, and not specific to older adults.
In other countries, widowed and single people may have a
higher risk of depression than married people,7 but the risk
with widowhood may decrease with time.8
Satisfaction with a living partner could also be associated with
depression. There are relatively few population-based studies
of marital quality and depression in older adults. People in
unhappy marriages or who are not satisfied with their partner
may have higher levels of depressive symptoms, as has been
shown in some studies of younger adults,9 and in older
adults.10,11 Conversely, those with depression may be at a
higher risk of poor marital relations.12 We therefore con-
ducted a secondary analysis of an existing population-based
epidemiologic study. The objectives were: to determine if
marital status is associated with depressive symptoms in men
and women, and if there is an interaction between marital sta-
tus and sex in this effect; and to determine if satisfaction with
their partner is associated with depressive symptoms in men
and women.
Abbreviations used in this article
CES-D Center for Epidemiologic Studies—Depression
MSHA Manitoba Study of Health and Aging
488
Methods
We conducted a secondary analysis of the MSHA, an
epidemiologic study conducted in Manitoba in conjunction
with the Canadian Study of Health and Aging.13 During
1991–1992, 1751 adults aged 65 years and older were inter-
viewed in their homes by trained interviewers. The original
sampling frame, which was comprehensive and representa-
tive, was from a list provided by Manitoba Health. Older
groups were oversampled. People residing in institutions
(nursing homes, hospitals, and prisons) were not included in
these analyses. Initially, 2890 people were selected. Among
these, 443 refused to participate, 480 were not eligible (had
died, had entered a nursing home, or were too ill), 162 could
not be located, and 54 did not complete the screening ques-
tionnaire. This left a sample of 1751 participants. The MSHA
received ethics approval from the Research Ethics Commit-
tee of the University of Manitoba, and adhered to the Helsinki
Declaration. Informed consent was obtained from the partici-
pants or from the appropriate proxy.
Measurements
Age, sex, education, and marital status were all self-reported.
For the purpose of these analyses, marital status was catego-
rized as never married, currently married, widowed, sepa-
rated, or divorced. An item regarding satisfaction with
current living partner was taken from the terrible–delightful
scale.14,15 This is a scale that measures satisfaction with vari-
ous life circumstances. The participant was asked to rate their
satisfaction with their current living partner on a 7-point
Likert-type scale from terrible to delightful. Responses of
mixed, dissatisfying, very dissatisfying, and terrible were
categorized as dissatisfied, while those who rated their satis-
faction with their current partner as being delightful, very sat-
isfying, or satisfying were considered to be satisfied with
their partner.
The CES-D scale16 was used to measure depressive symp-
toms. This is a reliable, valid measure of depressive symp-
toms in older adults. However, it is not a diagnostic tool for
major depression. It consists of 20 items, each scored from 0
to 3, giving a possible score from 0 to 60. Participants with a
score of 16 or greater were considered to have depressive
symptoms. In sensitivity analyses, we considered the entire
score as a continuous variable.
Analysis
Student t tests (assuming unequal variance) and analysis of
variance were used to compare continuous variables.
Chi-square tests were used for categorical variables. The out-
come variable was the dichotomized CES-D score. Stratified
analysis and logistic regression models were used to deter-
mine the effects of marital status and sex on depressive symp-
toms. Analyses stratified on sex were conducted. As well, a
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 Marital Status, Partner Satisfaction, and Depressive Symptoms in Older Men and Women

Table 1 Characteristics of the sample

Women

Never married Married, satisfied Married, dissatisfied Separated or divorced Widowed

Characteristics n = 68 n = 320 n = 31 n = 26 n = 579

Age, years, mean (SD) 77.4 (7.1–27.0) 72.3 (5.6–30.0) 72.3 (5.6– 21.0) 71.4 (5.5–22.0) 79.0 (6.7–36.0)
Education, years, mean (SD) 11.1 (3.7–19) 10.1 (3.2–23.0) 9.0 (2.6–11.0) 9.6 (13.1–15) 8.9 (3.4–18.0)
Living alone, % 72.1 3.1 6.5 73.1 85.3
CES-D, % >15 11.8 14.4 41.9 23.1 15.4
Men

Never married Married, satisfied Married, dissatisfied Separated or divorced Widowed

Characteristics n = 34 n = 518 n = 21 n = 26 n = 127

Age, years, mean (SD) 74.3 (7.6–26.0) 75.0 ( 6.7–30.0) 76.2 (7.3–23) 71.6 (5.3–21.0) 80.5 (7.1–35.0)
Education, years, mean (SD) 8.4 (3.7–18.0) 9.4 (3.8–25.0) 6.9 (3.2–11) 7.8 (3.0–11.0) 8.2 (3.8–18.0)
Living alone, % 67.6 1.4 38.1 80.8 85.8
CES-D, % >15 20.6 7.3 38.1 19.2 17.3

logistic regression model with the main effects terms marital
status, sex, and the interaction term of Marital status ´ Sex was
constructed. As this interaction term was highly significant,
all analyses were stratified on sex, and separate logistic
regression models were constructed for men and women.
Regression diagnostics were performed. All analyses were
performed using SPSS software, version 11.5 (SPSS Inc,
Chicago, IL).
Results
Characteristics of the sample are shown in Table 1. Women
were more likely than men to be widowed, while men were
more likely to be married. Women who had never married
were more educated and older than those who were married.
Conversely, men who had never married were younger and
less educated than married men. Most people were satisfied
with their living partner: 95% of married or common-law
men, and 89.2% of married or common-law women reported
being satisfied with their partner.
Overall, married people who were dissatisfied with their part-
ner were most likely to have depressive symptoms (Figure 1).
People who were divorced or separated were also more likely
to experience depressive symptoms. This was true both in
men and in women. However, there was a difference in
depressive symptoms in married and never-married men and
women. Married men were less likely to experience depres-
sive symptoms, compared with their never married counter-
parts. In women, marital status was not associated with
depressive symptoms.
Regression models with interaction terms showed a large and
statistically significant interaction between sex and marital
status. Therefore, separate models for men and for women
were constructed (Table 2). In men, the effect of marital sta-
tus on depressive symptoms persisted, even after accounting
for age (Model 1), and age and education (Model 2); married
men were less likely to have depressive symptoms than their
never-married counterparts. In women, being dissatisfied
with their living partner was strongly associated with depres-
sive symptoms after accounting for age (Model 1) and age
and education (Model 2). As living arrangements (living
alone, compared with not living alone) was collinear both
with marital status and with sex, we did not include living
arrangements in the logistic regression models. Sensitivity
analyses considering the CES-D as a continuous, rather than
dichotomous, score gave similar results.
Discussion
In this sample, marital status is associated with depressive
symptoms in men but not in women. Specifically, married
men were less likely to have depressive symptoms than
unmarried men. As well, being dissatisfied with one’s living
partner is associated with depressive symptoms in women.
Marriage has been reported to confer health advantages to
people. Others have reported that married people have less
risky health behaviours,1 and better survival than unmarried
people.2–4 There may also be differences in depression, as has
been demonstrated in younger Canadians.6 However, it is
possible that the effect of marriage is different in men and

The Canadian Journal of Psychiatry, Vol 54, No 7, July 2009 W 489

Original Research

Figure 1 The association between marital status and depression was different in men
and women. Never-married men were less likely than married men to have depressive
symptoms (c2 = 32.98, df = 4; P < 0.05,), whereas never-married women were less likely
to have depressive symptoms (c2 = 18.33, df = 4, P < 0.05). Dissatisfaction with living
partners was associated with depressive symptoms both in men and in women.
Depressive symptoms were defined as a score of 15 or more on the CES-D scale.

Depressive symptoms, %

1 2 4 5

1 Never married; 2 Married satisfied; 3 Married dissatisfied;

4 Separated or divorced; 5 Widowed

Marital status and satisfaction

women. This may be for several reasons; there may be marital
selection. Unmarried women in this cohort may have pursued
careers and (or) education which may have positively influ-
enced their health throughout life. Indeed, the unmarried
women in this cohort had higher educational levels than mar-
ried women. Conversely, men who had never married may
have had characteristics which impeded marriage. A second
possible explanation is that marriage itself has effects on
mood, which are protective for depression in men but not in
women.
In the multivariable models, widowers had a similar risk for
depressive symptoms, compared with other groups. In a
pan-European study, it was found that unmarried people had
higher rates of depression than other groups,7 but the effect
was fairly small. In addition, the effect of widowhood may
lessen over time.8 We do not have longitudinal data, and so are
unable to follow the temporal course of depressive symptoms
with widowhood or separation. Others have reported that wid-
owhood is associated with depressive symptoms in women
more than men, and that this effect is due to the financial strain
associated with losing one’s spouse (and their income).17 We
were unable to examine the effect of financial strain on
depressive symptoms in this study.
Strengths and Limitations
There are numerous limitations to this analysis. First, this was
a cross-sectional analysis. While the MSHA is a cohort study,
the number of people surviving to the follow-up assessment
did not allow for a prospective analysis (as many cells did not
contain 5 or more people). Thus the temporal effect of wid-
owhood and separation could not be studied. However,
population-based longitudinal studies over the entire course
of adult life are rare. Second, the numbers in many of the cate-
gories were small. Notably, there were very few separated
and divorced people in the sample, limiting the inferences
that can be drawn in these groups. The small sample size also
did not allow us to control for some known potential con-
founding factors: in particular, functional impairment and
cognitive impairment are associated with depressive symp-
toms. While activities of daily living and cognitive status
were measured in the MSHA, there were very few people
with disabilities in some of the marital status categories. We
therefore could not adjust for these factors. The third limita-
tion is the measurement of marital status and satisfaction. We
crudely grouped people into marital status categories, likely
oversimplifying the complex effects of marriage. Further, the
measure of partner satisfaction was even more limited,

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 Marital Status, Partner Satisfaction, and Depressive Symptoms in Older Men and Women

Table 2 Results of logistic regression models

Model 1a Model 2b
OR (95% CI) OR (95% CI)

Women
Never married (n = 68) Reference Reference
Married-satisfied (n = 320) 1.48 (0.65–3.36) 1.35 (0.59–3.10)
Married-dissatisfied (n = 31) 6.61 (2.33–18.78) 5.52 (1.92–15.87)
Separated or divorced (n = 26) 2.81 (0.85–9.23) 2.40 (0.72–8.03)
Widowed (n = 579) 1.30 (0.60–2.8) 1.04 (0.47–2.29)
Men
Never married (n = 34) Reference Reference
Married-satisfied (n = 518) 0.30 (0.12– 0.74) 0.31 (0.13–0.77)
Married-dissatisfied (n = 21) 2.28 (0.68–7.69) 2.37 (0.69–8.12)
Separated or divorced (n = 26) 0.99 (0.27–3.57) 0.96 (0.27–3.51)
Widowed (n = 127) 0.70 (0.26–1.85) 0.69 (0.26–1.84)

Dissatisfaction with living partner was strongly associated with depressive symptoms. In men, being married was
associated with less depressive symptoms. In women, being dissatisfied with living partner was associated with
depressive symptoms. Living arrangement (alone, compared with not alone) was highly correlated with sex. It was not
included in logistic regression models. Both OR and 95% CI were derived from the logistic regression model.
a
Model 1 is adjusted for only age. Covariate: age
b
Model 2 is adjusted for age and education. Covariate: age and education

consisting only of a single item drawn from a larger scale.
Fourth, we considered only current marital status. It is possi-
ble that some participants had been married on several occa-
sions, with different effects in different marriages throughout
their life. Another final limitation is our measure of depressive
symptoms. While the CES-D is a valid, reliable measure of
depressive symptoms, it is not a measure of major depression.
As such, it is difficult to draw inferences about the prevalence
of major depression in the various marital status groups.
There are also strengths to our study. First, it is a large repre-
sentative sample consisting of the entire province of
Manitoba, except for extremely remote areas. It contains a
large urban and a large rural sample. Second, the sampling
frame was extensive and representative. Third, the measure of
depression was a reliable, valid measure of depressive symp-
toms that has been widely used in other studies.
Conclusions
Being married appears to be associated with a lower risk of
depressive symptoms in men, but not in women. It is not clear
if this effect is limited to this cohort of older adults, where
marital roles and responsibilities are different than in younger
cohorts. As these younger cohorts age, it will be relevant to
study the effects of marital status on depression over their life
course. As well, further study is needed to verify these find-
ings in other settings. It is possible that the effects we observe
for depressive symptoms are limited to older Canadian
adults, and may not be true in other settings.
Our findings have implications for clinicians and health
policy-makers. Older men who are not married should be
considered carefully for evidence of depression. This group
has a particularly high rate of depressive symptoms. Socially
isolated men are also at an increased risk of suicide, and it is
possible that attention to depressive symptoms in this group
may lessen this risk.18,19 Health policy-makers should con-
sider unmarried men in planning and delivering health pro-
motion and prevention activities for depression.
Funding and Support
The MSHA was funded primarily by Manitoba Health, with
additional funding provided through the Canadian Study of
Health and Aging and by the Seniors Independence Research
Program of the National Health Research and Development
Program of Health Canada. The second wave of the MSHA was
funded primarily by Manitoba Health’s Healthy Communities
Development Fund, with additional funding provided through the
Canadian Study of Health and Aging and by the Seniors
Independence Research Program of the National Health Research
and Development Program of Health Canada (Project
6606–3954-MC[S]). The results and conclusions are those of the
authors and no official endorsement by Manitoba Health or other
funding agencies is intended or should be inferred.

The Canadian Journal of Psychiatry, Vol 54, No 7, July 2009 W 491

Original Research

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Manuscript received March 2008, revised, and accepted July 2008.
This research was presented at the Gerontological Society of America
meeting in November 2007 in San Francisco, California.
1
Assistant Professor and Acting Head, Section of Geriatric Medicine,
Department of Medicine, Centre on Aging, University of Manitoba,
Winnipeg, Manitoba.
2
Associate Professor, Section of Geriatric Medicine, Department of
Medicine, Centre on Aging, University of Manitoba, St Boniface General
Hospital, Winnipeg, Manitoba.
Address for correspondence: Dr PD St John, Section of Geriatrics,
Department of Medicine, and the Centre on Aging, University of
Manitoba, GE 545 Health Sciences Centre, 820 Sherbrook Street,
Winnipeg, MB R3A 1R9; pstjohn@hsc.mb.ca

Résumé : L’état matrimonial, la satisfaction à l’égard du partenaire, et les symptômes dépressifs

chez les femmes et les hommes âgés
Objectifs : Déterminer si l’état matrimonial est associé aux symptômes dépressifs chez les femmes et les
hommes, et déterminer si la satisfaction à l’égard du partenaire est associée aux symptômes dépressifs.
Méthodes : Des adultes (n = 1751) résidant dans la communauté âgés de 65 ans et plus ont été échantillonnés à
partir d’un registre représentatif de la population. L’âge, le sexe, le niveau d’instruction, et l’état matrimonial
étaient auto-déclarés. La satisfaction à l’égard du partenaire de vie a été évaluée à l’aide d’un item de l’échelle
terrible–enchanteur. L’échelle du Centre d’études épidémiologiques-Dépression (CES-D) a été utilisée pour
évaluer les symptômes dépressifs, et à un score de 15 ou plus, les symptômes dépressifs étaient considérés.
Résultats : Seulement 3 % de l’échantillon étaient insatisfaits à l’égard de leur partenaire de vie, et ceux qui
étaient insatisfaits à l’égard de leur partenaire de vie avaient des niveaux plus élevés de symptômes dépressifs.
Les proportions d’hommes présentant des symptômes dépressifs étaient : 20,6 % chez les jamais mariés; 19,2 %
chez les séparés ou divorcés; 17,3 % chez les veufs; 7,3 % chez les mariés (satisfaits); et 38,1 % chez les mariés
(insatisfaits) (c² = 32,98, dl = 4, P < 0,001). Chez les femmes, les résultats étaient différents : 11,8 % chez les
jamais mariées; 23,1 % chez les séparées ou divorcées; 15,4 % chez les veuves; 14,4 % chez les mariées
(satisfaites); et 41,9 % chez les mariées (insatisfaites) (c² = 18,33, dl = 4, P < 0,001). Dans les modèles de
régression logistique, un terme d’interaction significatif pour état matrimonial ´ sexe a été observé. Dans les
modèles stratifiés, après ajustement de l’âge et du niveau d’instruction, un effet de l’état matrimonial se voyait
chez les hommes, mais pas chez les femmes.
Conclusions : Les effets du mariage sur les symptômes dépressifs des hommes et des femmes peuvent être
différents; les hommes mariés ont des taux plus faibles de symptômes dépressifs, comparé aux hommes non
mariés, mais les taux sont semblables chez les femmes mariées et les femmes non mariées. L’insatisfaction à
l’égard du partenaire de vie n’était pas fréquente, mais hautement associée aux symptômes dépressifs.

492 W La Revue canadienne de psychiatrie, vol 54, no 7, juillet 2009