A brief marital satisfaction screening tool for use in primary care medicine

In the last 3 decades, research has shown consistent association with marriage and mortality and morbidity benefits. Despite the known emotional and physiological benefits of marriage, and the high rate of marriage failure, there are no well-defined screening tools to identify at-risk marriages in primary care settings.

Patients presenting to a family medicine clinic were asked to complete a one-item screening question about the level of satisfaction with their marriage. Participants were also asked to fill out the Dyadic Adjustment Scale (DAS), a validated 32-item marital adjustment scale.

A total of 159 of 208 (76%) respondents completed the survey. The average DAS score was 111 (SD=21.5), similar to the national average of 114 (SD=17.8). Using the DAS as the gold standard for marital satisfaction, we assessed the level of agreement between the one item screener and the longer DAS. A Pearson's Correlation Coefficient showed a correlation of 0.67. ROC curve showed sensitivity 86% and specificity 86% for the one item screener. Area under the curve was 0.89 (95% CI=0.83-0.93). In addition, analysis of variance showed that predictors of marital satisfaction included more dinners shared a week (compared 0--2, 3-6, 7 nights a week) and dates a month (0, 1--3, >3). Paired t test showed perceived health and living with spouse to be significant.

The one-item screening question was shown to have good correlation to the gold standard, as well as acceptable sensitivity and specificity for identifying current dissatisfaction with marriage in a primary care setting. Further research is needed to determine if screening in a primary care setting, correlated with early intervention, can help improve satisfaction and avoid divorce.