Intimate relationship distress and incidence of major depression in a U.S. probability sample: A preregistered...

Poor intimate relationship quality is prospectively associated with elevated levels of depressive symptoms and higher incidence of a major depressive episode. Propensity score matching analyses, which statistically equate people in the exposure sample (e.g., people in distressed relationships) with a comparison sample (e.g., people in nondistressed relationships), provide a complementary means to traditional covariate analyses for addressing confounding in observational research, thereby enhancing the ability to evaluate potential causal associations. In this preregistered study, propensity score matching analyses were conducted using a probability sample of married adults in the United States aged 50 years and older who participated in 2014/2016 or 2016/2018 waves of the Health and Retirement Study and who were (a) not depressed at baseline and (b) continuously married at baseline and 2-year follow-up. Women (n = 407) and men (n = 525) in distressed relationships were matched with an equal number of women and men in nondistressed relationships on the propensity to experience relationship distress. Women and men in distressed relationships were significantly more likely than propensity-matched women and men in nondistressed relationships to meet criteria for a past-year major depressive episode at follow-up. In the full sample of women (n = 2,273) and men (n = 2,345), similar results were obtained for covariate analyses using the propensity score as well as traditional covariate analyses examining covariates independently. Findings provide strong support for the perspective that relationship distress is causally associated with depression and support the use of couple-based interventions for preventing and treating depression in middle-aged and older adults. (PsycInfo Database Record (c) 2026 APA, all rights reserved).