The Role of Depression in the Relationship Between Psychological and Physical Intimate Partner Violence

Abstract

Physical and psychological intimate partner violence (IPV) are significant public health concerns often associated with negative consequences for individuals, families, and society. Because IPV occurs within an interpersonal relationship, it is important to better understand how each partner’s depressive symptoms, marital satisfaction, and psychological and physical IPV are interlinked. The purpose of this study was to identify actor and partner effects in a dyadic data analysis association between marital satisfaction and depressive symptoms, its links to psychological IPV, and then to physical IPV. Guided by the social information processing model, this study has implications for understanding the processes leading to various types of IPV in people seeking couples therapy. Using cross-sectional data from 126 heterosexual couples, we conducted an actor–partner interdependence model (APIM) to test actor and partner effects. Indirect actor and partner effects were also assessed. More depressive symptoms were associated with lower marital satisfaction. More depressive symptoms were generally linked with increased perpetration of psychological and physical IPV. Psychological IPV was associated with an individual’s use of physical IPV. Effect sizes were moderate to large in magnitude. Four specific indirect effects were identified from depressive symptoms to psychological IPV to physical IPV. Depressive symptoms may be an important factor related to psychological and physical IPV for males and females. Implications include assessing for and treating depression in both partners, and discussing preferred ways of supporting each other that do not include psychological or physical IPV.

Keywords

intervention/treatment domestic violence mental health and violence predicting domestic violence

Intimate partner violence (IPV) and depression are significant public health issues. According to a recent review, approximately one in four women (23%) and one in five men (19.3%) reported experiencing IPV in the past 10 years (Desmarais, Reeves, Nicholls, Telford, & Fiebert, 2012). Even though most IPV research has focused on physical violence, psychological IPV has also found to be associated with higher risk for mental health problems (Al-Modallal, 2012). Although research has identified a link between depressive symptoms and IPV (Al-Modallal, 2012), few studies have examined both partners to test dyadic links between depressive symptoms, marital satisfaction, and IPV perpetration (e.g., Mair, Cunradi, & Todd, 2012; Marshall, Jones, & Feinberg, 2011).

As IPV occurs within an interpersonal relationship, it is important to understand how each partner’s depressive symptoms, marital satisfaction, and psychological IPV are associated with their partner’s depressive symptoms and marital satisfaction, and how these factors may relate and pose more or less risk for physical IPV. From this perspective, does one partner’s level of marital satisfaction or psychological IPV mediate the relationship between his or her level of depression and level of physical IPV perpetration? Is one partner’s depression associated with his or her use of physical IPV? Do these factors relate differently for males and females?

Considering that there is substantial research about the association between depression and relationship distress (e.g., Whisman, 2001), previous study has highlighted the importance to further understand this association in terms of the dynamics of the relationship (Davila, 2001). From this perspective, understanding physical IPV as a serious form of relationship distress, this study aims to advance the understanding of relationship dynamics that could exacerbate the links between depression and physical IPV. This study will expand what is known by testing a more complete picture of the development of IPV within couples who are seeking treatment for IPV. A better understanding of this dyadic process may provide more targeted information that can be incorporated into treatment for the reduction of IPV in couples therapy. The data from this project came from a study designed to develop and test a couples treatment program for couples experiencing situational couple violence (Kelly & Johnson, 2008) who choose to stay together (Stith, Rosen, McCollum and Thomsen, 2004a, Stith and McCollum, 2011). This is particularly important due to high number of couples who experience IPV and do choose to stay together, as well as the prevalence of forms of IPV being bidirectional (Stith et al., 2004a). Furthermore, previous research has found that a quarter of all couples will experience violence at some point in their relationship, and over half of this violence will be perpetrated by both partners (Whitaker, Haileyesus, Swahn, & Saltzman, 2007). The purpose of the larger project was to determine the efficacy and safety of conjoint treatment for carefully screened couples. The purpose of the current study is to use data collected from the clinical sample of couples who have experienced IPV to explore the relationship between male’ and females’ depression, marital satisfaction, and the use of psychological and physical IPV by both partners.

Theory: Social Information Processing (SIP) Model

Multiple theories have been applied to the examination of IPV. In this study, we use Crick and Dodge’s (1994) reformulation and expansion of McFall’s (1982) SIP model to test the associations between depressive symptoms, marital satisfaction, psychological IPV, and physical IPV. Crick and Dodge’s (1994) model has been offered as an organizational framework to advance the study of IPV (Murphy, 2013). SIP involves a series of steps with regard to one’s behavior in intimate relationships. The six-stage model includes (a) encoding of external and internal social cues, (b) interpretation and mental representation of social cues, (c) goal clarification or selection, (d) response access or construction, (e) response decision, and (f) behavioral enactment of chosen response (Crick & Dodge, 1994). This nonlinear model proposes a series of sequential and repeating steps, or a circular feedback loop, in which the enactment and evaluation of an offender’s own behavior may negatively alter their subsequent decoding and interpretation of their partner’s social cues.

In interpreting the behavior of one’s partner as negative and intentional, one may respond with psychological violence, which in turn alters their subsequent decoding of their partner’s behavior, and they may respond with physical violence. It is important to note that in applying an SIP model to the study of IPV, violence is seen as an actively selected response option, highlighting the role of personal choice and placing accountability on offenders, while also elucidating targets for intervention (Murphy, 2013). Because emotional factors, such as depression, may negatively bias one’s appraisal of their partner’s behavior (e.g., believing one’s partner is responding negatively toward them when they are not), contributing to the risk for IPV (Murphy, 2013), we speculated that in considering both the reformulated and expanded SIP model (Crick & Dodge, 1994) and the research on marital satisfaction, that depressive symptoms may skew interpretations of social cues that lead to lower marital satisfaction and greater risk for acting violently toward a partner. Moreover, a meta-analysis of risk markers for IPV revealed that decreased marital satisfaction is positively associated with IPV (Stith, Smith, Penn, Ward and Ttritt, 2004b).

We, therefore, envision depression as a condition that may negatively alter the first stage of Crick & Dodge’s (1994) SIP model (the encoding of internal and external relational cues), placing couples at increased risk for IPV. We see decreased marital satisfaction as a potential outcome that may be perpetuated by the circular feedback loop, while we see psychological IPV and physical IPV as potential response options that may be behaviorally enacted as part of the feedback loop.

Considering that in this study we did not infer causal relationships among the variables, we conceptualize depression as part of the stages of the SIP model. Based on that model, we understand that one’s level of depressive symptoms may impair the whole coding of social cues, which might lead to one’s lower level of marital satisfaction as well as use of psychological violence. As a consequence of a dynamics of misunderstandings and psychological abuse, a person with higher levels of depressive symptoms may act aggressively toward the partner.

Depressive Symptoms and Physical IPV

The understanding of the association between depressive symptoms and physical IPV perpetration and victimization is particularly important for clinicians working with couples. Couples may seek therapy showing depression or IPV as the presenting problem, when in fact neither of these problems stand alone, but occur within relationships.

The association between depression and physical IPV is well-known: Depression has been found to be a risk marker for physical IPV perpetration and victimization among males and females (Stith, Green, Smith, & Ward, 2008). Recent research suggests that regardless of gender, victims of IPV experience more depression than do nonvictims, and male perpetrators experience more depression than do nonperpetrators (Graham, Bernards, Flynn, Tremblay, & Wells, 2012). We know less about the relationship between depression and female IPV perpetration. Consistent with the broader research examining IPV, studies investigating the link between depression and different forms of IPV have focused on unilateral (i.e., male-to-female) perpetration of IPV, noting higher levels of depression among female victims of physical IPV (Houry, Reddy, & Parramore, 2006) and of psychological IPV (Beydoun, Beydoun, Kaufman, Lo, & Zonderman, 2012). This study tests these associations for women and men simultaneously.

Previous research has found differing results in relation to how gender moderates the association between depression and physical IPV perpetration, especially with regard to the links between male depression, and self and partner perpetration of physical IPV. Mair and colleagues (2012) found that males’ depression was related only to females’ physical IPV perpetration. Conversely, Marshall, Jones, and Feinberg (2011) found that males’ and females’ depression was significantly associated with partner’s IPV perpetration. As most of previous research has been based on data assessing only one partner, more research is needed to further investigate gender differences, based on dyadic analysis.

Association Between Depressive Symptoms and Physical IPV as Mediated by Marital Satisfaction

Considering the importance of dynamics of couple relationship that is associated to IPV, we have included another factor, marital satisfaction, which could enhance our understanding of the association between depressive symptoms and physical IPV. Previous research based on a systematic review of risk factors for IPV (Capaldi, Knoble, Shortt, & Kim, 2012) and on a meta-analysis review (McCollum and Stith, 2007) suggests that low marital satisfaction is associated with IPV perpetration and victimization. Furthermore, depression is negatively associated with marital satisfaction (e.g., Kouros, Papp, & Cummings, 2008), and this association has been found to be stronger for women than for men (Whisman, 2001). Although the majority of studies have focused on associations within partners only, in the sense that one’s depression is related to his or her own marital satisfaction, there is evidence that this association is also evidenced between partners (Whisman, Uebelacker, & Weinstock, 2004).

Depressive symptoms were found to be associated with marital problems, in a context where at least one partner is chronically depressed (Foran et al., 2012). An individual’s level of depression was negatively associated with partner’s marital satisfaction (Whisman et al., 2004). Altogether, these suggest the need for research and treatment to consider the associations between depression and marital satisfaction for both partners. The focus on the treatment of depression in couples therapy is warranted because a reduction of depression has been found to be associated with increased levels of marital satisfaction and dyadic adjustment (Denton et al., 2010).

Research, however, is not clear with regard to possible gender differences: McCollum and Stith (2007) meta-analytic review found a stronger association between marital satisfaction and IPV victimization for females, whereas a study based on a systematic review has suggested no significant difference for that association (Capaldi et al., 2012).

Research comparing rates of physical and psychological IPV has found differences with regard to sex, marital satisfaction, and direction of perpetration. In this regard, it has been observed that level of marital satisfaction is an important factor influencing reporting of both physical and psychological IPV (Marshall, Panuzio, Makin-Byrd, Taft, & Holtzworth-Munroe, 2011b): Those with higher level of marital satisfaction reported lower levels of IPV victimization, compared with what was reported by the partner.

There has been research on the association between depression and physical IPV, as well as on the link between marital satisfaction and IPV. These studies, however, were limited to consider these paths separately, and based on individual’s factors, not on dyadic data. From this perspective, one study found marital satisfaction to mediate the association between depressive symptoms and IPV victimization among couples where there was one chronically depressed partner (Foran et al., 2012). In that study, participants were women who were interested in treatment for chronic depression; data collected focused only on psychological and physical IPV victimization. More research is needed, however, to investigate the complexity among depressive symptoms, marital satisfaction, and perpetration and victimization of IPV. We moved beyond Foran et al.’s (2012) study in that we have included dyadic data, to test both self and partner perpetration of IPV. This study aims to move the field toward filling this gap in the literature with regard to the lack of clarity about the associations between depressive symptoms, marital satisfaction, and IPV, across both partners.

Association Between Depressive Symptoms and Physical IPV as Mediated by Psychological IPV

Previous studies have produced varying results about the link between males’ and females’ depression with regard to their own (actor path) and their partners’ (partner path) perpetration of psychological and/or physical IPV. Compared with males’ depression, females’ depression appears to be more strongly related to perpetration of psychological (Kim & Capaldi, 2004) and physical IPV for both partners (Mair et al., 2012).

Although differing forms of IPV have been suggested to coexist (Lawrence, Orengo-Aguayo, Langer, & Brock, 2012), there is a lack of research on the associations between psychological and physical IPV, especially in a dyadic context. Most research has focused on physical IPV (e.g., Mair et al., 2012; Marshall, Jones, & Feinberg, 2011), and when including psychological IPV, this has been framed as an outcome, not in association with depression and physical IPV (Kim & Capaldi, 2004). Considering that IPV occurs within the context of interpersonal relationships, more research is needed to identify interdependencies in couples with regard to depression, psychological, and physical IPV.

Previous research has found that the practice of coping mechanisms, such as prayer, social support, distancing, accepting responsibility, self-controlling, to mediate the association between physical IPV and depression among low-income African American women (Mitchell et al., 2006). In addition, considering that communication problems and difficulties with marital adjustment have been found to be associated with male perpetration of psychological IPV (Schumacher, Slep, & Heyman, 2001), the latter could also mediate the association between depression and physical IPV, but this warrants further investigation. It will also be important to investigate those associations among couples in long-term relationships, in a clinical sample of those who seek help for experiencing violence in the realm of marital relationships.

Hypotheses

We propose five hypotheses to accomplish these aims. First, we hypothesize that higher scores on depressive symptoms will be associated with lower scores on marital satisfaction (Hypothesis 1), higher scores on perpetration of psychological IPV (Hypothesis 2), and higher scores on perpetration physical IPV (Hypothesis 3). Also, we hypothesize that higher scores on psychological IPV perpetration will be associated with higher scores on perpetration of physical IPV (Hypothesis 4). Finally, we hypothesize that the association between depressive symptoms and physical IPV will be mediated by marital satisfaction and/or psychological IPV (Hypothesis 5). Each of these direct and indirect associations will include tests of both actor and partner effects to better understand how these variables work within and between romantic partners.

Method

Sample and Procedure

Participants were 126 couples seeking conjoint treatment for high conflict, including physical IPV (Stith, Rosen, McCollum, & Thomsen, 2004a). The study protocol was reviewed and approved by the University Institutional Review Board under which this study was conducted. The couples were recruited in the Washington, D.C., metropolitan area from court system referrals, social service agencies, and mental health providers, and in response to community advertisements. Couples came to the program because they had experienced high conflict (including some level of physical aggression), but wanted to stay together, eliminate violence, and improve their relationships. Prior to participating in the study (and the subsequent couples treatment), partners were separated for individual safety assessment interviews. The safety interviews were modeled after the Dangerousness Assessment Scale (Campbell, Webster, & Glass, 2009) which was used to exclude couples from the couples treatment program. At this time, participants also independently completed pretest instruments, which were also used to help determine if the couple was appropriate for conjoint treatment, to ensure all participants’ safety. The present study included variables from the larger study that were relevant for this analysis. Not all participants began treatment. Some were unable to meet the scheduled appointments and others were deemed ineligible because of a variety of potential factors, such as victim fear and substance abuse.

Table 1 presents the demographic characteristics of the sample. The mean length of current relationship was 6.55 years (SD = 7.32). Relationship length in the sample ranged from 1 to 45 years. The mean age of the males was 35.91 (SD = 10.37) years old with a range of 19 to 74. The mean age of the females was 33.58 (SD = 9.66) with a range of 18 to 68. Most participants were Caucasians (52% for men and 53.6% for women), followed by African American (27.6% for men and 21.6% for women). More than half the males and three fourths of the females reported at least some college education (68% of men and 78% of women), and most were employed outside the home (99% of men and 82% of women). Table 1 presents the means, standard deviations, t test comparing males and females on each measure, and reliability scores for each of the measures in the study.

Table 1.

Descriptive Statistics for Study Variables (N = 126 couples).

Variables	Men	Women	t(256)	α
Variables	M (SD) or %	M (SD) or %	t(256)	α
Physical IPV	1.09 (1.08)	0.60 (0.71)	5.48***	.89 (male), .89 (female)
Psychological IPV	2.55 (1.18)	2.01 (1.10)	4.97***	.75 (male), .81 (female)
Depression	1.26 (0.83)	1.54 (0.92)	−2.38*	.92 (male), .91 (female)
Marital satisfaction	4.33 (1.54)	3.50 (1.44)	6.23***	.93 (male), .96 (female)
Age	36.9 (10.1)	34.1 (9.7)	—	—
Education
Less than H.S.	8.2%	6.9%	—	—
H.S./GED	23.7%	14.7%	—	—
Some college/Voc-Tech	32.0%	32.3%	—	—
4-year degree	19.6%	22.6%	—	—
Graduate degree	16.5%	23.5%	—	—
Ethnicity
Asian	3.3%	5.6%	—	—
Black	27.6%	21.6%	—	—
Hispanic	9.8%	12.0%	—	—
Native American	0.8%	0.0%	—	—
White	52.0%	53.6%	—	—
Other	3.3%	0.8%	—	—
Multiethnic	3.3%	6.4%	—	—
Income
Unemployed	1.1%	17.8%	—	—
<US$19,999	18.4%	27.8%	—	—
US$20,000-US$59,999	54.0%	43.3%	—	—
US$60,000-US$99,999	19.5%	5.5%	—	—
>US$100,000	6.9%	5.6%

Note. IPV = intimate partner violence; H.S. = high school; GED = General Educational Development; Voc-Tech = vocational technical.

p < .05. **p < .01. ***p < .001 (two-tailed).

Measures

Psychological IPV

Psychological IPV was measured using the Conflict Tactics Scale–2 (CTS-2; Straus, Hamby, Boney-McCoy, & Sugarman, 1996). This is a widely used measure to assess self and partner perpetration of physical, sexual, or emotional IPV. Considering some criticisms to this measure with regard to participants’ potentially underreporting IPV due to social desirability factors, as suggested by other authors (e.g., Ganellen, 2007), we have assessed self and partner’s use of IPV. For the purpose of the present study, we used the higher score from self or partner report of psychological IPV. From the CTS-2, the Psychological Aggression subscale was comprised of eight items (e.g., “My partner called me fat or ugly”). Each item on this subscale ranged from 0 (no, this has never happened) to 6 (more than 20 times in the past year), and ratings of the items comprising the subscale were averaged to create total subscale scores. Higher scores indicated more psychological IPV. This subscale showed acceptable reliability (α = .81 for females and α = .75 for males).

Physical IPV

We utilized the Physical Assault subscale from the CTS-2 (Straus et al., 1996) to measure physical IPV. For the present study, we used the higher score from self or partner report of physical IPV. The Physical Assault subscale was composed of 12 items (e.g., “My partner used a knife or a gun on me”). Each item on this subscale ranged from 0 to 6, and ratings of the items comprising the subscale were averaged to create total subscale scores. Higher scores indicated more physical IPV. The Physical Assault subscale resulted in acceptable reliability (α = .89 for females and α = .89 for males).

Depressive symptoms

Depression was measured using the Depression subscale of the Symptom Checklist-90–Revised (SCL-90-R; Derogatis, 1983), including 13 depressive symptom items. Participants were asked to rate on a 5-point scale (0 = not at all to 4 = extremely) the extent to which they experienced depressive symptoms (e.g., “Feeling hopeless about the future”). Scores were averaged so each person’s score could range from 0 to a maximum of 4. This subscale showed an acceptable reliability (α = .91 for females and α = .92 for males).

Marital satisfaction

Marital satisfaction was measured through the Kansas Marital Satisfaction Scale (KMS) comprised of three items (Schumm et al., 1986). Participants were asked to rate on a 7-point scale (1 = extremely dissatisfied to 7 = extremely satisfied) their overall satisfaction with their current relationship (e.g., “How satisfied are you with your current marriage or relationship?”). Higher scores indicated higher levels of marital satisfaction. This subscale showed acceptable reliability (α = .96 for females and α = .94 for males).

Demographic variables

Participants were asked to report their age in years. They were also asked to report on their level of education, ethnicity, and income as categorical variables (see Table 1).

Analytic Plan

To test the hypotheses of this study, we first estimated descriptive statistics, testing for mean differences between men and women, and estimating bivariate correlations (see Table 2). Next, we used Mplus 6.11 (Muthén & Muthén, 1998-2012) to estimate an actor–partner interdependence model (APIM; Kline, 2011). APIMs are a type of model used to examine interdependence in interpersonal relationships. In other words, APIMs allow for the exploration of associations between variables in a dyadic context (e.g., husband and wife dyads, parent and child dyads). In this study, we used both partners’ reports of their depressive symptoms to predict marital satisfaction, as well as psychological IPV, as predictors of physical IPV (see Figure 1). Actor and partner effects were assessed, where an actor effect was the effect a person has on himself or herself, and a partner effect is an effect a person has on a partner. Although it would have been preferable to test these dyadic indirect effects in a longitudinal design, all these measures were assessed at a single time point. No causal or longitudinal claims can be inferred from this model due to the measurement being cross-sectional. However, previous community-based research has found that although depressive symptoms do fluctuate across the years, the median for recovery from a depressive episode was about 2 or 3 years, for both males and females (Eaton et al., 2008). Furthermore, previous research has found that personality traits are associated with marital satisfaction among long-term couples (Claxton, O’Rourke, Smith, & DeLongis, 2011). As a result, it could be said that due to the longitudinal stability across time of depressive symptoms and marital satisfaction, this model is still befitting (Claxton et al., 2011; Eaton et al., 2008). We also used bootstrapping to test indirect effects (5,000 bootstraps; Macho & Ledermann, 2011), assessing the 95% confidence interval (CI) of the bootstrapped indirect effect. If the 95% CI for the bootstrapped indirect effect includes zero, the indirect effect is not significant.

Table 2.

Correlations Among Variables in the Actor–Partner Interdependence Model (N = 126 couples).

	1	2	3	4	5	6	7	8
1. Male physical IPV	—
2. Female physical IPV	.41***	—
3. Male psychological IPV	.63***	.38***	—
4. Female psychological IPV	.34***	.62***	.43***	—
5. Male depression	.26**	.31***	.25**	.43***	—
6. Female depression	.28***	.28**	.29***	.13	−.14	—
7. Male marital satisfaction	−.18*	−.08	−.32***	−.35***	−.37***	−.11	—
8. Female marital satisfaction	−.15	−.14	−.36***	−.28**	−.18*	−.28**	.49***	—

Note. IPV = intimate partner violence.

p < .05. **p < .01. ***p < .001 (two-tailed).

Figure 1.

Actor–partner interdependence structural equation model (N = 126 couples).

Full information maximum likelihood was used to handle missing data (Acock, 2005), but it is important to note that there was very little missing data in this study. Of all the participants included in the analysis, two of the women and one of the men did not report marital satisfaction, but there was no other missing data. Prior to conducting analysis, the Omnibus Test of Distinguishability (I-SAT) was utilized to test for empirical distinguishability between men and women, as recommended prior to conducting dyadic data analyses (Olsen & Kenny, 2006). We also conducted t tests and chi-square difference tests to compare males and females.

Results

Preliminary Analyses

Correlations between all the variables in the model were calculated and can be viewed in Table 2.

We tested for mean differences between males and females on the variables of interest. Our t tests revealed that males had significantly higher scores than females on physical and psychological IPV perpetration, lower depressive symptoms, and higher marital satisfaction (p < .05; see Table 1), yet we did not find significant gender differences in the strength of the pathways in our APIM models. The I-SAT (Olsen & Kenny, 2006) revealed that males and females were empirically distinguishable, χ²(22) = 190.16, p < .001. We, therefore, tested our hypotheses by freely estimating all the parameters in this APIM.

APIM Path Analyses

To test our hypotheses, we analyzed an APIM testing the associations between each partner’s depressive symptoms, marital satisfaction, psychological IPV, and physical IPV (see Figure 1). The data fit the model reasonably well, χ²(4) = 7.84, p = .10, root mean square error approximation (RMSEA) = .09, comparative fit index (CFI) = .99, standardized root mean square residual (SRMR) = .05; the only indicator of model fit that did not support the model was the RMSEA (Hu & Bentler, 1999; Kline, 2011).

Direct Paths

There was a significant association in our model between male depression and several outcome variables, including male marital satisfaction (β = −.39, p < .001), female marital satisfaction (β = −.22, p < .01), male psychological IPV perpetration (β = .51, p < .001), and female psychological IPV perpetration (β = .28, p < .05). Female depression was likewise significantly associated with several outcome variables, including male marital satisfaction (β = −.16, p < .05), female marital satisfaction (β = −.29, p < .01), male psychological IPV (β = .16, p < .05), female psychological IPV (β = .34, p < .05), male physical IPV (β = .22, p < .01), and female physical IPV (β = .18, p < .05). In other words, all the possible actor and partner paths between female depression and all the six outcomes were significant. Males’ depressive symptoms, on the contrary, predicted both partners’ marital satisfaction and psychological violence, but did not directly predict either partners’ physical violence. There were no significant paths between marital satisfaction and physical IPV. The actor paths from psychological IPV perpetration to physical IPV perpetration were significant for males (β = .46, p < .001) and females (β = .52, p < .001). However, neither the partner path from male psychological IPV perpetration to female physical IPV perpetration (β = .04, p = .52) nor the partner path from male psychological IPV perpetration to female physical IPV perpetration (β = .06, p = .58) reached statistical significance.

Indirect Paths

Nonparametric bootstrapping methods (5,000 bootstraps; Macho & Ledermann, 2011) were used to test indirect effects from depressive symptoms to physical IPV (see Table 3). Four significant indirect effects were identified. First, there was an indirect effect from female depression → male psychological IPV perpetration → male physical IPV perpetration (β = .09, p < .05, 95% CI = [.02, .17]). In other words, on average, a 1 standard deviation unit increase in female depression was associated with a .09 standard deviation unit increase in male physical IPV perpetration via its prior effect through male psychological IPV perpetration. Second, there was an indirect effect from male depression → male psychological IPV perpetration → male physical IPV perpetration (β = .24, p < .01, 95% CI = [.11, 36]). The third significant indirect effect was from female depression → female psychological IPV perpetration → female physical IPV perpetration (β = .17, p < .01, 95% CI = [.09, 36]). The fourth indirect effect was from male depression → female psychological IPV perpetration → female physical IPV perpetration (β = .14, p < .01, 95% CI = [.07, .34]).

Table 3.

Significant Indirect Pathways.

	Indirect b	95% CI
Female depression → Male psychological IPV → Male physical IPV	.09*	[.02, .17]
Male depression → Male psychological IPV → Male physical IPV	.24*	[.11, .36]
Female depression → Female psychological IPV → Female physical IPV	.17**	[.09, .36]
Male depression → Female psychological IPV → Female physical IPV	.14**	[.07, .34]

Note. CI = confidence interval; IPV = intimate partner violence.

p < .05. **p < .01 (two-tailed).

Robustness Check

After testing the original model, an alternative model in which marital satisfaction was the predictor variable and depression was the outcome variable was tested. The results demonstrated that the alternative model did not fit the data adequately, χ²(4) = 20.37, p < .01, RMSEA = .18, CFI = .92, SRMR = .11. The only model fit index that did not show a good fit between the data and the original model was the RMSEA, but for the alternative model, none of the model fit indices showed an acceptable fit between the data and the model. Furthermore, whereas 11 direct effects and four indirect effects were significant in the original model, only five direct effects and none of the indirect effects reached statistical significance in the alternative model. These results provide evidence that the original model is a more useful model in understanding direct and indirect dyadic processes linked with IPV.

Discussion

The present study examined the dynamics between depressive symptoms and IPV, in a dyadic context, and considering levels of marital satisfaction, using data collected from couples seeking conjoint treatment for IPV. Based on Crick and Dodge’s (1994) reformulation and expansion of McFall’s (1982) SIP model, we hypothesized that an individual’s level of depression would be associated with their own level of marital satisfaction and level of perpetration of psychological and physical IPV. We also hypothesized partner effects from an individual’s level of depression would be associated with his or her partner’s level of marital satisfaction and level of perpetration of psychological and physical IPV.

We first found that participants’ depressive symptoms were linked with both their own and their partners’ marital satisfaction. Depressive symptoms were generally linked to perpetration of psychological IPV and physical IPV by the participant and by his or her partner. Participants’ perpetration of psychological IPV was linked to his or her perpetration of physical IPV, but not to their partners’ perpetration. Results also revealed that in four instances, psychological IPV mediated the association between depressive symptoms and perpetration of physical IPV. Our results support the importance of including data from both partners in a dyadic data analysis to improve understanding of the relationship dynamics among couples experiencing IPV and seeking treatment for IPV.

We also identified links between depressive symptoms and IPV. We found that an individual’s depressive symptoms were associated with their partner’s psychological IPV, for both males and females, but with their partner’s perpetration of physical IPV for females only (e.g., Mair et al., 2012; Marshall, Jones, & Feinberg, 2011). In contrast, others have found that only females’ depression was significantly associated with male perpetrated physical and psychological IPV (Kim & Capaldi, 2004). It is important to note that females’ and males’ depressive symptoms tend to be linked with elevated risk for psychological and physical IPV. We found significant gender differences in the mean levels of psychological aggression, depression, and physical IPV, but we did not find any statistically significant gender differences in the way these variables related to each other. This may be a Type II Error, as our sample size may not have been sensitive to detect small differences in the strength of these associations.

Our indirect effects revealed that depressive symptoms were linked with perpetration of physical IPV indirectly through its relationship with perpetration of psychological IPV, which held true for both males and females in four specific indirect effects. We found a dyadic indirect effect, such that females’ depressive symptoms were linked with males’ perpetration of psychological IPV, and males’ perpetration of psychological IPV predicted males’ perpetration of physical IPV. In addition, we found similar results for indirect pathways from males’ depressive symptoms to females’ perpetration of physical IPV through its association with females’ perpetration of psychological IPV. Thus, some individuals may act more aggressive psychologically and physically when their partner is feeling more depressed. There are a number of plausible explanations for this, but treatment efforts would likely benefit by including both partners and assisting them with finding new ways to more sensitively deal with their partners’ depressive symptoms. This could include more understanding, support, and compassion, while eliminating harsh verbal and physical attacks as a way to deal with a partner’s depression.

Our findings could be interpreted through the lens of socio-information processing theory (Murphy, 2013), in the sense of the importance of understanding the role of depressive symptoms in contributing to the risk for IPV through biasing one’s appraisal of their partner’s behavior. According to our findings, there may be a dyadic association between one’s depressive symptoms and the partner’s psychological violence. It is possible that higher levels of an individual’s depressive symptoms may be associated with hostility and a negative response from his or her partner, which may escalate the perpetrating partner’s use of physical IPV. This aligns with previous research suggesting that in response to the demands of reassurance, partners of individuals with depression are at increased risk of directing their anger and frustration outward against the depressed individual, increasing the risk for IPV (Knobloch-Fedders, Knobloch, Durbin, Rosen, & Critchfield, 2013).

Although we did not find evidence that marital satisfaction mediated the relationship between depression and physical IPV, we found that higher levels of depression were associated with lower marital satisfaction for both people in the relationship. It could be said that marital satisfaction covaries fairly well with depression, and that both could be used as clinical risk markers. Nonetheless, based on our results, it may be most useful to clinically intervene with depression, opposed to marital satisfaction in an effort to reduce IPV.

Limitations and Strengths

Some important limitations of our study should be noted. As noted earlier, because our data were cross-sectional, we cannot test the temporal ordering of these variables, as we would prefer in this model testing dyadic indirect effects. Longitudinal data would allow for increased confidence in the longitudinal prediction of these variables, opposed to simply their associations within time. In addition, we had a convenience sample, in the sense that we utilized data obtained from couples seeking treatment for domestic violence. Although the present findings provide important information about relationships and couples experiencing IPV that could elucidate clinical work, regardless of client’s structure—if individual or couple—our findings should not necessary be generalized to every couple presenting with IPV. Therefore, the findings from this study may not generalize to couples in which only one partner is seeking or mandated to attend treatment. Furthermore, our findings may not be generalizable to couples with history of IPV, who have decided to end the relationship. All the couples in our study were trying to maintain their relationship.

Due to our limited clinical sample size, we could not include additional control variables, such as income, education, or length of relationship in our APIM models. Our limited sample size may also have reduced our power to detect certain pathways, or to assess for differences by gender. A number of factors could have been controlled for in this study if a larger sample was available, such as posttraumatic stress disorder (PTSD; Sherman, Sautter, Jackson, Lyons, & Han, 2006) and personality disorders (Kim & Capaldi, 2004).

Implications for Diverse Groups

In considering the implications of our research, we must first examine the larger context in which our study is embedded. Our sample was heterogeneous, with regard to race, sex, age, and socioeconomic status. As the majority of our sample (52% of men and 53.6% of women) identified as Caucasian, followed by African American (27.6% of men and 21.6% of women), our results may have limited generalizability to those who identify as members of other racial groups. We are also limited in that data on the ethnic identity of our sample were not available.

Consistent with the broader research examining IPV, this study used data collected from heterosexual couples seeking treatment for IPV. Although increasingly more research is examining IPV among same-sex couples (e.g., Frankland & Brown, 2014), a limitation of this study is that only heterosexual couples were included in the sample. This underscores that our historical understanding and contemporary approaches to treating IPV have been based on the experience of IPV in heterosexual couples.

This study, nonetheless, contributes to our understanding of the effects of both actor and partner pathways in the context of depression and IPV in a number of ways. We analyzed data obtained from couples seeking conjoint treatment for IPV. Although this could also be considered as a limitation of this study, our findings may also inform clinical practice, as a reasonable number of couples who experience IPV decide to stay together (Stith, & McCollum, 2011). Furthermore, we tested an APIM model, including data from both partners, which allowed for a better understanding of couple relationship dynamics, thus informing clinical practices for couples’ treatment.

Clinical and Policy Implications

This study used dyadic data from couples to explore the relationship between depressive symptoms and the use of psychological and physical IPV. Recognizing and treating depression is critical given that the World Health Organization predicts that unipolar depression will be the second leading cause of global disability by 2020 (Murray & Lopez, 1996).

One of the most important implications of this research is the suggestion that clinicians treating couples who are experiencing depression and/or IPV should specifically talk with clients about how being depressed may be connected with the use of IPV. By helping couples explore how their own (or their partner’s) depressed mood may be associated with IPV, they may be more motivated to address mood issues to prevent IPV. Helping clients understand the link between depression and IPV can increase their motivation to focus on building resilience and reducing depressive symptoms. In addition, clinicians should engage in continuous assessment for IPV throughout the treatment process.

The results of our study suggest that when males, females, or couples seek treatment for relationship problems, it is important for clinicians to screen for depression and IPV. It is particularly important that clinicians assess for not only physical IPV but also psychological IPV, and understand the seriousness of psychological IPV in intimate relationships and how psychological IPV may potentially interact with their partner’s depressive symptoms. In addition, we recommend that treatment for depressive symptoms should be included in batterer intervention programs for those who are mandated to complete treatment following the perpetration of IPV. In situations in which a couple intends to remain together following physical IPV, our results suggest it may be important for the partner of the victim of physical IPV to receive his or her own treatment, particularly for depression, in an effort to decrease the risk for future relationship violence.

Finally, because the diagnostic criteria for major depressive disorder includes symptoms such as psychomotor retardation and fatigue (American Psychiatric Association, 2013), clinicians may fail to recognize that more severe impairment may disrupt interpersonal relationships through symptoms such as anger and aggression, particularly when the individual is also the perpetrator of psychological IPV. Consistent with previous research, our findings corroborate the importance of treating both partners for depressive symptoms in a context of conflictual couple relationships (e.g., Knobloch-Fedders et al., 2013). It is important to understand the interplay between multiple factors and how partners respond to each other to provide informed treatment.

The results of our study also suggest that providing psychoeducation to couples in which at least one partner is experiencing depressive symptoms is indicated. This psychoeducation may include educating the partners about strategies that could be utilized to increase support to the depressed partner during treatment. In addition, it is important for both partners to be aware of the symptoms of anger and aggression that may accompany more severe impairment so that both will be able to work together to maintain a safe relational environment. The effectiveness of couples therapy for the quality of marital relationship when at least one partner is presenting with depressive symptoms has been reported somewhere else (Denton, Wittenborn, & Golden, 2012). In a study with couples where the female partner met criteria for major depressive disorder, Denton et al. (2012) found that those couples who received medication management and Emotionally Focused Therapy (EFT) as couple therapy intervention significantly improved their relationship quality, in comparison with those who were under medication management only.

Research Implications

The present study adds to the literature on IPV and it provides information for intervention and prevention programs, but future research should also examine the impact of other mental health conditions, such as other affective disorders and PTSD as potential predictors of psychological and physical IPV, especially in a dyadic context. Examining the role of PTSD may be especially valuable, because previous research has found anger and violence to be among the most common reasons why veterans with a diagnosis of PTSD enter couples treatment (Sherman et al., 2006). This study also highlights the need for future research utilizing dyadic data in an effort to better understand the dynamics of violence in intimate relationships. In particular, longitudinal studies recruiting a larger number of help-seeking couples are needed to further explore the relationship between depressive symptoms and the use of psychological and physical IPV among both male and female partners. Much of the research on IPV continues to examine male perpetration and female victimization without adopting a systemic lens (Knobloch-Fedders et al., 2013). This may be particularly damaging because not all couples who experience relationship violence will choose to terminate their relationship. In addition, because our results are not generalizable to same-sex couples, it is important for further research in this area to utilize dyadic data to explore the dynamics of IPV in same-sex couples as well.

We do recognize that IPV in same-sex couples may share similar dynamics as among heterosexual couples (Coleman, 2007). However, it is important to not generalize the present findings, as the understanding of IPV among homosexual couples requires a more multidimensional understanding, to include attention to individual, relational, and societal factors (Coleman, 2007). A previous study has found that in comparison with heterosexual couples, homosexual couples present higher level of psychological IPV, and lower levels of sexual and physical IPV (Merrill & Wolf, 2000).

Understanding the antecedents and processes preceding the development of IPV is important for efforts to prevent and reduce IPV. This study highlighted how depressive symptoms are linked with psychological and physical IPV within and between partners. Depressive symptoms were closely related to psychological and physical IPV, and were interdependently linked between partners. Thus, improving the perpetrator’s understanding of, interpretation of, and response to the victim’s depressive symptoms may be an important focal point for clinicians helping to break a couple’s cycle of violence—especially for those perpetrating high levels of psychological IPV.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was supported, in part, by a grant from the National Institute on Mental Health: Grant 1 R21 MH54613-02A1.

Author Biographies

Patrícia Barros-Gomes is a licensed marriage and family therapist, in the District of Columbia. She is a clinical fellow of the American Association for Marriage and Family Therapy (AAMFT) and an AAMFT approved supervisor. She is an assistant clinical professor at University of Maryland. Her research is focused on family and individual resilience as well as on partner violence. She has presented her research on national and international-level conferences.

Jonathan Kimmes is a licensed marriage and family therapist. He is an assistant professor at the Department of Family and Child Studies at Florida State University. He earned PhD from Kansas State University’s marriage and family therapy program. From 2013 to 2015, he was a fellow in AAMFT/SAMHSA’s (Substance Abuse and Mental Health Services Administration) Minority Fellowship Program. His research is focused on attachment and attributions of romantic relationships. He has presented his work posters at state- and national-level AAMFT conferences.

Erika Smith, PhD, is a licensed marriage and family therapist in private practice in Pensacola, Florida. She is a clinical fellow of the AAMFT and an AAMFT-approved supervisor. She has over a decade of experience specializing in the treatment of trauma and posttraumatic disorder and is a certified trauma specialist through the Association of Traumatic Stress Specialists. Her clinical and research interests converge around the treatment of trauma.

Bryan Cafferky is an assistant professor of marriage and family therapy at Loma Linda University. He teaches courses on statistics, family violence, and clinical assessment. His research interests focus on how at-risk families respond to crisis and trauma. He is currently working on research with military families and meta-analyses about family violence. His research has been presented at several state and national conferences.

Sandra Stith is a university distinguished professor of the family therapy program at Kansas State University. Her research focuses on partner violence. In 2011, American Psychological Association (APA) published her book—Couples Treatment for Domestic Violence: Finding Safe Solutions—describing a treatment program developed with National Institute on Mental Health (NIMH) funding. In 2004, she received the AAMFT’s Outstanding Contribution to Marriage and Family Therapy Award, and in 2007, she received the American Family Therapy Association’s Distinguished Contribution to Family Systems Research Award. In 2013, she was named as fellow of the National Council on Family Relations.

Jared Durtschi is an assistant professor of marriage and family therapy at Kansas State University. He teaches on the topics of structural equation modeling, solution-focused therapy, emotionally focused couples therapy, and narrative therapy. He provides clinical supervision to masters and doctoral students. His research and clinical interests center on romantic relationships and family processes. He studies couples and families by analyzing longitudinal, dyadic data using quantitative methods, with large data sets. He is externally funded by the Department of Defense, and a past project with the Kansas Department of Children and Families.

Eric McCollum is a professor and director of the marriage and family therapy master’s program at Virginia Tech. He has practiced psychotherapy for nearly 40 years. His research interests have included substance abuse, domestic violence, and mindfulness meditation. He is the author or coauthor of five books and many journal articles and book chapters. He regularly presents nationally and internationally.

References

Acock

(2005). Working with missing values. Journal of Marriage and Family, 67, 1012-1028. doi:10.1111/j.1741-3737.2005.00191.x

Al-Modallal

(2012). Psychological partner violence and women’s vulnerability to depression, stress, and anxiety. International Journal of Mental Health Nursing, 21, 560-566. doi:10.1111/j.1447-0349.2012.00826.x

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Beydoun

H. A.

Beydoun

M. A.

Kaufman

J. S.

Zonderman

A. B.

(2012). Intimate partner violence against adult women and its association with major depressive disorder, depressive symptoms and postpartum depression: A systematic review and meta-analysis. Social Science & Medicine, 75, 959-975.

Campbell

J. C.

Webster

D. W.

Glass

(2009). The danger assessment: Validation of a lethality risk assessment instrument for intimate partner femicide. Journal of Interpersonal Violence, 24, 653-674. doi:10.1177/0886260508317180

Capaldi

D. M.

Knoble

N. B.

Shortt

J. W.

Kim

H. K.

(2012). A systematic review of risk factors for intimate partner violence. Partner Abuse, 3, 231-280. doi:10.1891/1946-6560.3.2.231

Claxton

O’Rourke

Smith

J. Z.

DeLongis

(2011). Personality traits and marital satisfaction within enduring relationships: An intra-couple discrepancy approach. Journal of Social and Personal Relationships, 29, 375-396. doi:10.1177/0265407511431183

Coleman

V. E.

(2007). Dangerous dances: Treatment of domestic violence in same-sex couples. In Hamel

Nicholls

T. L.

(Eds.), Family interventions in domestic violence: A handbook of gender-inclusive theory and treatment (pp. 397-416). New York, NY: Springer.

Crick

N. R.

Dodge

K. A.

(1994). A review and reformulation of social information-processing mechanisms in children’s social adjustment. Psychological Bulletin, 115, 74-101.

10.

Davila

(2001). Paths to unhappiness: The overlapping courses of depression and romantic dysfunction. In Beach

S. R. H.

(Ed.), Marital and family processes in depression: A scientific foundation for clinical practice (pp. 71-87). Washington, DC: American Psychological Association.

11.

Denton

W. H.

Carmody

T. J.

Rush

A. J.

Thase

M. E.

Trivedi

M. H.

Arnow

B. A.

. . . Keller

M. B.

(2010). Dyadic discord at baseline is associated with lack of remission in the acute treatment of chronic depression. Psychological Medicine, 40, 415-424.

12.

Denton

W. H.

Wittenborn

A. K.

Golden

R. N.

(2012). Augmenting antidepressant medication treatment of depressed women with emotionally focused therapy for couples: A randomized pilot study. Journal of Marital and Family Therapy, 38(Suppl. 1), 23-38.

13.

Derogatis

L. R.

(1983). SCL-90-R revised manual. Baltimore, MD: John Hopkins School of Medicine.

14.

Desmarais

S. L.

Reeves

K. A.

Nicholls

T. L.

Telford

Fiebert

M. S.

(2012). Prevalence of physical violence in intimate relationships, Part 1: Rates of male and female victimization. Partner Abuse, 3, 140-169. doi:10.1891/1946-6560.3.2.140

15.

Eaton

W. W.

Shao

Nestadt

Lee

Bienvenu

Zandi

(2008). Population-based study of first onset and chronicity in major depressive disorder. Archives of General Psychiatry, 65, 513-520. doi:10.1001/archpsyc.65.5.513

16.

Foran

H. M.

Vivian

O’Leary

K. D.

Klein

D. N.

Rothbaum

B. O.

Manber

Trivedi

M. H.

(2012). Risk for partner victimization and marital dissatisfaction among chronically depressed patients. Journal of Family Violence, 27, 75-85.

17.

Frankland

Brown

(2014). Coercive control in same-sex intimate partner violence. Journal of Family Violence, 29, 15-22. doi:10.1007/s10896-013-9558-1

18.

Ganellen

R. J.

(2007). Assessing normal and abnormal personality functioning: Strengths and weaknesses of self-report, observer, and performance-based methods. Journal of Personality Assessment, 89, 30-40. doi:10.1080/00223890701356987

19.

Graham

Bernards

Flynn

Tremblay

P. F.

Wells

(2012). Does the relationship between depression and intimate partner aggression vary by gender, victim-perpetrator role, and aggression severity. Violence and Victims, 27, 730-743. doi:10.1891/0886-6708.27.5.730

20.

Houry

Reddy

Parramore

(2006). Characteristics of victims coarrested for intimate partner violence. Journal of Interpersonal Violence, 21, 1483-1492. doi:10.1177/0895904805293483

21.

Bentler

P. M.

(1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1-55.

22.

Kelly

J. B.

Johnson

M. P.

(2008). Differentiation among types of intimate partner violence: Research update and implications for intervention. Family Court Review, 46, 476-499.

23.

Kim

H. K.

Capaldi

D. M.

(2004). The association of antisocial behavior and depressive symptoms between partners and risk for aggression in romantic relationships. Journal of Family Psychology, 18, 82-96. doi:10.1037/0893-3200.18.1.82

24.

Kline

(2011). Principles and practice of structural equation modeling (3rd ed.). New York, NY: Guilford Press.

25.

Knobloch-Fedders

L. M.

Knobloch

L. K.

Durbin

Rosen

Critchfield

K. L.

(2013). Comparing the interpersonal behavior of distressed couples with and without depression. Journal of Clinical Psychology, 69, 1250-1268. doi:10.1002/jclp.21998

26.

Kouros

Papp

Cummings

(2008). Interrelations and moderators of longitudinal links between marital satisfaction and depressive symptoms among couples in established relationships. Journal of Family Psychology, 22, 667-677.

27.

Lawrence

Orengo-Aguayo

Langer

Brock

R. L.

(2012). The impact and consequences of partner abuse on partners. Partner Abuse, 3, 406-428.

28.

Macho

Ledermann

(2011). Estimating, testing, and comparing specific effects in structural equation models: The phantom model approach. Psychological Methods, 16, 34-43. doi:10.1037/a0021763

29.

Mair

Cunradi

C. B.

Todd

(2012). Adverse childhood experiences and intimate partner violence: Testing psychosocial meditational pathways among couples. Annals of Epidemiology, 22, 832-839. doi:10.1016/j.annepidem.2012.09.008

30.

Marshall

A. D.

Jones

D. E.

Feinberg

M. E.

(2011). Enduring vulnerabilities, relationships attributions, and couple conflict: An integrative model of the occurrence and frequency of intimate partner violence. Journal of Family Psychology, 25, 709-718. doi:10.1037/a0025279

31.

Marshall

A. D.

Panuzio

Makin-Byrd

K. N.

Taft

C. T.

Holtzworth-Munroe

(2011). A multilevel examination of interpartner intimate partner violence and psychological aggression reporting concordance. Behavior Therapy, 42, 364-377.

32.

McCollum

E. E.

Stith

S. M.

(2007). Conjoint couple’s treatment for intimate partner violence: Controversy and promise. Journal of Couple and Relationship Therapy, 6(1/2), 71-82.

33.

McFall

R. M.

(1982). A review and reformulation of the concept of social skills. Behavioral Assessment, 4, 1-33.

34.

Merrill

G. S.

Wolf

V. A.

(2000). Battered gay men: An exploration of abuse, help seeking, and why they stay. Journal of Homosexuality, 39(2), 1-30.

35.

Mitchell

M. D.

Hargrove

G. L.

Collins

M. H.

Thompson

M. P.

Reddick

T. L.

Kaslow

N. J.

(2006). Coping variables that mediate the relation between intimate partner violence and mental health outcomes among low-income, African American women. Journal of Clinical Psychology, 62, 1503-1520.

36.

Murphy

C. M.

(2013). Social information processing and the perpetration of intimate partner violence: It is (and isn’t) what you think. Psychology of Violence, 3, 212-217. doi:10.1037/a0033344

37.

Murray

C. J.

Lopez

A. D.

(1996). The global burden of disease: A comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Cambridge, MA: Harvard School of Public Health.

38.

Muthén

L. K.

Muthén

B. O.

(1998-2012). Mplus user’s guide (6th ed.). Los Angeles, CA: Author.

39.

Olsen

J. A.

Kenny

D. A.

(2006). Structural equation modeling with interchangeable dyads. Psychological Methods, 11, 127-141. doi:10.1037/1082-989X.11.2.127

40.

Schumacher

J. A.

Slep

A. M. S.

Heyman

R. E.

(2001). Risk factors for child neglect. Aggression and Violent Behavior, 6(2), 231-254.

41.

Schumm

W. R.

Paff-Bergen

L. A.

Hatch

R. C.

Obiorah

F. C.

Copeland

J. M.

Meens

L. D.

Bugaighis

M. A.

(1986). Concurrent and discriminant validity of the Kansas Marital Satisfaction Scale. Journal of Marriage and the Family, 48, 381-387.

42.

Sherman

M. D.

Sautter

Jackson

M. H.

Lyons

J. A.

Han

(2006). Domestic violence in veterans with posttraumatic stress disorder who seek couples therapy. Journal of Marital and Family Therapy, 32, 479-490. doi:10.1111/j.1752-0606.2006.tb01622.x

43.

Stith

S. M.

Rosen

K. H.

McCollum

E. E.

Thomsen

C. J.

(2004a). Treating intimate partner violence within intact couple relationships: Outcomes of multi-couple versus individual couple therapy. Journal of Marital and Family Therapy, 30(3), 305-318.

44.

Stith

S. M.

Smith

D. B.

Penn

Ward

Tritt

(2004b). Intimate partner physical abuse perpetration and victimization risk factors: A meta-analytic review. Journal of Aggression and Violent Behavior, 10, 65-98.

45.

Stith

S. M.

Green

Smith

D. B.

Ward

(2008). Marital satisfaction and discord as risk markers for intimate partner violence: A meta-analytical review. Journal of Family Violence, 23, 149-160.

46.

Stith

S. M.

McCollum

E. E.

(2011). Conjoint treatment of couples who have experienced Intimate Partner Violence. Aggression and Violent Behavior, 16, 312-318.

47.

Straus

M. A.

Hamby

S. L.

Boney-McCoy

Sugarman

D. B.

(1996). The revised conflict tactics scales (CTS2) development and preliminary psychometric data. Journal of Family Issues, 17, 283-316. doi:10.1177/019251396017003001

48.

Whisman

M. A.

(2001). The association between depression and marital dissatisfaction. In Beach

S. R. H.

(Ed.), Marital and family processes in depression: A scientific foundation for clinical practice (pp. 3-24). Washington, DC: American Psychological Association.

49.

Whisman

M. A.

Uebelacker

L. A.

Weinstock

L. M.

(2004). Psychopathology and marital satisfaction: The importance of evaluating both partners. Journal of Consulting and Clinical Psychology, 72, 830-838. doi:10.1037/0022-006X.72.5.830

50.

Whitaker

Haileyesus

Swahn

Saltzman

(2007). Differences in frequency of violence and reported injury between relationships with reciprocal and nonreciprocal intimate partner violence. American Journal of Public Health, 97, 941-947.