THESIS. Sara E. Sandberg-Thoma, B.A. Graduate Program in Human Ecology. The Ohio State University. Master's Examination Committee:

Transcription

1 The Association between Mental Health and Relationship Progression THESIS Presented in Partial Fulfillment of the Requirements for the Degree Master of Science in the Graduate School of The Ohio State University By Sara E. Sandberg-Thoma, B.A. Graduate Program in Human Ecology The Ohio State University 2012 Master's Examination Committee: Claire M. Kamp-Dush, Advisor Kristi Williams

2 Copyright by Sara E. Sandberg-Thoma 2012

3 Abstract Individuals with poor mental health may face greater obstacles to entering a romantic relationship, which may have long-term consequences due to the health benefits of longterm, committed relationships, such as marriage, and the developmental importance of forming committed unions in emerging adulthood. The National Longitudinal Study of Adolescent Health was used to examine prospective associations between mental health in adolescence (depressive symptoms, substance use, and suicidal ideation) and romantic relationship and union formation and dissolution in emerging adulthood (N = 13,549). Poisson regression results indicated that adolescent depressive symptoms did not predict entrance into multiple romantic relationships; however adolescent suicidal ideation and greater substance use was associated with a greater number of romantic relationships in emerging adulthood. Turning to union entrance, Cox proportional hazard regression results suggested that individuals who had poorer mental health, suicidal ideation, and substance use in adolescence were significantly more likely to enter into a cohabiting union rather than remain single, and further, adolescent substance use deterred transitions directly into marriage. These results held for women; for men, only substance use was associated with an increased likelihood of entering cohabitation as compared to staying single. When examining transitions within first cohabiting unions, regardless of gender, adolescent substance abuse was associated with a lower likelihood of either cohabitation dissolution or marriage, and a greater likelihood of continuous cohabitation. For women ii

4 only, greater adolescent depressive symptoms were associated with decreased odds of cohabitation dissolution as compared to continuous cohabitation. iii

5 Dedication To my family and Marcus for their constant support. iv

6 Acknowledgements This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website ( No direct support was received from grant P01-HD31921 for this analysis. v

7 Vita Northridge High School B.A. Psychology, Anthropology Minor,...University of Minnesota 2010 to present...graduate Teaching Associate, Graduate Research Associate, Department of Human Development and Family Science, The Ohio State University Fields of Study Major Field: Human Ecology vi

8 Table of Contents Abstract ii Dedication..iv Acknowledgments... v Vita... vi List of Tables... viii The Association between Mental Health and Relationship Progression....1 Mental Health and Romantic Relationships... 2 Mental Health and Romantic Relationship Churning..3 Mental Health and Relationship Progression to More Committed States...5 Gender Differences in Mental Health..6 Methods...7 Sample... 7 Variables... 8 Analytic Plan Results 11 Discussion..16 References vii

9 List of Tables Table 1. Descriptive Statistics...30 Table 2. Poisson Regression Analyses Predicting Number of Romantic Relationships from Mental Health Indicators Table 3. Poisson Regression Analyses Predicting Number of Romantic Relationships from Depressive Symptoms...32 Table 4. Competing-Risks Cox Regression Model of the Relationships between Mental Health Symptoms and the Hazard of Cohabiting and Marriage...33 Table 5. Competing-Risks Cox Regression Model of the Relationships between Depressive Symptoms and the Hazard of Cohabiting and Marriage...34 Table 6. Competing-Risks Cox Regression Model of the Relationship between Mental Health Symptoms for those Cohabiting and the Hazard of Entering a Marital Union or Cohabitation Dissolution..35 Table 7. Competing-Risks Cox Regression Model of the Relationship between Depressive Symptoms for those Cohabiting and the Hazard of Entering a Marital Union or Cohabitation Dissolution..36 viii

10 The Association between Mental Health and Relationship Progression Romantic relationships provide many benefits for individual wellbeing, such as decreasing the likelihood of risky behavior (Braithwaite, Delevi, & Fincham, 2010) and increasing available social (e.g. Coombs, 1991) and emotional support (Frech & Williams, 2007). However, for those with poor mental health, there may be greater obstacles to entering into a romantic relationship, maintaining that relationship, and eventually transitioning into more committed relationship states. Manning, Trella, Lyons, and du Toit (2010) suggested that women with poor mental health experienced increased obstacles within the marriage market and, once in a relationship, their mental health status challenged relationship stability. In this instance, poor mental health was seen as detrimental for the marriageability of these women; that is, women with mental health problems felt that they had a more difficult time entering into and sustaining marital relationships. While Manning et al. (2010) suggested that those with poor mental health face more obstacles to entering into a long-term romantic relationship that may eventually transition into cohabitation or marriage, researchers have yet to test this association. The social support hypothesis (Cohen & Wills, 1985) states that intimate relationships may act as a buffer against life stressors. Although individuals with poor mental health may face considerable difficulties remaining in an intimate relationship and progressing toward more committed relationship states, they may also benefit the most 1

11 from being in an intimate relationship. Indeed, Frech and Williams (2007) found that individuals with depressive symptoms experienced more psychological benefits after transitioning to marriage in comparison to those that were not depressed or those that remained unmarried. Using data from the National Longitudinal Study of Adolescent Health (Add Health), I examined the association between relationship progression and mental health status during emerging adulthood and into young adulthood. Understanding these associations during this time period is critical because the formation and perpetuation of romantic relationships is a central task of this period of the life course (Furman & Shaffer, 2003), and may influence later relationship patterns (Larson, Clore, & Wood, 1999). Mental Health and Romantic Relationships The causal link between mental health and romantic relationships is often difficult to determine. Extensive research exists on the psychological benefits gained from highquality romantic relationships (Coombs, 1991) and the psychological drawbacks from low-quality romantic relationships (Williams, 2003), a concept known as social causation. Social causation focuses on the impact of romantic relationships on an individual s mental health, yet it does not account for the characteristics of an individual prior to relationship entrance. Social selection states that those with poor mental health face increased obstacles within a romantic relationship, which may eventually lead to relationship dissolution. Thus, those with poor mental health may already be selected into experiencing increased difficulties within the marriage market based on their mental health status. Indeed, research has shown that individuals without mental distress are more likely to attract and maintain positive social relationships overall, while individuals 2

12 with mental health distress face more difficulty establishing and maintaining social ties (Johnson, 1991). Consistent with the social selection perspective, the Coyne (1976) interaction model states that the behavior and affect of individuals experiencing depressive symptoms negatively affects their intimate relationships and increases the probability of rejection. Experiencing rejection may then increase depressive symptoms, further creating a cycle that an individual may have difficulty escaping. This cycle may lead to disadvantageous outcomes for the individual, such as a decreased likelihood that an individual will enter and remain in a committed romantic relationship and an increased likelihood of relationship churning (e.g. Sassler, 2010) defined in the current study as a quick, successive cycling through romantic partners. In support of this model, Johnson (1991) found that psychological distress negatively influences primary social relationships, characterized by relationships with the most interaction, such as romantic relationships; additionally, the association between relationship dysfunction and depressed affect in late adolescence was stronger for romantic relationships than close friendships (Daley & Hammen, 2002). Mental Health and Romantic Relationship Churning Emerging adulthood is a time period where significant focus is placed on forming romantic relationships and transitioning within these relationships (Furman & Shaffer, 2003), with the ultimate goal of finding an emotionally significant, long-term partner (Simon & Barrett, 2010). Yet, those with poor mental health may be more inclined to churn through relationships, regardless of whether or not they desire a more committed relationship, as their mental health may be perceived as detrimental to their partner or 3

13 cause difficulties within their relationship. A history of poor mental health may not be detrimental to partners hoping to engage in casual, short-term dating relationships; rather, a history of poor mental health may only become a problem within the relationship when both partners are hoping to engage in a more committed relationship, which may eventually lead to cohabitation or marriage. Indeed, research has shown that, when desiring a short-term relationship, individuals have different expectations for their future partners (Stewart, Stinnett, & Rosenfeld, 2000); attributes related to physical appearance are most appealing to casual partners (Fletcher, Tither, O Loughlin, Friesen, & Overall, 2004). Once in a relationship, those with poor mental health may have less successful romantic relationships, as research has shown that individuals with negative affect are more vulnerable to stress in their relationships (Beach & O Leary, 1993; Tolpin, Cohen, Gunthert, & Farrehi, 2006) and experience decreased relationship quality (Frech & Williams, 2007; Remen & Chambless, 2001), which could lead to relationship dissolution. Furthermore, an individual s mental health symptoms may influence their partner s behavior; indeed, male romantic partners of women with depressive symptoms perceived their partners as having poorer social skills and reported providing them with less emotional support (Daley & Hammen, 2002). A romantic partner s response to mental health symptoms may contribute to low-quality relationships and increase the likelihood of relationship dissolution and relationship churning; not only are individuals with mental health symptoms perceiving their relationships as less satisfying, their partners may also be reacting negatively to their mental health status. Thus, regardless of 4

14 their desire, those with poor mental health may cycle quickly through their romantic relationships as they face increased obstacles maintaining the relationship. Mental Health and Relationship Progression to More Committed States Not only do individuals with mental health symptoms face difficulties maintaining their romantic relationships, as their mental health status may be perceived as a negative attribute (Manning, et al., 2010) and they may react more negatively to everyday relationship stressors (Tolpin, et al., 2006), these individuals may also face different relationship trajectories, such as entering into cohabitation rather than marriage, and ending that cohabitation rather than progressing to a marital union. The social exchange perspective (Nye, 1979) proposes that individuals weigh the rewards and costs of prospective partners prior to progressing toward more committed relationship states. Even if an individual with poor mental health is able to successfully enter into a romantic relationship and maintain the relationship, the cost of their mental health status for their partner may prevent relationship progression. Indeed, British research has suggested that individuals with poor mental health currently involved in a cohabiting union are more likely to see that union dissolve rather than transition into marriage (Pevalin & Ermisch, 2004). As increased relationship commitment has been shown to lead to greater subjective well-being, even when controlling for the possibility that those high in subjective well-being select into more committed relationships (Kamp Dush & Amato, 2005), and transitioning specifically into marriage has been shown to improve mental health (Simon, 2002; Williams, 2003), much emphasis is placed on partners with marriage potential. Contrary to marital unions, cohabiting unions may not be perceived as 5

15 a significant increase in commitment, rather they represent a next step in the dating process (Stanley, Rhoades, & Markman, 2006), and, thus, the threshold for entering into cohabitations is lower than the threshold for entering into marriage (Sassler, 2004). Additionally, research has shown that transitioning specifically from a cohabiting union to a marital union does not reduce depressive symptoms (Kim & McKenry, 2002), nor does transitioning into a cohabiting union from remaining single (Lamb, Lee, & DeMaris, 2004). Furthermore, although the dissolution of cohabiting unions and marital unions has detrimental effects for mental health (Wu & Hart, 2002), cohabitation dissolution is less distressing than marital dissolution (Blekesaune, 2008). Therefore, potential costs accrued from a history of poor mental health may not translate into costs for cohabiting unions, as both unions have inherent differences. Gender Differences in Mental Health Women and men experience discrepancies in reported mental health, specifically regarding the prevalence of depressive symptoms. Therefore, in order to assess mental health in both sexes, our current study included additional indicators of mental health symptoms. Not only are women twice as likely to experience depression compared to men (Kessler, 2003; Nolen-Hoeksema, 2001), the risk of depression during the transition from adolescence to adulthood is especially pronounced for women (Rao, Hammen, & Daley, 1999). Adolescent females are also more likely to self-report depressive symptoms and express overall distress by internalizing emotions (Simon, 2002). Additionally, in adolescence, although depression puts one at-risk for suicidal ideation for both genders (e.g. Kandel, Raveis, & Davies, 1991), women are slightly more susceptible to suicidal ideation (Harlow, Newcomb, & Bentler, 1986). Contrary to 6

16 women, men may be more likely to underreport depression on self-reported scales (Sigmon, et al., 2005), and adolescent males are more likely to self-report substance use and express distress through externalizing emotions (Simon, 2002). As men may, therefore, exhibit reckless behavior when dealing with depression (Cochran & Rabinowitz, 2000) and are more likely to turn to substance use when depressed (Harlow, Newcomb, & Bentler, 1986), substance use may be a more common indicator of depressive symptoms among men. In order to capture mental health in adolescence for both genders, depressive symptoms, substance use and suicidal ideation were included as additional mental health indicators. The following hypotheses were posited: H1: Individuals with poor mental health in adolescence, that is more depressive symptoms, suicidal ideation, and substance abuse, will have a greater number of romantic relationships in emerging and young adulthood than those without poor mental health in adolescence. H2: Individuals with poor mental health in adolescence will be more likely to transition into cohabiting unions rather than marital unions in emerging to young adulthood. H3: Among those in cohabiting unions in emerging and young adulthood, individuals with poor mental health in adolescence will be less likely to progress into marriage and more likely to dissolve their union. Method Sample The current study used the National Longitudinal Study of Adolescent Health (Add Health) data designed to examine the influences of the environment and individual 7

17 characteristics on health (Harris et al., 2009). Data was collected from adolescents nationwide during the 1994 to 1995 school year in 80 high schools and 52 middle schools; the schools were chosen using stratified, random sampling from all high schools in the United States. Subsequent waves were conducted in 1996, when the adolescents were in grades 8 through 12 (Wave 2); in , when the participants were 18 to 26 years old (Wave 3); and in 2008, when the participants were 24 to 32 years old (Wave 4; Harris et al., 2009). I use data from Waves 1, 3, and 4. Out of the initial sample of 20,745 adolescents who completed in-home interviews in which mental health issues were assessed, the sample size was restricted to those that had completed Wave 3 or Wave 4 (n = 17,861), those that had valid mental health indicators at Waves 1 (n = 15,193), and those who were not missing control data or weight variables (n = 13,549). For the subsample of cohabiting unions, the sample size was restricted to those that had reported a cohabiting union at either Wave 3 or Wave 4 (n = 6,970), those that had valid mental health indicators (n = 6,820), those who were not missing control data or weight variables (n = 5,978). Variables Romantic Relationships. Add Health collected a variety of variables assessing relationship characteristics at Wave 3. Emerging adults self-identified their relationships as romantic; the actual interpretation of what constituted a romantic relationship was left up to the individual. A count variable of the number of romantic relationships reported in the past 5 years was created from data at Wave 3. Union entrance. In months, the timing from age 16 to first union, either marriage or cohabitation, was created. Month and year dates were recorded for all cohabiting and 8

18 marital unions reported at Wave 3 and 4; using this data, I coded month and year of the first union, as well as the type. At both Waves 3 and 4, a cohabiting union was defined as whether the respondent lived with someone in a marriage-like relationship for more than one month. For the sample of current cohabiting unions, the proportion of these unions that transitioned into marital unions was 21%; most cohabiting unions dissolved at 38%. By gender, for males, 20% of cohabiting unions transitioned into marital unions, while 36% cohabiting unions dissolved; for women, 21% cohabiting unions transitioned into marital unions while 40% dissolved. Depressive symptoms. Depressive symptoms were measured at Wave 1. An abridged version of Radloff s (1977) Center for Epidemiological Studies Depression Scale (CES-D) was used. Participants were asked to indicate how often they had experienced emotions within the past seven days. The frequency of emotions experienced within the past seven days was coded 0 (never) to 4 (every day). Questions measuring instances of positive affect (i.e. In the past 7 days, I enjoyed life) were reverse scored, so that a higher score on the abridged CES-D scale was indicative of increased depressive symptoms. Substance Use. Substance use was a cumulative measure of smoking, drinking, and marijuana usage at Wave 1. Smoking was measured as reporting smoking at least one cigarette in the past 30 days; Cigarettes not consumed in their entirety were not included in smoking use. Drinking was measured as consuming five or more alcoholic beverage in a row in the past 12 months. Marijuana use was measured as using marijuana in the past 30 days. Substance use was then created by summing these variables and ranged from 0 (no usage) to 3 (used all substances). 9

19 Suicidal ideation. Suicidal ideation was measured at Wave 1 as whether or not the respondent seriously thought about committing suicide within the last 12 months, coded 0 (no) or 1 (yes). Control Variables. Control variables were measured at Wave 1. Race was measured as White, Black, Hispanic, and other (Asian, American Indian). Nationality was measured as foreign born or not foreign born. Gender was measured as female or male. Family structure was measured as single-mother household, step-family household, nuclear family household, and other (e.g. Grandparent household). Mother s education was measured as less than a high school degree, high school degree, some college, and college degree. Use of public assistance was measured as a dichotomous variable (whether or not an individual received any assistance). Analytic Plan I used both Poisson regression models and competing-risks Cox proportional hazards models to answer my research questions. For Hypothesis 1, a Poisson regression model predicted the number of romantic relationships in the past 5 years, reported at Wave 3, from depressive symptoms, substance use, suicidal ideation, and controls at Wave 1. Additionally, Hypothesis 1 was tested using depressive symptoms as the only indicator of poor mental health. Hypothesis 2 was first tested with a competing-risks Cox proportional hazards model predicting entrance into either a (1) marital union or a (2) cohabiting union from depressive symptoms, substance use, suicidal ideation, and controls at Wave 1. Hypothesis 2 was subsequently tested using depressive symptoms as the only indicator of poor mental health. Hypothesis 3 was tested with a competing-risks Cox proportional hazards model predicting whether a cohabiting union will end in (1) 10

20 marriage or (2) relationship dissolution from depressive symptoms, substance use, suicidal ideation, and controls at Wave 1. Hypothesis 3 was additionally tested with depressive symptoms as the only indicator of poor mental health. Hypothesis 2 and 3 were also analyzed separately by gender. For Hypothesis 1, I used a Poisson model because my dependent variable in this analysis is a count variable of the number of romantic relationships in the five years preceding Wave 3 data collection. For Hypothesis 2, I used a competing-risks Cox proportional hazard model. Individuals were censored at the Wave 4 interview date if they had never cohabited or married by Wave 4; for those missing at Wave 4, censoring occurred at the Wave 3 interview date if they had not reported marriage or cohabitation prior to that point. When discrepancies occurred between reported Wave 3 union entrance dates and Wave 4 union entrance dates, data was analyzed using either Wave 3 reported union dates or Wave 4 union entrance dates; results were consistent regardless of the wave used. For Hypothesis 3, in my competing risks Cox proportional hazard model, individuals were censored at the Wave 4 interview date if they had not reported a cohabiting union; those missing at Wave 4 were censored at the Wave 3 interview date if they had not reported a current cohabitation by that point. Only those individuals who reported a cohabiting union were included in the model. Results Due to the clustered nature of the Add Health sample, all statistics were run in Stata using the survey suite of commands, which are able to adjust for the three levels of weights (individual, school, and region) in the Add Health sample. Weights used in the 11

21 present analyses were used from Wave 4; models were also analyzed using Wave 3 weights and results were comparable. Sample characteristics. The full sample was predominately White, native born, and was living with their married, biological parents at the first wave (Table 1). Most of the sample did not receive public assistance and the largest majority of the mothers received a high school degree. Men and women were represented equally within the sample; when analyzed separately by gender, sample characteristics were similar to the full sample (Table 1). The total number of romantic relationships reported at Wave 3 ranged from 1-48, with an average of 3.41 relationships per person; these results were comparable by gender. Mean age at first union was 21 for the full sample; by gender, mean union age was 22 for men, while mean age was 21 for women. When examined by union type, among cohabiting unions, mean age was 21 for the full sample; by gender mean age for cohabitations was 22 for men and 21 for women. For marital unions, mean age was 22 for the full sample, 23 for men, and 22 for women. Number of romantic relationships. Poisson regression models examined whether mental health symptoms were associated with the number of romantic relationships (Table 2). Results indicated that depressive symptoms were not significantly associated with the number of romantic relationships reported by Wave 3. However, substance use and suicidal ideation were both statistically significant predictors of an increased number of romantic relationships. That is, for every one unit increase in substance use, the incidence rate of romantic relationships increased by 9%. Those adolescents who reported suicidal ideation had a 14% increase in the incidence of romantic relationships. Several control variables were also significant. Age, mother s education of less than a 12

22 high school degree, public assistance, being Hispanic or being foreign born all negatively predicted number of relationships. Having a mother with some college education, having a mother with completed college education, having a single-parent household, and having a step-family household all significantly positively predicted number of relationships. When analyzed by gender, for men, substance use was significantly associated with number of romantic relationships; for every one unit increase in substance use, the incidence rate of romantic relationships increased by 5%. Age was the only significant control variable for men. For women, both substance use and suicidal ideation were predictive of an increased number of romantic relationships; that is, for every one unit increase in suicidal ideation or substance use, the incidence rate of romantic relationships increased by 12% and 12%, respectively. For women, several control variables were significant as well. Age and mother s education of less than a high school degree all negatively predicted number of romantic relationships; having a mother with some college education, having a mother who completed college, having a single-parent household, and having a step-family household all significantly positively predicted number of romantic relationships. Furthermore, when analyzed using depressive symptoms as the only indicator of poor mental health, results showed that depressive symptoms were significantly associated with number of romantic relationships (Table 3); for every one unit increase in depressive symptoms, the incidence rate of romantic relationships increased by 1%. Among women, adolescent depressive symptoms were predictive of number of romantic relationships; for every one unit increase in depressive symptoms, the incidence rate of 13

23 romantic relationships increased by 2%. Adolescent depressive symptoms for men were not significantly predictive of number of romantic relationships. Entrance into first union. Competing-risks Cox proportional hazard regression models examined whether mental health symptoms were associated with the hazard of cohabitation and marriage (Table 4). Control variables were also included in the model; additionally, the model was analyzed separately by gender. In the full sample, every one unit increase in adolescent depressive symptoms and substance use was significantly associated with a 1% and a 22% (respectively) increase in the hazard of entering into cohabitation. Adolescent suicidal ideation was not significantly associated with entering into cohabitation or marriage and depressive symptoms were also not significantly associated with the hazard of entering into marriage. However, for every one unit increase in adolescent substance use, the hazard of entering marriage decreased by 16%. When analyzed by gender, for men, only adolescent substance use was significantly predictive of entering into a cohabiting union; a one unit increase in substance use was associated with a 20% increase in the hazard of entering a cohabiting union. Depressive symptoms were the only mental health indicator significantly associated with the hazard of marriage for men. Every one unit increase in adolescent depressive symptoms was significantly associated with a 3% increase in the hazard of entering a marital union. For women, only adolescent depressive symptoms and substance use were significantly predictive of entering into a cohabiting union. For every one unit increase in adolescent depressive symptoms and substance use, the hazard of entering a cohabitating union increased by 2% and 24% respectively. In contrast, adolescent substance use was the only mental health indicator that significantly predicted 14

24 entering a marital union for women; for every one unit increase in substance use, women s hazard of entering a marital union decreased by 21%. With adolescent depressive symptoms as the only indicator of mental health symptoms, results from the full sample indicated that adolescent depressive symptoms were significantly predictive of entering into a cohabiting union (Table 5). For every one unit increase in depressive symptoms in adolescence, the hazard of entering into a cohabiting union increased 3%. For both genders, adolescent depressive symptoms were significantly predictive of entering into a cohabiting union, but not a marital union. A one unit increase in depressive symptoms in adolescence led to a 2% and 3% increase in the hazard of entering a cohabiting union for men and women, respectively. Transitions out of first cohabitation. Competing-risks Cox proportional hazard regression models examined whether mental health symptoms of those in a cohabiting union were significantly associated with the hazard of becoming married to that same partner or cohabitation dissolution (Table 6). All control variables were included in the model; the model was also analyzed separately by gender. For the full sample, after accounting for control variables, only adolescent depressive symptoms and adolescent substance use was significantly associated with the hazard of entering a marital union. For every one unit increase in depressive symptoms and substance use, the hazard of entering into a marital union decreased by 2% and 13%, respectively. Adolescent depressive symptoms and suicidal ideation was not significantly associated with the hazard of entering into cohabitation dissolution. However, for every one unit increase in adolescent substance use, the hazard of cohabitation dissolution decreased by 15%. 15

25 When analyzed by gender, adolescent substance use was the only mental health indicator significantly predictive of marriage entrance for men. A one unit increase in adolescent substance use was associated with a 19% decrease in the hazard of entering a marital union. For women, adolescent substance use was the only mental health indicator significantly predictive of cohabitation dissolution and entrance into marriage. A one unit increase in adolescent substance use was associated with an 19% decrease in the hazard of dissolving a cohabitating union and a 3% decrease in the hazard of entering a marital union. When analyzed with adolescent depressive symptoms as the only indicator of poor mental health, results from the full cohabiting sample suggest that adolescent depressive symptoms are significantly predictive of cohabitation dissolution and entrance into marriage (Table 7). For every one unit increase in adolescent depressive symptoms, the hazard of transitioning into cohabitation dissolution and transitioning into marriage decreased by 1% and 3%, respectively. By gender, adolescent depressive symptoms were only significantly predictive of transitioning into either a cohabitation dissolution or marital union for women; every one unit increase in depressive symptoms during adolescence led to a 2% and 4% decrease in transitioning into cohabitation dissolution and transitioning into marriage, respectively. Discussion Individuals with a history of mental health problems have been hypothesized to have a more difficult time maintaining romantic relationships, as their mental health status may be detrimental to their relationships (Manning et al., 2010). Although those with poor mental health may hope to enter into a highly committed union, they may be 16

26 more susceptible to relationship churning. In support of my first hypothesis, that individuals with poor mental health would have a greater number of romantic relationships, I found that individuals who, as adolescents, were suicidal and used substances churned through more romantic relationships than those without these mental health problems. These individuals may be more inclined to churn through romantic relationships because their history of suicidal ideation and substance use in adolescence is perceived as a drawback to potential mates hoping to engage in highly-committed relationships, such as marriage or cohabitation. Furthermore, their history of suicidal ideation and substance use may place additional stressors on their current relationships. For instance, those with a history of suicidal ideation and substance use may be more inclined to perceive their relationships as less successful, thus influencing the outcome of their relationships; it may be that those with suicidal ideation and substance use choose not to continue this unsuccessful relationship. When examining adolescent depressive symptoms as the only mental health indicator, depressive symptoms in adolescence were predictive of number of romantic relationships in emerging to young adulthood. Although the effect of this association is small, these findings further indicate that those with poor mental health may face increased difficulties in sustaining romantic relationships. It is unclear in this instance whether or not an individual is more inclined to churn through perceived unsatisfying relationships, or engage in many romantic relationships hoping to improve their mental health status only to have their depressive symptoms seen as a deterrent to partners. It is most likely that these relationships end due to the difficulties faced within the relationship as well as a partner s reaction to an individual s mental health status. 17

27 Consistent with my second hypothesis, that individuals with a history of mental health problems would be more likely to progress into cohabiting unions and less likely to progress into marital unions, individuals with a history of depressive symptoms and substance abuse entered cohabiting unions, while individuals with a history of adolescent substance abuse were less likely to enter into a marital union. Sassler (2004) argued that the threshold to enter cohabitation is lower than the threshold to enter marriage, thus mental health problems may not be a barrier to entering cohabitating unions, as it appears to be for entering marital unions. My results support this notion, as a history of depressive symptoms and substance use does not deter partners from entering into cohabitation, but a history of substance use deters partners from entering into a marriage; conclusions can be made further suggesting that desired partner attributes differ by union status. Additionally, cohabitation may not even be perceived as an increase in commitment, but rather a step forward in the dating process (Stanley, Rhoades, & Markman, 2006). As transitioning into cohabiting unions from remaining single does not reduce mental health symptoms (Lamb, Lee & DeMaris, 2004), it is unlikely that individuals in my sample are entering these cohabiting unions hoping to use psychological benefits associated with entrance into a marriage. Thus, it is likely those with a history of poor mental health are entering into cohabitations as part of a next step in their relationships, rather than actively seeking out these unions in order to use them to improve mental health. When adolescent depressive symptoms were the only mental health indicator included in the model, the effect of adolescent depressive symptoms on entrance into a cohabiting union in emerging to young adulthood became slightly more pronounced; that 18

28 is, individuals with depressive symptoms were more likely to enter into cohabiting unions. This finding further supports the notion that the threshold to entrance into cohabiting unions may be lower than the threshold to entrance into marital unions (Sassler, 2004). Yet, the nature of this effect may suggest that a history of depressive symptoms in adolescence does not have a large effect on union formation in emerging to young adulthood. The time lapse between the measurement of depressive symptoms in adolescence and entrance into a cohabiting or marital union in emerging to young adulthood may weaken the effect slightly; yet, the significance of the effect suggests that entrance into cohabiting unions is not perceived as a significant increase in commitment, thus, individuals may be more accepting of mental health symptoms in their partners. Consistent with my third hypothesis, I found that among those in cohabiting unions, those with a history of depressive symptoms and substance use were significantly less likely to transition from a cohabiting union into a marital union. Contrary to my third hypothesis that those with history of mental health problems would be more likely to dissolve their first cohabitation, adolescent substance use decreased the likelihood that a current cohabitation will dissolve, and adolescent depressive symptoms and suicidal ideation were not associated with cohabitation dissolution. These results may indicate that, as cohabitation may be perceived as a trial-run for marriage (Bumpass, Sweet, & Cherlin, 1991), a history of mental health problems may not be an initial barrier to entering into a cohabiting union or remaining in that union, rather it may be a barrier to progressing within the union. Marriage is a long-term commitment, thus individuals may have different expectations for partners with whom they wish to enter into marital unions (Stewart, Stinnett, & Rosenfeld, 2000). In accordance with social exchange perspective 19

29 (Nye, 1979), individuals weighing the rewards and costs of prospective partners may perceive those with a history of substance use as a cost to partners wishing to marry, although it may not be seen as a cost for partners only wishing to cohabit. Furthermore, although research has indicated that those with poor mental health in cohabiting unions are more likely to dissolve their union (Pevalin & Ermisch, 2004), my results indicate that those with a history of substance use are neither likely to dissolve their union nor transition into a marital union. This pattern of results was replicated in the model using depressive symptoms as the only indicator of poor mental health; depressive symptoms in adolescence were associated with a decreased likelihood of transitioning into cohabitation dissolution, and transitioning into a marital union Thus, it may be that a history of substance use (and depressive symptoms) in adolescence may not appear detrimental to cohabiting partners in emerging and young adulthood, as they may already be more forgiving regarding partner attributes. Previous research suggested that substance abuse would be a more salient indicator of mental health problems among men, thus I examined men and women separately. For men, adolescent substance use was associated with an earlier entrance into cohabiting unions. Adolescent suicidal ideation and adolescent substance use did not influence the likelihood of entering into a marital union, while adolescent depressive symptoms were predictive of entering into marriage. My findings indicate that men may be using marital unions to improve their depressive symptoms, consistent with findings that increased levels of commitment improve subjective well-being (Kamp Dush & Amato, 2005). As transitioning from a cohabiting union into a marital union does not reduce depressive symptoms (Kim & McKenry, 2002), it is informative that men are 20

30 entering marital unions as their first union. Yet, when depressive symptoms were the only mental health indicator in the analysis, men were more likely to enter a cohabiting union, not a marital union. Therefore, it appears that adding substance use as an additional indicator of mental health in adolescence may help capture a portion of mental health problems for men, as adolescent substance use has a much stronger effect on the entrance into cohabiting unions. Once in a cohabiting union, men with a history of substance use in adolescence were less likely to transition into a marital union. While this finding could further indicate that cohabiting and marital partners have different expectations for partner attributes, it may also be that cohabitation is not seen as a significant increase in commitment. Rather, cohabiting unions may represent a more gradual relationship progression, where individuals slide into cohabiting unions (Stanley, Rhoades, & Markman, 2006). For women, those with a history of depressive symptoms and substance use were more likely to enter cohabiting unions, and a history of substance use was associated with a decreased likelihood of entering a marital union. Furthermore, once in a cohabiting union, a history of substance use decreased the likelihood of cohabitation dissolution or transitioning into marriage. Contrary to men, who may use marital unions to improve their adolescent depressive symptoms, women s adolescent depressive symptoms may be more detrimental to their future marriageability, and, thus, depressive symptoms may be less acceptable attributes on the marriage market. As research has shown that men report that they provide less emotional support to female partners with depressive symptoms, and rank their female partners as having poorer social skills (Daley & Hammen, 2002), it may be that females settle into cohabiting unions in which their 21

31 partners expectations are lowered. However, as both the effect of adolescent depressive symptoms on entrance into cohabitation for women, and entrance into marriage for men, were both small, there appears to be no significant gender difference regarding desired partner attributes. Furthermore, when adolescent depressive symptoms were the only indicator of mental health for women, women were more likely to enter a cohabiting union in a pattern identical to men. Additionally, women s adolescent substance use does not deter future cohabiting partners, yet a history of adolescent substance use deterred future marital partners; furthermore, once in a cohabiting union, women with a history of adolescent substance use were less likely to dissolve their cohabiting union and less likely to progress into marriage. This adolescent substance use pattern is similar to men (although not significant for men); a history of adolescent substance use does not appear to deter future cohabiting partners. When adolescent depressive symptoms were the only indicator of mental health within the model of current cohabiting unions, women s depressive symptoms in adolescence were predictive of cohabitation dissolution and transition into marriage. These findings might suggest that substance use as an additional indicator of mental health may be capturing depressive symptoms for women as well as for men; yet, due to the small influence of depressive symptoms on current cohabitation dissolution or transitioning from cohabitation into marriage, it may also be that depressive symptoms in adolescence may not have an especially strong, long-lasting influence on relationship progression. This study is not without limitations. First, this study utilizes data from only one individual; taking data from both partners would provide greater understanding of this association as both partners may have depressive symptoms that serve to affect the 22

32 relationship dynamic and potentially influence relationship progression. It would also be useful to understand how each partner s depressive symptoms interact to contribute to relationship outcomes. Future studies should account for each partner s mental health in examining the association between mental health and romantic relationships. Secondly, the measurement in this study fails to account for relationship quality in determining relationship outcomes. It may be that increased relationship quality may offset potential difficulties that arise from mental health problems, while decreased relationship quality may contribute to increasing mental health problems. Furthermore, relationship quality may act to mediate the association as one s mental health may negatively influence a romantic relationship, indirectly leading to relationship dissolution. Future studies should determine the influence of relationship quality in this association. Furthermore, the measurement does not account for current mental health at time of union entrance. A more frequent measure of mental health status would allow researchers to gain insight into the current state of an individual s mental health prior to entering a romantic relationship or union. Additionally, a frequent measure of mental health would provide insight into the strength of the effect and the potentially long-lasting influence of mental health on relationship progression. By relying on measurement from adolescence, the effect of mental health on relationship progression may appear smaller than in actuality; it may also be that poor mental health is more detrimental to relationships short-term. Even with these limitations, my study provides a unique insight into the association between mental health and romantic relationships that may have clinical implications. By using a population sample, results are more translatable for an increased population of people and clinical application that draws on these results will be more 23

33 applicable and successful. Additionally, my findings suggest that depressive symptoms may not be the only indicator of poor mental health in adolescence. Suicidal ideation and substance use also contribute to poor mental health and directly influence romantic relationships. Focusing on several indicators of mental health provides more insight into the association between overall mental health and romantic relationships that would be worth exploring; several indicators may also successfully capture both genders mental health status equally. Finally, this study provides insight into the association between mental health and relationship progression across adolescence and emerging adulthood. As these early relationships influence later relationship patterns (Larson, Clore, &Wood, 1999), it is important to target this time period. My findings suggest that a history of depressive symptoms, substance use, and suicidal ideation in adolescence have long-term implications for relationship outcomes during emerging and young adulthood; thus, mental health in adolescence has a significant, long-term impact on future relationship success. By identifying adolescents struggling with mental health problems, substance use issues, and suicidal ideation, interventions can be targeted to improve the future relationship outcomes of an individual. 24

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