Maternal Chronic Depression Affects Love Styles: A Cohort Study in Southern Brazil

Major depressive disorder (MDD) is a common mental disorder and is a leading cause of disability (considering the years lost) worldwide. In addition, it is two to three times more common in women. The main characteristics of the MDD are sadness, loss of interest in activities and decreased energy, but also by loss of confidence and self-esteem, unjustified feeling of guilt, ideas of death and suicide, decreased concentration and sleep and appetite disturbances (Marcus, Yasamy, van Ommeren, Chisholm, & Saxena, 2012). Another important issue is persistence and recurrence, which are common to the MDD (Hames, Hagan, & Joiner, 2013).

The consequences of MDD are extensive and these not only include the impacts on the way individuals feel and think but also the deleterious effects on interpersonal functioning and romantic relationships (Burke, 2003; Hames, Hagan, & Joiner, 2013; Hammen & Brennan, 2002; Vujeva & Furman, 2011). When suffering from MDD, people tend to present insecure interpersonal behavior patterns and are less likely to elicit positive social interactions (Burke, 2003; Gadassi, Mor, & Rafaeli, 2011; Hames et al., 2013; Hammen, 2006). Sadness, loss of interest, and feelings of worthlessness/self-blame were all identified as symptoms that severely impair close relationships (Fried & Nesse, 2014). MDD has been found to be associated with lower empathic accuracy and poor romantic relationship quality, including the amount of conflict and quality of problem solving (Frizzo, Brys, Lopes, & Piccinini, 2010; Gadassi et al., 2011; Hames et al., 2013). Moreover, it is known that being in love seems to be challenging and daunting for adolescents and young adults (Bajoghli et al., 2014; Furman, 2002); therefore, these interpersonal relationships of a new mother, especially the relationship with her partner, usually suffer, for example, in terms of relationship satisfaction and privacy as a couple (Frizzo et al., 2010; Mortensen, Torsheim, Melkevik, & Thuen, 2012). Considering this scenario, young mothers who are in their adolescence/emerging adulthood and suffering from MDD are probably at risk of portraying love in a more pathological way, since the interpersonal behavioral patterns of those suffering from MDD and symptoms such as sadness, loss of interest, and feelings of worthless/self- blame can severely impair close relationships.

According to Reis and Aron (2008), the love can be understood as the desire to enter, to maintain or to expand a continuous close relationship with another person. It is a sophisticated set of psychological devices that perform different functions in applicable contexts (Buss, 2006). Shiramizu and Lopes (2013) propose that love “includes selected feelings and thoughts throughout our evolutionary history that favored the bonding of partners, promoting an approach and a different investment of time and attention between them, which may vary according to ecological, social and cultural conditions”. This understanding of love certainly does not cover all definitions on the subject, but it appears as a very comprehensive description on the basis that it has not been studied on the subject.

Lee (1977) developed a typology considering six love styles. On the basis of this typology, Hendrick and Hendrick (1986) created the Love Attitudes Scale (LAS) to measure the love styles characterized as follows: Eros - strong physical attraction, emotional intensity, a preferred physical appearance, and a sense of inevitability of the relationship. Ludus - love is a game to be played with a diverse set of patterns over time. Deception of the partner and lack of disclosure about self and other partners are prime attributes of Ludus. Storge - this takes love as friendship; it is quiet and companionate. Storge has sometimes been dubbed “love by evolution” rather than “love by revolution.” Pragma - love is a shopping list of desired attributes (e.g., fitting into the family and good parent). Mania - this might be called “symptom love,” and is similar to pathological love (Sophia et al., 2009). Mania is intense, alternating between ecstasy and agony. Agape - this love style is sacrificial, placing the love person’s welfare above one’s own.

The authors of the LAS consider that love styles seem to be both personality traits and flexible attitudes. Their theoretical approach maintains that everyone is, at a given time, located on each of the dimensions. Constitutional differences may tend to sustain one (or more) dimension, but they are changeable by experience (e.g., the interaction with the partner, the social network) and could present variations over time (Hendrick & Hendrick, 2006).

Although MDD has been associated with damage in interpersonal relationships, there is still a lack of evidence in the literature regarding the association of MDD, and mainly, its chronicity, with love styles. Considering the role that love has in an individuals’ life, the fact that love styles are changeable, and major depressive episodes (which could bring harm to interpersonal and romantic relationships), the present study aimed to verify the effect of major depressive episodes on the love styles of young mothers, from the gestational period to 30 months of life of their children. The hypothesis tested in this study is that women diagnosed with MDD during the study - and especially those who presented chronically - tend to exhibit love styles pathologically or in an undesirable and unsuitable way.

Method

Results

Of the initial 544 young mothers with a 30-month post-partum follow-up, 540 (99%) completed the demographics questions, 502 (93%) completed the diagnostic assessment for MDD, and the missings of the love styles variables is indicated in the Table 1. Their mean age was 20.1 years (SD ± 1.5); 39% had studied for between 5 and 8 years; 69% were inhered to C socioeconomic status; and 55% were living with a partner. The prevalence of MDD in the perinatal, current, and chronic periods were 10%, 19%, and 13%, respectively (Table 1).

In a bivariate analysis, low Eros was associated with socioeconomic status D/E (p = .009), living with a partner (p < .001), and the presence of major depressive episode, in the current period and chronically (p = .003). high Ludus (p = .004) and low Storge (p = .014) were related to not living with a partner. High Pragma had an association with low education (p = .019), while high Mania was associated with low education (p < .001), and major depressive episodes chronicity (p ≤ .001). High Agape was associated with living with a partner (p = .001), and there was a presence of major depressive episodes in the perinatal, current, and chronic periods of the episodes (p = .038; Table 2).

After adjusting for possible confounding variables, low Eros was still related with socioeconomic status, not living with a partner, and the presence of current and chronic major depressive episodes. Mothers from socioeconomic status D/E were 7.9 times (95% CI [3.1, 20.6]) more likely to present low Eros when compared with mothers from socioeconomic status A/B. Women who did not live with their partner were 4.9 times (95% CI [3.0, 7.9]) more likely to show low Eros in relation to those who did. Those who were diagnosed with current major depressive episodes were 2.1 times (95% CI [1.2, 3.8]) more likely to be in the low Eros group than women who had never been diagnosed with major depressive episodes; those who presented chronic episodes were 2.6 times (95% CI [1.3, 5.1]) more likely to show low Eros than those who never had any major depressive episodes.

Ludus and Storge remained associated with not living with a partner (p = .004 and p = .011, respectively). Mothers who were not living with a partner were 1.7 times (95% CI [1.2, 2.5]) more likely to exhibit high Ludus and 1.6 times (95% CI [1.1, 2.3]) more likely to present low Storge.

Pragma remained associated with education. Mothers who had studied for less than 5 years were 3.3 times (95% CI [1.5, 7.4]) more likely to show high Pragma when compared with mothers with 11–14 years of education.

Mania maintained an association with age, education, and the presence of depressive episodes. The youngest mothers were 1.4 times (95% CI [1.0, 2.0]) more likely to disclose high Mania in relation to the oldest mothers. Regarding education, women who studied for few years were 4.8 times (95% CI [1.8, 12.8]) more likely to present high Mania than those who had a higher education. Moreover, mothers with chronic depressive episodes were 2.7 times (95% CI [1.4, 5.1]) more likely to show high Mania when compared to mothers who had never had a major depressive episode.

Finally, with respect to Agape, mothers who were currently experiencing a depressive episode were 1.8 times (95% CI [1.1, 3.2]) more likely to present high Agape. Those mothers who suffered from chronic depressive episodes were 1.9 times (95% CI [1.1, 3.2]) more likely to show high Agape in comparison to those who have never had a major depressive episode (Table 3).

Discussion

This study aimed to verify the effect of major depressive episodes on the romantic love styles of emerging adult mothers. Although the literature suggests that MDD impairs romantic relationships (Burke, 2003; Vujeva & Furman, 2011), this cannot be affirmed in the present study because love styles were assessed only at the T3 stage. Therefore, appropriate statistical treatment of the data was applied and does not necessarily point to a causal relation between depression and love styles. Considering this, an inverse relationship is also possible in which the love styles trigger the depression.

We found that chronic major depression has the largest effect on love styles (low Eros, high Mania, and high Agape), followed by current major depression. However, the same relationship was not observed in the perinatal period, probably because women are more focused on the baby and the transition to motherhood during this period than on their romantic relationship. Moreover, perinatal depression seems to be a very specific form of depression, probably associated with changes in ovarian hormones, even though the underlying mechanisms need further explanations (Albert, 2015; Bloch, Daly, & Rubinow, 2003).

Eros can be considered the healthiest love style. As explained by Levine, Aune, and Park (2006), people with high Eros scores may be able to maintain their relationships more easily and for longer if they increase contact, show tokens of affection, and demonstrate behavioral adaptations. Besides being characterized by strong physical attraction, high complicity, and emotional intensity (Hendrick & Hendrick, 1986), Eros lovers commonly conduct their personal relationships in a warm and positive way and are shown to be content about life and work and show self-confidence in love (Lee, 1977). Thus, it is not surprising that low Eros scores matched with major depressive states, considering the common characteristics and the interpersonal processes on MDD such as low interest or pleasure from social interactions, isolation, extreme feelings of worthlessness or guilt (Hames et al., 2013).

On the opposite side of this are Mania and Agape, already found to be associated with pathological love in another study (Sophia et al., 2009) and associated with depression in the present research. Studies found that people with MDD tend to engage in excessive interpersonal feedback seeking behaviors, core beliefs reflecting insecurity in relationships, interpersonal dependency, and insecure attachment styles (Hames et al., 2013). Characteristics of a manic lover seem to present a similar direction, including loneliness, lack of friends, and lack of enjoyable work (Lee, 1977). Moreover, manic lovers are more likely to enact negative relational maintenance behaviors (Goodboy, Myers, & Members of Investigating, 2010). This pattern can, in turn, possibly play an important role in the maintenance of the MDD, providing a feedback cycle of the disorder.

An important characteristic of MDD is the difficultly that the individual experiences in having positive attitudes toward themselves, as it explains part of Beck's (Beck, Rush, Shaw, & Emery, 1979) cognitive triad, also known as the negative triad, that is a cognitive-therapeutic view of the three key elements of a person's belief system present in depression (negative view of oneself, environment and future; Pössel & Pittard, 2016). High Agape scores (too self regardless, low attention to self needs, and high level of sacrifice) seem to be a symptom of MDD. It is likely that the focus on their lover’s needs is used to take the focuses off their own suffering and needs. Furthermore, making sacrifices for their lover can dissemble worthlessness feelings. Thus, some damages to interpersonal and loving relationships related to the presence of MDD are evident.

The finding that mothers who were not living with a partner interestingly presented low Eros, high Ludus, and low Storge. Assuming that Eros and Storge are defined by commitment in relationships, and Ludus is defined by avoiding commitment, it seems this was a group (low Eros, high Ludus, and low Storge) for who is difficult to establish intimate relationships and maintain a partnership.

Another finding was that women who were inhered of low socioeconomic status presented low Eros. One possible explanation for this is that Eros-style love is very intense and the relationship has a very important place in the individuals’ life, and financial difficulties can cause problems in personal relationships, particularly this love style, which demands a considering level of surrender.

Finally, it was verified that adolescent mothers presented high Mania, which can be related to the “storm and stress” period when unstable mood is common (Arnett, 1999). This association was not found in another study (Shulman & Scharf, 2000), which identified Storge as more prevalent in the youngest group. Considering that romantic relationships can positively affect development and also place adolescents at risk of problems (Furman, 2002), the results call attention to the need to take their “love difficulties” seriously, as a potential risk for present and future mental health.

The results of this research need to be interpreted in the light of some limitations. First, as already mentioned, love style information was available only in the last period of the study. Evaluation of love styles at other points in the research could enrich analyses and ground a causal relation between variables. Another limitation was the lack of data regarding relationship characteristics, such as duration of the relationship, level of satisfaction, quality of interactions, and intensity of couple commitment. Some of these variables could moderate, in part, the relation between MDD and love styles and enhance the study, prompting a suggestion for future research.