Abstract
Relationship distress is a pervasive problem in the United States that disproportionally impacts low-income (LI) couples. Unfortunately, the negative effects of relationship distress are not limited to the romantic relationship; individuals who are unhappy in their relationships are more likely to experience problems with individual mental and physical health.
The goal of the present research is to evaluate the effectiveness of two online, self-help, healthy marriage programs for LI couples – the OurRelationship program and the ePREP program – in improving mental and physical health compared to a six-month long wait-list control group. The first study tested whether couples experienced significant change in individual mental and physical health over the course of the two month online program, maintained gains over the four-month follow-up period, and determined if initial level of individual functioning or relationship functioning moderated change in outcomes during the program and over the four-month follow-up period.
The second study tested whether changes in positive relationship functioning, negative relationship functioning, or mental health were mechanisms of change in physical health. This study utilized 742 LI couples (1,484 individuals) collected as a part of a larger study examining the effects of these programs on relationship functioning. Couples were randomized to a waitlist control group or one of two online, relationship-focused programs that consisted of about 8 hours of online material completed in approximately two months. Couples were assessed pre-, mid-, and post-intervention as well at 4 and 6 months after randomization; couples assigned to the waitlist were assessed at similar time intervals. I used hierarchical linear modeling and latent growth curve modeling to assess the questions stated above.
Results of Study 1 indicated that individuals in the intervention groups reported significantly greater increases in individual mental health (psychological distress, anger, alcohol use, and perceived stress) and physical health (alcohol use, insomnia, and exercise) than individuals in the waitlist control group during the program; furthermore, there were no differences in maintenance between treatment groups and the waitlist over follow-up. Treatment gains in both mental and physical health were generally stronger for individuals who began treatment with greater difficulties in those areas; however, gains in health were not moderated by baseline levels of relationship distress. Results of Study 2 partially supported the Strengths and Strains Model of Relationships and Physical health. Specifically, both conflict and intimacy were mechanisms of perceived health while only conflict was a mechanism of insomnia and only intimacy was a mechanism of alcohol. Psychological distress was not a mechanism of change for any outcomes. Implications of these findings with regard to treatment and policy are discussed.