title: The association of marital relationship and perceived social support with mental health of women in Pakistan.
abstract: BACKGROUND
  Marital circumstances have been indicated to be a salient risk factor for disproportionately high prevalence of depression and anxiety among Pakistani women. Although social support is a known buffer of psychological distress, there is no clear evidence as to how different aspects of marital relations interact and associate with depression and anxiety in the lives of Pakistani married women and the role of social supports in the context of their marriage.
  
  
  METHODS
  Two hundred seventy seven married women were recruited from Rawalpindi district of Pakistan using a door knocking approach to psychometrically evaluate five scales for use in the Pakistani context. A confirmatory factor analysis approach was used to investigate the underlying factor structure of Couple satisfaction Index (CSI-4), Locke-Wallace Marital Adjustment Test (LWMAT), Relationship Dynamic Scale (RDS), Multidimensional Scale for Perceived Social Support (MSPSS) and the Hospital Anxiety and Depression Scale (HADS). The interplay of the constructs underlying the three aspects of marital relations, and the role of social support on the mental health of married Pakistani women were examined using the Structural Equation Model.
  
  
  RESULTS
  The factor structures of MSPSS, CSI-4, LWMAT, RDS and HADS were similar to the findings reported in the developed and developing countries. Perceived higher social support reduces the likelihood of depression and anxiety by enhancing positive relationship as reflected by a low score on the relationship dynamics scale which decreases CMD symptoms. Moreover, perceived higher social support is positively associated with marital adjustment directly and indirectly through relationship dynamics which is associated with the reduced risk of depression through the increased level of reported marital satisfaction. Nuclear family structure, low level of education and higher socio-economic status were significantly associated with increased risk of mental illness among married women.
  
  
  CONCLUSIONS
  Findings of this study support the importance of considering elements of marital relationship: satisfaction, adjustment and negative interactions which can be prioritized to increase the efficiency of marital interventions. It also highlights the role of social support in the context of marital relationships among Pakistani women. Furthermore, the study presents the etiological models of depression and anxiety with reference to the above.
authors.forename: Farah
authors.initials: F
authors.lastname: Qadir
authors.forename: Amna
authors.initials: A
authors.lastname: Khalid
authors.forename: Sabahat
authors.initials: S
authors.lastname: Haqqani
authors.lastname: Zill-e-Huma
authors.forename: Girmay
authors.initials: G
authors.lastname: Medhin
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology*; D003863:Depression / Q000453:epidemiology*; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008393:Marriage / Q000523:psychology* / Q000706:statistics & numerical data; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D010549:Personal Satisfaction; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D012944:Social Support; D055815:Young Adult