Systemic Couple Therapy for Marital Dynamics and Mental Health

Systemic Couple Therapy for Enhancement of Marital Dynamics and Mental Health Among Individuals With Depression: A Mixed Method Approach

The goal of this clinical trial (randomized controlled trial within a mixed-method study) is to learn whether Systemic Couple Therapy (SCT) can treat depression and improve relational functioning in married couples where at least one partner is experiencing mild to moderate depression and relational distress.

The main questions it aims to answer are:

• Does Systemic Couple Therapy improve relationship quality, marital communication, dyadic coping, interpersonal functioning, and overall mental health?
• Does Systemic Couple Therapy reduce depressive symptoms compared to Treatment-as-Usual (TAU)? Researchers will compare Systemic Couple Therapy (intervention group) with Treatment-as-Usual (control group) to see if SCT leads to greater improvements in mental health and relational outcomes and greater reduction in depression.

Participants will:

• Complete standardized psychological assessments at baseline, post-treatment (8 weeks), and 3-month follow-up
• Participate in 8 weekly Systemic Couple Therapy sessions (intervention group)
• Receive Treatment-as-Usual such as routine couple therapy services or medication (control group)

Study Overview

• Status: Not yet recruiting
• Conditions: Depression
• Intervention / Treatment: Behavioral: Systemic Couple Therapy

• Study Type: Interventional
• Enrollment (Estimated): 48
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Tamkeen Saleem, Phd; Phone Number: 923325412281; Email: tamkeen.dcp@stmu.edu.pk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Inclusion criteria

  • Participant must be 18 years or older to participate in the study.
  • At least one partner must meet the diagnostic criteria for depression (mild to moderate) as defined by the DSM-5 TR.
  • Participants must be married for at least a year to ensure adequate context for systemic couple therapy.
  • Both partners must agree to participate in the study, showing their willingness to engage in the intervention and complete all required assessments.

Exclusion Criteria:

• • Participants with severe depression, psychosis, bipolar disorder, or active substance use disorder will be excluded from the study due to potential interference with therapy.

  • Participants currently engaged in ongoing individual psychotherapy during the study period will be excluded to avoid confounding treatment effects.
  • Additionally, couples will be excluded if there is presence of domestic violence or abuse, as identified during the initial screening or clinical interview, to ensure participant safety.
  • Couple who will be undergoing legal separation or divorce proceedings will not be eligible to participate, as the focus of the systemic couple therapy is relational commitment and stability.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Systemic Couple Therapy	Behavioral: Systemic Couple Therapy; Systemic Couple Therapy for Depressive Sample
No Intervention: TAU; Treatment As Usual

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Relationship Quality	Relationship quality will be measured using the Relationship Quality Scale, a 9-item self-report questionnaire assessing participants' perceptions of the quality of their current relationship. Each item is rated on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). Total scores range from 9 to 45, with higher scores indicating better relationship quality. Assessments will be conducted at baseline (August) after enrollment, post-intervention (8-weeks )(September), and the 3-month follow-up (December).	Assessed at baseline (after enrollment and prior to intervention), immediately after completion of the 8-week intervention, and 3 months after completion of the intervention.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Depression	Depression severity will be measured using the Patient Health Questionnaire-9, a 9-item self-report questionnaire assessing the frequency of depressive symptoms experienced during the previous two weeks. Each item is scored from 0 (not at all) to 3 (nearly every day). Total scores range from 0 to 27, with higher scores indicating more severe depressive symptoms. Assessments will be conducted at baseline (August) after enrollment, post-intervention (8-weeks )(September), and the 3-month follow-up (December).	Assessed at baseline (after enrollment and prior to intervention), immediately after completion of the 8-week intervention, and 3 months after completion of the intervention.
Marital Communication	Marital communication is defined as the verbal and nonverbal sharing of information among spouses. Marital communication will be assessed using the Dyadic Communication Assessment Scale. The scale consists of 16 items, each rated on a 5-point Likert scale ranging from 1 (Rarely) to 5 (Always). Total scores range from 16 to 80, with higher scores indicating better and more effective marital communication. Assessments will be conducted at baseline (August) after enrollment, post-intervention (8-weeks )(September), and the 3-month follow-up (December).	Assessed at baseline (after enrollment and prior to intervention), immediately after completion of the 8-week intervention, and 3 months after completion of the intervention.
Dyadic coping	Dyadic coping is the process by which couple assist each other when one or both are under stress. Dyadic coping will be assessed using the Dyadic Coping Inventory. The inventory consists of 37 items rated on a 5-point Likert scale ranging from 1 (very rarely) to 5 (very often). Total scores range from 37 to 185, with higher scores indicating more effective dyadic coping between partners. Assessments will be conducted at baseline (August) after enrollment, post-intervention (8-weeks )(September), and the 3-month follow-up (December).	Assessed at baseline (after enrollment and prior to intervention), immediately after completion of the 8-week intervention, and 3 months after completion of the intervention.
Interpersonal relationships	Interpersonal relationships will be assessed using the Interpersonal Relationships Rating Scale. The scale consists of 18 items rated on a 5-point Likert scale ranging from 1 (completely inconsistent) to 5 (completely consistent). Total scores range from 18 to 90, with higher scores indicating better interpersonal relationships and interpersonal functioning. Assessments will be conducted at baseline (August) after enrollment, post-intervention (8-weeks )(September), and the 3-month follow-up (December).	Assessed at baseline (after enrollment and prior to intervention), immediately after completion of the 8-week intervention, and 3 months after completion of the intervention.
Mental Health	Mental health will be measured using the Mental Health Inventory-38, a 38-item self-report questionnaire that assesses overall psychological well-being and psychological distress experienced during the previous month. Responses are recorded using 5-point or 6-point response options depending on the item, and scores are summed to produce a Mental Health Index ranging from 38 to 226. Higher scores indicate better overall mental health, reflecting greater psychological well-being and lower psychological distress. Assessments will be conducted at baseline (August) after enrollment, post-intervention (8-weeks )(September), and the 3-month follow-up (December).	Assessed at baseline (after enrollment and prior to intervention), immediately after completion of the 8-week intervention, and 3 months after completion of the intervention.

Collaborators and Investigators

• Sponsor: Shifa Tameer-e-Millat University

Study record dates

Study Major Dates

• Study Start (Estimated): August 1, 2026
• Primary Completion (Estimated): October 1, 2026
• Study Completion (Estimated): December 31, 2026

Study Registration Dates

• First Submitted: July 19, 2026
• First Submitted That Met QC Criteria: July 25, 2026
• First Posted (Actual): July 30, 2026

Study Record Updates

• Last Update Posted (Actual): July 30, 2026
• Last Update Submitted That Met QC Criteria: July 25, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Behavioral Symptoms; Behavior; Depression
• Other Study ID Numbers: 484-25

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No