Marital History in Adult Patient Assessment
A thorough marital history is not mandatory for all adult patients, but it is a recommended component of comprehensive social history assessment, particularly for patients with mental health concerns, chronic illnesses, or HIV infection. The evidence shows that marital status assessment serves as a contextual factor rather than a diagnostic requirement.
When Marital History Should Be Obtained
Psychiatric Evaluations
- The American Psychiatric Association recommends obtaining personal and social history during initial psychiatric evaluation, which includes assessment of interpersonal/relationship problems and psychosocial stressors 1
- This assessment helps identify support systems and relationship-based stressors that may impact mental health outcomes 1
- Research demonstrates that marital status and marital support are associated with mental health outcomes, with higher marital support protective against internalizing, fear, bipolar, and externalizing disorders 2
HIV and Chronic Disease Management
- For HIV-infected patients, the HIV Medicine Association recommends obtaining information about the patient's family, living situation, partners, and support systems as part of comprehensive initial assessment 1
- This includes asking whom patients have informed of their HIV status, what support they have been receiving, and plans for having children 1
- The assessment should cover sexual practices, partner notification, and contraceptive use 1
Depression Screening Context
- The U.S. Preventive Services Task Force identifies marital status as a demographic factor associated with depression risk, with previously married persons having higher rates 1
- However, marital status alone cannot distinguish patients with depression from those without depression 1
What Marital History Is NOT
Not a Mandatory Screening Requirement
- For emergency department psychiatric evaluations, the American College of Emergency Physicians recommends that diagnostic evaluation be directed by history and physical examination findings, not routine demographic data collection 1
- History and physical examination predict 83-98% of clinically significant abnormalities in psychiatric patients 3
- Marital status is a contextual factor, not a diagnostic criterion or mandatory screening element 1, 3
Not a Substitute for Clinical Assessment
- The focus should be on functional assessment of psychosocial stressors, support systems, and relationship problems rather than simply documenting marital status 1
- Assessment should identify the presence and quality of social support, not just marital status category 1, 2
Practical Approach to Marital/Relationship History
Essential Elements to Assess
- Living situation and household composition 1
- Quality and availability of social support systems 1, 2
- Interpersonal/relationship problems as psychosocial stressors 1
- Impact of relationship status on coping with illness 1
Clinical Context Determines Depth
- For routine primary care visits without mental health or chronic disease concerns: Brief documentation of living situation and support systems is sufficient 4
- For mental health presentations: More detailed assessment of relationship stressors, support quality, and relationship history 1
- For HIV care: Specific focus on partner notification, sexual practices, and family planning 1
- For chronic disease management: Assessment of family support for disease management and caregiver availability 1
Common Pitfalls to Avoid
- Do not collect marital status as a checkbox item without assessing functional support and relationship quality 1, 2
- Do not assume marital status alone predicts mental health outcomes—the quality of relationships matters more than legal status 2
- Do not delay psychiatric evaluation or treatment to obtain detailed social history in acute presentations 1
- Do not overlook assessment of domestic violence and trauma history, which are more clinically relevant than marital status alone 1