Several studies report steady associations between mental health outcomes of elderly spouses. Nevertheless, the specific role of marital relationships in the non-independence of mental health status is not clear given the diversity of theoretical approaches, the various methodologies used and the lack of studies focusing on people aged 60 and over. Based on the PRISMA methodology, a systematic search of PubMed, PsycINFO, and PsycARTICLES was conducted. A total of 21 articles were included. The quality of the studies was evaluated using the National Institute for Health and Clinical Excellence tool. Additional criteria were added to ensure that the associations observed are related to the marital relationship. The main finding of this systematic review is a lack of evidence for the specific role of marital relationships. Based on the current findings, we propose methodological recommendations to develop research designs more suited to address the role of marital relationships in mental health similarities and interdependence in older couples. In particular, we recommend including covariates related to marital relationships, comparisons with dyads of pseudo-couples and a development of studies in daily life. Finally, this review underscores the importance of a dyadic approach to better understand the elderly’s mental health in clinical practice.Read less <