Being alone together: A longitudinal dyadic analysis on the impact of loneliness and relationship quality on well-being in couples coping with disability

Abstract

Introduction Persons with physical disabilities and their caregiving partners are at an increased risk of experiencing reduced well-being. One potential explanation for this trend may be the potentially harmful effects of loneliness and poor relationship quality, which this population is frequently exposed to. Both loneliness and poor relationship quality have been found to elicit a stress response, which is detrimental for psychosomatic health and well-being. To date, little is known about how the perceptions of loneliness and relationship quality within couples coping with a disability affect well-being, furthermore the directionality of effect is not well understood. Methods In this study, we investigate the actor and partner effects, and the reciprocal effects of loneliness and relationship quality on well-being. The analyses are based on longitudinal dyadic data from the pro-WELL study (n = 246), a Swiss community survey of persons with spinal cord injury (SCI) and their partners. Data was collected over a 12-month period using telephone interviews and questionnaires. We employed mixed effects modelling to explore actor and partner effects and used cross-lagged path analysis to explore reciprocal effects. Both of these analyses were stratified by role, i.e. persons with SCI and caregiving partners. Results We found loneliness to be more prevalent in persons with SCI compared to their caregiving partners. In caregiving partners, we found significant actor effects of loneliness (β=−0.20; CI: −0.31, −0.10) and relationship quality (β=0.15; CI: 0.04, 0.26) on well-being, and significant partner effects of relationship quality on well-being (β=0.21; CI: 0.10, 0.32). In persons with SCI, only the actor effect of loneliness was significant (β=−0.30; CI: −0.41, −0.18). Over time, loneliness demonstrated reciprocal associations with well-being, as did relationship quality in caregiving partners, indicating a possible cycle of positive development between reducing loneliness, improving relationship quality and enhancing well-being. Conclusions The findings of our study highlight the high prevalence of loneliness in persons with SCI and the importance of reducing loneliness and strengthening relationship quality in order to improve well-being in partnerships of persons coping with disability. It may also inform the trial and evaluation of targeted interventions, which promote qualitative aspects of social relationships in order to enhance well-being.