Abstract
Managing cardiac illness is not easy because it dramatically disrupts people’s daily life and both the patient and his/her spouse are at risk for experiencing distress, which, in turn, may affect the support provided by the partner as caregiver. The partner, in fact, is the main source of support, but his/her support may sometimes be inadequate. In addition, dyadic coping (i.e., the way partners cope together against stress and support each other in times of difficulty) could likely be a moderating factor. The main aim of the present study was to examine the role that dyadic coping (DC, in terms of positive, negative, and common dyadic coping responses) plays in moderating the link between patient and partner cardiac illness-related distress (in terms of anxiety and depression) and partner support (in terms of overprotection, hostility, and partner support for patient engagement). The study included 100 married couples faced with cardiac illness who completed a self-report questionnaire. We analyzed our data in PROCESS using multiple regressions in order to assess the moderating effects of DC responses in the relationship between the couple’s cardiac illness-related distress and partner support. With regard to patient distress, results showed that higher levels of patient anxiety and depression were linked with ineffective partner support (i.e., overprotection and hostility). With regard to partner distress, higher levels of partner depression were linked with hostility; higher levels of partner depression and anxiety were associated with less partner support for patient engagement. Moreover, the association between distress and partner support was moderated by the quality of DC. In particular, low positive DC represented a risk factor for both the patient and the partner during a cardiac illness, as low positive DC exacerbated the link between patient and partner distress and less effective partner support styles. Also, higher levels of negative DC were risky for couples: The association between distress and less adequate partner supportive behaviors was stronger in the case of higher negative DC. These results imply a need for psychosocial interventions for couples in cardiac illness, especially for couples lacking relational competences, such as positive dyadic coping.
Highlights
Cardiac illness is a stressful situation because it disrupts daily life and demands many lifestyle changes
The partner’s depression was positively associated with hostility, but only in those partners who perceived that the patient adopted low positive dyadic coping [β = −0.18; 95% bootstrap CI (−0.36, −0.01); Figure 7], R2 = 0.04, F(1,94) = 1.24, p = 0.03
Partner Support for Patient Engagement There was a significant interaction effect resulting from partner anxiety and partner positive dyadic coping on partner support for patient engagement [F(3,92) = 5.47, p = 0.01]: Partners’ positive dyadic coping moderated the effect of their anxiety [β = −0.17; 95% bootstrap CI (−0.36, −0.01)] on partner support for patient engagement (Figure 8)
Summary
Cardiac illness is a stressful situation because it disrupts daily life and demands many lifestyle changes (e.g., diet, physical activity, smoking and alcohol consumption, medical check-ups, prescription drug compliance, etc.). An overprotective partner underestimates the patient’s capabilities, resulting in unnecessary help, excessive praise for accomplishments, or attempts to restrict activities, thereby resulting in worse outcomes for the patient (Bertoni et al, 2020), such as decreased quality of life and self-efficacy (Joekes et al, 2007; Zniva et al, 2017). Hostility is associated with decreased patient engagement in his/her care (Rapelli et al, 2020a), increased psychological distress, and higher risk of relapses (Fiske et al, 1991). Evidence exists for the partner’s (un)supportive behaviors to be associated with (low) patient wellbeing and (low) self-efficacy, but whether and how patients’ and partners’ distress is associated with specific types of support has not yet been clarified. Research is needed on factors that can reduce or exacerbate the negative interplay between the patients’ and partners’ cardiac illness-related distress and the partner’s unsupportive behaviors
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