Couple-oriented Interventions Research Articles

Couple-Oriented Interventions for Mental Health: A Scoping Review.

The purpose of this research was to systematically examine and collate evidence on couple-oriented interventions for mental health to identify trends in the literature, review research strategies, and suggest directions for future research. A systematic search included studies relating to couple-oriented interventions for preventing mental disorders and/or promoting mental health. We identified a total of 52 studies, which included 55 articles. Our findings revealed that interventions were delivered through various modes, including face-to-face, telephone, and online, with the majority of couple-oriented interventions operating in conjoint sessions. The most common intervention was for selective prevention, targeting patients with cancer and their partners. This review provided evidence of the applicability of theoretical frameworks, dyad analysis, and measurements associated with couple-oriented interventions. Findings can help family nurse practitioners and health care professionals advance strategies to develop and implement evidence-based, couple-oriented interventions for primary prevention of mental disorders and the promotion of mental health.

Psychological couple-oriented interventions for patients with heart disease and their partners: a scoping review and guidelines for future interventions.

This scoping review aims to provide an accessible summary of available evidence on the efficacy of psychological couple-based interventions among patients with heart disease and their partners focusing on specific aspects and strategies by assessing different emotional and physical cardiac-related outcome measures. A literature search was performed in PubMed, Scopus, Medline, PsycINFO, and Web of Science databases using the keywords "heart diseases" and "couple-based intervention." A literature search using systematic methods was applied. Data were extracted to address the review aims and were presented as a narrative synthesis. The database search produced 11 studies. Psychological couple-based interventions varied in terms of the type of intervention, personnel, format (group or individual, phone or in person), number of sessions, and duration. Most of the contributions also lacked adequate details on the training of professionals, the contents of the interventions, and the theoretical models on which they were based. Finally, although partners were involved in all the treatment, in most studies, the psychological strategies and outcomes were focused on the patient. The variability of the psychological couple-based interventions of included studies represents a challenge in summarizing the existing literature. Regarding their impact, psychological interventions for patients with cardiovascular disease and their partners were found to moderately improve patients' and partners' outcomes.

Online coaching blended couple-oriented intervention for preventing depression among Korean middle adulthood: A feasibility study.

Depression and marital satisfaction have a reciprocal cause-and-effect relationship. Thus, couple relationships should be considered to maximize the effectiveness of couple-oriented interventions for depression. Moreover, developing culturally tailored couple-oriented interventions is critical for improving cultural acceptability and enhancing the perceived effectiveness of the interventions. A new culturally tailored MindGuide Couple intervention was developed to prevent Korean middle adulthood depression and enhance couple relationships using intervention mapping. This feasibility study used a single-arm, pre- and post-test, and 2-month follow-up design to explore the reach, acceptability, and preliminary effectiveness of this preventive intervention. Reach was assessed by recruitment, retention, and completion rates; acceptability was measured based on helpfulness, suitability, and satisfaction; and preliminary effectiveness was measured by depression (CES-D), positive and negative affect (PANAS), satisfaction with life (SWLS), couple satisfaction (CSI), and healthy relationship between spouses (FRAS). Fifteen middle-aged couples participated in four psychoeducational and asynchronous online modules and four synchronous coaching sessions via videoconferencing for 5-7 weeks. Data were analyzed using descriptive statistics and repeated measures with analysis of variance. With a 94.1% completion rate, the participants demonstrated high satisfaction with the online coaching blended intervention and reported that it was helpful and easy to use. Both husbands and wives showed significant differences over time in depression, couple satisfaction, and healthy relationships between spouses. This feasibility study demonstrated the successful reach, acceptability, and potential effectiveness of this preventive intervention. Additionally, we suggest the importance of culturally tailored and online coaching blended couple-oriented intervention for preventing depression and promoting healthy couple relationships.

Couple Efficacy and Communal Coping for HIV Prevention Among Kenyan Pregnant Couples.

Involving both partners of a couple in HIV prevention can improve maternal and child health outcomes in sub-Saharan Africa. Using data from 96 couples, we explored the actor and partner effects of perceived relationship dynamics on a couple's confidence and ability to reduce HIV risk together. Perceived relationship quality altered perceived confidence and ability to reduce HIV threat. One's own ability to confidently act together with their spouse appeared to be stronger for husbands than wives with respect to relationship commitment. A partner's confidence to communicate with their spouse about HIV risk reduction appeared to be stronger from husbands to wives for relationship satisfaction and trust. Gender differences in perceived relationship quality and effects on communal coping may exist and requires further study for applicability in intervention development in this setting. Efficacious couple-oriented interventions for HIV prevention should incorporate evidence on how partners mutually influence each other's health beliefs and behaviors.

Perceived Gratitude, Role Overload, and Mental Health Among Spousal Caregivers of Older Adults.

We investigated whether spousal caregivers' greater perception of being appreciated by their partner for their help was associated with caregivers' better mental health and whether caregivers' higher role overload was related to their poorer mental health. We further evaluated whether spousal caregivers' greater perceived gratitude buffered the association between their role overload and mental health. We examined 306 spousal caregivers of older adults with chronic illness or disability, drawn from the 2011 National Health and Aging Trends Study and National Study of Caregiving. We defined mental health as better psychological well-being and less psychological distress (i.e., fewer depressive and anxiety symptoms). Hierarchical regression models were estimated to test hypotheses. Greater perceived gratitude was associated with better psychological well-being, and higher role overload was related to poorer psychological well-being and greater psychological distress. In addition, greater perceived gratitude buffered the associations between role overload and anxiety symptoms as well as psychological well-being. Findings suggest that spousal caregivers' role overload may be a strong risk factor for their poorer mental health, especially when caregivers feel less appreciated by their partner. Couple-oriented interventions to improve spousal caregivers' mental health could be aimed at reducing their role overload and enhancing perceived gratitude.

Perceived partner responsiveness, pain, and sleep: A dyadic study of military-connected couples.

The health-promoting influence of supportive close relationships has been extensively documented, yet the mechanisms of this effect are still being clarified. Leading researchers have theorized that examining particular interpersonal interactions and the mediating intrapersonal processes they facilitate is the key to understanding how close relationships benefit health. The purpose of this study was to investigate the influence of perceived partner responsiveness (PPR) on pain and sleep quality via affect in a sample of veterans and spouses (collectively called military-connected couples). Military-connected couples (N = 162) completed 32 days of daily diaries. Mediated actor-partner interdependence models were conducted using multilevel structural equation modeling to assess the effects of PPR at baseline on the daily levels of positive affect, negative affect, pain, and sleep across the following 32 days. Indirect effects emerged such that affect mediated the association between PPR and pain for veterans only whereas affect mediated the association between PPR and sleep quality for both partners. Daily direct effects emerged as well; for example, positive affect was positively associated with higher sleep quality for both partners and lower pain for veterans. Partner effects were revealed such as veteran PPR was positively associated with spouse positive affect. Overall, greater PPR was associated with positive health outcomes for military-connected couples. The implications of this study include providing insights for couple-oriented interventions for preventing and treating pain and sleep problems in couples who are at high risk of these health problems such as military-connected couples. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Can promoting romantic relationship quality help gay and bisexual men better face HIV stigma?

Advancements in antiretroviral treatment and a greater access to medication have contributed to an increased life expectancy for people who live with HIV/AIDS. As a result, new psychosocial goals in the treatment of HIV, such as improving the quality of life and levels of well-being of those who are infected, have become increasingly relevant. Since men who have sex with men, particularly those who identify as gay and bisexual, continue to be a group of primary concern within the HIV-affected population, new interventions to help them reach the aforementioned goals must be developed. Considering HIV stigma represents a paramount psychosocial threat for individual’s psychological and physical well-being, the authors embrace a resilience-oriented perspective and propose a relational approach to helping gay and bisexual men living with HIV/AIDS better face social stigma. Through an integrative literature review that discusses scholarly works published in the past 15 years on the topics of HIV stigma, relationship quality, and interventions with couples dealing with chronic illness, the authors suggest several couple-oriented interventions as promising strategies to help gay and bisexual men living with HIV/AIDS cope with the social stigma. Future directions in research and plausible components for interventions with these HIV-affected male couples are also discussed.

The impact of daily arthritis pain on spouse sleep

Although chronic pain has been linked to poorer psychosocial well-being in the spouse, the extent to which patient pain affects spouse sleep is unknown. The aim of the present study was to test the hypothesis that greater daily knee pain would be associated with poorer sleep for the spouse that evening. We also tested the hypothesis that this pain contagion is exacerbated in couples who have a close relationship. A total of 138 knee osteoarthritis (OA) patients and their spouses completed baseline interviews and a 22-day diary assessment. Multilevel lagged models indicated that greater knee OA pain at the end of the day was associated with spouses’ poorer overall sleep quality that night and feeling less refreshed after sleep. In contrast, there was no evidence that spouse sleep was related to greater patient pain the next day. The effects of patient pain on spouse sleep were not due to disturbances in patient sleep and were also independent of spouse sex, depressive symptoms, and physical comorbidities; both partners’ negative affect; and the quality of marital interactions throughout the day. As predicted, we also found that patient pain was more strongly related to less refreshing sleep for spouses who were in a close relationship. Findings illustrate that chronic pain may place the spouse’s health at risk and suggest an important target for couple-oriented interventions.

Couple-oriented interventions for chronic illness

There is emerging evidence that couple-oriented behavioral interventions (CIs) for chronic illness yield benefits for patients. However, conceptual and methodological advances are critical for strengthening the impact and evaluation of this treatment approach. First, it would be useful to develop CIs that work for multiple chronic conditions and are tailored to couples’ needs, and that can be delivered in ways that help couples apply new skills to challenges that they encounter in daily life. Second, there is a need for studies that compare CIs to evidence-based, patient-oriented interventions, and that assess mechanisms in ways which improve our understanding of how intimate relationships affect illness management. Finally, new directions in research on marriage and health will yield findings that are important for the next generation of CIs.

Changing everyday activities of couples in late life: Converging and keeping up

The influence of mutual spousal interrelations in domains such as health and wellbeing has been demonstrated, but little is known about the domain of everyday activities of couples in late life. In the present explorative study, we considered all of the activities participating couples talked about to be their everyday activities. Its aim was to understand, over time, changes in everyday activities as experienced by late-life community-dwelling couples. In a two-year period, 41 individual and joint interviews were conducted with 8 couples, who were purposefully selected from the Longitudinal Aging Study Amsterdam. Analyses involved the construction of couple narratives and constant comparisons within and across couples. Changing everyday activities in late-life couples was interpreted to be a two-way process of (1) converging, and (2) keeping up, which occurred in three fluid phases. Converging was a slow inward movement with a shift towards diminished everyday activities performed in a smaller world. Keeping up was an outward movement in order to resist the converging process by using everyday activities as a means to keep fit, physically and mentally, and to connect with the wider social world. In the first phase, couples maintained their unique linked activity pattern. In the second phase, spouses resisted converging by keeping up. In the third phase, spouses co-performed everyday activities closely together. The findings support the need to develop couple-oriented interventions that aim to enhance the couples' functioning in the domain of everyday activities.

Are Couple-Oriented Interventions Effective Across Chronic Illnesses?: A Reply to Arthurs and Colleagues

We appreciate the opportunity to respond to the commentary of Arthurs and colleagues regarding our review of coupleoriented interventions for chronic illness [1]. Arthurs and colleagues raise four points concerning our meta-analysis. First, the authors note that we did not report effect sizes for each study, as suggested in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [2]. The effect sizes were available at the time of submission, and we are happy to provide this information (see Tables 1, 2, and 3). Second, the authors state that it is not clear how we arrived at our conclusions regarding methodological limitations of the studies that we reviewed and that we did not address risk of bias as suggested in the PRISMA statement. The three limitations that we highlighted were easily discerned from the articles (i.e., lack of intent to treat analyses, lack of information regarding number of intervention sessions attended, and lack of statistical power to detect between-group differences). The proportion of studies with these three limitations ranged from 77% to 84%. Although it can be worthwhile to rate the methodological quality of individual studies along multiple dimensions, this was not a goal of our review. Moreover, the value of incorporating this information in meta-analysis is unclear [3]. The third criticism raised by Arthurs and colleagues is that the broad range of intervention strategies and formats of the studies that we reviewed leaves clinicians with little guidance regarding the best treatment approach and type of patient to target. Indeed, couple-oriented interventions reflect the broader psychosocial intervention literature in terms of diversity in number of components and sessions, as well as type of content (e.g., cognitive-behavioral skills training, education). As we have noted elsewhere, the decomposition of effective interventions for the purpose of identifying effective components is an important goal for future intervention research [4]. However, the couple-oriented intervention literature is not yet at this stage. We would also like to note that our review is not meant to be prescriptive to clinicians. As stated in the original article, our findings are preliminary and in need of corroboration. We do believe that couple-oriented interventions are a promising treatment approach for the many patients who are partnered and that a cross-disease perspective to reviewing this literature and developing new interventions may yield conceptual advances. Finally, Arthurs and colleagues state that we combined outcomes from different studies without regard to whether those outcomes were specifically targeted by an intervention. The authors provide the example of a weight loss intervention that was not targeted at pain reduction but assessed this outcome and therefore was included in our analysis. In our experience, it is uncommon for researchers to assess change in outcomes that are not targeted in an intervention, and this did not occur in the studies that were included in our review. L. M. Martire (*) Penn State University, University Park, PA, USA e-mail: lmm51@psu.edu

Are Couple-Oriented Interventions Effective Across Chronic Illnesses? A Commentary on Martire et al.

Are Couple-Oriented Interventions Effective Across Chronic Illnesses? A Commentary on Martire et al.

Independence centrality as a moderator of the effects of spousal support on patient well-being and physical functioning.

In this study, we examined whether the benefits of spousal assistance for patient well-being and physical functioning depend on the fit between amount of assistance provided and the personal importance of completing activities independently. Individuals with osteoarthritis of the hip or knee were assessed for independence centrality, depressive symptoms, self-efficacy for managing pain, and physical functioning (N = 159 to 230). Spouses reported the amount of support provided with daily tasks. As predicted, moderation analyses indicated that spousal support was associated with greater self-efficacy for managing pain in patients with low independence centrality, but was not associated with self-efficacy in patients with high independence centrality. Also consistent with our hypotheses, spousal support was associated with greater depressive symptoms and slower walk time in patients with high independence centrality, but there were no effects of spouse support on these outcomes for patients with low independence centrality. Our findings demonstrate the implications of miscarried spousal support for patient well-being and physical functioning, and they suggest a means of tailoring couple-oriented interventions for chronic illness.

Review and Meta-analysis of Couple-Oriented Interventions for Chronic Illness

Evidence continues to build for the impact of the marital relationship on health as well as the negative impact of illness on the partner. Targeting both patient and partner may enhance the efficacy of psychosocial or behavioral interventions for chronic illness. The purpose of this report is to present a cross-disease review of the characteristics and findings of studies evaluating couple-oriented interventions for chronic physical illness. We conducted a qualitative review of 33 studies and meta-analyses for a subset of 25 studies. Identified studies focused on cancer, arthritis, cardiovascular disease, chronic pain, HIV, and Type 2 diabetes. Couple interventions had significant effects on patient depressive symptoms (d = 0.18, p < 0.01, k = 20), marital functioning (d = 0.17, p < 0.01, k = 18), and pain (d = 0.19, p < 0.01, k = 14) and were more efficacious than either patient psychosocial intervention or usual care. Couple-oriented interventions have small effects that may be strengthened by targeting partners' influence on patient health behaviors and focusing on couples with high illness-related conflict, low partner support, or low overall marital quality. Directions for future research include assessment of outcomes for both patient and partner, comparison of couple interventions to evidence-based patient interventions, and evaluation of mechanisms of change.

Couple-oriented education and support intervention for osteoarthritis: Effects on spouses' support and responses to patient pain.

The purpose of this study was to determine whether a couple-oriented education and support intervention for osteoarthritis was more efficacious than a similar patient-oriented intervention in terms of enhancing spouses' support of patients and their positive and negative responses to patient pain. Repeated-measures analyses of covariance with the completers sample (N = 103 dyads) showed that at the postintervention assessment, patients in the couple-oriented intervention reported a greater decrease in their spouses' punishing responses (e.g., anger, irritation) than did patients in the patient-oriented intervention. In addition, a trend effect was observed in regard to the advantage of couple-oriented intervention for increasing spouses' attempts to distract patients from their pain. At the 6-month follow-up, patients in the couple-oriented intervention reported greater increased spouse support than those in the patient-oriented intervention. Findings illustrate the value of examining change in specific types of marital interactions targeted in a couples intervention, and the need to strengthen the impact of future couple-oriented interventions.