Marital Strain Research Articles

Abstract C059: Disparities in psychological distress among colorectal cancer survivors: Impact on emergency room usage and overall mortality

Abstract Introduction: Cancer survivorship often entails considerable psychological distress. Colorectal cancer (CRC) presents distinct stressors including the use of colostomy and multimodality treatments resulting in side effects for many patients. These factors increases the likelihood of social isolation, body image issues, intimacy problems, and marital strain which affect mental health of CRC survivors. However, information about the prevalence of psychological distress in this population and its association with clinical outcomes are lacking. We examined the prevalence of psychological distress and its association with emergency room usage (ER) and all-cause mortality among CRC survivors. Methods: We utilized data from the 2000-2018 National Health Interview Survey (NHIS) and the NHIS linked mortality files. The NHIS is an annual cross-sectional, nationally representative, in-person survey of the civilian, noninstitutionalized population in the United States. The main exposure was psychological distress, assessed with the six-item Kessler Psychological Distress Scale (K6) and classified as (no/low, moderate, severe). The outcomes were ER usage during the past 12 months and all-cause mortality. Multivariable logistic and Cox proportional hazards models were used to examine the associations between psychological distress, and ER usage and all-cause mortality, respectively. The models were adjusted for age, gender, survey year, race/ethnicity, marital status, education, smoking, geographic region, visit to mental professionals, general health status, comorbidities, and time since cancer diagnosis. Results: A total of 3198 CRC survivors were included in the study, of whom 4.1% and 19.6% reported severe and moderate psychological distress, respectively. In the 12 months preceding the survey, 29.8% of CRC survivors had ER usage and 41.5% deaths occurred with a median follow-up of 84 months. In the adjusted model, compared to CRC survivors with low/no psychological distress, those with severe (aOR=1.86; 95% CI, 1.11–3.10) or moderate (aOR=1.60; 95% CI, 1.22–2.11) psychological distress had high odds of reporting ER use. Similarly, after adjusting for covariates, CRC survivors with severe (aHR =1.32; 95% CI, 1.30–1.34) or moderate (aHR =1.02; 95% CI, 1.01–1.02) psychological distress had higher risk of all-cause mortality compared with survivors experiencing low/no psychological distress. Conclusion: CRC survivors with severe or moderate psychological distress have higher ER usage and all-cause mortality. This finding emphasizes the significance of timely identifying and addressing psychological distress to improve quality of life and clinical outcomes of patients diagnosed with CRC. Integrating mental health support into routine cancer care may reduce distress levels, potentially leading to fewer ER usage and lower mortality rates among CRC survivors. Citation Format: Mrudula Nair, Pranali Patel, Chaitali S Dagli, Nada Al-Antary, Oluwole A Babatunde, Nosayaba Osazuwa-Peters, Eric Adjei Boakye. Disparities in psychological distress among colorectal cancer survivors: Impact on emergency room usage and overall mortality [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C059.

Marital strain and emotional intimacy in midlife couples: The moderating role of empathy

Marital strain and emotional intimacy in midlife couples: The moderating role of empathy

Who's Worried? Memory, Worries About Dementia, and Marital Strain in Midlife Same- and Different-Sex Marriages: A Dyadic Perspective.

Prior scholarship has highlighted the importance of marriage for cognition. However, little research has considered how cognition-related concerns may impact marriage. In this study, researchers examine how aging couples view each other's memory and worry about their potential development of dementia in the future. Additionally, researchers investigate whether these cognition-related concerns may strain marriage, and how these dynamics differ for men and women in same- and different-sex marriages. Researchers used 2 waves of dyadic data from the Health and Relationships Project (HARP; 2015-2022), including 594 respondents from 297 same- and different-sex married couples (aged 41-71 at Time 2). Researchers employed the Actor-Partner Interdependence Model (APIM) to explore associations between actor and partner reports of memory and dementia worry with marital strain. Men and women in same- and different-sex marriages were equally likely to report worries about their own potential development of dementia. However, women reported more concerns about their spouse developing dementia in the future than men did, regardless of whether they were married to a man or a woman. Both partners' reports of memory and dementia worry played a complex role in influencing marital strain, with variations observed across couple types. Concerns about cognitive decline and dementia are common in older populations, and for married couples, spouses have concerns about their own memory as well as that of their partner. Researchers finding identified the significance of concerns about a spouse's memory on marital dynamics among aging couples.

A longitudinal investigation of marital dissolution, marital quality, and generalized anxiety disorder in a national probability sample

Generalized anxiety disorder (GAD) is a common psychiatric disorder that is associated with high levels of distress and impairment. The present study was conducted to examine the 10-year longitudinal associations between marital dissolution, three measures of marital quality, and GAD among married participants from the Midlife in the United States (MIDUS) survey, a probability sample of American adults aged 24–74 years. Results indicated that GAD at baseline was significantly and positively associated with incidence of marital dissolution during the 10-year follow-up and marital strain (i.e., negative partner interaction) at baseline was significantly and positively associated with incidence of GAD at the 10-year follow-up. These associations remained statistically significant after adjusting for demographic characteristics and neuroticism. In comparison, marital satisfaction and marital support (i.e., positive partner interaction) at baseline were not significantly associated with incidence of GAD, GAD at baseline was not significantly associated with any of the three measures of marital quality at follow-up, and marital dissolution during follow-up was not significantly associated with incidence of GAD. These findings suggest that negative interactions with one’s partner may be a risk factor for GAD and that improving marital functioning may be important for the prevention and treatment of GAD.

Interpersonal Discrimination and Relationship Quality among Married Mid-Life and Older Black Adults

Theories of minority stress contagion suggest that the consequences of racial discrimination may extend beyond the individual to impact close others. We empirically test direct and spillover associations between racialized stress and marital support and strain among mid-life and older Black spouses. We use actor-partner interdependence models to analyze dyadic data from 280 different-sex, married Black couples from the 2014 and 2016 Health and Retirement Study who completed the psychosocial leave-behind module. We find significant actor effects for husbands’ racial discrimination on their own marital support and strain, while wives’ racial discrimination is positively associated with their own marital strain. We find no evidence of partner effects nor significant gender differences in the association between racial discrimination and marital quality. The findings highlight pathways by which racial discrimination affects the marriage quality of Black men and women in mid- to late-life.

The impact on graduate students when a university closes

PurposeThis study aimed to investigate the impact of a university’s abrupt closure on the lives of graduate students and examined the role of grit, social support and school identification as they transferred to a new institution.Design/methodology/approachAn online survey was administered to a diverse sample of 130 psychology graduate students after their university unexpectedly closed and the students transferred to another institution to complete their degrees. The survey included both qualitative and quantitative measures of the impact on different areas of their lives, anxiety and depression, life satisfaction, social support, grit and school identification.FindingsStudents reported experiencing financial loss, family and marital strain, anger, fear, uncertainty and loss of progress toward professional goals. Nearly 40% of participants had scores indicating elevated anxiety and depression. Students with higher anxiety and depression and lower life satisfaction tended to identify less with their new institution. Both social support and grit were related to better adjustment and life satisfaction.Originality/valueTo the best of the authors’ knowledge, this is the first study to examine the impact on graduate students following the closure of an institution of higher education. The findings have implications for educational policy and graduate student support services.

Influence of child’s autism on relationships

Background: Although the world has been witnessing a steady increase in the autism population, there is a paucity of research on the maternal experiences of caregiving a child with autism. Aim: The rationale of this study is to explore the maternal experiences of children with autism in Kerala, India. Materials and Methods: Ten mothers of children with autism were interviewed and the transcripts were analyzed using interpretative phenomenological analysis. Findings: Two superordinate themes were identified in the analysis: a) deteriorating marriage, and b) deteriorating social relations. Mothers in the study were affected by their child’s autism, as it reflected on their personal, marital and social aspects of life. Mothers had conspicuous marital strain due to the increasing demands of caregiving and child’s autism influenced their family planning decision-making. Mothers were blamed for their child’s autism and discriminative and judgmental behaviours from the public restricted their social participation. The findings provide an understanding of the maternal experiences in raising a child with autism in Kerala. Conclusion: These findings can be useful for researchers, healthcare providers and policy makers to provide support and address the issues faced by the mothers in raising children with autism.

Independent associations of inter-spousal gaps in age and education with long-term mortality and cancer survival: The Jerusalem Perinatal Study 1964–2016

To identify factors responsible for variation in health among married individuals, we investigated the independent associations of gaps in spousal age and education (or "heterogamy") with all-cause and cause-specific mortality as well as with survival of cancer patients. Using over four decades of follow-up data on 36,717 couples from Jerusalem (1964-2016), we compared heterogamous with homogamous couples. Having a less educated spouse was associated with an increased risk for several outcomes in both genders, such as all-cause mortality in males (hazard ratio [HR]=1.18, 95% confidence interval [CI]: 1.12, 1.25) and in females (HR=1.11, CI: 1.01, 1.22). Having a more educated spouse was associated with decreased all-cause mortality in males (HR=0.93, CI: 0.87, 0.99), but not in females. Having an older spouse was detrimental for health of both genders. For example, increased all-cause mortality was seen in men (HR=1.22, CI: 1.10, 1.34) and in women (HR=1.10, CI: 1.02, 1.19). A younger spouse was beneficial for some of the outcomes in males, such as decreased cancer-specific mortality (HR=0.88, CI: 0.78, 0.99), but not in females. Spousal gaps in education and age may be independently associated with health outcomes. The observed relationships may be driven by combined amounts of marital strain as well as shared spousal resources (such as knowledge or income) depending on gender.

Marital Strain and Support and Subjective Well-Being in Later Life: Ascribing a Role to Early-Life Conditions

Decades of research have the beneficial effects of marital support and the detrimental consequences of marital strain on health and well-being. However, we know relatively less about how circumstances in childhood—a key developmental period of the life course—influence the relational structure in which later life is embedded and any implications this may hold for well-being. We integrate the life course perspective with the stress process model to offer a framework for how childhood conditions (childhood happiness, family structure, and financial strain) moderate the relationship between marital support/strain and subjective well-being in older adulthood in potentially different ways for men and women. The consequences of marital strain may be more severe and the benefits of marital support may not be as strongly felt for those adults who experienced greater adversity during childhood. Drawing on longitudinal data from Waves 2 (2010-2011) and 3 (2015-2016) of the NSHAP project (N = 1,376), results from lagged dependent variable models suggest that marital support buffers the effect of not living with both parents in childhood on subjective well-being for men. Meanwhile, women raised in families that experienced financial hardship reported lower subjective well-being in the context of marital strain in later life. No significant interaction effects were obtained for childhood happiness. Taken together, our findings suggest that adverse experiences in childhood can be scarring, particularly in the context of strained intimate relationships. However, a supportive marriage can, in some cases, offset the effects of childhood hardship on subjective well-being in later life.

Infertility-related stress: A concept analysis.

To develop a clear definition of infertility-related stress using Rodgers' method of concept analysis. Infertility affects approximately 13% of women in the United States. Though poorly defined in the literature, previous studies suggest infertility-related stressors contribute to psychological distress. Rodgers' method of concept analysis guided the review, including sample and setting, literature search, and data analysis. PubMed, CINAHL, and PsycINFO were searched for relevant literature. Following abstract, title, and text screenings, 21 articles were included and reported using the PRISMA-S checklist. Texts were analyzed and results informed the proposed definition of infertility-related stress. Antecedents included infertility, desire for children, and fear of the unknown. Attributes were identity crisis, social isolation and stigma, sexual stress, and financial strain. Consequences included treatment dropout and marital strain. Anxiety, depression, and decreased quality of life were identified as both attributes and consequences. Synthesized results informed a proposed definition of infertility-related stress. Improved understanding of infertility-related stress allows for measurement development and facilitates recognition of patients in need of additional support, while potentially reducing the impact on the health and well-being of infertile women.

Marital Strain and Support and Subjective Well-Being in Later Life: Ascribing a Role to Childhood Adversity.

Objectives: We integrate the life course perspective with the stress-process model to offer a framework for how childhood conditions moderate the relationship between marital support/strain and subjective well-being in older adulthood for men and women. Methods: Drawing on longitudinal data from the National Social Life, Health, and Aging Project (NSHAP), we use a series of lagged dependent-variable models and stratify the sample by gender. Results: Our results suggest that the benefits associated with greater marital support are stronger for those that did not live with both parents in childhood for men. Women raised in families that experienced financial hardship reported lower subjective well-being in the context of marital strain. Conclusion: Adverse experiences in childhood can be scarring or foster resilience related to well-being in the context of strained or supportive marriages.

A national longitudinal study of marital quality and cognitive decline among older men and women

We provide one of the first national longitudinal studies of the association between trajectories of marital quality and cognitive functioning among older adults, with close attention paid to gender differences. Data were drawn from the Health and Retirement Study (HRS) 2006–2016. Marital quality trajectories were assessed at three waves: 2006/2008, 2010/2012, and 2014/2016. Cognitive trajectories were assessed at five waves: 2008, 2010, 2012, 2014, and 2016. The final analytic sample included 7901 respondents age 50 and older (4334 men and 3567 women) who were either married or cohabiting during the study period. Results from parallel linear growth curve models suggest that among older adults, initial positive marital quality was associated with better initial cognition, and initial negative marital quality was associated with worse initial cognition. Results from multiple group analysis further suggest that marital quality was significantly associated with men's cognitive trajectories but not women's. Among men, an increase in positive marital quality was associated with a slower rate of cognitive decline, whereas an increase in negative marital quality was associated with a faster rate of cognitive decline. These findings suggest that older men who experience a decline in marital quality may be vulnerable to cognitive decline and that reducing marital strain and improving marital quality may protect men's cognitive health in later life.

Childhood Maltreatment and Mindfulness: Implications for Older Adult’s Marital Outcomes

Childhood maltreatment has well-established links to poorer marital functioning. Mindfulness has been shown to improve marital relationships and may buffer the effects of maltreatment. Using the Midlife Development in the United States (MIDUS) data, the current study examined whether mindfulness buffered the effects of maltreatment on marital quality, support, and strain in a sample of 560 married men and women. Moderation analysis revealed that mindfulness buffered the relationship between childhood maltreatment and adults’ marital quality, marital support, and marital strain. Mindfulness-based interventions may help adults who were maltreated improve their relationships. Clinical implications are discussed.

The association between relationship strain and emotional well-being among older adult couples: the moderating role of social connectedness

Objectives The present study examines the moderating role of social connectedness (i.e. closeness, talk frequency, social network size, and neighborhood social ties) in the association between one’s own and spouse’s relationship strain and emotional well-being (i.e. depressive symptoms, happiness, and loneliness). Method Married couples (N = 865) were drawn from the second wave of the National Social, Health, and Aging Project. One Actor Partner Interdependence Model (APIM) and one Actor Partner Interdependence Model with Moderation (APIMoM) were conducted. Results In terms of actor effects, relationship strain was associated with all emotional well-being outcomes. Wives’ and husbands’ greater relationship strain was associated with spouses’ loneliness. Only wives’ greater relationship strain was associated with her husbands’ higher level of depressive symptoms and no partner effects were found for happiness. In six instances, social connectedness factors helped to ameliorate the association between self/spouse relationship strain, depressive symptoms, and happiness. However, wives’ greater neighborhood social ties amplified the association between wives greater relationship strain and husbands’ greater depressive symptoms. We did not find that social connectedness factors moderated the associations between self/spouse relationship strain and loneliness. Conclusion Even in late life marriages, marital strain is associated with less happiness and greater depressive symptoms and loneliness. Practitioners addressing emotional well-being may need to pay attention to spousal perceptions of relationship strain and social relationships external to the marital relationship when working with heterosexual couples. Efforts throughout the life course should be made to ensure connections with diverse types of social networks. Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2021.1910786.

The Intersection of Childhood Maltreatment and Marriage: Implications for Adult’s Health

Childhood maltreatment is associated with mental and physical health problems across the life course. Marriages may be a risk factor for continued mental and physical health problems or, alternatively, they could buffer the effects of maltreatment severity on adult health. Using data from the study of Midlife Development in the United States (MIDUS), we evaluated marital support and strain as moderators of child maltreatment and adults’ subjective evaluations of physical and mental health in a sample of 760 married adults using the life course perspective. Results show that the interaction between childhood maltreatment severity and marital strain was associated with poorer physical health and was marginally associated with mental health. Marital support did not significantly interact with childhood maltreatment severity in predicting adult mental or physical health. Results suggest maltreatment and marital strain interact resulting in a greater accumulation of disadvantage leaving adults at risk for health problems.

Cognitive Functioning, Gender, and Marital Quality Among Older Married Couples: A Dyadic Approach

ABSTRACT This study examines associations of older husbands’ and wives’ cognitive functioning with both partners’ marital quality. Generalized structural equation modeling analyzed data from 1,432 opposite-sex couples drawn from the 2016 wave of the Health and Retirement Study. Findings revealed that wives’ poorer cognitive functioning was associated with wives reporting greater closeness and enjoyment of time with a spouse, whereas husbands’ poorer cognitive functioning was associated with wives reporting greater marital strain, lower marital support, lower closeness, and less enjoyment of time with a spouse. This suggests that cognitive functioning has dyadic consequences for marital quality, which are highly gendered.

Precarious Work, Marital Quality, and Divorce: A Gendered Dyadic Analysis of Aging Couples

Precarious work – work that is unstable and insecure – is often stressful and may contribute to marital strain and dissolution among midlife adults. However, prior research has not considered how precarious work spills over to spouses. Using longitudinal dyadic data of midlife couples from the Health and Retirement Study, I examine whether having a spouse in precarious work is associated with marital strain and dissolution, with attention to differences by gender. I find that indicators of precarious work (job insecurity, schedule variability) are associated with a heightened risk of marital strain and divorce in midlife. These patterns depend on the gender of the spouse experiencing precarious work. Understanding the implications of precarious work for marriage is important because poor marital quality and divorce hasten health declines at older ages. Thus, this study suggests that precarious work may be a risk factor for divorce and poor health among aging adults.

Daily Marital Strain and Sleep in Same-Sex and Different-Sex Couples

Marital strain has consistently been linked to many indicators of daily health and well-being, including sleep. Prior studies show that, on days when marital strain is higher, women in different-sex couples experience poorer sleep outcomes. However, this work has not yet considered whether and how these relationships differ for men and women in same-sex couples. Using 10 days of dyadic diary data from 756 midlife U.S. men and women in 378 gay, lesbian, and heterosexual marriages, we examine the associations of daily marital strain with sleep quality and duration and consider whether these relationships differ across union type. Results suggest that increased marital strain is associated with poorer sleep quality and shorter sleep duration, but only for women married to men. These findings underscore the importance of including same-sex couples when exploring linkages between marital dynamics and health, especially when considering how gender impacts these processes.

Perceptions of Aging and Inflammation in the Context of Older Adult Married Couples

The current study takes a dyadic perspective to understand how self-perceptions of aging are associated with C-reactive protein, an inflammation marker, among older adult married couples. The potential moderating role of marital support and strain are also examined. Respondents include 668 married couples who participated in the 2014 wave of the Health and Retirement Study. Actor-Partner Interdependence Models were conducted in Mplus. Age, functional limitations, income, and race served as covariates. Husbands’ greater positive perceptions of aging were significantly associated with their own lower levels of inflammation. Husbands’ greater positive perceptions of aging were significantly associated with lower levels of inflammation for women who reported lower levels of marital strain; this was not the case for women who reported higher levels of marital negativity. This study exemplifies how relationship factors are necessary to consider when examining age perceptions and health among marrieds.

Aging in Context: The Past, Present, and Future of Research on Older Adults’ Social Ties

This symposium will examine positive and negative aspects of older adults’ relationships and their impacts on health and well-being. We will begin by reviewing the past decade of research on family gerontology. Seidel’s meta-analysis of 995 articles will identify prominent theories and methods, as well as remaining research gaps. The subsequent presentations provide current, cutting-edge research. Marini examines how associations between rumination and sleep unfold within a social context. The findings highlight how spousal support protects older adults’ sleep quality from rumination, whereas support from family and friends is vulnerable to rumination. Using an actor-partner approach, Novak investigates the dynamics of support and control on health among older gay couples. Results reveal the benefits of support and risks of control for partners’ diet quality and depression. Ermer adopts a dyadic perspective to examine links between self-perceptions of aging and inflammation. Results highlight how wives’ inflammation is sensitive to husbands’ aging perceptions, particularly if marital strain is low. Finally, Wilson characterizes age-graded patterns of relationship narratives and their protective effects on emotional well-being. The findings demonstrate how older-adult couples’ narratives are less self- and present-focused, which helps explain protective linkages between age and negative mood. The symposium will conclude with remarks from discussant Katherine Fiori, a GSA Fellow and internationally recognized scholar on older adults’ social networks. She will synthesize the research and put forth her new theory about the importance of peripheral ties in later life to help direct the future of research on older adults within a social context.