Patient-spouse Dyads Research Articles

Dyadic coping, resilience, and posttraumatic growth in spinal cord injury patients and their spouses: An actor-partner interdependence mediation model analysis.

Despite the recognized importance of posttraumatic growth (PTG) in the recovery process, the mechanisms that promote PTG in spinal cord injury (SCI) patients and their spouses, especially the roles of dyadic coping (DC) and resilience, have not been fully explored. This study aimed to assess the PTG of patients with SCI and their spouses and to investigate the interrelationships among DC, resilience, and PTG within the dyadic context. A total of 154 SCI patient-spouse dyads were recruited from a rehabilitation hospital in China. All participants completed questionnaires about DC, resilience, and PTG. Our study was based on the actor-partner interdependence mediation model (APIMeM). SCI patients and their spouses experienced comparable PTG level, M(patients) = 56.05 ± 14.09, M(spouses) = 54.74 ± 15.31. In the APIMeM, the patients' and their spouses' DC exerted actor effects on their own resilience, β(patients) = .418, p < .001; β(spouses) = .409, p < .01, and their own resilience also exerted actor effects on their own PTG, β(patients) = .416, p < .001; β(spouses) = .431, p < .001. The mediating effects of resilience on the impact of patients' and spouses' own DC on their own PTG were confirmed. Our research offers new insight into the PTG of SCI patients and their spouses at the individual and dyadic levels. Resilience partially mediates the relationship between DC and PTG in couples coping with SCI. Specifically, DC between SCI patient-spouse dyads can not only directly influence the level of PTG but also impact PTG through resilience. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Family resilience, patient-reported symptoms in young stroke dyads: The effect of caregiver readiness and social support.

To investigate empirically the direct effect and potential mechanism of family resilience on patient-reported outcomes among young stroke dyads in China. Young patients with stroke have been becoming an important public health issue. According to relevant theories and previous studies, we found that family resilience might play an important role in patient's symptoms. However, it is less clear about the specific relationship and potential mechanisms of these two variables. We used a prospective cross-sectional design. A multi-item questionnaire was used to assess the constructs of interest. Researchers progressively constructed and validated conditional process models. The PROCESS macro was used to verify the research hypotheses. A total of 560 questionnaires were collected in this study. We found that family resilience of stroke patients and their spouses had a direct effect on the physical, psychological and social aspects of patient-reported symptoms. We further revealed that caregiver preparedness partially mediated the relationship between family resilience and patient's symptoms in stroke patient-spouse dyads, while perceived social support moderated the relationship between caregiver preparedness and patient's symptoms. Finally, we observed that the impact of caregiver readiness and social support on patients' symptoms predominantly manifested in physical and physiological outcomes. Our research provides evidence about the positive impact of family resilience on patient-reported symptoms in young stroke dyads. Meanwhile, it further revealed how caregiver preparedness and perceived social support may play out in the relationship. Our research introduces a novel perspective and pathway to enhance short-term recovery outcomes for patients. It also furnishes clinicians and nurses with evidence to guide the implementation of interventions aimed at improving patient health outcomes and facilitating smoother transitions from the hospital to home. What problem did the study address? Families play a crucial role in a patient's recovery process from illness, with family resilience serving as an important force for families to overcome adversity. However, the impact on patient symptoms and the underlying mechanisms of this relationship are uncertain. Empirical research is required to validate these aspects. What were the main findings? Family resilience has a positive impact on the physical, psychological and social aspects of patient-reported symptoms in young stroke dyads. Both the actor effect and partner effect are supported. The impact of caregiver readiness and social support on patient-reported symptoms is primarily observed in physical and physiological outcomes. Where and on whom will the research have an impact? This study offers a novel approach to enhance the short-term recovery of stroke patients. The researchers believe that the findings of this study will play an even more significant role during patients' transition from the hospital to home. This study followed the STROBE statement of cross-sectional studies. The study was conducted by patients, their spouses, healthcare professionals and the research team.

The association between communication behavior and psychological distress among couples coping with cancer: Actor-partner effects of disclosure and concealment

ObjectiveThis study applies the Actor-Partner Interdependence Model (APIM) to explore the associations between disclosure and concealment with depression and anxiety among patients with cancer and their partners. Method90 patient-spouse dyads completed the Self-Disclosure Index (SDI), the Self-Concealment Scale (SCS), the Couples Illness Self-Concealment (CISC) questionnaire, and anxiety and depression via the Patient-Reported Outcomes Measurement Information System (PROMIS) and the Hospital Anxiety and Depression Scale (HADS). ResultsSignificant actor effects were found for most variables, showing disclosure is negatively and concealment is positively associated with depression and anxiety (β between |0.29| to |0.65|, p ≤ .029). Partner's effect showed a negative association between patients' self-disclosure and their spouses' depression (β = −0.35, p = .043). Patients' anxiety was negatively associated with similarity in all communication variables (β between −0.21 to −0.22, p = .042). ConclusionsDyadic communication is an important correlate of distress among couples coping with cancer. Specifically, concealment behaviors have a positive association with distress, whereas disclosure is related to lower levels of anxiety and depression among both partners. In addition, whereas patients are affected more strongly than their spouses by the dyadic similarity, spouses seem to be more attuned to their partners' behaviors and therefore potentially more related to patients' propensity for sharing.

What’s love got to do with it? Relationship quality appraisals and quality of life in couples facing cardiovascular disease

ABSTRACT Objective Changes in couples’ relationship quality are common post-cardiac event but it is unclear how relationship quality is linked to patients’ and spouses’ quality of life (QoL). The purpose of the present study was to examine the association between relationship quality on QoL in patient-spouse dyads within six months of a cardiac event. Methods Participants (N = 181 dyads; 25.9% female patients), recruited from a large cardiac hospital, completed validated questionnaires measuring demographic, relationship (Dyadic Adjustment Scale; DAS) and QoL variables (Heart-QoL & Quality of life of Cardiac Spouses Questionnaire). An Actor-Partner Interdependence Model was used to investigate actor (i.e. responses influencing their own outcome) and partner effects (responses influencing their partner’s outcome) of relationship quality and QoL. Results Patients’ and spouses’ perceptions of relationship quality were in the satisfied range (DAS > 108; 65% of sample) and, as expected, patients reported lower general physical QoL than did their spouse (t (180) = −10.635, p < .001). Patient and spouse relationship quality appraisals were positively associated with their own physical (patient β = .25; spouse β = .05) and emotional/social (patient β = .21; spouse β = .04) QoL. No partner effects were identified. Conclusion High quality relationship appraisals appear to matter for patients’ and spouses’ QoL after the onset of CVD.

Self-reported effects of perceived social support on marital quality in balanced translocation patients and their spouses undergoing preimplantation genetic testing in China: actor–partner interdependence model

This study aimed to analyse the relationship between perceived social support and marital quality in balanced translocation patients and their spouses undergoing a preimplantation genetic testing (PGT) treatment cycle in China. The authors assessed the actor and partner effects of perceived social support on marital quality in patient–spouse dyads using a dyadic analysis approach. In total, 59 couples were assessed using self-report questionnaires for marital quality and perceived social support. There were significant differences in marital quality between patients and their spouses (p=.0025) based on the APIM (actor–partner interdependence model) analyses. The perceived social support of both patients (p=.0076) and spouses (p<.001) had a significant effect on individual marital quality for actor effects. Partner effects showed that patients’ perceived social support had a significant effect on spouses’ marital quality (p=.0156) and the spouses’ perceived social support had a significant effect on patients’ marital quality (p=.0084). The findings indicate that the level of perceived social support affected both his/her own marital quality and that of his/her spouse. Impact Statement What is already known on this subject? Infertility and reproductive treatments affect both partners, that is, the couple as a unit and have a negative impact on an individual’s marital satisfaction and social relationships. What do the results of this study add? There are significant differences in marital quality between balanced translocation patients and their spouses. Perceived social support significantly correlated with marital quality in both the actor and partner effects. What are the implications of these findings for clinical practice and/or further research? Health professionals should provide couple-based interventions involving both patients and spouses throughout the PGT treatment to improve perceived social support, thereby improving their marital quality.

Family resilience, perceived social support, and individual resilience in cancer couples: Analysis using the actor-partner interdependence mediation model.

This study aimed to examine the impact of family resilience on the individual resilience of couples during cancer and explore the potential mediating role of perceived social support and the moderating role of sex in this association in cancer patient-spouse dyads. The participants were 272 cancer patients and their spouses (N=544) who completed the Family Resilience Assessment Scale, the Perceived Social Support Scale and the Resilience Scale. We adopted the actor-partner interdependence mediation model to examine whether and how patients' and their spouses' family resilience was associated with their own and their partners' perceived social support and individual resilience. The results indicated that the patients' and their spouses' level of family resilience was positively associated with their own individual resilience directly and indirectly by increasing their own perceived social support. The family resilience of the spouses was associated with an increase in the patients' individual resilience only indirectly by increasing the patients' perceived social support. The spouse-actor effects between family resilience and individual resilience differed significantly by sex. Enhancing family resilience and perceived social support within the family can improve individual resilience. The findings regarding the sex differences serve as a rationale for gender-based approaches to improving individual resilience in the family context.

Associations Among Perceived Control, Depressive Symptoms, and Well-being in Patients With Heart Failure and Their Spouses: A Dyadic Approach.

High levels of perceived control and lower levels of depressive symptoms are associated with better well-being in both patients with heart failure and their spouses at an individual level. However, there is a knowledge gap about how these individual factors have reciprocal influences on partners' well-being within the patient-spouse dyads. The aims of this study were to examine dyads of patients with heart failure and their spouses on whether the patients' perceived control over the management of heart failure and depressive symptoms predicts their own and their spouses' physical and emotional well-being and to examine whether patients' perceived control predicts their own and their spouses' depressive symptoms. A total 155 patient-spouse dyads (patients: 75% male, mean age of 71 years, 53% classified as New York Heart Association III; spouses: 75% female, mean age of 69 years) were recruited from 2 hospital-based outpatient heart failure clinics. Participants completed the Control Attitude Scale, the Beck Depression Inventory, and the Short-Form 36. Dyadic data were analyzed using multilevel regression of the actor-partner interdependence model. Perceived control had an actor effect on emotional well-being only for patients, and there were partner effects of perceived control on emotional well-being for both patients and their spouses. Depressive symptoms exhibited an actor effect on physical and emotional well-being for patients and spouses, but there were no partner effects of depressive symptoms on emotional well-being. Perceived control had partner effects on depressive symptoms for patients and spouses, but an actor effect of depressive symptoms was only found for patients. In an interdependent relationship within the patient-spouse dyads, each dyad member's perceived control influenced their partner's emotional well-being as well as depressive symptoms. The findings suggest development of dyadic interventions that can increase perceived control over the heart condition.

Appraisals, perceived dyadic communication, and quality of life over time among couples coping with prostate cancer.

Little research has examined how prostate cancer patients' and their spouses' appraisals of illness and quality of life (QOL) interact with one another. This study examined the interdependent relationships between their appraisals of illness and QOL and if their perceived dyadic communication mediated these relationships. We used the Actor-Partner Interdependence Mediation Model (APIMeM) approach to conduct a secondary analysis of longitudinal data from 124 prostate cancer patient-spouse dyads. We examined actor effects (each person's influence on his/her own outcomes) and partner effects (each person's influence on his/her partner's outcomes). Appraisals of illness, perceived dyadic communication, and QOL were measured using Appraisal of Illness Scale, Lewis Mutuality and Interpersonal Sensitivity Scale, and Functional Assessment of Chronic Illness Therapy General Scale, respectively. Analyses controlled for effects of prostate cancer symptoms and demographic factors. Among actor effects, spouses with more negative appraisals at baseline perceived worse dyadic communication 4months later (p<.05) and worse QOL 8months later (p<.001). Patients and spouses who perceived more dyadic communication at 4months had better QOL at 8months (p<.01). Among partner effects, there was only weak evidence for an association between patient perceived dyadic communication at 4months and better spouse QOL at 8months of follow-up (p=.05). No mediation effects were found. Patients' and spouses' appraisals of the illness and their dyadic communication were associated with their long-term QOL. Interventions that reduce negative appraisals of illness and promote dyadic communication may improve QOL for both patients with prostate cancer and their spouses.

Abstract 19199: The Effects of Self Efficacy and Social Support on Quality of Life of Patients and Family Caregivers After Coronary Artery Bypass Grafting

Introduction: Personal and social resources are critical factors in patient recovery after coronary artery bypass grafting (CABG). Family members are an importance source of support for the patient. Because of the importance of interdependent relationships, it is vital to examine associations between self efficacy, social support and quality of life at the dyadic level. No known studies have explored patient’s cardiac self efficacy and family caregiver’s perceptions of patient self efficacy and social support as influences on quality of life in CABG Aims: To examine the effects of patient’s pre-operative cardiac self efficacy and family caregiver’s perceptions of patient self efficacy on their own and their partner’s quality of life after CABG; to examine the effects of patient’s and family caregiver’s preoperative social support on their own and their partner’s quality of life after surgery. Methods: A total of 80 dyads completed questionnaires before and 4 months after CABG. Self-efficacy was assessed using the Cardiac Self Efficacy, social support was assessed using the MOS Social Support Survey, and quality of life assessed using the Short-Form 12 Health Survey. Longitudinal data were analysed using Multilevel modelling regression, the Actor-Partner Interdependence Model with distinguishable dyad regression. Results: Of the 80 dyads, 75 were patient-spouse dyads. Patients were 80% males, aged 64.5 years and family caregivers were 90% females, aged 61.05 years. Patients’ tangible support exhibited an actor e ffect on their mental health,indicating low tangible support pre-operatively predicted their poorer mental health 4 months after CABG (β = .087, t = 2.059, p = 0.042). Patients’ self efficacy for maintaining function (SE-MF) exhibited a partner effect (β = -.768, t = 3.275, p = 0.002) on family caregivers physical health, indicating patient’s pre-operative SE-MF influenced the family caregivers health in a negative way. Conclusions: Patient’s post-operative mental health was affected by their low pre-operative tangible support. The family caregivers physical health was negatively affected by patients self efficacy for maintaining function.

Comparison of caregiver strain in Parkinson's disease between Yamagata, Japan, and Maryland, The United States

BackgroundJapan and the United States (US) have different cultures of caregiving including differences in family structure and social programs that may influence caregiver strain. Differences in caregiver strain between regions in Japan and in the US have not been investigated in patient–spouse dyads in PD. ObjectivesTo compare caregiver strain in spouses of PD patients between Yamagata, Japan and Maryland, US. Correlations between caregiver strain and patient/spousal variables are also examined. MethodsIn Yamagata and Maryland, spouses of patients with PD completed questionnaires assessing caregiver strain. Patients and spouses completed scales assessing mental health, and medical co-morbidity. PD severity and disability were assessed with the Unified Parkinson's Disease Rating Scale and the Schwab and England Activities of Daily Living Scale. Results in the two regions were compared with Chi-square and Student's t-tests. Relationships between caregiver strain and patient/spousal variables were analyzed with univariate correlations and multivariate regression. Results178 Spouse–patient pairs were assessed. The level of caregiver strain in PD did not differ between Yamagata, Japan and Maryland, US despite differences in demographics and social support programs in the two regions. Yamagata spouses reported physical, time and financial constraints, while Maryland spouses reported more emotional distress. In both regions, spousal depression was a significant contributor to caregiver strain. ConclusionDifferent approaches to reduce caregiver strain will likely be necessary in Yamagata and Maryland since the contributing factors to caregiver strain are influenced by differences in culture and social supports in each country.

Depressive symptoms in spouses of older patients with severe sepsis*

To examine whether spouses of patients with severe sepsis are at increased risk for depression independent of the spouse's presepsis history, whether this risk differs by sex, and is associated with a sepsis patient's disability after hospitalization. Prospective longitudinal cohort study. Population-based cohort of U.S. adults over 50 yrs old interviewed as part of the Health and Retirement Study (1993-2008). Nine hundred twenty-nine patient-spouse dyads comprising 1,212 hospitalizations for severe sepsis. Severe sepsis was identified using a validated algorithm in Medicare claims. Depression was assessed with a modified version of the Center for Epidemiologic Studies Depression Scale. All analyses were stratified by gender. The prevalence of substantial depressive symptoms in wives of patients with severe sepsis increased by 14 percentage points at the time of severe sepsis (from 20% at a median of 1.1 yrs presepsis to 34% at a median of 1 yr postsepsis) with an odds ratio of 3.74 (95% confidence interval: 2.20, 6.37), in multivariable regression. Husbands had an 8 percentage point increase in the prevalence of substantial depressive symptoms, which was not significant in multivariable regression (odds ratio 1.90, 95% confidence interval 0.75, 4.71). The increase in depression was not explained by bereavement; women had greater odds of substantial depressive symptoms even when their spouse survived a severe sepsis hospitalization (odds ratio 2.86, 95% confidence interval 1.06, 7.73). Wives of sepsis survivors who were disabled were more likely to be depressed (odds ratio 1.35 per activities of daily living limitation of sepsis survivor, 95% confidence interval 1.12, 1.64); however, controlling for patient disability only slightly attenuated the association between sepsis and wives' depression (odds ratio 2.61, 95% confidence interval 0.93, 7.38). Older women may be at greater risk for depression if their spouse is hospitalized for severe sepsis. Spouses of patients with severe sepsis may benefit from greater support and depression screening, both when their loved one dies and when their loved one survives.

Content validity and acceptability of the daily enhancement of meaningful activity program: intervention for mild cognitive impairment patient-spouse dyads.

Persons with mild cognitive impairment (PwMCI) are at greater risk for developing Alzheimer disease and experience various difficulties that decrease their quality of life. Very few interventions focus on helping PwMCI improve or maintain functional performance and enhance quality of life through meaningful activity engagement. The purpose of the study was to explore PwMCI and their spouses' perspectives on the content validity, usefulness, and acceptability of the Daily Enhancement of Meaningful Activity (DEMA) program, which included 6 biweekly face-to-face sessions between session assignments and a self-management tool kit of written educational handouts. Nine PwMCI-care partner dyads participated in 3 focus groups (PwMCI alone, spouses alone, and couples) to capture their perspectives on DEMA. The transcribed focus group data were analyzed through content analysis. The three groups provided support for content validity and acceptability of the program, and they suggested additional content areas important to couples experiencing MCI. They also attested to the usefulness of the tool kit and gave suggestions for its further improvement. The findings provide evidence of the content validity and acceptability of the DEMA program. A pilot study to assess feasibility and preliminary efficacy of the DEMA on health-related outcomes is the recommended next research step for this program.

The effects of depressive symptoms and anxiety on quality of life in patients with heart failure and their spouses: Testing dyadic dynamics using Actor–Partner Interdependence Model

Background Depressive symptoms and anxiety are common in heart failure patients as well as their spousal caregivers. However, it is not known whether their emotional distress contributes to their partner's quality of life (QoL). This study examined the effect of patients' and partners' depressive symptoms and anxiety on QoL in patient–spouse dyads using an innovative dyadic analysis technique, the Actor–Partner Interdependence Model (APIM). Method A total of 58 dyads (patient: 43% in males, mean age 62 years, mean ejection fraction 34% ±11, 43% in New York Heart Association III–IV) participated in the study. Depressive symptoms and anxiety were assessed using the Brief Symptom Inventory. QoL was assessed using the Minnesota Living with Heart Failure Questionnaire. Dyadic data were analyzed using the APIM with distinguishable dyad regression model. In APIM, actor effect is the impact of a person's emotional distress on his/her own QoL. Partner effect is the impact of a person's emotional distress on his/her partner's QoL. Result Depressive symptoms exhibited actor effect of both patients ( P<.001) and spouses ( P<.001) and only partner effect of patients ( P<.05) on QoL. Patients and spouses with higher depressive symptoms had poorer QoL. Patients whose spouses had higher depressive symptoms were more likely to indicate their own QoL was poorer. Anxiety has similar actor and partner effects on QoL as depressive symptoms. Conclusion Interventions to reduce depression and anxiety and to improve patients' QoL should include both patients and spouses.

Randomized clinical trial of a family intervention for prostate cancer patients and their spouses

Few intervention studies have been conducted to help couples manage the effects of prostate cancer and maintain their quality of life. The objective of this study was to determine whether a family-based intervention could improve appraisal variables (appraisal of illness or caregiving, uncertainty, hopelessness), coping resources (coping strategies, self-efficacy, communication), symptom distress, and quality of life in men with prostate cancer and their spouses. For this clinical trial, 263 patient-spouse dyads were stratified by research site, phase of illness, and treatment; then, they were randomized to the control group (standard care) or the experimental group (standard care plus a 5-session family intervention). The intervention targeted couples' communication, hope, coping, uncertainty, and symptom management. The final sample consisted of 235 couples: 123 couples in the control group and 112 couples in the experimental group. Data collection occurred at baseline before randomization and at 4 months, 8 months, and 12 months. At 4-month follow-up, intervention patients reported less uncertainty and better communication with spouses than control patients, but they reported no other effects. Intervention spouses reported higher quality of life, more self-efficacy, better communication, and less negative appraisal of caregiving, uncertainty, hopelessness, and symptom distress at 4 months compared with controls, and some effects were sustained to 8 months and 12 months. Men with prostate cancer and their spouses reported positive outcomes from a family intervention that offered them information and support. Programs of care need to be extended to spouses who likely will experience multiple benefits from intervention.

Chronic pain couples: Perceived marital interactions and pain behaviours

Patient adjustment to chronic pain is well known to be influenced by the spouse and his or her response to patient expressions of pain. However, these responses do not occur in a vacuum, and the aim of the present study was to investigate patient–spouse interactions in chronic pain in detail. Ninety-five patient–spouse dyads completed questionnaires relating to mood, marital satisfaction and communication, and 80 couples also took part in semi-structured interviews. Data were analysed using quantitative and qualitative methods. Results showed that spouses of chronic pain patients reported engaging in a far wider repertoire of responses to pain behaviours than has been recognised to date. New response categories of ‘hostile-solicitous’ and ‘observe only’ were identified. Patients generally interpreted solicitous responses less favourably than spouse responses which encouraged task persistence. Male spouses identified fewer pain-related situations than female spouses but were more likely to report responding solicitously to patient pain behaviours. Marital satisfaction was significantly higher in patients who rated themselves as talking more frequently about their pain. Spouse perceived frequency of pain talk was not related to spouse marital satisfaction. There were no gender differences in marital satisfaction. The results of this study challenge some of the assumptions that have been held regarding chronic pain patient–spouse interactions.

Spouses' and physicians' perceptions of pain severity in older women with osteoarthritis: dyadic agreement and patients' well-being

This study examined agreement between patients and two role partners (spouses and physicians) on patients' pain severity and the relationships between dyadic agreement and patients' well-being. We hypothesized that compared to disagreement between patients and role partners, dyadic agreement would be related to better psychological well-being (more disease-specific self-efficacy and positive affect, and less depression). Participants were 114 older women with osteoarthritis, their caregiving husbands, and their rheumatologists. Among patient–spouse dyads, agreement was associated with better well-being, especially when compared to spouses' underestimation of patients' pain. Contrary to predictions, patient–physician agreement was not related to better patient well-being. Agreement between patients and physicians was associated with less (rather than more) self-efficacy and positive affect when compared to physicians' underestimation of patients' pain.

A computer-assisted observational method for assessing spouses' ratings of osteoarthritis patients' pain

This article presents preliminary data on a new method for analysing spouses' ratings of their marital partner's pain. Subjects were 19 individuals with persistent osteoarthritic knee pain and their spouses. Spouses viewed a videotape of the patient engaging in a series of daily activities (sitting, walking, standing, and reclining) and simultaneously made continuous ratings of the patient's pain using a computer-controlled mouse. Ratings made by the spouse were directly compared to ratings of pain provided by the patient to establish agreement about both the mean level of pain as well as the temporal synchrony between patients' and spouses' ratings. There was a significant positive correlation between spouses' mean ratings of pain and the patient's mean ratings of their own pain. However, when individual patient-spouse dyads were examined separately using time series analysis individual differences in synchrony were clearly apparent. In some couples there was very high synchrony between patient's and spouse's ratings, while in other couples there was very low synchrony between these ratings. The level of synchrony was found to be higher in couples where the spouse was female and in which the patient had pain for a shorter duration or lower levels of physical disability. Although these findings are preliminary, they suggest that further research using this approach is warranted.