Relationship Discord Research Articles

HIV self-testing intervention experiences and kit usability: results from a qualitative study among men who have sex with men in theSELPHI(Self-Testing Public Health Intervention) randomized controlled trial in England and Wales.

ObjectivesSELPHI (HIV Self‐Testing Public Health Intervention) is the largest randomized controlled trial (RCT) of HIV self‐testing (HIVST) in a high‐income setting to date, and has recruited 10 000 men who have sex with men (cis‐ and transgender) and transgender women who have sex with men. This qualitative substudy aimed to explore how those utilizing self‐tests experience HIVST and the implications for further intervention development and scale‐up. This is the first qualitative study in Europe investigating experiences of HIVST among intervention users, and the first globally examining the experience of using blood‐based HIVST.MethodsThirty‐seven cisgender MSM SELPHI participants from across England and Wales were purposively recruited to the substudy, in which semi‐structured interviews were used to explore testing history, HIVST experiences and intervention preferences. Interviews were audio‐recorded, transcribed and analysed through a framework analysis.ResultsMen accessed the intervention because HIVST reduced barriers related to convenience, stigma and privacy concerns. Emotional responses had direct links to acceptability. Supportive intervention components increased engagement with testing and addressed supportive concerns. HIVST facilitated more frequent testing, with the potential to reduce sexually transmitted infection (STI) screening frequency. Substudy participants with an HIV‐positive result (n = 2) linked to care promptly and reported very high acceptability. Minor adverse outcomes (n = 2; relationship discord and fainting) did not reduce acceptability. Ease of use difficulties were with the lancet and the test processing stage.ConclusionsIntervention components shaped acceptability, particularly in relation to overcoming a perceived lack of support. The intervention was broadly acceptable and usable; participants expressed an unexpected degree of enthusiasm for HIVST, including those with HIV‐positive results and individuals with minor adverse outcomes.

Relationship discord and depressive symptoms in sexual minority individuals over time.

Although there is a well-established positive association between romantic relationship discord and depressive symptoms, there have been few studies assessing this association with sexual minority individuals, who are at increased risk for depression and whose relationships may be subjected to unique challenges (and strengths) given their sexual minority status. This study examined the cross-sectional and longitudinal associations between romantic relationship discord and depressive symptoms in sexual minority individuals using data from Project STRIDE, which is a longitudinal survey of 18-59 year-old residents of New York City. Data from 107 individuals in romantic relationships showed significant positive cross-sectional associations between relationship discord and depressive symptoms both at baseline and at a 1-year follow-up. Results from multiple regression analyses indicated that relationship discord at baseline was significantly and positively associated with depressive symptoms 1 year later, whereas depressive symptoms at baseline were not significantly associated with relationship discord 1 year later. The longitudinal association between relationship discord and depressive symptoms remained statistically significant adjusting for internalized heterosexism and discrimination at baseline. Findings are largely similar to those in research conducted in samples not recruited based on sexual minority status and provide an important extension of work that has shown a positive association between relationship discord and depressive symptoms for sexual minority individuals cross-sectionally. If replicated, these findings may have implications for the use of couple-based interventions for depression in sexual minority individuals. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Do Cognitive Therapy Skills Neutralize Lifetime Stress to Improve Treatment Outcomes in Recurrent Depression?

Cognitive therapy (CT) is an efficacious treatment for major depressive disorder (MDD), but not all patients respond. Past research suggests that stressful life events (SLE; e.g., childhood maltreatment, emotional and physical abuse, relationship discord, physical illness) sometimes reduce the efficacy of depression treatment, whereas greater acquisition and use of CT skills may improve patient outcomes. In a sample of 276 outpatient participants with recurrent MDD, we tested the hypothesis that patients with more SLE benefit more from CT skills in attaining response and remaining free of relapse/recurrence. Patients with more pretreatment SLE did not develop weaker CT skills, on average, but were significantly less likely to respond to CT. However, SLE predicted non-response only for patients with relatively weak skills, and not for those with stronger CT skills. Similarly, among acute-phase responders, SLE increased risk for MDD relapse/recurrence among patients with weaker CT skills. Thus, the combination of more SLE and weaker CT skills forecasted negative outcomes. These novel findings are discussed in the context of improving CT for depression among patients with greater lifetime history of SLE and require replication before clinical application.

083 Proper Assessment for Cosmeto-gynecological Interventions: The Need to Evaluate the Relationship Discord, Body Dysmorphic Syndrome, and the Correct Energy-Based Technology

Only 10% of women who undergo vaginal rejuvenation procedures report that there was an external influence (friend, partner or spouse) that influenced their decision for the cosmetic/ functional procedure. Despite this fact, it is estimated that between 6-53% of women who complete these procedures may suffer from some form of body dysmorphic syndrome (BDS). The importance of proper assessment for women undergoing cosmetic and/or functional procedures cannot be underscored. Relationship discord, partner coercion and female BDS need to be properly evaluated before any woman should be considered an appropriate candidate for interventions such as genital surgery, laser and radiofrequency treatments. In addition, the basic tenets of available energy-based technologies, the scientific data supporting the use of each in the clinical setting. The primary differences between energy-based device (laser versus radiofrequency) outcomes are important considerations prior to any vaginal cosmetic procedures. A literature search was conducted with the combination of following key words, vaginal rejuvenation and vaginal laxity; a total of 58 articles were obtained. Animal studies, male studies, and those with unrelated topics, or foreign language publications were not included. 45 publications (case studies, reviews, commentaries, randomized clinical trials, cohort trials) were all reviewed. When feasible, methods and or inclusion/exclusion criteria were reviewed in detail.

HP-07-001 Proper assessment for female vaginal rejuvenation: The need to evaluate the relationship discord and Body Dysmorphic Syndrome

HP-07-001 Proper assessment for female vaginal rejuvenation: The need to evaluate the relationship discord and Body Dysmorphic Syndrome

Financial Behaviors, Couple-Level Conflict, and Adolescent Relationship Abuse: Longitudinal Results From a Nationally Representative Sample.

Financial disagreements have been identified as a severe source of discord in adult relationships, yet limited work has considered whether financial considerations contribute to conflict among younger samples. Drawing on longitudinal data from a nationally representative sample of adolescents, the current investigation examined the extent to which money lending practices, feelings of financial resentment, and exposure to economic control contribute to couple-level interactions, and in turn, to conflict that escalates to the point of violence. Findings provide evidence of an association between adolescent financial behaviors and concurrent conflict due to economic considerations. Moreover, conflict due to economic considerations was an important predictor of future adolescent relationship abuse perpetration. We discuss the implications of our findings for intervention/prevention efforts.

The Role of Dyadic Discord in Outcomes in Acute Phase Cognitive Therapy for Adults With Recurrent Major Depressive Disorder

Major depressive disorder (MDD) and relationship discord between cohabiting partners frequently co-occur, with bidirectional effects established. As relationship quality influences understanding and treatment of MDD, the current analyses clarified the relations of pretreatment dyadic discord with outcomes during and at the end of acute phase cognitive therapy (CT) for adults with recurrent MDD. Married or cohabiting patients (n = 219) completed the Dyadic Adjustment Scale (DYS) before and after a 16–20 session, 12–14 week CT protocol. Lower levels of dyadic adjustment indicated higher levels of dyadic discord. Response to CT was defined as the absence of a major depressive episode and ≤ 12 on the 17-item Hamilton Rating Scale for Depression. Pretreatment dyadic discord, whether defined as a continuous or categorical variable (using DYS cutoff score of 97), was not associated with treatment completion or response but was positively associated with levels of depressive symptoms at the end of acute phase CT. Furthermore, CT was associated with declines in dyadic discord, with 23.3% of initially discordant couples moving to nondiscordant status at the end of CT. Depressive symptoms did not significantly mediate changes in dyadic discord. Finally, pre- (but not mid-) treatment dyadic discord was associated with subsequent changes in depressive symptoms, suggesting limited mediation. These findings replicate prior research indicating that individual CT is associated with reductions in depressive symptoms and dyadic discord while clarifying that lower pre-treatment dyadic discord may predict initial improvement in depressive symptoms.

Theoretical and Clinical Foundations of Siblings in Therapy: Use of Parental Context in Adult Sibling Discord

A growing body of literature indicates that clinical attention to sibling relationship enhancement can be beneficial for relational outcomes and broader psychological well-being. Working with clients on strengthening their sibling relationship can impact not only the sibling dyad but can serve as an important source of support enhancing well-being and adjustment. In addition to a clinical review of the importance of integrating sibling relationship issues in therapy, the current paper highlights an effective therapeutic approach to sibling relationship discord including two case studies describing the effective integration of this modality.

Social support and relationship satisfaction in bipolar disorder.

Social support is positively associated with individual well-being, particularly if an intimate partner provides that support. However, despite evidence that individuals with bipolar disorder (BPD) are at high risk for relationship discord and are especially vulnerable to low or inadequate social support, little research has explored the relationship between social support and relationship quality among couples in which a partner has BPD. The current study addresses this gap in the literature by examining the association between social support and relationship satisfaction in a weekly diary study. Thirty-eight opposite-sex couples who were married or living together for at least one year and in which one partner met diagnostic criteria for BPD completed up to 26 weekly diaries measuring social support and relationship satisfaction, as well as psychiatric symptoms. Results revealed that greater social support on average was associated with higher average relationship satisfaction for individuals with BPD and their partners, and that more support than usual in any given week was associated with higher relationship satisfaction that week. The converse was also true, with greater-than-average relationship satisfaction and more satisfaction than usual associated with greater social support. The results emphasize the week-to-week variability of social support and relationship satisfaction and the probable reciprocal relationship between support and satisfaction among couples in which a partner has BPD. Thus, social support may be important for maintaining relationship satisfaction and vice versa, even after controlling for concurrent mood symptoms. (PsycINFO Database Record

Interdependence of attachment styles and relationship quality in parent-adolescent dyads

The current study examined how attachment styles of parents and adolescents may jointly influence the quality of their relationship. Parent-adolescent (Ndyads = 77) pairs were recruited from a Midwestern town in the United States. The mean of adolescents' age was 16.25. Both members reported their attachment styles, relationship closeness, and relationship discord. The Actor-Partner Interdependence Model (APIM) showed that both members' attachment avoidance was associated with self-report lower levels of closeness. Parents' attachment anxiety was related to relationship discord. Parents with higher avoidant attachment reported lower closeness when adolescents were higher in avoidant attachment. Higher parents' anxious attachment was related to higher relationship closeness when adolescents were higher on anxious attachment. Such an association was negative when adolescents had lower anxious attachment. Higher parents’ anxious attachment was related to greater discord when adolescents were lower on anxiety attachment. This study reveals the complex dyadic dynamics of relationship quality in parent-adolescent pairs.

Intimate relationships, individual adjustment, and coronary heart disease: Implications of overlapping associations in psychosocial risk.

Being married or involved in a similar intimate relationship is associated with reduced risk of coronary heart disease (CHD). However, the quality of these relationships matters, as strain and disruption are associated with increased risk. These effects are typically studied separately from well-established psychosocial factors for CHD that are aspects of personality and emotional adjustment, even though discord and disruption in intimate relationships are related to these same individual characteristics. Thus, research to date tends to parse correlated risks, often taking a piecemeal approach by focusing on intimate relationships without considering aspects of personality and emotional adjustment that contribute to risk and protection, or focusing on individual-level risks while largely ignoring closely related health-relevant relationships. As an alternative, this article describes an integrative approach, first reviewing associations of the quality of intimate relationships with personality characteristics and aspects of emotional adjustment that confer CHD risk, and then discussing conceptual models of these associations and the biobehavioral mechanisms linking them with CHD. Current approaches to couple interventions are then discussed, including those that have a combined focus on intimate relationship difficulties and emotional adjustment. An integrative agenda for future research emphasizes aggregated risks, combining concepts and methods in current relationship science with those in biobehavioral research on CHD, and including parallel disparities in relationship functioning, emotional adjustment, and CHD risk. Such efforts could ultimately inform empirically based assessments and interventions for interrelated aspects of individuals and their intimate relationships that influence the development and course of CHD. (PsycINFO Database Record

The Potential Role of Science, Technology, Engineering, and Math Programs in Reducing Teen Dating Violence and Intimate Partner Violence.

Science, technology, engineering, and math (STEM) are growing fields that provide job stability, financial security, and health prosperity for professionals in these fields. Unfortunately, females are underrepresented in STEM, which is potentially both a consequence and precipitant of gender inequity in the United States. In addition to the financial and health benefits, increasing the number of girls and women in STEM fields may also indirectly prevent and/or reduce teen dating violence and intimate partner violence by: (1) increasing women's financial independence, thereby reducing dependence on potentially abusive partners; (2) decreasing household poverty and financial stress, which may lead to reductions in relationship discord; and (3) increasing attitudes and beliefs about women as equals, thereby increasing gender equity. In this commentary, we discuss the potential role of primary and secondary school STEM programs in reducing violence against women. We review the literature on existing evaluations of STEM programs for educational outcomes, discuss the limitations of these evaluations, and offer suggestions for future research.

Personal assistance, disability, and intimate partner violence: A guide for healthcare providers.

Our objective was to provide evidence-based guidance for health care providers to engage in brief and extensive assessment of intimate partner violence (IPV) and to initiate appropriate safety precautions and referrals, all within the context of disability. Research Method/Design: This article is a review of the literature on prevalence and risk factors for IPV in nondisabled couples and in couples where a partner has a disability, on various assessment tools, and on the impact of personal assistance on relationships. When an individual has a disability, it is often her or his partner who provides personal assistance. While providing this assistance can produce individual and/or interrelational benefits, it is also associated with a number of mental and physical health problems, including anxiety, depression, anger, drug abuse, and relationship discord and dissatisfaction. In addition, IPV is not uncommon among couples, and risk for partner violence may include depression, drug abuse, and relationship dissatisfaction, among others. It is likely that health care providers will encounter individuals with disabilities who are both receiving care from their partners and who are also the victims of partner violence. Thus, they will need to be prepared to assess and triage patients who are in or may be at risk for abusive relationships and to ensure patient safety in the context of these relationships. However, it is also critically important that this assessment occurs within a culturally inclusive and disability-affirming context. (PsycINFO Database Record

Dopa-testotoxicosis: disruptive hypersexuality in hypogonadal men with prolactinomas treated with dopamine agonists.

Dopamine agonists are the first line of therapy for prolactinomas, with high rates of biochemical control and tumour shrinkage. Toxicity is considered to be low and manageable by switching of agents and dose reduction. Dopamine agonist-induced impulse control disorders are well described in the neurology setting, but further data are required regarding this toxicity in prolactinoma patients. We performed a multicenter retrospective cohort study of eight men with prolactinomas and associated central hypogonadism. The eight men had no prior history of psychiatric disease, but each developed disruptive hypersexuality whilst on dopamine agonist therapy at various doses. Cabergoline, bromocriptine and quinagolide were all implicated. Hypersexuality had manifold consequences, including relationship discord, financial loss, reduced work performance, and illicit activity. We hypothesise that this phenomenon is due to synergy between reward pathway stimulation by dopamine agonists, together with rapid restoration of the eugonadal state after prolonged hypogonadism. We refer here to this distinct drug toxicity as 'dopa-testotoxicosis'. Given the profound impact in these patients and their families, cessation of dopamine agonists should be considered in men who develop hypersexuality, and pituitary surgery may be required to facilitate this. Awareness of this distinct impulse control disorder should enable further research into the prevalence, natural history and management of dopa-testotoxicosis. The condition is likely under-reported due to the highly personal nature of the symptoms and we suggest a simple written questionnaire to screen for hypersexuality and other behavioural symptoms within the first six months of dopamine agonist treatment.

The Role of Resilience and Anti-Resilience Behaviors in the Romantic Lives of Black Same Gender Loving (sgl) Men.

This study examines the role of resilience in the romantic lives of Black same gender loving romantic male couples in the nyc metropolitan area. Twenty in-depth interviews (N=40) were conducted, ranging in age from 18 to 67, and were predominately low income and moderately educated. Research questions were: 1) What strategies do Black sgl couples use to preserve and improve their relationships and (2) What are the potential problems or barriers your relationship experiences? The data from interviews were aggregated and three major themes emerged: direct communication strategies, relationship support, and intentional and thoughtful decision making. Additional themes identified as anti-resilient to Black sgl couples were relationship discord, hostile neighborhood climate, poor communication, and lack of support. Findings show that additional research Black gay couples is needed to identify the contextual factors that influence their romantic relationships and the resilient strategies that they uses to support their romantic relationships.

Personality and dyadic adjustment: Who you think your partner is really matters.

Research has demonstrated consistently that a broad range of personality traits affect intimate relationship quality; however, most of this research has used only self-ratings of personality. More recently, researchers have acknowledged that how partners perceive one another may also influence intimate relationships. The primary goal of the present study was to determine the predictive utility of partner-ratings of personality above and beyond self-ratings for explaining dyadic adjustment in a community sample of committed heterosexual couples (N = 87). This research was embedded within a Big Three model of personality, using both self- and other-rating measures that tap the core of these broad dimensions of personality and other specific trait facets across the normal-abnormal spectrum. An actor-partner interdependence model (APIM) was used, which estimates both actor (self) and partner effects, and models interdependence that is inherent in dyadic data. Both men and women reported greater relationship discord to the extent that they rated their partners as high in negative temperament and disinhibition, and low in positive temperament, controlling for self-ratings of personality. Further, partner-ratings of numerous other specific trait scales were uniquely associated with dyadic adjustment, providing considerable detailed information about personality-adjustment relations beyond the core of the 3 broad trait dimensions. Results of the present study highlight the importance of routinely assessing both self- and partner-ratings of personality, from both partners of a dyad, to explain intimate-relationship quality more fully and accurately. We discuss the implications of this research with regard to how it may inform treatment of relationship discord. (PsycINFO Database Record

Drawing the Line: The Development of a Comprehensive Assessment of Infidelity Judgments

Infidelity is a leading cause of relationship discord and dissolution, and couples generally report expectations to maintain monogamy. However, a majority of men and women report engaging in some form of infidelity at least once in their lives. Research assessing judgments of the behaviors that constitute infidelity is lacking. The three studies reported here advanced the literature by developing and validating the Definitions of Infidelity Questionnaire (DIQ), a comprehensive measure examining infidelity judgments. Exploratory and confirmatory factor analyses indicated four factors to the scale: sexual/explicit behaviors, technology/online behaviors, emotional/affectionate behaviors, and solitary behaviors. Investigation of the psychometric properties demonstrated the DIQ to be reliable and valid. Participants agreed that sexual/explicit behaviors comprised infidelity to the largest extent, whereas other types of behaviors (technology/online behaviors, emotional/affectionate behaviors, and solitary behaviors) were judged as comprising infidelity to a lesser extent. Men reported more permissive judgments than did women. This study provides insights regarding operationalizing infidelity and identifying areas of ambiguity and consensus. Implications of the findings for educators and practitioners working with individuals in intimate relationships are discussed.

The association between relationship distress and psychopathology is consistent across racial and ethnic groups.

The association between intimate relationship discord and DSM-IV Axis I psychiatric disorders has been described in studies that oversampled White participants; however, the racial and ethnic differences in marital distress and divorce as well as in prevalence rates of some forms of psychopathology led us to hypothesize that the association between relationship discord and psychopathology would vary across races and ethnicities. Relationship quality and psychopathology were assessed in three national surveys (the National Comorbidity Survey Replication, the National Latino and Asian American Study, and the National Survey of American Life), for a total sample size of 10,057. We found that the log odds of being diagnosed with both narrow-band (e.g., major depressive disorder) and broad-band disorders (e.g., mood disorder) were negatively associated with relationship quality consistently across 11 different racial and ethnic groups. We discuss the implications of the cross-cultural reliability of the association between relationship discord and psychopathology in the context of etiological models and culturally competent practices.

Marital discord and depression in middle-aged and older couples

Although a large literature links relationship discord with depression, most prior studies have evaluated relationship discord as a continuous variable and have examined this association in younger couples. Based on findings suggesting that the latent structure of marital discord is taxonic, this study evaluated whether taxon status was associated with depressive symptoms in middle-aged and older individuals and whether taxon status accounted for unique variance in depressive symptoms, over and above that which was accounted for by continuous measures of marital quality. This association was examined in a community sample of 502 couples who had been married at least 10 years and in which at least one spouse was 55 to 75 years old. There were statistically significant differences between taxon (discordant) and complement (nondiscordant) women and men in depressive symptoms, with discordant spouses reporting higher levels of depressive symptoms than nondiscordant spouses. For wives but not for husbands, taxon status contributed to symptoms beyond the effect of the mean of continuously distributed marital quality scales, indicating a point at which couple taxon status incrementally predicts a significant increase in depressive symptoms. Implications for clinical assessment and further research are discussed.

A new model of the role of psychological and emotional distress in promoting obesity: conceptual review with implications for treatment and prevention.

The lack of significant treatment and prevention progress highlights the need for a more expanded strategy. Given the robust association between socioeconomic factors and obesity, combined with new insights into how socioeconomic disadvantage affects both behaviour and biology, a new causal model is proposed. The model posits that psychological and emotional distress is a fundamental link between socioeconomic disadvantage and weight gain. At particular risk are children growing up in a disharmonious family environment, mainly caused by parental socioeconomic disadvantage, where they are exposed to parental frustrations, relationship discord, a lack of support and cohesion, negative belief systems, unmet emotional needs and general insecurity. Without adequate resilience, such experiences increase the risk of psychological and emotional distress, including low self-esteem and self-worth, negative emotions, negative self-belief, powerlessness, depression, anxiety, insecurity and a heightened sensitivity to stress. These inner disturbances eventually cause a psycho-emotional overload, triggering a cascade of weight gain-inducing effects including maladaptive coping strategies such as eating to suppress negative emotions, chronic stress, appetite up-regulation, low-grade inflammation and possibly reduced basal metabolism. Over time, this causes obesity, circular causality and further weight gain. Tackling these proposed root causes of weight gain could potentially improve both treatment and prevention outcomes.