Spousal Dyads Research Articles

Role of cancer survivor health and health service use in spouses' use of mental health-related care.

Spouses of cancer survivors are at an increased risk of poor mental health outcomes but are known to underuse supportive services. The objective of the current study was to determine how the health and health care use of cancer survivors were associated with depression and anxiety-related health care use in their spouses. The current observational study used data from the Medical Expenditure Panel Survey to identify married individuals with a cancer-related medical event or disability ("cancer survivors"), and linked health and health care use data across spousal dyads. Spouses reporting a prescription for an antidepressant or antianxiety medication or any psychotherapy were flagged as having used mental health care. Correlates of use were assessed, with a focus on the health and health care use of the cancer survivor. Greater than 25% of the spouses of cancer survivors used mental health care over the approximately 2.5 years of follow-up. Controlling for their own predisposing, enabling, and need characteristics, spouses were found to be less likely to use mental health care if the cancer survivor reported more health conditions or elevated depressed mood compared with dyads in which the survivor reported low distress and depression. Spouses were nearly 3 times more likely to use mental health care if the cancer survivor themselves had used mental health care (odds ratio, 2.98; 95% confidence interval, 2.17-4.09). The findings of the current study enhance understanding of how health outcomes are intertwined in families with cancer, and reinforce the importance of a family-centered approach to cancer care that facilitates psychosocial care. The health and well-being of cancer survivors and their spouses are intertwined. The results of the current study demonstrated that this interrelationship extends to mental health care related to depression and anxiety. Spouses of cancer survivors were found to be less likely to receive mental health care when the survivor had more health care needs. Spouses were nearly 3 times more likely to receive care if the survivor also was receiving mental health care. Caregiving spouses may face more challenges finding the time, money, or energy to engage in their own self-care. However, providing supportive care to one partner may help the other partner access care as well.

Interdependence of physical and psychological morbidity among patients with cancer and family caregivers: Review of the literature.

Caregivers for patients with cancer have an integral role in maintaining patients' health. Although patients and caregivers experience the impact of cancer individually, studies suggest their health is interdependent. The objective of this review was to synthesize the literature on interdependent physical and psychological morbidity in patient-caregiver dyads published since 2016. A search of PubMed, CINAHL, Embase, and PsycInfo databases was performed using Cooper's recommendations and the Preferred Reporting Items for Systematic Reviews And Meta-Analyses Guidelines. Studies were included if they measured individual physical or psychological morbidity in cancer patient-caregiver dyads, evaluated interdependence, and were published in a peer-reviewed journal. Twenty-three studies met criteria, characterized by mainly spousal dyads. Studies included a variety of cancers and methodologies. Findings were inconsistent, indicating varying interdependence. However, the studies demonstrated a stronger relationship between patients' and caregivers' psychological morbidity than between their physical morbidity. This review revealed a need for continued exploration of dyadic health interdependence. Future studies should consider samples of patients with a single type of cancer, testing cultural mediators/moderators, and using longitudinal designs.

Buffer or Blade: Perceived relationship closeness in couples navigating Alzheimer's

Given the paucity of support from the welfare state, the lion's share of care for American seniors with memory loss is shouldered by their spouses who tend to be older and sometimes are frail themselves. Previous research has bifurcated attention to either accounts from diagnosed individuals or carers rather than understanding the experience within a socio-relational context of sometimes half-century long relationships. The present study was a qualitative investigation of 11 community-dwelling dyads (N = 22) living in the Greater Boston Area to understand how married heterosexual couples experience Alzheimer's. They were predominately white, highly educated individuals with mild to moderate AD and their spouses. Grounded theory methodologies were used to collect, code, and analyze all narrative study data. The data from these spousal dyads reveal that most couples approached AD as a joint challenge and were committed to maintaining their prior roles and lives for as long as possible, including shared outlooks, approaches, and activities. By showing how some couples navigate AD together rather than separately, these data provide an important counter narrative to the burden-based framing of AD in our social imagination. Regardless of perceptions of relationship closeness, all dyads employed strategies to live life positively with Alzheimer's. Despite being a highly privileged sample, or an “ideal type,” these data reveal the importance of studying AD as a coupled or family event; that is, a social and relational matter, rather than simply an individual medical problem. They also highlight the importance of relationship-centered care in meeting families “where they are” in terms of existing social roles. Universalizing all AD experiences leads to an over-reliance on reductionist tropes such as “stress” and “burden” and exacerbates the very real threat to social disenfranchisement.

SPOUSE OR CAREGIVER? EXAMINING CORRELATES AND CONSEQUENCES OF SPOUSES BEING IDENTIFIED AS CANCER CAREGIVERS

Spouses provide critical support to cancer survivors, but are not always identified as caregivers. This study sought to understand the differences between such spouses. Using the Medical Expenditures Panel Survey 2016 Experiences with Cancer Supplement, spousal dyads in which one spouse had cancer were identified (n=670). Cancer survivors reported which family members or friends, if any, provided care during or after their cancer treatment. Survivor and spouse sociodemographic characteristics and spouse psychosocial characteristics including depression (Patient Health Questionnaire-2), distress (Kessler-6), and self-rated health were self-reported in the survey. The proportion of spouses identified as caregivers was calculated and compared with those not identified as caregivers on dyadic characteristics. Multivariable logistic regressions compared spouses’ depression, distress, and self-rated health by identification as a caregiver. All analyses employed survey weighting. Most married cancer survivors reported that their spouse was a caregiver (32%) or that they did not have a caregiver (65%); very few did not list their spouse as a caregiver (3%). Survivors who were white (non-Hispanic) or off treatment were less likely to report that their spouse was a caregiver (30% vs. 46%, p0.10; 9.6% vs 11.1%, p>0.10; and 46% vs 50%, p>0.10, respectively). The findings suggest that spouses’ experiences may be similar regardless of whether they are considered a caregiver, with implications for research and service delivery.

Money matters: ananalysis ofadvanced cancer couples' communication about financial concerns.

To determine if advanced cancer patient-caregiver spousal dyads identified and/or discussed financial concerns. Advanced cancer spousal dyads (n = 26) were asked to discuss their concerns (including finances) for 10min. Discussions were audio-recorded and transcripts were analyzed for content and depth. We used the constant comparative analysis to analyze communication and demographic data from those who identified financial concerns relevant to cancer treatment. Of the 26 couples identifying finances as a concern relevant to cancer, there was variability in perception of their overall financial situation, and roughly a third had discordant reports on the degree of financial concern. Thirty-five percent of dyads (n = 9) did not discuss finances during the audio-recorded discussions; for the other dyads, financial conversations varied in depth and breadth for specific concerns. Couples were discordant in reports of concern about finances and perceptions of their financial situations. Even if finances were identified as a concern, many couples chose not to discuss financial concerns in depth. Some degree of shielding or avoidance between spouses may be beneficial, but couple financial discussions are important, especially when decisions may impact long-term plans. More research is needed to determine how to facilitate financial conversations to improve patient's and caregiver's well-being.

PARTICIPANT AND INFORMANT PREDICTION AND IDENTIFICATION OF COGNITIVE IMPAIRMENT IN PRE-CLINICAL ALZHEIMER’S DISEASE: IMPLICATIONS OF INFORMANT RELATIONSHIP

Alzheimer's disease (AD) trials require enrollment of a participant and an informant. In preclinical AD trials, participants are cognitively unimpaired, raising questions of whether informants or participants provide more insight into participant cognition and whether the additional benefit of informant information differs by informant type. We used data from the Alzheimer's Disease Cooperative Study (ADCS) Prevention Instrument Project, a 48-month longitudinal study of cognitively unimpaired participants aged 75 years and older, to compare participant and informant ability to predict the cognitive performance of the participant. We used the Cognitive Function Instrument (CFI) to represent assessment of the participant's cognition and an altered version of the modified ADCS Preclinical Alzheimer's Cognitive Composite (mADCS-PACC) as an objective measure of cognition (Table 1). Random forests stratified by cognitive status and informant type (including mMMSE, CDR-SB, ethnicity, sex, cardiovascular disease, age, and education), were used to assess how well participants and informants predict cross-sectional and future cognitive status. When using baseline CFI scores to predict mADCS-PACC, participants performed better than their informants. In cross-sectional analyses, informant and participant CFI performed similarly. Dyad type impacted this relationship. Among spousal dyads, informant baseline CFI better predicted mADCS-PACC scores in years three and four. Among non-spousal dyads, participant baseline CFI better predicted future scores. In the fourth year, among spousal dyads in the lowest mADCS-PACC quartile, the observed variable importance (oVI) associated with participant baseline CFI was 0.13 (95%CI: 0.11, 0.14), compared to 0.19 (95%CI: 0.18, 0.21) for informant baseline CFI. Among non-spousal dyads, the oVI for participant baseline CFI was 0.37 (95%CI: 0.35, 0.41) compared to 0.07 (95%CI: 0.06, 0.11) for informant CFI. In cross-sectional models, oVI was 0.08 (95% CI: 0.07, 0.09) for participant and 0.21 (95% CI: 0.19, 0.23) for informant CFI among spousal dyads and 0.17 (95% CI: 0.16, 0.18) for participant and 0.10 (95% CI: 0.09, 0.11) for informant CFI among non-spousal dyads.

“Just got to live life as it comes”: A case study of the spousal-dyad longitudinal mild stroke transitional experience

ABSTRACTObjective: To longitudinally explore the transition home for a spousal dyad following mild stroke, in the context of a mild stroke-specific health service.Research Design: A case study approach, using an Interpretative Phenomenological Analysis (IPA), was identified as suitable for this study, as it enabled the essence of the phenomenon to be examined.Method: Participants were purposively chosen from a Randomised Control Trial (RCT), to reflect the average age, gender and marital status of the mild stroke population. The participants were a male (age 64) and his wife (age 62). Participants received the RCT intervention. Semi-structured interviews were completed separately with participants at 1-, 3-, 6- and 9- months post stroke.Results: Two themes were identified: (1) The Unexpected, Undesirable and Short-Lived, and (2) The New ‘Normal’. The first theme reflects the confusion, adjustment and adaptation that occurred for the couple, especially during the first month at home. The second represents the couple’s journey back to their everyday lives following hospital discharge, but also the questions and changes that remained present at 9-months post-discharge.Conclusions: Themes demonstrate an ongoing process of adjustment and the contextual nature of the transitional experience. Results also indicate the need to ensure that individuals have access to mild-stroke specific information across the transition continuum.

Psychosocial interventions for informal caregivers of people living with cancer.

Psychosocial interventions for informal caregivers of people living with cancer.

Killing in Pairs: Radicalisation Patterns of Violent Dyads

In recent years there has been an upsurge in violent attacks conducted by pairs of individuals who have undergone a shared process of radicalisation. Violent dyads remain a relatively understudied phenomenon. Using a relational approach, this article analyses the unique character of dyadic radicalisation and how it differs from instances of lone actor or group-based terrorism. It draws on a number of recent case studies, analysing instances of non-kin, fraternal, and spousal dyads. Its principal case study is a failed attack in Germany in 2006, based on a range of documentary sources as well as an interview with one of the perpetrators.

General psychological distress among Japan Self-Defense Forces personnel dispatched on United Nations peacekeeping operations and their spouses.

AimThe importance of family care during international deployment is emphasized within military organizations, but mental health interactions between deployed personnel and their spouses have not yet been assessed. This study addressed this gap by examining couples’ mental health throughout a deployment period.MethodsThe mental health of 324 spousal dyads of Japan Self‐Defense Forces personnel dispatched for a half‐year United Nations Disengagement Observer Force mission was examined, using longitudinal data derived from a survey at four time points: one‐month pre‐deployment, initial deployment, middle deployment, and immediately after homecoming. The 30‐item General Health Questionnaire was used to evaluate general psychological distress, with high scores (≥7) indicating adverse mental health.ResultsThe spouses’ general psychological distress was significantly higher compared with the deployed personnel (P < 0.001). The high general psychological distress of personnel was significantly related to that of their spouses (odds ratio = 2.24; 95% confidence interval, 1.32–3.80), and vice versa (odds ratio = 2.38; 95% confidence interval 1.39–4.08).ConclusionMental health care will be beneficial for not only deployed personnel but also their spouses.

Stressors and Resources Related to Medication Management: Associations With Spousal Caregivers' Role Overload.

Managing medications can be stressful for spousal caregivers, but little is known about particular aspects of medication management that are most consequential for caregiving outcomes. We examined care stressors and resources related to medication management, their associations with role overload among spousal caregivers, and whether these links vary by care recipients' number of chronic health conditions and dementia status. This cross-sectional study included 377 spousal caregivers of adults aged 65 and older from the 2011 National Health and Aging Trends Study and National Study of Caregiving. Linear regressions were estimated to evaluate how medication-related stressors (ordering medication, keeping track of medications, giving injections) and resources (medication reminder systems, shared medication management within the spousal dyad) are associated with caregivers' role overload. Care recipients' number of chronic health conditions and dementia status were considered as moderators. Models controlled for caregivers' sociodemographic characteristics, chronic health conditions, and other care tasks. Caregivers who administered injections reported more role overload, whereas those who worked with care recipients to jointly manage medications reported less role overload. Keeping track of medications was linked to caregivers' greater role overload when care recipients had 5 or more chronic health conditions. Finally, care recipients' use of medication reminder systems was linked to less role overload for caregivers of a partner with dementia. Devising strategies to assist spousal caregivers in the more onerous components of medication management and promote resources that mitigate medication-related stress may improve caregiver well-being.

Mama Mach and Papa Mach: Parental Machiavellianism in Relation to Dyadic Coparenting and Adolescents' Perception of Parental Behaviour.

Parental personality is a main contributor to parenting outcomes. However, research on parental personality and parenting or coparenting behaviour is scarce. These few studies showed that disagreeableness and neuroticism are consequently related to negative parenting outcomes. Machiavellianism is an antagonistic and socially aversive personality trait. Machiavellianism has been linked to unfavourable outcomes in several different types of relationships (e.g., romantic relationships, workplace relationships). Using self-report measures, I investigated the association between parental Machiavellianism, adolescents’ perceptions of parenting behaviour, and parent reported coparenting in a sample of 98 families raising adolescents. According to the results, Machiavellianism was positively related to adolescents’ perceptions of rejecting and overprotective parenting behaviour in mothers. With regard to coparenting, fathers’ Machiavellianism had a negative effect both on their own and on their spouses’ reports of coparenting quality. Differences between fathers’ and mothers’ results are discussed with regard to their functions in the parent-child interaction and in the spousal dyad.

Experiences of loss and relationship quality in couples living with dementia.

Couples living with dementia face multiple losses in their relationship, and may experience changes in their overall sense of relationship quality. These topics have predominantly been researched from the caring partner’s perspective therefore, this study aimed to explore how couples adapt to relational losses to maintain quality in their relationship from the perspective of both partners. Using a constructivist grounded theory approach 10 spousal dyads, where one partner has a diagnosis of dementia, engaged in a joint interview. The results revealed three master themes: consolidating us, contextual positioning, and living well together, as well as an overarching theme of ‘turning to and away’. The findings are discussed in relation to theories of loss and family adaptation, and implications for clinical practice and future research are proposed.

Untying the Ties That Bind: Dispositional and Relational Patterns of Negative Relational Disclosures and Family Members’ Feelings of Being Caught

This study examined the associations among family members’ reports of negative relational disclosures and their feelings of being caught. Participants included a mother, father, and young adult child from 170 families. Social relations analyses revealed positive associations between each family member’s actor effect for negative disclosures (i.e., each member’s individual disposition to perceive receiving negative disclosures across all family relationships) and their feelings of being caught between the other two members of the family triad. The child’s actor effect for receiving negative disclosures from parents was positively associated with both parents’ feelings of being caught between their child and spouse. Important patterns of association emerged between unique relationship effects of receiving negative disclosures and family members’ feeling caught. Whereas negative disclosures in parent–child dyads were positively associated with feeling caught (especially for mothers and children), in spousal dyads, they were inversely associated with feeling caught.

Association Between Spousal Caregiver Well-Being and Care Recipient Healthcare Expenditures.

To measure the association between spousal depression, general health, fatigue and sleep, and future care recipient healthcare expenditures and emergency department (ED) use. Prospective cohort study. Health and Retirement Study. Home-dwelling spousal dyads in which one individual (care recipient) was aged 65 and older and had one or more activity of daily living or instrumental activity of daily living disabilities and was enrolled in Medicare Part B (N=3,101). Caregiver sleep (Jenkins Sleep Scale), depressive symptoms (Center for Epidemiologic Studies Depression-8 Scale), and self-reported general health measures. Primary outcome was care recipient Medicare expenditures. Secondary outcome was care recipient ED use. Follow-up was 6months. Caregiver depressive symptoms score and six of 17 caregiver well-being measures were prospectively associated with higher care recipient expenditures after minimal adjustment (P<.05). Higher care recipient expenditures remained significantly associated with caregiver fatigue (cost increase, $1,937, 95% confidence interval (CI)=$770-3,105) and caregiver sadness (cost increase, $1,323, 95% CI=$228-2,419) after full adjustment. Four of 17 caregiver well-being measures, including severe fatigue, were significantly associated with care recipient ED use after minimal adjustment (P<.05). Greater odds of care recipient ED use remained significantly associated with caregiver fatigue (odds ratio (OR)=1.24, 95% CI=1.01-1.52) and caregiver fair to poor health (OR=1.23, 95% CI=1.04-1.45) after full adjustment. Caregiver total sleep score was not associated with care recipient outcomes. Poor caregiver well-being, particularly severe fatigue, is independently and prospectively associated with higher care recipient Medicare expenditures and ED use.

Treatment Considerations for Depression Research in Older Married Couples: A Dyadic Case Study

Critical gaps remain in understanding optimal approaches to intervening with older couples. The focus of this report is to describe the pros and cons of incorporating spousal dyads into depression-prevention research. In an intervention development study, the authors administered problem-solving therapy (PST) dyadically to participants with mild cognitive impairment (MCI) and their caregivers. Dyads worked with the same interventionist in the same therapy session. The dyadic PST (highlighted in a case example of a husband with MCI and his wife/support person) and the potential feasibility of the program are described. The authors found that the wife of the individual with MCI could be trained as a PST coach to help her husband learn and use problem-solving skills. A decrease in depressive symptom severity was observed for the individual with MCI, which was sustained over 12 months of follow-up. Neither the husband nor wife experienced an incident episode of major depression over the course of the study. Dyadic interventions need to be further developed in geriatric psychiatry; proven methods such as PST can be modified to include patients' support persons. Recommendations are offered for developing randomized controlled trials that aim to recruit dyads and prevent depression in at-risk older married couples.

‘In this together’ or ‘Going it alone’: Spousal dyad approaches to Alzheimer's

Spouses provide the majority of care for individuals with Alzheimer's disease (AD). The qualitative literature suggests that couples adopt one of two perspectives in their accounts of AD: a We/Us approach where couples describe experiences as a composite whole or an I/Me approach where couples describe themselves as experiencing the impact of AD separately. Little is known about how these perspectives relate to the individual characteristics of either affected party. This study investigated the experiences of dyads taking both approaches. Eleven spousal dyads were divided into I/Me (n=5) and We/Us (n=6) groupings based on qualitative analyses completed as part of a larger project. Diagnosed individuals were given measures of cognitive and functional ability and caregivers completed anxiety, depression, burden, relationship satisfaction, and positive aspects of caregiving measures. We found no significant differences between groups on patient cognitive or functional ability, or caregiver anxiety, depression, burden, or relationship satisfaction. However, We/Us caregivers expressed more positive aspects of caregiving than I/Me caregivers. These findings suggest the I/Me approach is not associated with differences in variables of patient cognitive status or functional ability or caregiver emotional health, perceived burden, or relationship satisfaction. Caregivers taking a We/Us approach, however, were able to identify more positive aspects of caregiving. This may be related to mutual compassion, a characteristic of the We/Us approach, which may be protective.

INTERACTIONS BETWEEN LIFE-SPACE AND QUALITY OF LIFE IN SPOUSAL DYADS COPING WITH CHRONIC CONDITIONS

INTERACTIONS BETWEEN LIFE-SPACE AND QUALITY OF LIFE IN SPOUSAL DYADS COPING WITH CHRONIC CONDITIONS

Cancer and quality of life in spousal dyads: spillover in couples with and without cancer-related health problems.

Poor health of one spouse can adversely influence the partner's health outcomes ("spillover"). This study aimed to estimate quality of life spillover among spouses and to determine how presence of cancer influenced these effects. We examined data on husband-wife dyads with cancer-related health problems, medical events, or disabilities (n = 910) and matched comparison dyads from the 2004-2012 Medical Expenditures Panel Survey, a population-based survey of the USA. Mental and physical health-related quality of life and depressed mood were reported at two time points (T1 and T2, 11 months apart on average). Dyadic multilevel models evaluated the cross-lagged impact of HRQoL and depressed mood at T1 on spouses' HRQoL at T2, controlling for sociodemographics and health conditions. Small but statistically significant spillover was observed for mental and physical HRQoL among couples with cancer. Spillover occurred from both the spouse to the survivor and from survivor to spouse. Depressed mood, in particular, showed stronger spillover effects from the spouse to the survivor than the inverse. Similar effects were not observed in dyads without cancer. Screening for and treating poor HRQoL and depressed mood concurrently in both cancer survivors, and their spouses may positively influence HRQoL outcomes. Future research is needed to further elucidate these findings and determine whether a concurrent approach to psychosocial care in survivors and their spouses may improve long-term outcomes.

Aristophanes’ Fusion and Longing for Love: A Philosophical Hermeneutic of the Shared Dementia Phenomenon in Spousal Dyads

There is new and alarming evidence emerging in dementia research literature apropos of family system psychodynamics. This evidence indicates that spousal caregivers of dementia patients are at an increased risk for developing dementia themselves. By way of a philosophical hermeneutic rooted in Aristophanes' notion of love, as explicated in Plato's Symposium, depth psychological perspectives on this newly identified “shared dementia” phenomenon are explored. The author proposes deep psychodynamic forces that may be at work in the etiology of spousal dyadic shared dementia.