The psychosocial predictors of long-term distress in partners of patients with acute coronary syndrome

Objective: Partners of acute coronary syndrome (ACS) patients are at risk of experiencing long-term distress and the purpose of this study was to identify its predictors.

Design: Using an observational design, 80 partners of ACS patients completed validated questionnaires at three time points. The predictor variables, marital satisfaction and optimism were assessed three weeks after patient hospital discharge (T1). The outcomes, depressive symptoms and physical health status (from a quality of life scale) were measured 6 (T2) and 12 (T3) months post-discharge, and scores were combined to indicate the long-term response.

Main outcome measures: Depressive symptoms and physical health status.

Results: Partner depressive symptoms increased and physical health status deteriorated over the months following the patients’ ACS. After controlling for demographics, clinical severity of ACS and T1 levels of the outcome variable, partners’ long-term depressive symptoms were predicted by poor marital satisfaction and low optimism at T1, and poor physical health status was predicted by low T1 optimism.

Conclusion: Psychosocial factors are predictors of long-term distress for ACS partners. Partners in an unhappy marriage or with low optimism after ACS are at an increased risk of depression and low physical health status, and should be the target of additional support.     

The impact of individual trauma symptoms of deployed soldiers on relationship satisfaction.

Research traditionally has focused on the development of individual symptoms in those who experienced trauma directly but has overlooked the interpersonal impact of trauma. The current study reports data from 45 male Army soldiers who recently returned from a military deployment to Iraq (Operation Iraqi Freedom) or Afghanistan (Operation Enduring Freedom) and their female spouses/partners. The results indicated that increased trauma symptoms, particularly sleep problems, dissociation, and severe sexual problems, in the soldiers significantly predicted lower marital/relationship satisfaction for both soldiers and their female partners. The results suggest that individual trauma symptoms negatively impact relationship satisfaction in military couples in which the husband has been exposed to war trauma.     

Mechanisms of Change in Brief Couple Therapy for Depression

The goal of the present study was to investigate potential mechanisms of previously documented treatment effects for a brief, 5-session, problem-focused couple therapy for depression in a sample of 35 depressed women and their nondepressed husbands. The primary treatment effects were reducing women’s depressive symptoms and their husbands’ psychological distress and depression-specific burden. Secondarily, treatment resulted in increased relationship satisfaction for both partners. Given these significant treatment changes observed in 5 sessions, we sought to examine the mechanisms of change by testing the following three factors as potential mediators: (a) negative behaviors and attitudes toward depression, (b) support provision, and (c) empathic communication towards the depressed female partners. Women’s depression and husbands’ depression-specific burden were alleviated by positive changes in their illness-related attitudes and behaviors. Improvements in women’s marital satisfaction were also mediated by positive change in their illness-related attitudes and behaviors, along with perceptions of increased positivity and support from their husbands. Findings highlight the importance of targeting specific treatment agents in a brief couple therapy for depression such as psychoeducation about depression and support-building to increase partners’ understanding and acceptance of the illness, and teaching communication skills to reduce negative behaviors and criticism that are replaced by more empathic communication towards the depressed individual.     

Couple Therapy for Depression Within a Naturalistic Setting in Finland: Factors Related to Change of the Patient and the Spouse

The study examined factors related to change in treatments for depression in couple therapy (CT; N = 29) and treatment-as-usual (TAU; N = 22). Treatments were adapted in accordance with the patient’s need. The patients’ depressive symptoms, general mental health and marital satisfaction were assessed at baseline and at 6 months post-baseline. The Hamilton Depression Rating Scale, the Beck Depression Inventory (BDI), the Symptom Check List-90, and the Dyadic Adjustment Scale (DAS) were used for the patients. The BDI and the DAS were used for the spouses. The couples in CT group assessed their subjective distress (SD) at every session by using the Outcome Rating Scale. The results showed that the spouses’ gender, the spouses’ depressive symptoms at baseline, and the number of therapy sessions were related to differing changes in the CT and TAU groups at the 6-month post-baseline assessment. The spouses in the CT group demonstrated a higher treatment response than those in the TAU group. In the CT group, the spouse’s benefit from the treatment was related to SD at the outset on the part of either the patient or the spouse or both. The change in the patient’s SD predicted the patient’s change in depressive symptoms, general mental health, and was associated with the patient’s change in marital satisfaction. The study emphasizes the importance of the spouse’s involvement in the treatment of depression, the provision of feedback on SD, and discussion of individual well-being and relational issues, in addition to the focus on depression.     

The Application of Facilitated Imagery to Marital Counseling

SUMMARY

The purpose of this study was to assess whether facilitated imagery is a successful technique for improving both marital satisfaction and individual psychological functioning. Twenty marital couples were randomly assigned to two experimental groups: Both received three sessions of structured marital enrichment and one also received three facilitated imagery sessions. Posttests were given at one month and four months following treatment. Subjects exposed to facilitated imagery showed significantly greater improvement on some scales of marital satisfaction and individual psychological functioning, and these improvements persisted at the four-month posttest. In posttest interviews, subjects reported the primary benefit was insight into themselves and their spouses.

A series of 2x(3) repeated measure analyses of variance were used to detect changes for husbands and wives. Subjects exposed to facilitated imagery reported significantly greater improvement than enrichment-only subjects on some scales of marital satisfaction and individual psychological functioning. In addition, improvements persisted at the four-month posttest for the enrichment-plus-imagery subjects, but declined for the enrichment-only subjects. In interviews, the majority of imagery subjects reported that the process had been helpful to them both personally and relationally. Subjectively they reported gaining insight into themselves or their spouse as the primary benefit obtained from the imagery work.     

The Partners for Life Program: A Couples Approach to Cardiac Risk Reduction

Morbidity and mortality are reliably lower for the married compared with the unmarried across a variety of illnesses. What is less well understood is how a couple uses their relationship for recommended lifestyle changes associated with decreased risk for illness. Partners for Life compared a patient and partner approach to behavior change with a patient only approach on such factors as exercise, nutrition, and medication adherence. Ninety‐three patients and their spouses/partners consented to participate (26% of those eligible) and were randomized into either the individual or couples condition. However, only 80 couples, distributed across conditions, contributed data to the analyses, due to missing data and missing data points. For exercise, there was a significant effect of couples treatment on the increase in activity and a significant effect of couples treatment on the acceleration of treatment over time. In addition, there was an interaction between marital satisfaction and treatment condition such that patients who reported higher levels of marital distress in the individuals condition did not maintain their physical activity gains by the end of treatment, while both distressed and nondistressed patients in the couples treatment exhibited accelerating gains throughout treatment. In terms of medication adherence, patients in the couples treatment exhibited virtually no change in medication adherence over time, while patients in the individuals treatment showed a 9% relative decrease across time. There were no condition or time effects for nutritional outcomes. Finally, there was an interaction between baseline marital satisfaction and treatment condition such that patients in the individuals condition who reported lower levels of initial marital satisfaction showed deterioration in marital satisfaction, while non satisfied patients in the couples treatment showed improvement over time.     

Spousal understanding and marital satisfaction in pain patients and their spouses

The current study tested the hypotheses that knee osteoarthritis (OA) patients and spouses who report more spousal understanding of patient's pain would report greater marital satisfaction. A total of 124 couples completed interviews at three time points across 18 months. Results from dyadic analyses showed that patients who felt more understood by their spouse report, and have spouses who report, higher marital satisfaction concurrently. In addition, patients who felt more understood by their spouse reported higher marital satisfaction over time. Spouses' reports of understanding also had a significant influence on the patients' and their own marital satisfaction concurrently. Results highlight the importance of spouses understanding knee OA patients' pain for both dyad members' marital satisfaction.     

The limits of systems therapy: The problem of intimacy

By placing so much emphasis on systemic thinking, marriage and family therapists have lost sight of the individual within the system. One of the limits of a systemic therapy is its capacity to deal with problems in intimacy, a central problem in marital therapy. A knowledge of individual development is crucial for family therapists. The two themes dealt with in this paper are 1) some concepts of self psychology which can be useful in understanding the fear of intimacy, and 2) at what point, in couples' therapy, it is advisable to shift to individual therapy for one or both partners.     

MARITAL SATISFACTION AND DEPRESSION:

Abstract— A sample of 150 recently married couples provided data egarding marital satisfaction and depressive symptoms. Approximately 18 months later, 116 of these couples provided complete information on marital satisfaction and depression once again. The data were examined using three sets of causal models, which yielded converging results. For men, causal paths emerged from depression to marital satisfaction, whereas for women causal paths were from satisfaction to depression. The results are discussed in relation to the marital discord model of depression.     

The efficacy of couples-based interventions for panic disorder with agoraphobia

From this systematic literature review it was concluded that panic disorder with agoraphobia (PDA) can sometimes occur in conjunction with marital problems. Couples-based treatments for PDA – partner-assisted exposure and marital therapy – can be an effective treatment for the condition. It is as effective as individually based cognitive behaviour therapy. Involving partners of people with PDA in therapy may be appropriate in some cases, particularly those in which there are marital difficulties. Couple-focused interventions may enhance the maintenance of treatment gains by facilitating interactions that positively reinforce and perpetuate attempts by people with PDA to enter feared situations and cope with these effectively. People with PDA who have good marital relationships show a better response to both individual and couples-based treatment programmes. In some instances effective couples-based treatment leads to improvement in marital adjustment as well as in PDA symptomatology.     

The impact of attributions in marriage: a longitudinal analysis

In this study, we investigate the longitudinal relation between attributions for relationship events and marital satisfaction. Thirty-four couples were assessed at two points separated by approximately 12 months. Causal and responsibility attributions for marital difficulties and negative spouse behaviors were strongly related to concurrent marital satisfaction. For wives, later marital satisfaction was predicted by both causal and responsibility attributions after the effects of earlier satisfaction were removed. For husbands, attributions did not predict later marital satisfaction. Marital satisfaction did not predict later attributions for either husbands or wives. Marital satisfaction and the two types of attributions were related to concurrent unrealistic relationship expectations, but these expectations did not predict later marital satisfaction. The results are discussed in terms of a possible causal relation between attributions and marital satisfaction.     

Evaluating Marital Therapy: A Hospital and Community Study

The study investigated the application of marital therapy using three contrasting clinical approaches: conjoint treatment, couples groups, and treating the partner alone. Thirty-six couples comprised the research sample, with eighteen couples being treated in each of two NHS treatment settings. The duration of the treatment was ten weekly sessions each lasting one hour, and couples were followed up six months after termination. Outcome evaluations included marital satisfaction, sexual adjustment, and an assessment of target problems. The analysis of the results showed no significant difference between groups at the post-treatment and follow-up assessments. There was, however, a significant difference in the rates of change between experimental groups. The implications of these results are discussed.     

Parental Perceptions of Individual and Dyadic Adjustment as Predictors of Observed Coparenting Cohesion: A Cross‐National Study

Over the past 20 years, systemically guided approaches to understanding early family processes have helped to provide greater clarity concerning the interplay among individual, dyadic, and family level processes. Parental depression, marital functioning, and child adjustment in particular appear to be reliable predictors of coparental and family level functioning. Indeed, cohesion at the level of the family group covaries in theoretically meaningful ways with these indicators of individual and dyadic adjustment. In this study, two collaborating research groups (one in Switzerland, the second in the United States) partnered to examine whether similar patterns of relationships exist among individual and marital adjustment and coparenting processes in families of 4‐year‐old children. Using similar constructs but disparate and occasionally dissimilar measures, both groups measured parent‐reported depression, marital satisfaction, and child behavior problems. Coparenting cooperation and warmth were observed during family interactions. Despite differences between samples and evaluation tools, similar results were found for the Swiss and U.S. samples. A model with depression, marital satisfaction, and child symptoms as predictors of a latent factor of observed coparenting cooperation and warmth showed good fit to data in both samples, suggesting the model was relevant for each. Parameter estimation showed that higher coparenting cooperation and warmth was predicted by lower maternal depression and higher child internalizing symptoms. The common significant effects despite differences in assessment paradigms and instrumentation are of substantive interest. Future directions pertinent to the coparenting questions addressed in this research are discussed.     

Mother's marital satisfaction associated with the quality of mother‐father‐child triadic interaction

Low marital satisfaction has been shown to be a risk factor for early parenthood and parent‐child relationship problems (Erel & Burman, 1995 ; McHale, 1995 ). The aim of this study was to assess how parental reports of marital satisfaction related to family alliance and coordination in the observed triadic interaction. The study group included 120 families. Marital satisfaction was evaluated during pregnancy, at 4 months, and at 18 months using the Revised Dyadic Adjustment Scale (RDAS; Busby, Christensen, Crane & Larsson, 1995 ) for both parents. Mother‐father‐child interaction was analyzed in the Lausanne Triadic Play setting and coded using the Family Alliance Assessment Scale (Favez, Lavanchy Scaiola, Tissot, Darwiche & Frascarolo, 2011 ) when the child reached 18 months of age. The mother's higher marital satisfaction at every measuring point was associated with a cooperative family alliance and/or higher family coordination at 18 months. The father's experience of marital satisfaction was not related to family interaction at any assessment point. Our study suggests that a mother's experience of lower marital satisfaction during pregnancy may be an early sign of later problems in family relationships.     

A longitudinal examination of couples' coping strategies as predictors of adjustment to breast cancer

This study's goals were to examine coping strategies of women and their male partners as predictors of change in women's adjustment over the year following breast cancer treatment and to test whether partners' coping processes interact to predict adjustment. In a sample of women who had recently completed breast cancer treatment and were taking part in a psychoeducational intervention trial, the patients' and partners' cancer-specific coping strategies were assessed at study entry (average of 10 months after diagnosis). Assessed at study entry and 20 months after diagnosis (n = 139 couples), dependent variables were women's general (i.e., vitality, depressive symptoms, relationship satisfaction) and cancer-specific adjustment (i.e., cancer-specific distress, perceived benefits). Both patients' and partners' coping strategies at study entry predicted change in women's adjustment at 20 months. Women's use of approach-oriented coping strategies predicted improvement in their vitality and depressive symptoms, men's use of avoidant coping predicted declining marital satisfaction for wives, and men's approach-oriented strategies predicted an increase in women's perception of cancer-related benefits. Patients' and partners' coping strategies also interacted to predict adjustment, such that congruent coping strategy use generally predicted better adaptation than did dissimilar coping. Findings highlight the utility of examining patients' and partners' coping strategies simultaneously.     

The importance of similarity and understanding of partners' marital ideals to relationship satisfaction

This article extends earlier work on the association between relationship partners' similarity and understanding about marital ideals and relationship satisfaction by controlling for individual differences in stereotype endorsement or typical responding. For heterosexual couples we separated a measure of understanding into the general understanding of partners and understanding that is unique to the specific relationship partner. The measures of similarity and understanding were also separated into general similarity and understanding and into those that are unique between partners. We examined the contribution of each type of similarity and understanding to relationship satisfaction in 238 dating and married couples. Findings indicate that the more satisfied individuals believe that the partner endorses a “female” stereotype. Understanding does not relate to length of the relationship or satisfaction, but similarity in values does There is some indication that marital discord decreases with an increase in the male partners' understanding of their female partners.     

Everything Here is Fine: Protective Buffering by Military Spouses During a Deployment

To minimize potential distractions for deployed military service members (SMs), some nondeployed romantic partners have reported engaging in protective buffering, or intentionally withholding information or concerns to protect their deployed partner. This study assessed the associations of protective buffering and psychological distress and marital satisfaction for military couples during and after deployment. Additionally, the study explored whether protective buffering was related to SM reports of being distracted during deployment by family matters. A total of 54 couples provided data before, during, and after an Army deployment. In multilevel models, higher protective buffering by partners was associated with higher psychological distress and lower marital satisfaction for both SMs and partners during, but not after, deployment. Additionally, partners reported frequent use of protective buffering during deployment; however, protective buffering was not significantly correlated with family related distraction for SMs during deployment. Limitations and implications of these findings are discussed.     

A social learning analysis of couples during the second postnatal month

Abstract

This study examined the marital satisfaction and behaviors of 32 couples at one and two months following the births of their first children. Self-report measures of daily satisfaction and daily spouse-observed behaviors were analyzed for patterns approximating those associated with distressed marital interaction identified through earlier social learning studies. Over the time period from 30 to 60 days postnatally, increases were found in spouses' tendency to reciprocate one another's behavior. Except for helpful behaviors involved with care of the infant, spouses at two months postnatally were more likely to reciprocate both irritating and rewarding behaviors than at one month. Nonsignificant decreases in marital satisfaction were accompanied by a mixed pattern of change for spouse-observed behaviors. Predicted changes over time in the proportions of pleasing and displeasing behaviors were evident in only half the comparisons. Increases over time were found for the predictability from spouse-reported daily behaviors to marital satisfaction, but an expected increase in the importance of negative behaviors to the multiple correlation with satisfaction was not obtained. Cross-lagged panel correlation analysis indicated that, for wives, increases in satisfaction at 30 days preceded a parallel increase in their reports of rewarding behaviors and a decrease in aversive behaviors from their husbands at 60 days postnatally. Implications of these findings for identification of couple risk factors for later clinical problems and for early family intervention are discussed.     

Tracking Marital Adjustment,Hostility, and Physical Functioning Across Time in a Therapy Population: A Biopsychosocial Model

In this study we sought to explore the biopsychosocial connections between relational adjustment, hostility, and physical functioning of individuals who attended psychotherapy. Assessments were given at therapy intake, 6 months post intake, and 12 months after therapy intake. Path analyses between relational adjustment, hostility, and physical functioning revealed a good fit to the data. Results indicated that therapy may interrupt the relationship between hostility at intake and later marital satisfaction. Individuals’ ability to function physically day to day at 6 months post therapy intake contributed to increased marital adjustment 12 months after intake. Clinical implications are discussed.     

Paternal Postnatal and Subsequent Mental Health Symptoms and Child Socio‐Emotional and Behavioural Problems at School Entry

Research on the effect of paternal mental health problems, particularly on young children, is based predominantly on clinical levels of depression. Furthermore, potential mediators such as marital discord have often been overlooked. This longitudinal community study assessed the association between paternal mental health symptoms in a community sample (N = 705) assessed at 3 months postnatally (Edinburgh Postnatal Depression Scale) and 36 months (General Health Questionnaire) and children's socio‐emotional and behavioural problems at 51 months (Strengths and Difficulties Questionnaire) as reported by mother, father and teacher. Controlling for socioeconomic status and maternal mental health symptoms at 3 and 36 months, paternal postnatal depressive symptoms predicted more father‐reported child problems at 51 months but, in contrast to previous findings, not mother‐reported problems. Paternal mental health symptoms at 36 months predicted both maternal and paternal reports of child problems at 51 months controlling for both paternal and maternal postnatal symptoms. Paternal mental health symptoms at 3 and 36 months were not significant predictors of teacher‐reported child problems. Postnatal marital discord and paternal mental health problems at 36 months both mediated the relationship between paternal postnatal symptoms and later child emotional and behavioural problems. Child gender did not moderate the relationship. Implications for interventions are discussed. Copyright © 2013 John Wiley & Sons, Ltd.