Effects of received and mobilized support on recipients' and providers' self-efficacy beliefs: a 1-year follow-up study with patients receiving radical prostatectomy and their spouses

From a proactive agentic perspective, social support is not just seen as a protective cushion against environmental demands. Rather, support may facilitate an individual's self-regulation by enhancing perceived self-efficacy (i.e., enabling hypothesis). In the present study, patient-reported indicators of mobilized and received spousal support as predictors of their own and their spouses' self-efficacy beliefs were investigated within 1 year following radical prostatectomy. During this time frame, postoperative sequelae such as urinary incontinence and erectile dysfunctions are still likely to interfere with couples' everyday activities. Seventy-two patients receiving radical prostatectomy and their spouses participated. Patients' and spouses' self-efficacy beliefs and patients' received and mobilized spousal support were assessed prior to and 12 months following surgery. Additional patient-reported covariates at 1 year post-surgery were degree of bother by urinary incontinence, overall sexual satisfaction, and relationship satisfaction. Results indicated that patients' received spousal support was associated with higher levels of patients' self-efficacy only cross-sectionally, but not longitudinally. Support mobilized by the patient prior to and 1 year after surgery, however, positively predicted spouses' levels and changes in self-efficacy. Results, thus, did not fully confirm predictions by the enabling hypothesis of social support; rather, associated aspects, such as the degree of being mobilized as a provider of support or being needed, seem to enhance agency beliefs in spouses.     

Coping and quality of life after tumor surgery: personal and social resources promote different domains of quality of life

Personal and social resources facilitate the adaptation to critical life events. The present study investigates whether general self-efficacy beliefs and received social support elevate cancer patients' physical, emotional, and social well-being directly, or whether these effects are rather mediated by active or meaning-focused coping. Gastrointestinal, colorectal, and lung cancer patients were approached at 1 month and at 6 months after surgery (N=175). Structural equation models indicate that self-efficacy at 1 month after surgery exerted a positive direct effect on all three domains of health-related quality of life at 6 months after surgery, but indirect effects through active and meaning-focused coping were also observed. Initial received support elevated later emotional well-being, but not the other two quality of life domains. This effect was not mediated by coping. Results suggest the development of interventions to increase optimistic self-beliefs and coping skills in tumor-surgery patients.     

The dual-effects model of social control revisited: relationship satisfaction as a moderator

The dual-effects model of social control states that receiving social control leads to better health behavior, but also enhances distress in the control recipient. Associated findings, however, are inconsistent. In this study we investigated the role of relationship satisfaction as a moderator of associations of received spousal control with health behavior and affect. In a study with five waves of assessment spanning two weeks to one year following radical prostatectomy (RP), N=109 married or cohabiting prostate-cancer patients repeatedly reported on their pelvic-floor exercise (PFE) to control postsurgery urinary incontinence and affect as primary outcomes, on received PFE-specific spousal control, relationship satisfaction, and covariates. Findings from two-level hierarchical linear models with repeated assessments nested in individuals suggested significant interactions of received spousal control with relationship satisfaction predicting patients' concurrent PFE and positive affect. Patients who were happy with their relationships seemed to benefit from spousal control regarding regular PFE postsurgery while patients less satisfied with their relationships did not. In addition, the latter reported lower levels of positive affect when receiving much spousal control. Results indicate the utility of the inclusion of relationship satisfaction as a moderator of the dual-effects model of social control.     

Changes in attachment orientations across the transition to parenthood

According to attachment theory, individuals should experience changes in attachment orientations (styles) if they encounter experiences or events that strongly reinforce or directly contradict the major concerns of their existing orientations. Systematic changes should be most evident across stressful life transitions. Wives and husbands expecting their first child completed scales measuring their attachment orientations along with perceptions of themselves, their spouses, and their marriage both 6 weeks before and 6 months after childbirth. As predicted, women became more ambivalent across the transition if they entered parenthood perceiving less spousal support and more spousal anger, with perceptions of anger having stronger impact. Women who entered parenthood seeking less spousal support and those whose husbands were higher in avoidance became more avoidant across the transition. Men who perceived themselves as providing more prenatal support to their wives became less avoidant. These results extend attachment theory and research in novel directions.     

Dyadische Planungsintervention nach Prostatektomie

Background

Prostate cancer is one of the most prevalent forms of cancer in men. One treatment for localized prostate cancer is radical prostatectomy. Patients and partners have to deal with stressors associated with the diagnosis, the surgery and its consequences (e.g. incontinence). Dyadic planning prepares for the coping process with illness consequences in order to enhance self-regulation and reduce anxiety. Dyadic planning means generating plans together with a partner specifying when, where and how the target person wants to initiate a health behavior.

Patients and methods

In this longitudinal randomized controlled trial (RCT) 112 prostatectomy patients and their spouses were invited to participate in a dyadic planning intervention. Participants were randomly allocated to a dyadic pelvic floor exercise (pfe) planning group or one of three control groups (i.e., individual pfe planning, dyadic or individual nutrition planning). Patients and partners received questionnaires at baseline, 2 weeks and 6 months after surgery.

Results

Patients in the dyadic pfe planning group reported higher dyadic pfe planning 2 weeks after surgery than patients in the nutrition planning groups. No such differential effects were found in partners. Additionally, there were no group differences in patient reports on anxiety 6 months after surgery, whereas partners in the dyadic pfe planning group reported lower anxiety levels compared to partners in the individual pfe planning group. Self-reported pfe planning did not, however, mediate the effects of the intervention on partners?? anxiety.

Conclusion

Economical dyadic planning interventions may not only support change of health-relevant behaviour in target persons but also emotional adjustment of their partners.     

Effects of relationship maintenance on psychological distress and dyadic adjustment among couples coping with lung cancer

OBJECTIVE: Relationship maintenance strategies help to ensure the continuation of valued relationships by keeping them at a certain level of intimacy. This study evaluated how lung cancer patients' and spouses' efforts to maintain their relationships affected their psychological and marital adjustment over time. DESIGN: Psychosocial questionnaires were administered within 1 month of lung cancer treatment initiation (baseline) and 3 and 6 months later to 158 lung cancer patients and their spouses. MAIN OUTCOME MEASURES: Study outcomes were global severity index scores on the Brief Symptom Inventory, and total scores on the Dyadic Adjustment Scale. RESULTS: Multilevel modeling analyses using the Actor-Partner Interdependence Model showed that, regardless of gender or social role (i.e., patient or spouse), individuals who engaged in the strategies of positivity, networks, and shared tasks reported less distress at baseline than other participants. Over time, the effects of providing more assurances and experiencing a partner's increased reliance on social networks differed: patient distress was exacerbated, and spouse distress was alleviated. Couples where both partners engaged in more frequent maintenance behaviors reported greater dyadic adjustment at baseline and over time. CONCLUSION: For couples coping with lung cancer, the initial treatment period may be an important time that sets the tone for future spousal interactions. Engaging in relationship maintenance during this stressful time may help mold more resilient relationships and facilitate adjustment as the disease progresses.     

WOMEN WHO USE DOMESTIC VIOLENCE SHELTERS Changes in Depression Over Time

This study examined the levels of depression reported by women who had used a domestic violence shelter. Depressive symptoms were assessed three times: immediately after shelter exit, 10 weeks thereafter, and 6 months later. Whereas 83% of the women reported at least mild depression on the Center for Epidemiological Studies Depression (CES-D) scale upon shelter exit, only 58% were depressed 10 weeks later. This did not change at the 6–month follow-up. An ecological, longitudinal model was evaluated to predict battered women's depression 8/12 months postshelter exit. Results of hierarchical regression analyses suggested that, after controlling for previous levels of depression, the women's feelings of powerlessness, experience of abuse, and decreased social support contributed to their depression symptoms. The women's scores on these three variables (feelings of powerlessness, abuse, and social support) at 10 weeks postshelter exit and at 6-month follow-up predicted depression at 6 months. Thus, there were both predictive and concurrent effects for these constructs. Implications for clinical and community interventions are discussed.     

Predicting negative spousal attitudes toward depressed persons: a test of Coyne's interpersonal model

The utility of Coyne's (1976a) interactional model in predicting negative spousal attitudes toward depressed patients was examined. Eighty-nine couples with at least 1 member in treatment for depression were selected on the basis of semistructured diagnostic interviews. Overall, spouses living with a depressed patient reported significantly more distress than population norms. Consistent with prediction, patients' reassurance seeking and spouses' mood contributed to negative spousal attitudes. Additional analyses demonstrated that these effects persisted even after controlling for spouse marital adjustment, suggesting that negative spousal attitudes were more than a simple reflection of marital maladjustment.     

The relational context of social support: Relationship satisfaction moderates the relations between enacted support and distress

In two studies of kidney transplant patients and their significant others, the authors examined whether the relations between enacted social support and patient distress were moderated by patients' satisfaction with their relationship with the support provider (i.e., their significant other). In Study 1 (n = 121 couples), unsupportive spousal behaviors were associated with more distress only among patients who were less satisfied with their marital relationship. In Study 2 (n = 112 couples), the relations between unsupportive behaviors and distress again varied as a function of the patient's relationship satisfaction, although the particular pattern of the interaction depended on the specific unsupportive behaviors offered to the patient. In both studies, relationship dissatisfaction was associated with higher levels of patient distress. Supportive behaviors were not related to distress and did not interact with relationship satisfaction. Implications for future research on social support in marriage are discussed.     

Effects of Sex,Culture, and Support Type on Perceptions of Spousal Social Support: An Assessment of the “Support Gap” Hypothesis in Early Marriage

Several writers have suggested that a “support gap” characterizes modern marriages, with women receiving less support from their spouses than men receive from theirs. Although this support gap hypothesis (SGH) is used increasingly to explain marital interaction and satisfaction, there have been few rigorous evaluations of this hypothesis. In particular, existing research on the support gap has not systematically considered (a) different types of social support; (b) differences in provided vs. received support; (c) differences in reported levels of support desire, experience, and satisfaction; or (d) differences in distinct cultural groups with respect to social support in marriage. The present study provided a multidimensional assessment of desired and experienced spousal social support. Participants were recently married men and women (100 Americans and 102 Chinese) who completed questionnaires providing assessments of desired and experienced levels of spousal support for each of 5 support types. Men and women did not differ systematically with respect to the levels of support they experienced from their spouses; however, women reported desiring significantly higher levels of support from their spouses than did men for all 5 types of support. Evaluation of support satisfaction indicated that both American and Chinese women experience gaps with respect to emotional and esteem support; Chinese women additionally experience a gap in network support. These results specify the nature of marital support gaps much more precisely than previous work and suggest several issues to be addressed in future work.     

Deployment Stress and Well-Being Among Military Spouses: The Role of Social Support

The demands of military service, including the intensity and frequency of military operations, can have numerous effects on military families. Evidence suggests that spousal support may play an important role in the resiliency of military families. The present study examined the roles of deployment stress and social support in the psychological well-being of spouses of deployed military personnel (N = 639). The results showed that deployment stress and perceived social support from family, nonmilitary friends, and military partner played independent roles in the psychological wellbeing of military spouses. This evidence suggests the importance of taking perceived social support into account when explaining the variance in the psychological wellbeing of military spouses. Results are discussed in light of some methodological constraints, and the potential implications related to heightening families’ perceptions of interpersonal relationships are emphasized.     

Evaluation of a cognitive behavioral group intervention program for spouses of stroke patients

This study investigated the effectiveness of a cognitive behavioral group program for spouses of stroke patients. The program consists of 15 bi-monthly 112h sessions. The goal of the intervention is to reduce the prevalence of mental disorders and burnout among care-giving spouses of stroke patients. The sample (stroke patients and their spouses) consisted of one intervention group (n=38 couples) and two different control conditions, those receiving informational support (n=35 couples) and those receiving standard care (n=51 couples). We used the following instruments to measure spouses' mental health and quality of life: Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), WHO Quality of Life Questionnaire. Measurements were taken before the intervention (Time 1), directly following the intervention (Time 2) and 6 months after Time 2 (Time 3). Several regression analyses allowed for examination of the short-term and long-term effects of the intervention. The spouses' participation in the intervention program was associated with significant short-term changes in care-giving spouses' quality of life and with long-term changes in their quality of life and depression. The presented multi-component intervention appears to have an immediate effect on care-giving spouses' quality of life. In contrast, the intervention-related changes in more resistant mental-health-related variables did not appear until after a latent stage in the later post-intervention phase.     

Older adults' recovery from surgery for osteoarthritis of the knee: psychosocial resources and constraints as predictors of outcomes.

The authors investigated psychosocial resources (positive support, active coping) and psychosocial constraints (negative support, avoidant coping) as predictors of improvement in the health of 63 older adults undergoing surgery for osteoarthritis of the knee. Following surgery, patients and social partners are motivated both to strive for the appetitive goal of recovery (approach), and to protect themselves from pain and impairment (avoidance). The authors assessed resources and constraints 6 weeks after surgery as predictors of outcomes (improvement in knee pain, knee functioning, and psychological well-being) 6 months after surgery. The constraints patients encountered early in recovery were strong predictors of poor recovery. Although resources were associated with some improvement, these effects were largely accounted for by constraints.     

If you want to know, consider asking: how likely is it that patients will hurt themselves in the future?

Although self-harming behavior is a common and costly problem for psychiatric inpatients released from the hospital, standardized tools that assess patients' risk for self-harm are rarely used in clinical settings. In this study of dually diagnosed psychiatric inpatients (N = 147), we assessed the utility of patients' self-perceptions of risk in predicting self-harm in the community. Patients' self-perceptions of risk predicted self-harm 8 weeks after discharge from the hospital (Lag 1; area under the curve [AUC] = 0.75). Self-perceptions of risk at the 8-week interview also predicted self-harm 2 months later (Lag 2; AUC = 0.72). Self-perceived risk added predictive utility above and beyond scores on a measure of depression and seemed to capture changes in risk state over time. The results suggest that inpatients can accurately perceive their own risk and therefore may be important collaborators in the risk management process.     

The role of social supports in the bereavement process of surviving spouses of suicide and natural deaths.

This report examines the changing role of social supports in the bereavement of spouses of elderly suicide and natural deaths, focusing on differences and similarities in relation to gender, time, and mode of death. Measurements were obtained 4 times after death (within 2 months, at 6 months, at 12 months, and at 2 to 2 1/2 years) on 79% of the 108 survivors of elderly suicide, 89% of the 199 natural death survivors, and 79% of the nonbereaved controls. The results indicated that the suicide survivors received significantly less emotional support for their feelings of depression and grief than the natural death survivors, and that they did not confide in the persons in their network any more than the nonbereaved controls did. Women report receiving more support overall than men. A low spot in social supports occurred at the 6-month point after loss for both bereaved groups, but primarily in practical help received by natural death survivors. By the end of the second year, both practical and emotional supports had increased to at least the same level as immediately after death.     

Anxiety and body satisfaction before and six months after mastectomy and breast reconstruction surgery

As breast reconstruction is an important adjunct after mastectomy to regain physical integrity and also to improve affect, the present aim was to evaluate patients' subjective perceptions of body image during the whole breast reconstruction period and to assess the importance of their psychological reaction in terms of negative affectivity. Participants were 62 women, 43 women (M age = 46.4, SD = 9.8) who had had mastectomies and 19 healthy women (M age = 39.9, SD = 13.99). Patients were admitted for surgery at the Hospital S. Orsola in Bologna. Healthy subjects were relatives of the women and students, all with no history of breast pathology. The Body Satisfaction Scale and the State Anxiety Inventory-Y were administered to the two groups before, post, and 6 mo. after surgery. Analysis of scores indicated that during the period of the study, the women with mastectomies reported higher anxiety and also greater dissatisfaction with their body image than the healthy group, even when the breast had been reconstructed. This unexpected finding suggests patients' unrealistic expectations of the breast reconstruction and the surgical outcome.     

Coping strategies and quality of life in women with advanced breast cancer and their family caregivers

Abstract

This study examines the effects of personal resources of both heart patients and their close social partners on patients' coping and quality of life. Generalized personal resources (self-efficacy beliefs, dispositional optimism, self-regulation competence) and outcomes were assessed by questionnaire 1–3 days before surgery (n = 122) and again six months later (n= 50). Outcome variables were coping styles, social resources (social support and social integration), emotional states, and further measures of quality of life. Patients' personal resources were dominant in the prediction of most of the outcomes. Partners' resources were uniquely related to social support, social integration, and quality of life as perceived by the patients. Further, partners' personality resources predicted changes in patients' loneliness and energy levels during the six-month interval.     

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.     

Older spouses' perceptions of partners' chronic arthritis pain: implications for spousal responses, support provision, and caregiving experiences

This study of older patients with osteoarthritis and their spouses examined concordance between patients' and spouses' reports of patients' pain severity and the association of concordance with support and caregiving outcomes. Patients and spouses independently viewed videotapes of the patient performing simulated household tasks and provided ratings of patients' pain. Spousal overestimation of patients' pain was the most common type of nonconcordance. Spouses who were accurate in their perceptions of their partner's level of pain during a log-carrying task responded less negatively and provided emotional support that was more satisfying to patients. In addition, spouses who were accurate in their perceptions of their partner's pain during the log-carrying task reported less stress from providing support and assistance. Future research that uses such observational methods may be highly useful for understanding the effects of chronic illness on older couples.