An interpersonal perspective on depression: the role of marital adjustment, conflict communication, attributions, and attachment within a clinical sample

Previous studies have focused on the difficulties in psychosocial functioning in depressed persons, underscoring the distress experienced by both spouses. We selected conflict communication, attribution, and attachment as important domains of depression in the context of marital adjustment, and we analyzed two hypotheses in one single study. First, we analyzed whether a clinical sample of couples with a depressed patient would differ significantly from a control group on these variables. Second, we explored to what degree these variables mediate/moderate the relationship between depressive symptoms and marital adjustment. The perspectives of both spouses were taken into account, as well as gender differences. In total, 69 clinical and 69 control couples were recruited, and a series of multivariate analyses of variance and regression analyses were conducted to test both hypotheses. Results indicated that both patients and their partners reported less marital adjustment associated with more negative perceptions on conflict communication, causal attributions, and insecure attachment. In addition, conflict communication and causal attributions were significant mediators of the association between depressive symptoms and marital adjustment for both depressed men and women, and causal attributions also moderated this link. Ambivalent attachment was a significant mediator only for the female identified patients. Several sex differences and clinical implications are discussed.     

Variations in internet-related problems and psychosocial functioning in online sexual activities: implications for social and sexual development of young adults.

This survey of 760 university students examined differences in Internet-related problems and psychosocial functioning between four patterns of participation in online sexual information and entertainment activities. Students who did not participate in either online sexual activity were more satisfied with their offline life and more connected to friends and family. Those who engaged in both online sexual activities were more dependent on the Internet and reported lower offline functioning. Students who only sought sexual information maintained strong offline affiliations. Those who only sought entertainment did not report lower offline functioning. Respondents most deficient in offline social support did not report compensatory online support. Despite students' common participation in online sexual activities (OSA) as a venue for social and sexual development, those relying on the Internet and the affiliations it provides appear at risk of decreased social integration. The authors discussed the finding's implications for social and sexual development.     

The psychosocial effects of rheumatoid arthritis on the patient and the well partner

Rheumatoid arthritis (RA) is a chronic disorder that can have a severe impact on patient's lives. This present study investigated four questions regarding the psychosocial effects on patients and their well partners. First we found that depression for both patients and partners were slightly elevated and 35.7% of patients and 23.3% of well partners had scores above the cut-off for possible clinical depression on the Center for Epidemiological Studies Depression Scale. Second, there was no significant difference between the patients' level of distress and that of the partners. Third, there were moderate positive correlations between patients' and partners' scores on measure of psychological functioning. Fourth, there were no differences in either the patients' or partners' well-being based on the gender of the patient. Finally, an exploratory analysis was conducted to examine the factors which influence the patients' and partners' depression and their view of the relationship.     

A multilevel approach to the assessment of communication positiveness in distressed marital couples

Abstract

Although the improvement of communication tends to be a foremost objective of behavioral marital counseling (Jacobson and Martin, 1976), guidelines by which to define or measure “good communication” are lacking. The development of such guidelines has been hampered by the lack of empirical evidence on: 1. which communication skills contribute to successful marital functioning; 2. who is the best judge of those skills; and 3. what is the most appropriate method for examining communication processes between marital partners.     

Behavioral Marital Therapy: An Outcome Evaluation of Conjoint,Group and One Spouse Treatment

Abstract

Behavioral Marital Therapy has focussed on the modification of marital behavior in conjoint and couples group settings. This study extends previously published outcome studies in that one treatment condition involved treating only one of the partners. Fifty-seven couples were consecutively assigned to one of the three treatment conditions. Outcome evaluations included an independent assessment, marital satisfaction, sexual adjustment and an assessment of target problems. The results revealed no significant differences between the three treatment conditions. However, couples in the conjoint treatment resolved their target problems more rapidly than the other two treatments. The implications of the result as well as issues of outcome prediction, cost-effectiveness and the viability of treating one spouse are discussed.     

Trichotillomania: impact on psychosocial functioning and quality of life

This study explored the impact of hair pulling on psychosocial functioning for patients diagnosed with trichotillomania (TTM; n = 28). TTM patients were compared to age and gender-matched groups of psychiatric patients without TTM (n = 28) and nonpsychiatric control volunteers (NC, n = 28) on measures of psychological distress, functioning/quality of life, and self-esteem. Results indicated that TTM patients reported more severe psychosocial impairments than did NC volunteers; however, these differences were mediated by differences in level of depression. Regression analyses indicated significant relationships between some measures of psychosocial functioning and severity of hair pulling, independent of level of depression. Finally, an interview of the impact of hair pulling on 6 domains of daily functioning (negative affect/negative self-evaluations, grooming, recreational activities, social interaction, work/housework productivity, and physical health) indicated common and wide-ranging impairments for both lifetime and current (i.e., past week) ratings. These results highlight the importance of promoting and improving resources for the clinical care of TTM patients, and provide some directions for clinicians to enhance assessment of interference caused by TTM.     

Hidden reality: sexual sphere in brain tumor patients

Most reports emphasize that tumors and their treatments affect sexual function. To date, no studies have focused on sexual functioning in patients with brain tumors. Our study’s objective is to describe the sexual sphere of patients with brain tumors and examine the possible differences between patients who reported sexual dysfunctions and those who did not with respect to their psychological and functional status. We tested 46 patients with brain tumors. We used an ad hoc questionnaire to assess patients’ subjective perception of their own sexual sphere. To assess patients’ psychological status, we used the following questionnaires: Hospital Anxiety and Depression Scale; Psychological Distress Inventory; EORTC QLQ-C30; EORTC QLQ-BN20. Fifty-eight percent of patients reported sexual disturbance. Our data showed that a lack of or decrease in sexual desire is the most common sexual problem reported by our patients (56%). Patients with sexual problems reported higher levels of anxiety and depression and a worse self-reported quality of life (QoL) than did those who did not perceive adverse changes in their sexual sphere. In addition, we found that patients with a better performance status (KPS) reported more changes in sexual behaviors than did those who had performance difficulties. Of the patients, 15.2% received information regarding possible changes in the sexual sphere by physicians. Additionally, 10.8 of 15.2% of the patients reported having explicitly requested information from physicians. The study demonstrated a relation between QoL and sexual function. Therefore, it would be important to encourage clinicians to ask questions regarding patients’ sexual issues, thus providing them with an opportunity to expose their difficulties and receive adequate support.     

Psychosexual Dysfunction Among Gynecological Cancer Survivors

The purpose of this paper is to summarize the empirical findings related to the assessment and treatment of sexual difficulties commonly experienced by gynecological cancer survivors and to make suggestions for future research and practice in this area. First, we describe the sexual problems that are most frequently reported by gynecological cancer patients and some of their common medical and psychological correlates. These include pain, premature ovarian failure, changes in vaginal anatomy, emotional distress, body image, and sexual self-concept. The complex interaction of physiological and psychological variables plays an important role in the development of sexual dysfunction in this patient population. Furthermore, we review the empirical studies that have examined the effects of sexual rehabilitation therapy on the sexual functioning of gynecological cancer survivors and provide relevant research and clinical recommendations. We also discuss reasons to involve patients' sexual partners in psychosocial oncology research, given the complex interplay between patients' and partners' psychosexual issues.     

Relationship factors in the treatment of sexual dysfunction

The role of marital harmony in the development, assessment and treatment of sexual dysfunction is addressed in the present study. Twelve couples with mixed sexual dysfunctions received both sex therapy and marital therapy in a balanced cross-over design. The major variables investigated were therapy outcome on measures of sexual satisfaction and marital adjustment as a function of treatment modality (sexual or marital) and relationship functioning. Findings showed significant differences in outcome between treatment approaches with a strong mediating effect of relationship factors. Limited interpersonal understanding and inaccurate perceptual agreement in relationship functioning characterized those couples who failed to exhibit a differential response to treatment in favour of sex therapy over marriage therapy. Implications of these findings for the assessment and treatment of sexual dysfunction are discussed.     

Children's influence in the marital relationship.

In a 3-wave longitudinal study, the authors tested hypotheses regarding children's influence on the marital relationship, examining relations between interparental discord and children's negative emotional reactivity, agentic behavior, dysregulated behavior, and psychosocial adjustment. Participants were 232 cohabiting mothers and fathers who completed questionnaires and a marital conflict resolution task. Consistent with theory, interparental discord related to children's negative emotional reactivity, which in turn related to children's agentic and dysregulated behavior. Agentic behavior related to decreases in interparental discord, whereas dysregulated behavior related to increases in discord and elevations in children's adjustment problems. Person-oriented analyses of agentic and dysregulated responses indicated distinct clusters of children linked with meaningful individual differences in marital and psychosocial functioning. Results are discussed in terms of possible mechanisms of child effects, such as increased parental awareness of children's distress potentially leading to reduced marital conflict.     

Daily hassles,marital functioning and psychological distress among community-dwelling older couples

ObjectivesThis study attempts to examine the association between stress induced by daily hassles, marital functioning and psychological distress among a sample of older couples living at home without assisted living facilities. Moreover, the study looks to assess the moderator role of marital functioning on the association between stress and psychological distress.MethodsThe study included a representative sample of 508 older couples living at home where at least one spouse was aged 65 years or older. To take into account of the non-independence of the data, dyadic analyses were conducted.ResultsFor men, marital functioning and stress induced by daily hassles explained the variance of psychological distress 4.71% and 2.56% respectively. For women, these variables explained 10.96% and 2.43% respectively of this variance. Results found also that marital functioning can play a protective role between the association of stress and psychological distress among men, but not for women. Men with lower marital functioning present a significant higher level of psychological distress when they present stress than those who do not have stress. For those with high marital functioning, no significant differences have been found on psychological distress between those groups.ConclusionStress induced by daily hassles and marital functioning are significantly related to psychological distress among older people, and, for men, marital functioning can play a protective role in the association between those variables.     

Are Transgender Persons at Higher Risk for HIV Than Other Sexual Minorities? A Comparison of HIV Prevalence and Risks

SUMMARY

Recent studies have shown that transgender people are at high risk for HIV. Few studies, however, have directly compared the HIV risks and sexual health of transgender persons with that of other sexual minority populations. This study used baseline data of intervention studies targeting transgender persons, men who have sex with men, and women who have sex with women and men to compare their HIV risk behavior and sexual health. No significant differences were found between transgender persons and nontransgender men or women in consistent condom use or attitudes toward condom use. Transgender persons were less likely to have multiple partners and more likely to be monogamous than men who have sex with men; no differences were found between transgender persons and the women in this respect. When combining data on condom use, monogamy, and multiple partners, transgender persons did not differ from either nontransgender group in their overall risk for HIV. Transgender persons were less likely than the men or the women to have been tested for HIV. With regard to HIV prevalence, 17% of the men compared to only one transgender person and none of the women reported being HIV-positive. Transgender persons were also less likely than men who have sex with men to use drugs; no differences were found in the use of alcohol. However, with regard to mental health, transgender persons were more likely than the men to have experienced depression and more likely than men or women to have considered or attempted suicide. Finally, transgender persons reported the lowest levels of support from family and peers. Thus, in our sample, transgender persons appear to be at lower risk for HIV but at higher risk for mental health concerns than men who have sex with men. Remarkably few differences were found between transgender persons and women who have sex with women and men-a finding which might reflect the impact of social stigma on sexual health and have implications for the design of future HIV/STI prevention efforts.     

Feelings Matter: Depression Severity and Emotion Regulation in HIV/STI Risk-Related Sexual Behaviors

Human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention models may not address psychological complexities among adolescents with mental illnesses. This study examined contextual factors related to HIV/STI risk among heterosexually active Black adolescents with mental illnesses to inform the development of targeted HIV/STI prevention strategies. Black adolescent males and females (aged 14–17) were recruited from outpatient mental health programs in Philadelphia, PA to complete a computer-assisted personalized interview on sociodemographics, sexual behaviors, and emotion regulation (N?=?53). Two sample t-tests, Wilcoxon Rank Sum tests and regression modeling were used to examine differences in the study measures by gender and relationship status. Reports of sexual partner concurrency were high—both while already in a sexual relationship (67.3%) and multiple sexual partners in the same day (42.3%). Boys reported significantly more risk behaviors than girls. Sadness dysregulation predicted currently being in a relationship, older age at first oral sex, fewer vaginal sexual partners and fewer unprotected oral sexual encounters. Coping difficulties predicted a greater number of vaginal and oral sexual partners, and a lower age at first vaginal sex. Increasing depression severity was related to older age at first vaginal sex, fewer vaginal sexual partners and fewer unprotected oral sexual encounters in the past 3 months. This formative work suggests that coping mechanisms should be addressed in HIV/STI prevention research through the inclusion of activities targeted toward emotion regulation and decreasing sexual risk behaviors. Psycho-education and skills building may mitigate the psychopathology that contributes to HIV/STI risk in the target demographic.     

Childhood Sexual Assault,Quality of Life,and Psychiatric Comorbidity in Veterans With Military and Civilian Sexual Trauma

Veterans with military sexual trauma (MST) are at risk for a variety of psychiatric conditions, including posttraumatic stress disorder (PTSD) and depression. Survivors of MST are also likely to experience diminished quality of life (QoL). Individuals with higher lifetime incidence of sexual trauma may also be at increased risk for poorer outcomes in QoL and psychiatric symptomatology. The differences in psychological sequelae among those who have experienced sexual trauma as children, and those whose sexual trauma exposure is limited to adulthood are relatively understudied. The majority of sexual trauma literature has focused primarily on civilian trauma, and comparatively few studies have specifically examined psychosocial sequelae (e.g., QoL) in veterans with MST. This study examined how childhood sexual abuse (CSA) affects overall QoL as well as severity of PTSD and depressive symptoms. Veterans who reported CSA had significantly greater depression symptom severity than veterans who did not. No significant differences in PTSD symptom severity or QoL were found between veterans who did and did not report CSA. Results highlight the need for further examination of the relationship between CSA and depression in veterans with MST-related PTSD who also report CSA.     

Feasibility,Acceptability, and Preliminary Outcomes of the Fortalezas Familiares Intervention for Latino Families Facing Maternal Depression

This pilot study examined the feasibility, acceptability, and preliminary outcomes of a linguistically and culturally adapted intervention for immigrant Latina mothers with depression and their families. Fortalezas Familiares (Family Strengths) is a community‐based, 12‐week, multifamily group intervention that aims to increase communication about family processes leading up to and affected by the mother's depression, build child coping and efficacy, enhance parenting competence and skills, and promote cultural and social assets within the family. In terms of feasibility, of 16 families who enrolled and participated in the intervention, 13 families attended more than 90% of meetings and completed the intervention. Posttests reported positive changes following the intervention, including improved psychological functioning, increased family and marital support, and enhanced family functioning, as reported by mothers and other caregivers. Mothers also reported decreased conduct and hyperactivity problems among their children. Children reported positive changes in their psychological functioning and coping, parenting warmth and acceptance, and overall family functioning. Postintervention focus groups and surveys measuring acceptability revealed families' satisfaction with the intervention and suggested areas of improvement. We discuss similarities and differences in outcomes between the adapted intervention, Fortalezas Familiares, and the original intervention, Keeping Families Strong, and propose future areas of intervention adaptation and development.     

The Role of Life Stress and Social Support in the Adjustment of Sexually Victimized Pregnant and Parenting Minority Adolescents

Associations among sexual victimization and the psychosocial functioning of African American and Latina pregnant and parenting adolescents were examined. Forty-seven (17.7%) of the 265 participants reported histories of sexual victimization, most of which was unwanted sexual intercourse. The victimized adolescents reported higher levels of depression, anxiety, and life stress and, although the two groups reported no differences in their levels of social support, support was found to be differentially related to depression and anxiety in the two groups. In particular, victims derived benefits from social support at low levels of stress, but social support provided no protection against depression and anxiety at average or high levels of stress. For nonvictims, social support provided no benefits at low levels of stress, but protected against depression and anxiety at moderate levels of stress and against depression at high levels of stress. Implications of these findings for research, theory, and intervention are discussed.     

The relationship of sexual adjustment and related sexual behaviors and attitudes to marital adjustment

Abstract

This paper examines the extent of relationship between sexual adjustment and marital adjustment for 30 married couples followed for 3–6 months. Sexual adjustment was assessed by means of the LoPiccolo-Steger Sexual Interaction Inventory, and two other measures termed a Couple Interaction Scale (CI) and a Couple Compatibility Ratio (CCR). Marital adjustment was assessed by means of the Locke-Wallace Marital Adjustment Scale (L-W MAS) and a clinically-devised instrument based on the extent of support between the marital partners. The two marital adjustment instruments agreed closely. A high degree of association was obtained between most of the sexual adjustment measures and the two marital adjustment measures; using the most reliable of these measures, it is estimated that sexual adjustment contributed between 40 % and 55 % of the variance in marital adjustment. This association was not due to a specific stage of. the human sexual response cycle of desire, excitement, orgasm and gratification. Intercorrelation of measures of each of these stages with the marital adjustment measures generally yielded significant relationships.     

Family Functioning Moderating the Effects of Childhood Sexual Abuse on Memory Specificity

The main goal of this study was to investigate if adults sexually abused as children who were raised in a functional family are more able to generate specific autobiographical memories and suffer fewer depressive symptoms than sexually abused adults who were raised in a dysfunctional family. We found that abused males retrieved fewer specific memories than nonabused males, abused females, and nonabused females. The three latter groups did not differ from each other. Further, childhood sexual abuse did not predict depression among males and females. After accounting for family functioning, there were no group differences regarding memory specificity. Functional families appear to have beneficial effects on the adjustment of male victims of childhood sexual abuse.     

Psychological Aspects of Tinnitus: A Comparison With Hearing Loss and Ear,Nose and Throat Disorders

Abstract

It is well established that tinnitus is sometimes associated with marked psychological distress, including anxiety and depression. As yet, however, it is unclear whether the problems are specific to tinnitus or may occur in other hearing disorders too. A total of 95 patients with tinnitus were compared with 73 people with hearing loss but no tinnitus, and with a further 80 people attending an out-patient clinic for a variety of other ear, nose and throat (ENT) problems. The principal measures were the Hospital Anxiety and Depression Scale and the Eysenck Personality Questionnaire. The tinnitus patients were significantly more anxious, depressed, and neurotic than the hearing loss group, but were equivalent to the ENT group; and, like the hearing loss group, they were significantly less extraverted than the ENT controls. There were no differences between tinnitus patients with severe hearing loss, mild hearing loss, and no hearing loss. Results from Hallam's Short Tinnitus Questionnaire revealed that tinnitus patients without hearing loss reported significantly fewer difficulties with auditory perception than either of the other tinnitus groups, and significantly fewer irrational beliefs than the group with severe hearing loss. It is concluded that patients with tinnitus were more distressed than people with hearing loss, but that their distress was shared by patients with a variety of other ENT problems. People who reported the greatest problems with their tinnitus were generally those who also had severe hearing loss.