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.     

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.     

Environmental threat influences psychological distress and marital satisfaction among avoidantly attached individuals

This research examined the impact of stressful environments on marital relationships. In all, 133 Israeli couples exposed to different levels of terror threat and political uncertainty completed measures of attachment orientation, psychological distress, and marital satisfaction. Results indicated that in low‐threat areas, spouses high on attachment avoidance did not express distress despite their marital dissatisfaction. In contrast, in high‐threat areas, spouses high on attachment avoidance exhibited greater psychological distress, and psychological distress mediated the relation between attachment avoidance and marital dissatisfaction. Psychological distress only partially mediated the relation between attachment anxiety and marital dissatisfaction in the entire sample. The discussion stresses the importance of considering attachment dimensions when studying the effects of external stressors on marital relations.     

The Family Environment in Chronic Pain Patients: Comparison to Controls and Relationship to Patient Functioning

Operant and cognitive-behavioral models of chronic pain have called attention to the importance of examining the marital and family environments of chronic pain patients. In this study, 50 chronic pain patients and their spouses and 33 control participants and their spouses completed measures of the family environment, marital satisfaction, and patient physical and psychological functioning. Patients' overt pain behaviors were coded from videotapes of patient–spouse interactions. Compared to controls, pain patients and their spouses rated their family environments as lower in cohesion and higher in control, and there was a trend for spouses to report more marital dissatisfaction. Chronic pain patient depression was associated negatively with patient-rated family cohesion and expressiveness and spouse-rated family organization and positively with patient-rated family conflict. Overt patient pain behaviors and spouse-rated patient disability were related negatively to spouse-rated family cohesion. Spouse marital satisfaction was associated negatively with patient depression and with spouse ratings of patient disability and pain behaviors.     

Protective buffering and psychological distress among couples coping with breast cancer: The moderating role of relationship satisfaction.

This study examined whether the association between protective buffering and psychological distress was moderated by relationship satisfaction. Protective buffering is defined as hiding worries, denying concerns, and yielding to one's partner in an effort to avoid disagreement and reduce one's partner's upset and burden. Two hundred thirty-five women diagnosed with early stage breast cancer and their partners completed measures of protective buffering, psychological distress, and relationship satisfaction at 3 time points over an 18-month period after cancer diagnosis. The authors hypothesized that protective buffering would result in more distress among patients and partners reporting higher relationship satisfaction than among patients and partners reporting lower levels of relationship satisfaction. Patients' protective buffering predicted more distress among patients rating their relationships as more satisfactory, whereas the patients' buffering did not predict distress among patients rating their relationships as less satisfactory. Partner relationship satisfaction also moderated the association between patients' buffering and partners' distress. These findings elucidate conditions under which protective buffering may have detrimental effects.     

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.     

Perceived control, coping efficacy, and avoidance coping as mediators between spouses' unsupportive behaviors and cancer patients' psychological distress.

This study examined whether avoidance, coping efficacy, and perceived control mediate the effects of spouses' unsupportive behaviors on patient psychological distress among 191 married individuals enrolled in cancer treatment. Results of the structural equation analyses suggested that avoidance and coping efficacy mediated the relationship between spouses' unsupportive behaviors and patient psychological distress. Perceived control of emotional aspects of the illness, including emotional responses and relationships with family and friends, and perceived control of the medical course of the cancer did not mediate the relationship between spouses' unsupportive behaviors and patient psychological distress. These findings suggest 2 mechanisms to explain why unsupportive responses from spouses may be associated with psychological distress among cancer patients.     

Marital Satisfaction: A Validation Approach

It was hypothesized that the desire for equity in relationships and the desire for validation from significant others are common human concerns which affect marital relationship satisfaction. Sixty married couples completed a series of questionnaires which assessed equity in 23 areas of the marital relationship, global equity in the marital relationship, relationship satisfaction, perceptions of relationship stability, understanding from spouse, validation from spouse, assistance from spouse in intellectual and emotional growth, frequency of stimulating conversations between the marital pair, frequency of affectionate touching from spouse, and sexual satisfaction in the marital relationship. Subjects who felt validated by their spouses reported more relationship satisfaction, greater relationship stability, more assistance from their spouses in intellectual and emotional growth, and greater sexual satisfaction than did subjects who did not feel validated by their spouses. Overall, equitably treated subjects reported more relationship satisfaction, greater relationship stability, more assistance from spouse in emotional growth, greater sexual satisfaction, and a greater frequency of affectionate touching from their spouses than did inequitably treated subjects. However, these differences between equitably treated and inequitably treated subjects applied primarily to non-validated subjects.     

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.     

Negative representations of the self/spouse and marital distress

The link between marital distress and negative representations of both the self and the spouse was examined with data from an initial sample of 538 married couples studied over the first four years of marriage (Study 1) and 98 of these couples studied in their tenth year of marriage (Study 2). Findings from Study 1 indicated that, for both husbands and wives, representations of the self and representations of the spouse accounted for unique variability in distress. Across spouses, representations of the spouse accounted for more of the variability in distress than did representations of the self. Cross–spouse effects were especially pronounced for husbands such that their distress was linked to wives’ representations. Findings from Study 2 with self/spouse measures anchored to the marital context replicated this pattern. Findings support the view that marital distress is uniquely influenced by models of both the self and the spouse, that representations of the self and the spouse are dynamic relationship schemas, that models of the self and the spouse can be meaningfully assessed within the marital context, and that negative representations of the spouse—particularly those of wives—are especially diagnostic of marital distress.     

The impact of psychological distress on absence from work

The aims of this study were to examine the impact of psychological distress on absence from work; to compare psychological distress and job satisfaction as predictors of absence; and to compare the relative effects of 2 components of psychological distress, depression and anxiety, on absence. Organizational records of absence over a 3-year period were obtained for 323 health service staff in the United Kingdom, who also completed self-report measures of psychological distress and job satisfaction at the beginning of the study and 2 years later. Psychological distress, particularly depression, was found to predict absence, with higher levels of distress predicting a greater number of days and number of times absent. Job satisfaction and psychological distress independently predicted levels of absence. The psychological distress-absence relationship was not moderated by demographic variables.     

Psychological symptoms and marital satisfaction in spouses of Operation Iraqi Freedom veterans: relationships with spouses' perceptions of veterans' experiences and symptoms

Much research has shown that spouses of combat veterans with posttraumatic stress disorder (PTSD) have higher rates of psychological and marital distress than do spouses of veterans without PTSD; however, very few studies have examined potential mechanisms of this increased vulnerability. The current study examined spouses of National Guard soldiers recently returned from deployments in Iraq. In addition to documenting elevated levels of psychological symptoms in these spouses, the authors found that spouses experienced greater symptom severity when they perceived high levels of symptoms in soldiers but the soldiers endorsed low levels of symptoms. Furthermore, spouses' marital satisfaction was negatively linked to soldiers' self-reported symptom severity only when spouses perceived that soldiers had experienced low levels of combat activity while deployed. When spouses perceived high levels of such activity, soldiers' self-reported symptoms had no relationship with spouses' marital satisfaction. These findings highlight the importance of interpersonal perceptions in intimate relationships and are consistent with the notion that uncontrollable attributions for a relative's mental health problems may provide a buffer against relationship distress. (PsycINFO Database Record (c) 2008 APA, all rights reserved).     

Does who you marry matter for your health? Influence of patients' and spouses' personality on their partners' psychological well-being following coronary artery bypass surgery

Research suggests that presurgical personality attributes influence postsurgical well-being in both patients and their spouses in the context of coronary artery bypass grafting (CABG) surgery. The authors hypothesized that a spouse's characteristics would influence a partner's psychological well-being, regardless of whether he or she was the patient or the caregiver. In this study, 111 male patients and their caregiver spouses completed measures of neuroticism, optimism, perceived marital satisfaction, and depression prior to elective CABG. Follow-up was conducted at 18 months. As expected, higher caregiver presurgical neuroticism predicted higher patient depressive symptoms at follow-up, with caregiver's concurrent 18-month affect controlled for. Likewise, higher patient presurgical neuroticism predicted higher caregiver depressive symptoms at follow-up. Additionally, higher patient presurgical depressive symptoms and lower presurgical optimism contributed to greater caregiving burden. Relationship satisfaction moderated these effects. These results suggest that partners' personality traits are important determinants of both patients' and their caregiving spouses' well-being.     

Predictors of relapse in unipolar depressives: expressed emotion, marital distress, and perceived criticism

The predictive validity of expressed emotion (EE) and two conceptually related but more easily measured alternatives--marital distress, and patients' perceptions of criticism from spouses--were examined in a sample of hospitalized unipolar depressives. All three psychosocial variables were significantly associated with 9-month relapse rates. Expressed emotion and marital distress predicted the same proportion of variance in patients' outcomes. The single best predictor of relapse, however, was a patient's response to the question "How critical is your spouse of you?" Patients who relapsed rated their spouses as significantly more critical than did patients who remained well. Alone, the perceived criticism variable accounted for more of the variance in relapse rates than that explained by EE and marital distress combined. The results suggest that asking depressed patients how critical they believe their relatives are may facilitate the identification of individuals at high risk for relapse subsequent to hospital discharge.     

Ovarian cancer patients' psychological distress: the role of physical impairment, perceived unsupportive family and friend behaviors, perceived control, and self-esteem.

Although research has indicated that illness-related and interpersonal stress are associated with greater psychological distress among cancer patients, little empirical attention has been given to mechanisms that account for these relationships. In the present study, 2 mechanisms for the association between illness-related stress (physical impairment) and interpersonal stress (family and friend unsupportive responses) and psychological distress of 143 ovarian cancer patients were examined cross-sectionally. Separate structural equation models tested whether physical impairment impacted patients' distress via decrements in perceived control over their illness and whether unsupportive behaviors impacted patients' distress via decrements in patients' self-esteem. Results supported the proposed models and suggest that perceived control and self-esteem are 2 mechanisms for explaining how illness-related and interpersonal stress may be associated with psychological distress among women with ovarian cancer.     

Attribution processes in distressed and nondistressed couples: 4. Self-partner attribution differences

The importance of the self-other distinction for understanding the relation between attributions and marital satisfaction is examined in two studies. In Study 1, causal attributions for naturally occurring behavior by the self and spouse were investigated. Study 2 examined both causal and responsibility attributions for hypothetical behaviors. In both studies, the attributions of spouses seeking therapy were investigated in relation to those of happily married persons in the community. The results showed that self-other attribution differences varied as a function of marital distress. Nondistressed spouses showed a positive attribution bias by making more benign attributions for partner behavior as opposed to self-behavior, whereas distressed spouses showed a negative attribution bias by making less benign attributions for partner behavior than for self-behavior. These findings suggest that self-attributions may, in part, determine the impact of attributions for spouse behavior on marital satisfaction. The clinical relevance of the results and their implications for research on actor-observer attribution differences are outlined.     

A Cognitive Psychophysiological Model to Predict Functional Decline in Chronically Stressed Older Adults

The current study evaluated whether psychological distress (composite of depression, anxiety, vital exhaustion), inflammation (C-reactive protein, CRP) and cognitive function (Digit Symbol Test, DST) and their changes mediated the relationship between caregiver status and functional decline. Caregivers for spouses with Alzheimer’s disease were compared to demographically-similar non-caregiver spouses at study entry (T1), T2 (1 year later), and T3 (2 years after T1). Caregivers had greater functional impairment, higher distress scores, and poorer DST scores at all points of measurement and also showed functional decline. Non-caregivers did not demonstrate functional decline. Caregivers declined 85% faster than did non-caregivers. Regressions showed that after controlling for functional impairment at T1, illness, medication, and health behavior covariates, psychological distress at T1 and increases in CRP from T1 to T3 mediated the difference in functional decline. Moreover, after DST decline from T1 to T2 was entered in the model, caregiver status, psychological distress and increases in inflammation all showed reductions in their predictive importance. These findings suggest psychological distress and increases in inflammation may help explain why caregivers show greater functional decline than non-caregivers. However, the influences of these psychophysiological variables may be driven in part by cognitive decline prior to functional decline. This article is based upon an invited address, “Potential Hazards of Caring for a Loved One with Alzheimer’s Disease” given by the first author in recognition of the author’s receipt of the Association of Psychologists in Academic Health Centers 2005 Award for Distinguished Achievement in Research. The address was presented at the Annual meeting of the American Psychological Association, New Orleans, LA., August, 2006.     

When distress hits home: the role of contextual factors and psychological distress in predicting employees' responses to abusive supervision

We developed a model of the relationships among aggressive norms, abusive supervision, psychological distress, family undermining, and supervisor-directed deviance. We tested the model in 2 studies using multisource data: a 3-wave investigation of 184 full-time employees (Study 1) and a 2-wave investigation of 188 restaurant workers (Study 2). Results revealed that (a) abusive supervision mediated the relationship between aggressive norms and psychological distress, (b) psychological distress mediated the effects of abusive supervision on spouse undermining, (c) abusive supervision had a direct positive relationship with supervisor-directed deviance, (d) the positive relationship between psychological distress and spouse undermining was stronger for men as opposed to women, and (e) employees engaged in relationship-oriented occupations reported greater levels of abusive supervision and psychological distress. Implications for theory and practice are discussed.     

Spouses of Cancer Patients: A Review of the Literature

This article discusses the impact on the spouse when his or her partner is being treated for cancer. The disease is defined, treatment effects are outlined, and issues affecting the psychological and marital adjustment of spouses are described. Implications are offered for counselors who work with spouses of cancer patients.     

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.