Marital role strain,illness intrusiveness,and their impact on marital and individual adjustment in end-stage renal disease

Abstract

A marital role theory approach was used to investigate individual psychosocial well-being and marital adjustment in 89 end-stage renal disease (ESRD) patients and their spouses. Four different patient groups were selected according to a continuum of clinical milestones in the treatment of ESRD, including pre-dialysis (n=17), incenter dialysis (n=18), home dialysis (n=19), and posttransplant patients (n=17). A nephrology clinic control group (n=18) was also included. Standardized instruments were employed to investigate marital role strain (Marital Role Questionnaire, KDS-15), marital adjustment (Locke-Wallace Marital Adjustment Test), subjective well-being (Affect Balance Scale, Rosenberg Self-Esteem Inventory), and psychopathology (Symptom Checklist 90-R). Hierarchical multiple regression analyses provided strong and consistent support for the major hypotheses relating elevated marital role strain to compromised marital adjustment and individual well-being. Further analyses demonstrated that increased perceived intrusiveness of ESRD was significantly related to greater marital role strain, poorer marital adjustment, and decreased individual well-being. This is consistent with the idea that perceived intrusiveness may be an important mediator of marital role strain and of coping with chronic illness. “Objective” intrusiveness, defined in terms of patient group, was not significantly related to marital or individual well-being. These findings support a dyadic approach to the psychosocial study of chronic illness.     

Assessment of factors in marital adjustment

The present study sought to assess important factors in marital adjustment and their interrelatedness. The explored factors were (a) sexual satisfaction and adjustment, (b) verbal and nonverbal communication, and (c) several demographic variables (e.g., age and number of years married). Marital adjustment was found to be significantly related to verbal and nonverbal communication, but not to sexual satisfaction and adjustment. Demographic variables were not found to be related to marital adjustment, but some were significant predictors of verbal and nonverbal communication and sexual satisfaction and adjustment. The implications of these findings for assessment and intervention in marital and sexual counseling and for future research are discussed.     

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.     

Romantic relationships in early adulthood: Influences of family,personality, and relationship cognitions

Two hundred and sixty‐five participants and their romantic partners were involved in a prospective, longitudinal, and multimethod study during the transition from adolescence to adulthood. Guided by the development of the early adult romantic relationships (DEARR) model (Bryant & Conger, 2002), the research (a) investigated mid‐adolescent family experiences and individual differences in personality as predictors of qualities in the early adult romantic union and (b) evaluated the degree to which marital beliefs mediated these associations. Structural equation modeling partially supported the mediating effects of marital beliefs. The findings were generally consistent with the DEARR model, suggesting that it is informative to study early adult romantic relationship functioning within a developmental‐contextual framework, while simultaneously considering the unique effects of personality and relationship cognitions.     

Children's Adjustment to Parental Physical Illness

We review recent empirical literature examining the impact of parent physical illness on child functioning. We review studies of illness characteristics (n = 16), individual characteristics (n = 6), and family characteristics (n = 6). Although children's self-reports indicate heightened distress, parental reports do not suggest more problematic functioning. Child adjustment appears to be more closely related to perceptions of stressfulness rather than to objective illness severity indices. Adolescent girls seem to represent a group at heightened risk. Preliminary results suggest that family variables such as cohesion, conflict, and individual and family coping styles are important predictors of child adjustment.     

Infertility and Adjustment in Women: The Effects of Attachment Style and Social Support

The moderating effects of two psychological resources—attachment style and perceived social support—on adjustment were studied in 109 infertile women, examining the effects of duration of infertility and of primary (the woman has no child of her own) versus secondary (the woman already has a child of her own) infertility. Subjects were administered questionnaires measuring marital adjustment, psychological distress, and well-being. A model viewing attachment style and social support as moderators between stress psychological well-being was explored. The results showed that among the objective characteristics, only duration of infertility had any impact on the psychological measures. Furthermore, the psychological resources were highly associated with the adjustment scores in general. A hierarchical regression analysis showed that attachment style and social support both were related to marital quality and to psychological well-being and that these two resources function as stress moderators. It was concluded that attachment style and social support are important resources for individuals in times of stress, as exemplified in the infertility situation.     

A situational analysis of the relationship between spouse-specific assertiveness and marital adjustment

This study examined the relationship between marital adjustment and spousespecific assertiveness, conceptualized in terms of defense of rights, in a sample of 115 married women, 27 of whom were in a distressed marriage. Subjects indicated their likely behavioral responses in 11 commonly occurring marital conflict situations and provided ratings of the expected effectiveness of their responses, the amount of resentment they would experience in the situations, and the frequency of occurrence of the situations in their marage. Marital adjustment was found to be directly related to response effectiveness and level of assertive responding and inversely related to situational resentment and frequency of transgression by spouse. Surprisingly, the level of assertive responding was less strongly related to marital adjustment than were any of the other principal variables. A multiple regression analysis indicated that the set of experimental variables accounted for 45% of the variance in marital adjustment. All of the principal variables uniquely accounted for significant levels of variance in marital adjustment. Viewed collectively, the results of this study indicate that (1) parameters of marital conflict situations have considerable importance for the marital adjustment of women and (2) explication of the relationship between marital conflict and marital adjustment requires investigation of a variety of behavioral, affective, and contextual variables.     

On the Role of Mental Health Activities for Teachers’ Work and Life

Everyday behavior is getting increasingly attention, both in the prevention of mental impairment and the promotion of mental health – within and beyond the work context. The present study aimed to identify the importance of mental health activities for well-being and positive functioning of teachers, while taking affectivity into account. Teachers are confronted with various stressors, and identifying predictors of teachers’ well-being and positive functioning is important, not only for teachers’ personal health, but also for their students’ well-being and achievement. Based on the Broaden and Build (B&B) theory and Conservation of Resources (COR) theory, we assumed that (1) the practice of mental health activities is associated with well-being (i.e., positive mental health) and positive functioning (i.e., healthy and unhealthy work-related behavior and experiences), and that (2) mental health activities mediate the association between affectivity and the respective outcomes. These assumptions were tested in a sample of 326 German teachers (75% female, age: M = 44, SD = 11.85). The practice of mental health activities was associated with more positive mental health, more healthy work-related behavior and experiences, and less unhealthy work-related behavior and experiences. Moreover, mental health activities partly explained the relationship between affectivity and the respective outcomes. The present findings indicate the potential of mental health activities for mental health promotion in teachers but future studies are recommended in order to establish causal effects.

     

Perceived Criticism and Marital Adjustment Predict Depressive Symptoms in a Community Sample

Depressive symptoms are related to a host of negative individual and family outcomes; therefore, it is important to establish risk factors for depressive symptoms to design prevention efforts. Following studies in the marital and psychiatric literatures regarding marital factors associated with depression, we tested two potential predictors of depressive symptoms: marital adjustment and perceived spousal criticism. We assessed 249 spouses from 132 married couples from the community during their first year of marriage and at three time points over the next 10 years. Initial marital adjustment significantly predicted depressive symptoms for husbands and wives at all follow-ups. Further, perceived criticism significantly predicted depressive symptoms at the 5- and 10-year follow-ups. However, at the 1-year follow-up, this association was significant for men but not for women. Finally, a model where the contributions of marital adjustment and perceived criticism were tested together suggested that both play independent roles in predicting future depressive symptoms. These findings highlight the potential importance of increasing marital adjustment and reducing perceived criticism at the outset of marriage as a way to reduce depressive symptoms during the course of marriage.     

Work-related Stress,Self-efficacy,and Well-being of Female Clerical Workers

This study examines individual differences (self-efficacy, marital status) and environmental factors (work stressors, personal and work supports) as predictors of two measures of well-being (trait anxiety and work performance). The data were collected from 56 female clerical workers employed by a large university. Multiple regression analyses showed that individual differences and environmental factors were significant predictors of well-being. For the criterion variable trait anxiety, self-efficacy and perceptions of work stress significantly contributed to the explained variance. However, the relationship between work stress and trait anxiety was greater for single than for married women. Self-efficacy and perceptions of work stress also predicted work performance impairment; that is, women with diminished selfefficacy and high work stress tended to report greater impairment of work performance. These results are discussed in relation to an individual counseling approach to the study and remediation of work-related stress for female clerical workers.     

Adolescent Adjustment to Perceived Marital Conflict

The cognitive-contextual framework of Grych and Fincham (1990) and the emotional-security framework of Davies and Cummings (1994) were used to explore both the direct and indirect pathways between marital conflict and adolescent adjustment. Two hundred and three non-clinic adolescents (114 females and 89 males) from intact families completed self-report questionnaires concerning their adjustment behavior, perceptions of parental conflict, and attachment to parents and peers. Marital conflict was found to have a direct effect upon adolescent adjustment, with adolescents from high-conflict homes displaying greater adjustment difficulties. Indirect effects of conflict were evident through both the adolescents' cognitive appraisals of conflict, and the adolescents' perceptions of the parent-child relationship. Differential gender effects were obtained, highlighting the importance of adolescent gender as a mediating variable. These findings were used to propose that an integrated, cognitive-emotional framework might be necessary to fully understand the conflict/adjustment relationship.     

A Mixed-method Study of Individual,Couple, and Parental Functioning During the State-regulated COVID-19 Lockdown in Spain

During the recent COVID-19 outbreak in Spain, we explored the individual and relational well-being of people confined together with their partners and/or children during the first 3 weeks of state-regulated lockdown. Adults 18 years or older (N = 407) completed an online survey that included demographic, household, and employment information along with standardized measures of psychological distress (State-Trait Anxiety and Beck Depression) and relationship functioning—either the Dyadic Adjustment Scale if there were no children in the household or a Basic Family Relations Evaluation Questionnaire (CERFB) measuring conjugal, parental, and coparental functions. Qualitative analyses of responses to an open-ended question about perceived changes in couple or family dynamics during lockdown revealed nine specific themes comprising two overarching categories: relational improvement and deterioration. The overall prevalence of improvement themes (61.7%) exceeded deterioration themes (41.0%), with increased (re)connection and conflict atmosphere cited most often. Quantitative analyses found elevated levels of state anxiety but not trait anxiety or depression during lockdown. Consistent with the qualitative results, couples having no children at home reported high levels of dyadic adjustment, but with children present CERFB parental functioning exceeded conjugal functioning, a pattern sometimes associated with child triangulation into adult conflicts. Although correlates of psychological distress (e.g., unemployment, perceived economic risk) were relatively stable across subgroups, predictors of relationship functioning varied substantially with household/parental status (e.g., telecommuting and employment facilitated conjugal functioning only for couples with children).     

Prospective associations from family-of-origin interactions to adult marital interactions and relationship adjustment.

To test the social learning-based hypothesis that marital conflict resolution patterns are learned in the family of origin, longitudinal, observational data were used to assess prospective associations between family conflict interaction patterns during adolescence and offspring's later marital conflict interaction patterns. At age 14 years, 47 participants completed an observed family conflict resolution task with their parents. In a subsequent assessment 17 years later, the participants completed measures of marital adjustment and an observed marital conflict interaction task with their spouse. As predicted, levels of hostility and positive engagement expressed by parents and adolescents during family interactions were prospectively linked with levels of hostility and positive engagement expressed by offspring and their spouses during marital interactions. Family-of-origin hostility was a particularly robust predictor of marital interaction behaviors; it predicted later marital hostility and negatively predicted positive engagement, controlling for psychopathology and family-of-origin positive engagement. For men, family-of-origin hostility also predicted poorer marital adjustment, an effect that was mediated through hostility in marital interactions. These findings suggest a long-lasting influence of family communication patterns, particularly hostility, on offspring's intimate communication and relationship functioning.     

The role of need fulfillment in relationship functioning and well-being: a self-determination theory perspective

Self-determination theory posits 3 basic psychological needs: autonomy (feeling uncoerced in one's actions), competence (feeling capable), and relatedness (feeling connected to others). Optimal well-being results when these needs are satisfied, though this research has traditionally focused on individual well-being outcomes (e.g., E. L. Deci & R. M. Ryan, 2000). Three studies examined the role of need fulfillment in relationship functioning and well-being. Study 1 found that fulfillment of each need individually predicted both individual and relationship well-being, with relatedness being the strongest unique predictor of relationship outcomes. Study 2 found that both partners' need fulfillment uniquely predicted one's own relationship functioning and well-being. Finally, in Study 3, the authors used a diary recording procedure and tested a model in which the association between need fulfillment and relationship quality was mediated by relationship motivation. Those who experienced greater need fulfillment enjoyed better postdisagreement relationship quality primarily because of their tendency to have more intrinsic or autonomous reasons for being in their relationship.     

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.     

Social Anxiety, Emotional Intelligence, and Interpersonal Adjustment

There has been no published investigation made of the relationship between social anxiety and emotional intelligence (EI), or of their shared impact upon interpersonal adjustment. This study examined these questions using structural equation modeling with self-report data from a large nonclinical sample (N = 2629). EI was found to be highly related to social interaction anxiety, but not performance anxiety. A model permitting these three predictors to inter-correlate indicated that the EI factor was the dominant predictor of interpersonal adjustment, substantially reducing the unique contribution made by interaction anxiety. This pattern reflected the principal contributions made to interaction anxiety by the interpersonal and, particularly, intrapersonal domains of EI.     

家庭功能：理论、影响因素及其与青少年社会适应的关系

该文综述了中西方近20年有关家庭功能的定义、理论、影响因素及家庭功能与青少年社会适应关系的研究进展。有关家庭功能的理论可以分为两大类：以家庭发展结果为取向和以家庭发展过程为取向的家庭功能理论。现有研究主要探讨了家庭结构、社会经济地位、家庭关系、发展阶段、生活事件等对家庭功能的影响,并发现家庭功能与青少年的社会适应有着非常密切的关系。文章最后分析了已有家庭功能理论及相关研究的不足,并指出了未来家庭功能领域的研究方向。     

Mothers' and Fathers' Psychological Symptoms and Marital Functioning: Examination of Direct and Interactive Links with Child Adjustment

A community sample of 51 mother-father dyads with a school-age child rated marital functioning, parental psychological symptoms, and children's adjustment problems. Parents with more psychological symptoms reported lower marital satisfaction levels. Mothers' and fathers' marital functioning and symptomatology individually related to children's adjustment in the expected directions. In addition, interaction tests revealed that, for mothers but not fathers, the combination of poorer marital functioning and higher levels of psychological symptoms amplified the negative effects on children's adjustment problems. These findings support the hypothesis that parental psychopathology and marital adjustment together affect children's functioning in an interactive way, underscoring the need to consider multiple family influences in studies of child development.     

How self-enhancers adapt well to loss: the mediational role of loneliness and social functioning

Objective: The tendency toward unrealistically optimistic self-serving biases, known as trait self-enhancement, has been associated with both adaptive benefits and negative social consequences. This study explored these potential benefits and costs in the context of conjugal bereavement. Method: The study included 94 individuals who had experienced the death of a spouse 1.5–3.0 years prior. The sample (62 female, 32 male) ranged in age from 37 to 60 (M = 51.45, SD = 6.08). To examine benefits, we used relatively objective measures of overall adjustment: structured clinical interviews and ratings from participants’ close friends and relatives. To examine social adjustment, we examined friends’/relatives’ ratings of the quality of social interactions and the possible mediating roles of perceived loneliness and friend/relative ratings. Results: Trait self-enhancement was uniformly associated with positive adjustment: relatively lower symptom totals, and friend/relative ratings of both overall better adjustment and better social adjustment. Self-enhancers’ low loneliness was found to mediate reduced symptoms. Also, friends’/relatives’ ratings of social functioning appeared to mediate self-enhancers’ reduced loneliness. Conclusions: These findings provide further empirical data to challenge the longstanding assumption that inaccurate self-perception is inherently maladaptive. Authentic benefits may result from mistaken perceptions of oneself by influencing the experience of loneliness and how one is seen by close friends/relatives. Self-enhancement may be an adaptation that provides clinically relevant advantages.     

Stability and predictability of quality of women's marital relationships and demoralization

This longitudinal study was motivated by cross-sectional, clinical, and survey research on marital relationships and individual well-being. Perceptions of husbands' behavior toward themselves and self-reports of demoralization were collected from 51 low-income women during their children's kindergarten year and 3 years later. Longitudinal correlations of specific components and aggregated scores of perceptions of husbands' behavior and of demoralization revealed significant stability. Both initial and later marital relationship scores had higher correlations with later than with initial demoralization scores. Longitudinal correlations and multiple regression analysis supported the hypothesis that initial marital relationship would predict later demoralization. Quality of perceived marital relationship apparently has different immediate and long-term effects on components of individual adjustment. Integrated longitudinal studies of relationships and personality and their intercorrelations are needed to understand stability and change in adult personality and well-being.