Interactional patterns of bipolar patients and their spouses

This study examined the interactional patterns of eight bipolar patients (when manic and in remission) and their spouses by videotaping the couples' interactions and then quantifying those interactions using the Marital Interaction Coding system. These couples' interactions were compared to the interactions of eight happily and eight unhappily married nonbipolar psychiatric control patients and their spouses. The purposes were to determine (a) whether the interactional pattern between bipolar patients and their spouses changes or remains the same when the patient is in a manic vs. a nonmanic state and (b) how the interaction patterns of bipolar patients when manic and nonmanic compare to happily and unhappily married nonbipolar psychiatriccontrol patients. Significant differences in interactions were found between manic and nonmanic states, in addition to significant differences between these patients and the control groups. There were also expected differences between happily and unhappily married psychiatric control groups. Implications are discussed for marital therapy for manies that involves problemsolving and communication training.     

Social support and immune function among spouses of cancer patients

This study investigated whether social support was related to immune function among spouses of cancer patients. Effects of depression and negative life events were examined as potential mediators. Results showed evidence of greater immunocompetence on 2 of 3 dynamic measures: natural killer cytotoxicity and proliferation response to phytohemagglutinin among spouses who reported high levels of social support. All six components of social support assessed by the Social Provisions Scale (Cutrona & Russell, 1987) were strongly related to these indices of immune function. No evidence was found for mediation by either life events or depression.     

Getting in under the radar. A dyadic view of invisible support

There are many ways in which the provision of social support can be ineffective. Recent research suggests that the benefits of support may be maximized when it is provided invisibly. What remains unknown, however, is whether invisible support reflects the skillful behavior of support providers or recipients' blissful unawareness, as well as how invisible support is delivered during spontaneous social interactions. We hypothesized that both providers' skillful behavior and recipients' unawareness are necessary for invisible support to be effective, and we sought to document what effective invisible support looks like. Eighty-five couples engaged in a videotaped support interaction in the lab. Support recipients whose partners provided more invisible practical and emotional support (coded by observers) but who reported receiving less support experienced the largest preinteraction-to-postinteraction declines in negative emotions. In the case of practical invisible support, the combination of more support and less awareness of that support also predicted increases in self-efficacy. These results indicate that invisible support is a dyadic phenomenon.     

Bidirectional associations between hope,optimism and social support,and trauma-related symptoms among survivors of terrorism and their spouses

The study examined bidirectional relationships between three key resources of resilience: hope, optimism, and social support, and a range of trauma-related symptoms (posttraumatic stress disorder, depression, and anxiety) among injured survivors of terror attacks and their spouses (N = 210). A series of actor-partner interdependence models were used to test the bidirectional dyadic associations. The results demonstrate negative associations between resilience resources of the survivors and their spouses and their trauma-related symptoms. Further, the levels of hope and social support reported by the survivors were negatively associated with the trauma-related symptoms experienced by their spouses, whereas the level of optimism reported by the spouses was negatively associated with the trauma-related symptoms experienced by the survivors. Theoretical and clinical implications are discussed.     

Unraveling the daily stress crossover between unemployed individuals and their employed spouses

This study examined the dynamic relationship of distress levels between spouses when one is unemployed (and looking for a job) while the other is engaged in full-time employment. Using the diary survey method, we sampled 100 couples in China for 10 days and tested a model comprising three stress crossover mechanisms: the direct crossover, the mediating crossover, and the common stressor mechanisms. Results supported the direct crossover and common stressor mechanisms. Other stressors (e.g., work–family conflict and negative job search experience) were also related to distress of the unemployed individuals and their employed spouses. Additionally, we found a three-way interaction involving gender, marital satisfaction, and distress levels of employed spouses. We discuss how the study contributes to the unemployment and stress crossover literatures.     

Stress and coping strategies in spouses of depressed patients.

The relationships between the coping strategies used by spouses of clinically depressed patients and spouses' anxiety, depression, and marital maladjustment were investigated. Fifty spouses of clinically depressed patients completed a biographical questionnaire, the Coping Strategy Indicator (J. H. Amirkhan, 1990, 1994), the Beck Depression Inventory (A. T. Beck, 1967; A. T. Beck, C. H. Ward, M. Mendelson, J. Mock, & J. Erbaugh, 1961), the State-Trait Anxiety Inventory (C. D. Spielberger, R. E. Lushene, B. A. Vagg, & E. Jacobs, 1983), and the Locke-Wallace Marital Adjustment Test (H. J. Locke & K. M. Wallace, 1959, 1987). Anxiety was highly prevalent in the spouses; more than half were depressed, and half showed marital maladjustment. Significant positive correlations were found between an avoidant coping strategy and anxiety as well as depression, and a significant negative correlation was found between an avoidant coping strategy and marital adjustment. These findings indicate the ineffectiveness of an avoidant coping strategy for spouses of clinically depressed patients.     

Self-reported problems: a comparison between PTSD-diagnosed veterans,their spouses,and clinicians

This study investigated self-reported problems in a sample of help-seeking Vietnam veterans, comparing the veteran's own view with clinician and spouse perspectives, with the aim of examining convergence in reports across different informants. Veterans with PTSD (N = 459) were asked to list and rate their five most serious problems. Spouses and treating clinicians completed the same questionnaire in relation to the veteran. Rates of endorsement for each problem area, and levels of agreement between raters, were calculated. Veterans, spouses, and clinicians were all likely to rate anger as a high priority, with veterans also likely to nominate anxiety and depression. Spouses were likely to nominate more observable behavioural problems such as interpersonal difficulties and avoidance, while clinicians were likely to nominate indications of psychopathology, such as anxiety, depression, and intrusive thoughts. Agreement across raters was generally high, although interpretation of agreement levels was complex.     

A pilot study of an intervention for breast cancer survivors and their spouses

Recent studies have shown that interventions that increase breast cancer patients' communication with family members lead to reduced patient distress. In this article, we report on a treatment development and pilot study of an intervention for couples coping with breast cancer. In phase 1 of this study, 10 couples participated in two focus groups that generated ideas and themes for the intervention. In phase 2, we developed and pilot tested our intervention with 48 couples: 12 in a 2-session format, 21 in a 1-session format, and 15 in a non-experimental control group. Our response rate shows that breast cancer patients and spouses were willing to participate and that treatment providers were willing to refer patients and their spouses. The 2-session format showed the most promise for producing positive change in mental health functioning and cancer-related stress.     

Interaction of asthmatics and their spouses: A preliminary study of individual differences

Some asthmatics show evidence of airways reactivity triggered by strong emotions. Six case studies of married patients with severe asthma are reported. The videotaped interactions of the asthmatic and his/her spouse were coded for affect and behavior. Repeated measures of pulmonary function and affective state were recorded before and after two interaction tasks. Over the course of the experimental period, two patients' pulmonary function improved and four patients' deteriorated. In general, decreased pulmonary function was associated with more self-rated hostility and depression. The results are discussed in terms of their implications for the intra- and interpersonal factors that are important in asthma management.     

Drug-abusing patients and their intimate partners: dyadic adjustment, relationship stability, and substance use

The dyadic adjustment and substance use of couples with a drug-abusing husband (n = 94), couples with a drug-abusing wife (n = 36), couples in which both partners abused drugs (n = 87), and non-substance-abusing conflicted couples (n = 70) were examined. For couples with 1 drug-abusing partner, a higher percentage of days abstinent during the year before treatment for drug abuse was associated with a higher level of relationship satisfaction. When both partners abused drugs, the relationship between percentage of days abstinent and relationship satisfaction became stronger and more negative as the time partners spent together using drugs increased. A higher percentage of days abstinent was associated with relationship stability for couples with 1 drug-abusing partner during and 1 year after treatment; for couples in which both partners abused drugs, a higher percentage of days abstinent was associated with relationship instability.     

Risks and realities: dyadic interaction between 6-month-old infants and their mothers in opioid maintenance treatment

A number of studies point to methadone exposure in utero as a possible risk factor in the developing mother–infant relationship in the first year of life. This study is part of a larger, national follow-up of 38 infants prenatally exposed to methadone or buprenorphine and 36 comparison, low-risk infants. The aim of the present paper is to assess the quality of mother–infant relationship when the infants are 6 months old. Videotaped mother–infant interactions were rated in a global scale (NICHD). Maternal and infant contributions collapsed into the variables “infant style” and “maternal style” showed that the only factor making significant contribution to the outcome measure “dyadic mutuality” was maternal style. The importance of group membership (exposed versus non-exposed), was reduced when controlling for maternal drug use prior to opioid maintenance treatment (OMT), maternal depression and parenting stress as well as infants’ developmental status and sensory-integrative functions. This suggests that prediction of dyadic mutuality should be based on individual characteristics rather than group characteristics. These results support previous research findings that methadone and buprenorphine use per se does not have direct influence on the quality of early mother–infant relationship, but tailored follow-up procedures targeting drug-free pregnancies and parenting support are beneficial for women in OMT and their children.     

Marital attributions in spouses of depressed patients

Causal attributions (i.e., locus, stability, globality) and responsibility attributions (i.e., bad intent, selfish motivation, blame) were assessed in the spouses of 27 depressed psychiatric inpatients and 30 nondepressed dyads to test predictions derived from Hooley's (1987) symptom-controllability model of marital distress. Results indicated that (1) depressed patients and their spouses were less dyadically adjusted than nondepressed spouses, (2) causal and responsibility attributions about depressive behaviors predicted lower dyadic adjustment, and (3) attributions of causality mediated the relationship between group status (depressed or nondepressed) and dyadic adjustment among spouses who had higher expectations for their partner to change. Results suggest that among spouses with a high expectancy for change, depression may be a risk factor for marital distress.     

Distress in spouses of chronic pain patients

This paper critiques the research on distress in spouses of chronic pain patients and includes a review of two studies of spouses conducted at the Miriam Hospital Chronic Pain Research Unit. The clinical implications of this research are discussed and case material is presented to illustrate the role of spouse distress in the treatment of patients with chronic pain. Future directions for research in this area are recommended.The research conducted at the Miriam Hospital Chronic Pain Research Unit was supported by the Alcohol, Drug and Mental Health Administration of the National Institute of Mental Health, Small Grants Program, Grant No. 1 R03 MH39257001A1.     

Crossover between work and home in dyadic partner relationships

This study aimed at providing insight into the processes underlying crossover between "work" and "home" in dyadic partner relationships. Specifically, we examined to what extent husbands' work demands (work load and overtime hours) and psychological health (fatigue and depressive symptoms) "cross over" to their wives' home demands (home load) and psychological health. These associations were investigated among three couple groups, based on wives' working hours (i.e., more than 20 hours per week, from 1 to 20 hours per week, and not engaged in paid work) (253 couples in total). All husbands worked for at least 35 hours a week. Three possible crossover mechanisms were hypothesized: (i) time-based, (ii) strain-based, and (iii) empathy-based crossover. The results partially supported mechanisms (i) and (ii): when husbands reported higher work load (mechanism i) and more psychological health complaints (mechanism ii), their wives experienced higher home load. The results further supported mechanism (iii) that wives' and husbands' psychological health were associated. It is concluded that crossover from husbands to wives may occur through various mechanisms.     

The effects of perceived social support on quality of life in patients awaiting coronary artery bypass grafting and their partners: testing dyadic dynamics using the Actor-Partner Interdependence Model

Patients awaiting coronary artery bypass grafting (CABG) need support from their partners or family caregivers to manage their self care successfully and to maximise quality of life. Partners need social support to help overcome the stressful tasks of an unexpected caregiving role. It is not known whether the individual's perceived social support contributes to their own, as well as their partner's quality of life. The aims of this study were to assess differences in social support and quality of life in patients and partners awaiting CABG, and to examine whether patients' and partners' perceived social support predicted their own, as well as their partner's quality of life before CABG. This cross-sectional study recruited 84 dyads (patients 84% males, aged 64.5 years and partners 94% females, aged 61.05 years). Perceived social support was assessed using the Medical Outcomes Study Social Support survey, with sub-scales for informational/emotional support, affectionate support, tangible support and positive social interaction. Quality of life was assessed using the Short-Form 12 Health Survey. Dyadic data were analysed using the Actor-Partner Interdependence Model, with distinguishable dyad regression. Results revealed the patients' informational/emotional support exhibited an actor effect on their own mental health (? = 0.19, p = 0.001); indicating those with low informational/emotional support had poorer mental health. There was a partner effect of the patients' informational/emotional support on their partner's mental health (? = 0.14, p = 0.024), indicating the patients' informational/emotional support was associated with the partner's mental health. None of the other types of social support exhibited an actor effect or a partner effect on the patient's or the partner's mental or physical health. More research into the relationship between social support and mental health is needed to help inform the design of interventions that target the dyad.     

The marital and family functioning of adults with ADHD and their spouses

Little is known about the family relationships of adults with Attention-Deficit/Hyperactivity Disorder (ADHD). Thus, the marital adjustment and family functioning of 33 married adults with ADHD and their spouses was compared to 26 non-ADHD control participants and their spouses. Results revealed that married adults with ADHD reported poorer overall marital adjustment on the Dyadic Adjustment Scale (DAS; Spanier, 1989) and more family dysfunction on the Family Assessment Device (FAD; Eptein, Baldwin, & Bishop, 1983) than control adults. The spouses of adults with ADHD did not differ from control spouses in reports of overall marital adjustment and family dysfunction. A greater proportion of their marital adjustment scores, however, fell within the maladjusted range. The ADHD adults' perceptions of the health of their marriages and families were more negative than their spouses' perceptions. The way in which spouses of ADHD adults compensated for their partners' difficulties were explored through clinical interviews. The findings in this study underscore the need for assessments and treatments to address marital and family functioning of adults with ADHD.     

Psychological support needs of patients with head and neck cancer and their caregivers: A qualitative study

Objective: The aim of this study was to explore the psychological support needs of patients with head and neck cancer (HNC) and their caregivers. The appropriate timing, length, format and content of sessions were also investigated.

Design: Eighty-three patients with HNC and 73 of their caregivers completed questionnaires at diagnosis. Follow-up questionnaires were mailed to patients six months later.

Main outcome measures: Free text-comments to open-ended questions in the questionnaires were analysed using an inductive thematic approach with coding and theme development directed by the content of responses. This was used to determine psychological support needs both at diagnosis and at six month follow-up.

Results: Patients described ‘just being there’, empathy, maintaining normality and practical support as helpful from family/friends. They desired information, honesty, positivity and empathy from clinical staff. Formal psychological support was desired by approximately 40% of patients and caregivers, particularly early after diagnosis and during treatment. Most participants desired face to face sessions, providing individualised information and coping strategies.

Conclusion: The results of this study suggest that psychological interventions for patients with HNC and their caregivers should be delivered early after diagnosis in face to face sessions, presenting honest and factual information about the disease and coping strategies.     

An experimental investigation of the interaction between displays and models in multicriteria decision support

An experiment in multicriteria decision support was conducted that examined two types of information displays, two different multiattribute models and two levels of task complexity in a laboratory setting with students as subjects. The findings focused on the ‘process’ behaviour and the ‘design’ elements of the human-machine interface. Findings concerning the process behaviour suggested that the subjects' actions on data acquisition were guided by their cognitive preference for the attributes, but that the subjects had no discernible search pattern for evaluation. Findings for design included a significant interaction between display and model in weight estimation and assessment. The practical implications for software design are also discussed.     

Antecedents and consequences of mothers' autonomy support: an experimental investigation.

This study examined the effects of contextual and individual differences on mothers' autonomy support versus control on homeworklike tasks. Sixty mothers and their third-grade children worked on map and poem tasks, with mothers in either an ego-involving (high pressure) or a non-ego-involving (low pressure) condition. Later, children worked on similar tasks themselves. Mothers in the high-pressure condition were more controlling on the poem task. For the map task, mothers who came in with controlling styles and received the high-pressure manipulation were most controlling. Children whose mothers interacted in a more controlling manner wrote less creative poems when alone. Results suggest the importance of context, children's competence levels, and mothers' styles in determining levels of autonomy support.     

Heart rate-Qt interval relationship during postural change and exercise. A possible connection to cardiac contractility

The QT interval of the electrocardiogram, although often coordinated in an inverse relationship to heart rate, appears from the existing evidence to be regulated by mechanisms separate from those that govern heart rate. The purpose of this inquiry was to explore further the relationship of the two and to test other factors that may contribute to the regulation of QT. Heart rate and QT duration were measured in healthy human subjects during postural change and exercise. The data showed that, while coordinated in an inverse relationship under some circumstances, under others heart rate and QT were discordant, leading to the inference that there is no fixed linkage between the two. Previous work by the authors and other published studies have suggested that ventricular contractility may have more predictable association with QT shortening than do increases in heart rate. Observations of force of ventricular contraction (HI and IJ velocity) as reflected in ballisto-cardiographic tracings were made using each of 12 human subjects as the authors' own control. The data revealed a highly significant correlation between the velocity measures and QT duration (p less than 0.01) but not heart rate. These findings led to the conclusion that there is clearly not a fixed relationship between heart rate and QT interval and to the hypothesis that QT may more closely reflect the degree of cardiac contractility.