Prognostic significance of spouse we talk in couples coping with heart failure.

Recent research suggests that marital quality predicts the survival of patients with heart failure (HF), and it is hypothesized that a communal orientation to coping marked by first-person plural pronoun use (we talk) may be a factor in this. During a home interview, 57 HF patients (46 men and 16 women) and their spouses discussed how they coped with the patients' health problems. Analysis of pronoun counts from both partners revealed that we talk by the spouse, but not the patient, independently predicted positive change in the patient's HF symptoms and general health over the next 6 months and did so better than direct self-report measures of marital quality and the communal coping construct. We talk by the patient and spouse did not correlate, however, and gender had no apparent moderating effects on how pronoun use predicted health change. The results highlight the utility of automatic text analysis in couple-interaction research and provide further evidence that looking beyond the patient can improve prediction of health outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Couples coping with congestive heart failure: Role and gender differences in psychological distress.

Psychological distress and marital quality were assessed with male (n=128) and female (n=49) congestive-heart-failure (CHF) patients and their spouses. Hopkins Symptom Check List-25 scores were in the distressed range for 57% of patients and 40% of spouses. This role difference was greater for men than for women, and a gender difference (more distress in women than men) was greater for spouses than for patients. The patient's distress, but not the spouse's, reflected the severity of the patient's illness, and distress for both partners correlated negatively with ratings of marital quality. Female-patient couples reported better relationship quality than male-patient couples, however, and a mediation analysis indicated that the gender difference in spouse distress could be explained by marital quality. Results highlight the contextual nature of CHF distress and suggest that role differences in distress vary by gender. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self- and spouse ratings of anger and hostility as predictors of coronary heart disease.

Self- and spouse ratings of anger and hostility were examined as predictors of coronary heart disease (CHD) in 185 cardiac patients. Patients completed the Multidimensional Anger Inventory (MAI) and the Marlowe-Crowne Social Desirability (MCSD) Scale; the MAI (rewritten to 3rd person) was completed by Ss' spouses or by a peer. Thallium scans were used to measure CHD status. Results show that patient-rated MAI scores were inversely correlated with MCSD. There were no gender differences for patient-rated MAI scores, but spouse ratings showed gender effects for Anger-Arousal and Hostile Outlook: Women rated their husbands higher than men rated their wives. Patients with positive thallium scans were no different from those without CHD on patient-rated MAI scores; however, spouse ratings indicated that those with CHD had higher Hostile Outlook and Anger-In scores. After accounting for the effects of traditional CHD risk factors, only spouse-rated hostility contributed significant incremental variance to the prediction of CHD status. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expressed emotion, adaptation, and patient survival among couples coping with chronic heart failure.

Previous research (J. C. Coyne et al., 2001) that showed that marital functioning predicted mortality among patients with chronic heart failure (CHF) led to an examination of whether expressed emotion (EE) captured negative marital influences on patient survival. The authors assessed EE using 5-min speech samples obtained from patients (137 men and 47 women) and their spouses. Prevalence of EE was low, and patient and spouse EE were unrelated. Spouse EE was not associated with survival, after the authors controlled for severity of illness. Among patient EE variables, high EE status predicted survival, but in the opposite direction of what was anticipated. Overall, relations between EE and self-report measures of adaptation were weak and inconsistent. Despite the strength of findings concerning EE and psychiatric outcomes, EE does not show promise in predicting adaptation to CHF, and researchers and clinicians should instead seek to identify positive marital factors that may promote patient survival. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Genetic defects in Chediak-Higashi syndrome and the beige mouse

Nine spouses of people who had suffered from acute leukemia or highly malignant lymphoma were interviewed about their everyday life experiences throughout their partner's illness and treatment, and concerning their view of the professional care provided. The transcribed texts were subjected to phenomenological-hermeneutic analysis. The spouses felt they were in a situation of overall severe crisis (i.e., experiencing feelings of distress, restrictions, and limited or lack of support). The analysis revealed three family types: the couple acting as a unit, the couple acting independently on equal terms, and the couple acting separately with the spouse in a subordinate position. The spouses' evaluation of the entire experience varied according to the family type and the spouses' personal resources, which influenced the availability and utilization of their social network as well as the support of health-care staff. Contentment was related to the couple acting as a unit or the couple acting independently on equal terms and taking control over the situation, actively asking for support and requiring the staff to meet their needs. Discontentment was related to subordination of the spouse to the partner or to health-care staff, and failure of the couple to obtain support between them or from others. Empowering the spouses may mean helping them develop their skills, providing them with opportunities and authority, and assisting them in gaining access to resources based on knowledge of the family type, the consent of the partner, and the spouse's freedom to make choices. This may well lead to increased efficiency and have positive effects for the patient, for the spouse, and for them both as a couple.     

Depressive symptoms and marital satisfaction in the context of chronic disease: A longitudinal dyadic analysis.

These analyses examined the longitudinal relationships between depressive symptoms and marital satisfaction over a 2-year period as experienced by 315 patients with end-stage renal disease and their spouses. Using multilevel modeling, the authors examined both individual and cross-partner effects of depressive symptoms and marital satisfaction on patients and spouses, testing bidirectional causality. Results indicate that mean and time-varying depressive symptoms of both patients and spouses were associated with their own marital satisfaction. Although mean marital satisfaction was associated with own depressive symptoms for both patients and spouses, time-varying marital satisfaction did not affect depressive symptoms for either patients or spouses. Significant cross-partner effects reveal that both mean enduring and time-varying depressive symptoms of the spouse affected marital satisfaction of the patient. Findings highlight the complex nature of the relationship between depressive symptoms and marital satisfaction in late-life couples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Functional impairment, marital quality, and patient psychological distress as predictors of psychological distress among cancer patients' spouses.

This study investigated contextual determinants of psychological distress among 197 spouses of cancer patients. women, 30–82 years old). It was hypothesized that higher levels of patient functional impairment would lead to greater patient distress. Patient distress, in turn, would lead to lower spouse marital satisfaction and ultimately to higher spouse distress. Spouses completed measures of distress and marital quality at three time points. Cancer patients rated their functional impairment and psychological distress at the same time points. Results indicated that at all time points, greater patient impairment was associated with higher levels of patient distress which, in turn, was related to lower marital satisfaction. However, marital quality was related to spouse distress at only 1 time point, but spouse distress was directly associated with patient distress at each time point. Implications for cancer patients and spouses are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of spouse involvement in the behavioral treatment of overweight women.

Assigned 68 overweight women (mean age 39 yrs) to 1 of 5 groups: (a) cooperative spouse, in which spouses were trained in modeling, monitoring, and reinforcement techniques; (b) wives alone, in which Ss underwent the basic behavioral program by themselves; (c) nonparticipating spouse, in which spouses were told not to participate in their wives' behavioral program; (d) alternative treatment; and (e) delayed treatment control. The cooperative spouse group lost significantly more weight than the alternative treatment at the 3-, 6-, and 12-mo follow-ups and significantly more weight than the wives-alone group at the final follow-up. Both the cooperative spouse and the nonparticipating spouse conditions maintained their weight losses at the final follow-up, whereas the wives-alone group regained some weight. The absence of significant differences between the cooperative spouse and the nonparticipating spouse conditions suggests that instructing spouses not to sabotage their wives' efforts may be as effective for long-term maintenance as actively training them to aid their wives. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alzheimer's disease afflicted spouses who remain at home: can human dialectics explain the findings?

When one spouse has Alzheimer's disease (AD), marital interactions tend to decline. Findings from this study suggest that level of spousal interactions influence longitudinal outcomes for afflicted spouses. Thirty AD spouses and their spouse caregivers were assessed at baseline (time 1) and two years later (time 2). Continued in-home care at time 2 is predicted by high levels of positive spousal interactions, high caregiver commitment, good caregiver health, and shorter time as caregiver (all assessed at time 1). The same variables but in an inverse relationship predict which AD spouses are deceased at time 2. Nursing home placement is predicted by AD spouses' higher educational level, unhappy marital relationships, and low caregiver commitment. Afflicted spouses' cognitive and functional impairment levels, their physical health and depression do not predict outcomes. A theoretical explanation is developed drawing on Riegel's dialectical theory of human development and Bowlby's attachment theory. It is suggested that interactions between spouses are crucial for afflicted spouses' survival.     

Living with a depressed spouse.

The depressed mood and specific burdens experienced by spouses of patients in treatment for depression were examined. Forty-nine wife-depressed couples and 30 husband-depressed couples were administered the Structured Clinical Interview for DSM-IV (M. B. First, R. L. Spitzer, A Gibbon, & J. B. W. Williams, 1995), and spouses completed measures of depressed mood and burden. Overall, spouses living with a depressed patient reported significantly more depressed mood than general population norms and numerous specific burdens. Regression analyses showed that these burdens as well as gender of the spouse accounted for the spouses' depressed mood that would otherwise be attributed to mood contagion. It is suggested that as an alternative to an exclusive therapeutic focus on patient outcomes, attention might profitably be directed to the distress and burden experienced by spouses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality and family functioning in families of depressed patients.

In this cross-sectional study, the authors attempted to identify correlates of family functioning in 86 couples with a depressed member during the acute phase of the patient's depression. Demographic variables, psychiatric status, and personality traits of both the patient and spouse were investigated as potential predictors of family functioning. Regression analyses indicated that lower levels of personality pathology in the patient, higher levels of patient conscientiousness, and less psychological distress in the spouse were associated with healthier family functioning. Future research implications and clinical importance of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sequential analysis of chronic pain behaviors and spouse responses.

Social reinforcers such as spouse behaviors have been hypothesized to be important in maintaining chronic pain behavior. This study used direct observation to test whether solicitous and aggressive spouse behaviors systematically precede and follow patient pain behaviors. 50 chronic pain patients and spouses and 33 control couples were videotaped performing specified tasks. Spouse solicitous behaviors were significantly more likely to precede and follow nonverbal pain behaviors, and nonverbal pain behaviors were significantly less likely to follow spouse aggressive behaviors in pain than in control couples. Within couples, spouse solicitous behaviors preceded and followed verbal and nonverbal pain behaviors beyond chance levels more often in pain than in control couples. Results support an operant conceptualization of factors maintaining chronic pain behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attribution processes in distressed and nondistressed couples: IV. 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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hiding worries from One's spouse: associations between coping via protective buffering and distress in male post-myocardial infarction patients and their wives

The relationship between protective buffering, a style of coping in which the individual hides his/her concerns from spouse, and level of distress was studied among post-myocardial infarction (MI) patients and their spouses. Forty-three male married MI survivors and their wives completed measures of psychological distress and protective buffering at 4 weeks and 6 months post-hospital discharge. At both time periods, a greater propensity for protective buffering by the patient was related to higher levels of patient distress. Protective buffering by wife was also associated with higher levels of wife distress. In addition, patient buffering at 4 weeks predicted increased patient distress at 6 months. The results suggest that male MI patients who conceal their worries from their spouses adjust more poorly over time.     

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Collaborative coping and daily mood in couples dealing with prostate cancer.

Collaborative coping (i.e., spouses pooling resources and problem solving jointly) may be associated with better daily mood because of heightened perceptions of efficacy in coping with stressful events. The study examined the daily processes of collaborative coping (individuals' perceptions that the spouse collaborated), perceived coping effectiveness (ratings of how well they dealt with the event), and mood (i.e., Positive and Negative Affect Scale) across 14 days in 57 older couples coping with stressors involving the husband's prostate cancer and daily life in general. In hierarchical multivariate linear models, collaborative coping was associated with more positive same-day mood for both husbands and wives and less negative mood for wives only. These associations were partially mediated by heightened perceptions of coping effectiveness. Exploratory analyses revealed that collaborative coping was more frequent among wives who performed more poorly on cognitive tests and couples who reported greater marital satisfaction and more frequently using collaboration to make decisions. The results suggest that older couples may benefit from collaborative coping in dealing with problems surrounding illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A developmental-contextual model of couples coping with chronic illness across the adult life span.

A developmental-contextual model of couples coping with chronic illness is presented that views chronic illness as affecting the adjustment of both the patient and the spouse such that coping strategies enacted by the patient are examined in relation to those enacted by the spouse, and vice versa. The developmental model emphasizes that dyadic coping may be different at various phases of the life span, changing temporally at different stages of dealing with the illness as well as unfolding daily as spouses interact around dyadic stressors. In addition, couples engaged in dyadic coping are affected by broad sociocultural factors (culture and gender) as well as more proximal contextual factors (quality of the marital relationship and the specific demands of the chronic illness). The model provides a framework for understanding how couples coping with chronic illness may together appraise and cope with illness during adulthood and for determining when spousal involvement is beneficial or harmful to both patient and spousal adjustment. The developmental-contextual model to dyadic appraisal and coping has numerous research implications for the field, and the authors conclude with specific recommendations for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexuality and happiness ratings of husbands and wives in relation to first and second pregnancies.

200 spouses (aged 23–43 yrs) rated their sexuality and marital happiness in relation to 2 pregnancies. Wives showed significantly higher scores than husbands in both sexuality and happiness prior to the 1st-time pregnancy only. Intracomparisons were also made on each spousal group, based on sexuality and happiness scores. In relation to the 1st-time pregnancy, husbands and wives showed a similar pattern of high sexuality happiness ratings before pregnancy and low ratings during and after pregnancy. In the realm of happiness, mean scores were highest during pregnancy for both spouses and, for husbands only, during postpartum. For the 2nd-time pregnancy, sexuality scores were high before and after the pregnancy for both spouses. Only wives show high happiness ratings prior to and after the pregnancy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Functioning and life context among spouses of remitted and nonremitted depressed patients.

The functioning and life context of spouses of depressed patients were examined at the patients' treatment intake and again after 1 year. Three groups of spouses were defined according to their depressed partner's recovery status at follow-up: remitted (n?=?39), partially remitted (n?=?39), or nonremitted (n?=?40). These spouse groups were compared with each other and with spouses of demographically matched community control participants (n?=?157). At both assessments, the remitted and control spouses were comparable in functioning, stressors, and coping, but the remitted spouses had more social and family problems than control spouses. In contrast, nonremitted spouses had significantly more problems than control spouses on most indices, both at intake and at follow-up. There was no evidence that adaptation of remitted spouses improved or that adaptation of nonremitted spouses deteriorated. Spouse adaptation was typically unrelated to changes in the depression of the depressed partner. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for a medically inappropriate admission to a Department of Internal Medicine

OBJECTIVE: To identify patient- and admission-related risk factors for a medically inappropriate admission to a department of internal medicine. METHODS: Cross-sectional study of a systematic sample of 500 admissions to the department of internal medicine of an urban teaching hospital. The appropriateness of each admission and reasons for inappropriate admissions were assessed using the Appropriateness Evaluation Protocol. Risk factors included the time (day of week and holidays) and manner (through emergency department or direct admission) of admission, patient age and sex, health status of patient and spouse, living arrangements, formal home care services, and informal support from family or friends. RESULTS: Overall, 76 (15.2%) hospital admissions were rated as medically inappropriate by the Appropriateness Evaluation Protocol. In multivariate analysis, the likelihood of an inappropriate admission was increased by better physical functioning of the patient (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.1-2.1 [for 1 SD in Physical Functioning scores]), lower mental health status of the patient's spouse (OR, 2.6; 95% CI, 1.3-5.6), receipt of informal help from family or friends (OR, 3.3; 95% CI, 1.5-7.2), and hospitalization by one's physician (OR, 3.6; 95% CI, 1.7-7.5). Receiving formal adult home care was not associated with inappropriateness of hospitalization. CONCLUSIONS: Inappropriate admissions to internal medicine wards are determined by a mix of factors, including the patient's health and social environment. In addition, the private practitioners' discretionary ability to hospitalize their patients directly may also favor medically inappropriate admissions.