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. (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)     

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

Partner unsupportive responses, avoidant coping, and distress among women with early stage breast cancer: Patient and partner perspectives.

This 18-month longitudinal study examined the associations among partner unsupportive behavior, avoidant coping, and distress experienced by 219 women with early stage breast cancer. The role of patient and partner ratings of unsupportive behavior were evaluated. Results indicated that patient and partner ratings of unsupportive behavior were highly correlated. Growth curve modeling suggested that unsupportive behavior, from both patient and partner perspectives, predicted more avoidant coping and distress. When partner and patient perceptions were placed in the same model, patient perceptions mediated the association between partners' ratings of their unsupportive behavior and patient distress. Avoidance also mediated the association between unsupportive behavior and distress, extending prior cross-sectional findings. Results highlight the long-term detrimental effects of partners' unsupportive behavior on the quality of life of women with early stage breast cancer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spousal support and changes in distress over time in couples coping with cancer: The role of personal control.

This longitudinal study has examined the associations between perceived supportive and unsupportive spousal behavior and changes in distress in couples coping with cancer. We tested whether people relatively low in their sense of personal control were more responsive to spousal supportive and unsupportive behavior than were people relatively high in personal control. Patients with colorectal cancer and their partners (n = 70) completed questionnaires at two assessment points: 3 (at baseline) and 9 months (at follow-up) after the diagnosis. We assessed perceived spousal supportive (SSL) and unsupportive (SSL-N) behavior, sense of personal control (Pearlin & Schooler's Mastery), and depressive symptoms (CES-D) in both patients and partners. Multilevel analysis (MLwiN) was used to examine changes in distress over time in a dyadic context. Patients and partners who perceived more spousal support reported less distress over time, but this only applied to those relatively low in personal control. Moreover, partners who perceived more unsupportive spousal behavior reported more distress, again only if they were relatively low in personal control. Patients and partners relatively high in personal control reported relatively low levels of distress, regardless of spousal behavior. In conclusion, people relatively low in personal control may be more adversely affected by unsupportive behavior and benefit more from supportive behavior than people relatively high in personal control. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Dyadic Adjustment in Chronic Illness: Does Relationship Talk Matter?

Relationship talk involves talking about the nature and state of one's relationship. To determine the effectiveness of talking about the relationship when one spouse has a chronic illness, the study involved completion of a confidential questionnaire by 182 married couples. Ninety of these were couples in which both partners were healthy, and 92 were couples in which one spouse had a chronic illness. Results of multilevel modeling analyses showed that the association between relationship talk and dyadic adjustment was stronger for women than for men and for couples with an ill spouse than for couples where both spouses were healthy. These findings highlight the importance of taking a relationship perspective and suggest that relationship talk is a potentially useful tool couples can use in their repertoire of relationship-enhancing behaviors during chronic illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Strategies used in coping with a cancer diagnosis predict meaning in life for survivors.

The search for meaning in life is part of the human experience. A negative life event may threaten perceptions about meaning in life, such as the benevolence of the world and one's sense of harmony and peace. The authors examined the longitudinal relationship between women's coping with a diagnosis of breast cancer and their self-reported meaning in life 2 years later. Multiple regression analyses revealed that positive strategies for coping predicted significant variance in the sense of meaning in life--feelings of inner peace, satisfaction with one's current life and the future, and spirituality and faith--and the absence of such strategies predicted reports of loss of meaning and confusion (ps     

Curvilinear associations between benefit finding and psychosocial adjustment to breast cancer.

Two previously studied cohorts of women with nonmetastatic breast cancer (Ns = 230 and 136) were reexamined. Participants were assessed during the year after surgery and 5-8 years later. Associations were examined between benefit finding (BF) and several indicators of psychosocial adjustment (e.g., perceived quality of life, positive affect, negative affect, social disruption, and intrusive thoughts). Significant curvilinear relations between BF and other outcomes were observed cross-sectionally during initial assessment and at long-term follow-up in both samples. Compared with the intermediate BF group, low and high BF groups had better psychosocial adjustment. Further analyses indicated that the high BF group reported higher optimism and more use of positive reframing and religious coping than the other BF groups. Discussion highlights the need to examine nonlinear as well as linear relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Romantic partners' individual coping strategies and dyadic coping: Implications for relationship functioning.

Individual coping strategies and dyadic coping independently predict partner well-being and relationship functioning; however, it is unclear whether the coping processes are inter-related and whether they uniquely contribute to romantic relationship functioning. One hundred heterosexual dating couples rated the individual coping strategy of negative mood regulation as well as positive and negative dyadic coping. Relationship functioning was assessed via partners' reports of relationship satisfaction and observers' ratings of negative interaction in conflict. Actor-Partner Interdependence Models (APIMs; Cook & Kenny, 2005; Kashy & Kenny, 2000) revealed associations between individual coping and dyadic coping in the predicted directions. APIMs also indicated the unique contributions of positive and negative dyadic coping to relationship functioning, above and beyond contributions of individual coping strategies. Implications of dyadic coping as a target of efforts to prevent or treat partner and/or relational distress are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting posttraumatic growth in breast cancer survivors.

Wide variability exists with respect to how breast cancer survivors respond to common psychological and psychosocial challenges of their disease, ranging from posttraumatic stress disorder to posttraumatic growth. This cross-sectional study examined contextual, disease-related, and intraindividual predictors of posttraumatic growth in 224 randomly selected breast cancer survivors. A series of hierarchical regression analyses found that age at diagnosis, marital status, employment, education, perceived intensity of disease, and active coping accounted for 34%, 35%, and 28% of the variance in growth in relationships with others, new possibilities, and appreciation for life. These findings suggest that a more comprehensive model of growth will be helpful in understanding the various factors that play a role in breast cancer survivors' perception of psychological and psychosocial growth. (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)     

The relationship between dyadic coping and marital quality: A 2-year longitudinal study.

Previous studies have revealed that the ways couples deal with stress in their lives are significantly associated with their marital quality and overall marital functioning. However, there has been little empirical evidence linking dyadic coping with marital quality over time. This study addresses the relationship between dyadic coping and marital quality among 90 couples over a period of 2 years. The results reveal that dyadic coping was significantly associated with marital quality over 2 years. For women, both their own dyadic coping and that of their partner were significant predictors, whereas for men only their own dyadic coping was predictive. The results are discussed with regard to prevention of marital distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interdependence in women with breast cancer and their partners: An interindividual model of distress.

Objective: The aim of this investigation was to test whether interdependence in dyads living with breast cancer could account for person–partner crossover effects in distress outcomes. Method: The sample consisted of 95 dyads with early-stage breast cancer. By using reciprocal dyadic data from women with breast cancer and their partners, we fit a structural equation model of the actor–partner interdependence model to examine the interaction of participants’ depression and stress in predicting their partner’s health outcomes. Results: Results revealed a pattern of influence whereby the interaction of high levels of depression coupled with high levels of stress in women with breast cancer was associated with lowered physical health and well-being in their partners. Although depression seemed to be the key mechanism in predicting distressing outcomes, when depression was combined with any additional stress, the level of physical distress was significantly greater. Results provided preliminary empirical support for crossover effects in the physical well-being of close relational partners in a cancer-related context. Further, results showed that distressing outcomes need not be limited to emotional distress but can also include physical distress. Conclusions: The findings from this study illustrate why it is not sufficient to concentrate care solely on the patient with cancer. Monitoring the social well-being of patients as they go through the cancer process could be as important as assessing their psychological state or other peripheral biomarkers. This line of inquiry would be advanced by including methods other than self-report in assessments of psychological and physical health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Involvement in decision-making and breast cancer survivor quality of life.

Objective: This study examined the long-term effects on women's health related quality of life (HRQOL) of involvement in decision-making about their treatment for breast cancer and about follow-up care after treatment. Methods: Using a cross-sectional survey design, a sample of breast cancer survivors from Western Washington who were 2, 5, and 10 years postdiagnosis were recruited via a cancer registry and interviewed about their HRQOL and their involvement in decision-making about their cancer treatment and follow-up care. Main Outcome Measures: HRQOL was assessed using the SF-36. Results: Multiple regression analyses examining demographic and disease characteristics revealed age, and education, but not stage of cancer at diagnosis, to be significant predictors of perceived involvement in decision-making about cancer treatment and follow-up. Controlling for demographic and disease characteristics, perceived involvement in decision-making about treatment overall, surgery, chemotherapeutic treatment, and follow-up care were each associated with improved HRQOL, including the general health and vitality subscales of the SF-36 (p     

Effects of coping style and BRCA1 and BRCA2 test results on anxiety among women participating in genetic counseling and testing for breast and ovarian cancer risk.

Using the monitoring process model (MPM), the authors examined the immediate effects of coping style and test results on the psychological distress of women at increased risk for breast and/or ovarian cancers. Cases selected for analysis were 107 probands and relatives of positive probands participating in genetic counseling and testing for heritable cancer risk. Specifically, the authors explored the relationships among coping style (high and low monitoring), test results (BRCA1 and BRCA2 mutation carrier and noncarrier status), and psychological distress (state anxiety). Consistent with the MPM, higher monitoring was associated with greater psychological distress while anticipating genetic test results. After test results were disclosed, greater distress was associated with testing positive for a mutation. The implications of the findings for breast and ovarian cancer patients are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship of ambivalent coping to depression symptoms and adjustment.

Objective: To assess the influence of mental distancing and venting emotions on depressive symptoms and health-related quality of life (HRQOL). Participants: Seventy-six individuals hospitalized with acute burn injuries. Design: Prospective longitudinal study. Measures: Beck Depression Inventory (A. T. Beck, E. Ward, M. Mendelson, J. Mock, & J. Erbaugh, 1961), COPE (C. S. Carver, M. F. Scheier, & J. K. Weintraub, 1989), and Short Form--36 Health Survey (J. E. Ware, K. K. Snow, M. Kosinski, & B. Gandek, 1993). Results: Ambivalent coping at baseline (i.e., using both mental distancing and venting emotions, relative to using only 1 or neither) led to more symptoms of depression at follow-up, even when baseline symptoms were controlled. Ambivalent coping was related to postburn psychosocial HRQOL, and baseline symptoms of depression only slightly attenuated this relationship. Conclusions: Ambivalent coping appears to result from vacillation between motives. Decreasing inconsistent coping or reducing antithetical motivation may reduce depression and improve adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dyadic splitting in partner relational disorders.

The defense mechanism of splitting appears to underlie many interpersonal problems that are presently classified within the category of relational disorders of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) and, accordingly, bridges individual and family psychology. It is suggested here that certain relationships are marked by specific patterns and characteristics that can best be regarded as dyadic splitting. This article presents an overview of splitting in individuals and couples and reviews empirical studies establishing norms and validity of dyadic splitting, as measured by the Dyadic Splitting Scale. Research with samples of men who batter, battered women who return to their abusers, and couples clinically assessed as being narcissistically vulnerable demonstrates the presence of dyadic splitting in these populations. The notion of a defense mechanism influencing relationship dynamics strengthens the appreciation of mutuality between individual and relationship disorders and holds promise for treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Modeling Affective Processes in Dyadic Relations via Dynamic Factor Analysis.

An intraindividual variability design, including application of dynamic factor models, was used to examine the affective processes of a husband-wife dyad over 182 consecutive days. Structural equation analyses indicated differences in the affective structure between the husband and the wife, and these differences were characterized in terms of their factorial configuration and temporal organization. Examination of the dyad's affective dynamics revealed unidirectional (i.e., from the husband to the wife) interpersonal influences with a defined structure over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identification and prediction of distress trajectories in the first year after a breast cancer diagnosis.

Objective: In this article, we aim to (a) identify distinct trajectories of psychological distress in the first year after a breast cancer diagnosis in women treated with adjuvant therapy and (b) explore possible predictors of these trajectories, that is, demographic, medical, and personal characteristics. Method: The 171 patients were assessed after diagnosis, after surgery, after adjuvant treatment, in the reentry phase, and in the (short-term) survivorship phase (2 and 6 months after the end of treatment, respectively). Main Outcome Measure: Psychological distress was assessed with the 12-item General Health Questionnaire. Results: There were four trajectories of distress: a group that experienced no distress (36.3%), a group that experienced distress only in the active treatment phase (33.3%), a group that experienced distress in the reentry and survivorship phase (15.2%), and a group that experienced chronic distress (15.2%). Personality and physical complaints resulting from adjuvant treatment could distinguish the distress trajectories. Mastery was the only unique predictor. Conclusion: Most patients were not distressed in response to breast cancer or only temporarily so. Yet, a minority of patients became or remained distressed after the end of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The fit between stress appraisal and dyadic coping in understanding perceived coping effectiveness for adolescents with type 1 diabetes.

This study examined whether perceived coping effectiveness (PCE) was associated with better diabetes management and was higher when adolescents’ dyadic coping was matched to shared stress appraisals. There were 252 adolescents with Type 1 diabetes who completed stress and coping interviews where they appraised mothers’ and fathers’ involvement in stress ownership (mine, indirectly shared, directly shared with parent), in coping (uninvolved, supportive, collaborative, or controlling), and rated their effectiveness in coping. Adolescents completed assessments of depressive symptoms (Children’s Depression Inventory), self-care behaviors (Self-Care Inventory), and efficacy of disease management (Diabetes Self-Efficacy). Glycosylated hemoglobin levels were obtained from medical records. Higher PCE was associated with fewer depressive symptoms, self-care behaviors, and efficacy across age and, more strongly for older adolescents’ metabolic control. Appraisals of support or collaboration from parents were more frequent when stressors were appraised as shared. PCE was enhanced when dyadic coping with mothers (but not fathers) was consistent with stress appraisals (e.g., shared stressors together with collaborative coping). Stress and coping is embedded within a relational context and this context is useful in understanding the coping effectiveness of adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)