Financial strain, dyadic coping, relationship satisfaction, and psychological distress: A dyadic mediation study in Greek couples

Financial strain typically has a severe impact on a couple's functioning and the well-being of its members. In this study, we examined the indirect relation of financial strain to partners' relationship satisfaction and psychological distress, using dyadic coping as a mediator, in a sample of Greek couples. One hundred and eighteen couples participated in a cross-sectional study. Perceived material loss in the past and perceived threat of loss in the future were used as financial strain indices. The actor-partner interdependence mediation model was employed to test for the mediation hypotheses. According to the results, the complete mediation (i.e., only indirect) effects models showed an unsatisfactory fit to the data and were rejected. The partial mediation actor-partner interdependence mediation model revealed several statistically significant direct and indirect (actor and partner) effects of the financial strain indices. The results provide more support to the hypothesized mediated impact of financial strain on partners' relationship satisfaction than on psychological distress. The findings underline the importance of dyadic coping for couple's adaptation to financial strain. They also point to the need to examine responses to stress at a dyadic level.

Adaptation to inflammatory rheumatic disease: Do illness representations predict patients' physical functioning over time? A complex relationship

Patients with an inflammatory rheumatic disease (IRD), are often faced with significant limitations in physical functioning. Illness representations are a key-factor of their illness-related experience. Our aim was to examine (a) whether illness representations can predict or only reflect IRD patients' physical functioning over time, and (b) the specific pathways through which representations and physical functioning at baseline are associated with representations and functioning at follow-up. Patients with rheumatoid arthritis (N = 54) or systemic lupus erythematosus (N = 58) participated in the two phases of the study, 1 year apart. According to the results, illness representations were rather predicted by physical functioning than the other way around. At the same time, illness representations at baseline and at follow-up seemed to form a chain that mediated the relation between physical functioning at baseline and 1 year later. These findings may help us better delineate the interplay between the ways patients understand their condition and adaptation to illness.

Effects of sociodemographic, treatment variables, and medical characteristics on quality of life of patients with maxillectomy restored with obturator prostheses

STATEMENT OF PROBLEM

Restoration of maxillary defects resulting from tumor ablative surgery presents a difficult challenge, with both functional and esthetic issues. Whether rehabilitation with an obturator prosthesis could significantly contribute to improved quality of life in patients with maxillary resection has been scarcely studied, with relatively small study samples.

PURPOSE

The purpose of this survey study was to assess the overall functioning of the obturator prosthesis and the effect of specific sociodemographic, medical, and treatment variables on obturator functioning and quality of life in patients with maxillectomy.

MATERIAL AND METHODS

Global quality of life (QOL) and satisfaction with the obturator prosthesis of 57 patients who underwent maxillectomy and prosthetic rehabilitation at the National and Kapodistrian University of Athens were assessed using 3 questionnaires: European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 (QLQ-C30), the EORTC QLQ-HN35, and the obturator functioning scale. The data were analyzed using the Kruskal-Wallis 1-way ANOVA on ranks, hierarchical multiple regression analysis, and the Spearman rank order correlation (α=.05).

RESULTS

Satisfactory functioning of the obturator prosthesis was the most significant predictor of improved QOL (P<.05). QOL was significantly related to additional treatments (P<.05), the size of the primary tumor (P<.05), and the size of the maxillectomy defect (P<.05). The most significant predictors of good obturator functioning were additional treatments (P<.01), age at the time of surgery (P<.05), presence of mandibular teeth (P<.05), and previous maxillary removable prosthetic experience (P<.05). Obturator functioning scale appearance and insertion subscales (r=0.47, P<.01), followed by speech (r=0.42, P<.01), were significantly related to better QOL.

CONCLUSIONS

A well-functioning obturator prosthesis was the most significant determinant for improved QOL in patients with maxillary resection. Age at the time of surgery, adjuvant treatments, presence of mandibular teeth, and previous maxillary removable prosthetic experience were the most significant predictors for better obturator functioning, whereas the size of the maxillectomy defect had a significant effect on QOL but did not influence the functional outcome.

The impact of mild cognitive impairment on the self-regulation process: A comparison study of persons with mild cognitive impairment and cognitively healthy older adults

This study examined whether mild cognitive impairment affects the associations between personal expectations (i.e. optimism and self-efficacy), illness-related coping, and quality of life. In total, two groups of older adults participated: 127 persons diagnosed with mild cognitive impairment and 225 cognitively healthy older persons (cognitively non-impaired group). Several significant relationships observed in the cognitively non-impaired group did not reach significance among mild cognitive impairment patients, with the opposite trend noted for others (e.g. between palliative coping and physical health). These findings indicate that mild cognitive impairment may lead to problems in the self-regulation process and highlight the significance of the interplay between neurocognitive and psychosocial aspects of self-regulation.

Cognitive deficits early in the course of rheumatoid arthritis

OBJECTIVE

The aim was to examine the severity and prevalence of cognitive difficulties in persons with rheumatoid arthritis (RA) within the first three years of diagnosis.

METHOD

One hundred consecutive RA patients aged 28-67 years (90% women) were administered a battery of 6 neuropsychological tests yielding 14 cognitive indices. Self-reported measures of trait anxiety, depression, impact of disease on daily activities, and pain severity were also obtained along with physician-rated disease severity.

RESULTS

Twenty percent of RA patients were classified as cognitively impaired, defined as age- and education-adjusted scores at least 1.5 standard deviations below the population mean on 3 or more cognitive indices. Impaired performance, controlling for age, education, and premorbid cognitive capacity, was detected primarily on measures of short-term memory, immediate and delayed episodic recall, and phonemic fluency. There were modest negative associations between cognitive indices and measures of perceived disease severity (pain level, impact of disease on daily functionality, and overall health quality).

CONCLUSIONS

Cognitive deficits on several domains are frequently encountered in relatively young RA patients during the first few years of the disease and may need to be taken into account as important correlates of disease severity and progression.

Patient and partner dispositional optimism as a long-term predictor of illness representations in autoimmune diseases

We examined whether the dispositional optimism of patients suffering from an autoimmune disease as well as of their partners can predict, at a dyadic level, their representations of illness consequences, and personal and treatment control, assessed 1 year later. Patient optimism predicted several patient and partner illness representations. Partner optimism was unrelated to own or patient illness representations. Results highlight the strong long-term predictive power of patient optimism and underline the importance of the interpersonal function of personality traits. At the same time, study findings indicate that the dyadic effects of optimism are complex and probably conditional on several factors.

Illness representations and psychological adjustment of Greek couples dealing with a recently-diagnosed cancer: dyadic, interaction and perception-dissimilarity effects

The aim was to examine the impact of the dyadic, interaction and dissimilarity effects of the illness representations on the psychological health of recently diagnosed cancer patients and spouses in Greece. The sample consisted of 298 individuals nested in 149 couples. Effects were examined with the Actor-Partner Interdependence Model. Both actor (i.e., within person) and partner (i.e., between partners) effects were detected for both patients' and spouses' psychological symptoms. The negative association of patients' psychological symptoms with their representations of illness coherence was weak at the higher and medium levels, and stronger at the lower levels of spouse corresponding representations. Patient-partner discrepancy in perceived illness consequences was associated with more psychological symptoms in patients. Adaptation to cancer is a dyadic process within the context of which patient and partner psychological well-being is affected by each other's understanding of illness. Thus, the parallel examination of the illness representations of both partners is needed from the early phases of the illness trajectory.

Patient and physician reports of the information provided about illness and treatment: what matters for patients' adaptation to cancer during treatment?

OBJECTIVE

The aim of this study was to examine (a) whether illness representations mediate the relation of the amount of information provided by physicians to patients' adaptation to illness; (b) whether patient-physician agreement on the information provided impacts the aforementioned relationship. The study focused on information that, according to the Common Sense Self-Regulation Model, is essential for adaptation to illness.

METHODS

The sample consisted of 93 patients undergoing chemotherapy and their physicians. Indirect (mediation) effects and conditional (moderated) indirect effects were examined using bootstrapping.

RESULTS

The more illness and treatment-related information was provided by physicians, the more positive illness representations (specifically, illness consequences, emotional representations, and personal control) were reported by patients. In turn, these illness representations were related to better physical functioning and better adjustment to cancer. The degree of the patient-physician agreement on the information provided did not affect this relationship.

CONCLUSIONS

What seems to be more crucial for patients' adaptation to cancer during treatment is the amount of information provided by physicians rather than their agreement with patients on the information provided. Also, there is a need to thoroughly examine the pathways through which information provision impacts adaptation to illness.

Maladaptive health beliefs, illness-related self-regulation and the role of the information provided by physicians

This prospective study in 119 patients with cardiovascular diseases aimed to examine whether (a) illness representations mediate the relation of general maladaptive health beliefs to patients’ coping behaviours and (b) these relations are moderated by the patients’ perception of the amount of information provided by their physicians. Personal control and illness coherence mediated the relation of maladaptive health beliefs to coping behaviour. The amount of the provided information buffered the negative relation of maladaptive health beliefs to illness representations and coping. Thus, the detrimental effect of general maladaptive health beliefs may be counterbalanced by the amount of information provided by physicians.

The psychological well-being of couples experiencing a chronic illness: A matter of personal and partner illness cognitions and the role of marital quality

This study aimed to examine the effects of 75 cardiac patients’ and their spouses’ illness cognitions of acceptance and helplessness on their own and their partner’s psychological symptoms, as well as the impact of marital quality. Dyadic responses were examined with the Actor–Partner Interdependence Model, while PROCESS was used to examine possible conditional indirect effects. Patients’ and spouses’ cognitions were related to their partners’ symptoms through the partners’ cognitions. These relationships were not statistically significant at the higher levels of marital quality. Thus, there seems to be a flow of information between partners, while marital quality may impact self-regulation processes.

Perceived primal threat, stress, and health: further examination of the role of perceived primal threat in the stress process

The general aim of the two studies presented here was to further examine the role of Perceived Primal Threat (PPT) in the stress process. PPT refers to threats against a four-component set of interdependent "primal" needs: self-preservation, social integration, personal identity and growth, and personal worldview. These threats are suggested to represent a pathway through which stress affects health. The first study (cross-sectional) was conducted in a sample of 216 healthy adults, while the second (prospective) in a sample of 137 chronically ill outpatients. The findings of both studies underlined the incremental and discriminant validity of PPT in relation to other stress-related variables. Furthermore, they provided support to the hypotheses that PPT is independently related to well-being and also mediates the relation of the stressful condition to well-being. Overall, the two studies underlined the important role of PPT in the stress process and indicated that PPT represents a promising research area.

Representations of control and psychological symptoms in couples dealing with cancer: a dyadic-regulation approach

The aim of this study was to examine the relation between illness representations of personal and treatment control and psychological symptoms (i.e. symptoms of anxiety and depression) in 72 married couples dealing with a recently diagnosed cancer. Patients were first-diagnosed with early stage (45.83%) or metastatic cancer (54.17%). Dyadic responses were examined with the actor-partner interdependence model. Also, in order to examine whether patients and spouses' representations of control moderate the relation of their partners' corresponding representations to psychological symptoms, we used the relevant bootstrapping framework developed by Hayes and Matthes [(2009). Computational procedures for probing interactions in OLS and logistic regression: SPSS and SAS implementations. Behavior Research Methods, 41, 924-936]. Patients' symptoms of anxiety and depression were associated with both partners' representations of control. Chi-square difference tests indicated that actor and partner effects were equal. Spouses' symptoms of anxiety and depression were related only to their own representations. Moreover, spouses' representations of personal control moderated the relation of patients' corresponding representations to depressive symptoms, whereas patients' representations of treatment control moderated the relation of their spouses' corresponding representations to both anxiety and depression. Findings suggest that both partners' representations of control are important for adaptation to illness. Moreover, they indicate that dyadic regulation may be equally important to self-regulation as far as adaptation to illness is concerned.

The association between pandemic influenza A (H1N1) public perceptions and reactions: a prospective study

The aim of this study was to examine the relation between the public perceptions and reactions to the pandemic influenza A(H1N1) in Crete, Greece. It was conducted in two phases: at the early phase of the outbreak and during the peak. The Common Sense Model was used as an appropriate theoretical framework. Participants were 273 healthy adults. Perceptions, especially perceived control and emotions, were related to protective behaviours, infection management behaviours and detachment at both phases of the study and also predicted follow-up reactions. Moreover, emotions predicted changes in behaviour and moderated the effects of several perceptions on pandemic-related behaviour.

Changes in health perceptions after exposure to human suffering: using discrete emotions to understand underlying processes

BACKGROUND

The aim of this study was to examine whether exposure to human suffering is associated with negative changes in perceptions about personal health. We further examined the relation of possible health perception changes, to changes in five discrete emotions (i.e., fear, guilt, hostility/anger, and joviality), as a guide to understand the processes underlying health perception changes, provided that each emotion conveys information regarding triggering conditions.

METHODOLOGY/FINDINGS

An experimental group (N = 47) was exposed to images of human affliction, whereas a control group (N = 47) was exposed to relaxing images. Participants in the experimental group reported more health anxiety and health value, as well as lower health-related optimism and internal health locus of control, in comparison to participants exposed to relaxing images. They also reported more fear, guilt, hostility and sadness, as well as less joviality. Changes in each health perception were related to changes in particular emotions.

CONCLUSION

These findings imply that health perceptions are shaped in a constant dialogue with the representations about the broader world. Furthermore, it seems that the core of health perception changes lies in the acceptance that personal well-being is subject to several potential threats, as well as that people cannot fully control many of the factors the determine their own well-being.

Conditional indirect relations of cardiac patients’ subjective health to optimism through illness representations: a self-regulation circuit

The aim of this study was to examine whether chronic patients’ subjective health can prospectively predict optimism through illness representations, as well as whether this relation depends on health levels. A sample of 97 cardiac patients participated in the two phases of the study. Subjective health predicted optimism with several illness representations serving as mediators. These relations were, however, conditional on the values of subjective health. Such findings suggest that the interplay between patients’ subjective health, illness representations, and optimism seems to function rather as a complex circuit system, than as a process of simple cyclical feedbacks.

The Impact of Emotion Regulation and Illness-focused Coping Strategies on the Relation of Illness-related Negative Emotions to Subjective Health

In this study we examined whether emotion regulation and illness-focused coping strategies mediate and/ or moderate the relation of illness-related negative emotions to patients’ subjective health. One hundred and thirty-five cardiac patients participated in the study. Illness-focused coping strategies were found to mediate the relation of emotions to physical functioning, whereas emotion regulation strategies mediated the relation to psychological well-being. Moreover, an emotion regulation strategy (i.e. emotion suppression) and two illness-focused coping strategies (instrumental coping and adherence) moderated the two relationships. These findings suggest that both emotion regulation and illness-focused coping strategies are integral parts of the illness-related negative emotions—health relationship.

Illness Cognitions as a Pathway Between Religiousness and Subjective Health in Chronic Cardiac Patients

The aim of this study was to examine the role of illness cognitions as a possible pathway between religiousness and subjective health in chronic illness. A sample of 135 chronic cardiac patients completed questionnaires about intrinsic religiousness, frequency of church service attendance, basic illness cognitions (i.e., helplessness, illness acceptance, perceived benefits), and physical and emotional well-being. According to the results, religiousness was significantly associated with subjective health. However, this relationship was indirect, with helplessness and illness acceptance serving as mediators between intrinsic religiousness and health. This finding is significant for understanding the complex relation of religiousness to chronic patients’ well-being.

Illness acceptance, hospitalization stress and subjective health in a sample of chronic patients admitted to hospital

The aim of this study was to examine the effects of illness acceptance on the subjective health of hospitalized chronic medical patients. Participants were 128 patients with a previous diagnosis of chronic coronary artery disease, cancer, or chronic renal disease, who were admitted to a public hospital. Illness acceptance was associated with higher levels of subjective health. It was negatively related to psychological symptoms and positively to self-rated health, even after controlling for demographic variables, type of disease, years since diagnosis, health-related quality of life and hospitalization stress. Furthermore, acceptance mediated the effects of hospitalization stress on subjective health measures.