Review and meta-analysis of couple-oriented interventions for chronic illness

Couples' Experiences With Healthy Lifestyle Behaviors After Cardiac Rehabilitation

PURPOSE

Many cardiac patients discontinue heart-healthy eating and physical activity (PA) behaviors in the months following cardiac rehabilitation (CR). Involving the spouse in CR with the patient may be 1 strategy to increase the maintenance of these behaviors after CR. Assisting patients and spouses with the maintenance of healthy eating and PA behavior following CR begins with a better understanding of the couple-focused factors, impacting their experiences with these behaviors. The purpose of this study was to qualitatively examine couple-focused facilitators and barriers to maintaining changes in healthy eating and PA behavior from the perspectives of both cardiac patients and their spouses following phase 2 CR.

METHODS

A purposive sample of 11 couples (patients undergoing postcoronary artery bypass graft surgery and their spouses) were selected from a larger randomized control trial. Semistructured, in-person interviews were conducted with patients and their spouses separately following CR. Data were analyzed using line-by-line coding to identify facilitator and barrier themes.

RESULTS

Two couple-focused barrier themes emerged: unnegotiated situations and unshared behaviors. Two couple-focused facilitator themes emerged: supportive exchanges and partnerships.

CONCLUSION

These findings will help guide interventions targeting changes in diet and PA behavior in both patients and their spouses through minimizing unnegotiated situations, fostering supportive exchanges, and creating a partnership for the couple to work together on shared diet and PA goals. Targeting both patients and their spouses may be an innovative and effective way to intervene to increase adherence to healthy eating and PA behaviors post-CR.

A Qualitative Study of Experiences of Participants in Cardiac Rehabilitation

PURPOSE

Maintenance of lifestyle changes after cardiac rehabilitation (CR) is suboptimal. In addition, partners of cardiac patients are invited to participate in CR educational sessions and implicitly expected to assist patients with their lifestyle changes. The purpose of this study was to qualitatively examine patient and partner perceptions of phase 2 CR 3 mo after completion of the program.

METHODS

A purposive sample of 11 couples (patients post-heart surgery and their spouses) was interviewed following completion of CR. Semistructured, in-person interviews were conducted with patients and spouses separately. Data were analyzed using line-by-line coding to identify themes.

RESULTS

Themes were identified in relation to program elements of CR. Exercise themes were as follows: (1) benefitted from exercise and (2) felt held back. Education themes were as follows: (1) received basic education and (2) needed more personalized information. CR environment themes were as follows: (1) developed confidence; (2) made social comparisons; and (3) helped to have partner there.

CONCLUSION

Overall, participant perceptions of exercise, education, and the CR environment were very positive. Nevertheless, there is a need to improve educational efforts within CR to rely less on "canned" presentations and more on participants developing their own self-management methods to maintain a healthy lifestyle after CR.

Social Ambivalence and Disease (SAD): A Theoretical Model Aimed at Understanding the Health Implications of Ambivalent Relationships

The protective influence of social relationships on health is widely documented; however, not all relationships are positive, and negative aspects of relationships may be detrimental. Much less is known about the relationships characterized by both positivity and negativity (i.e., ambivalence). This article provides a theoretical framework for considering the influence of ambivalent relationships on physical health, including reasons why ambivalence should be considered separately from relationships characterized as primarily positive (supportive) or primarily negative (aversive). We introduce the social ambivalence and disease (SAD) model as a guide to understanding the social psychological antecedents, processes, and consequences of ambivalent relationships. We conclude by highlighting gaps in the literature and features of the SAD model that may serve as a guide to future research on potential health-relevant pathways of ambivalent relationships.

Daily Marital Tension and Symptom Severity in Older Adults With Diabetes or Osteoarthritis

Background

Greater marital quality is associated with better psychological and physical health. The quality of daily marital interactions is likely to be especially important for individuals with chronic illness, but this question has received little attention.

Purpose

Using data from two diary studies, the current study examined whether individuals with chronic illness would experience more severe symptoms on days with more marital tension due in part to greater negative affect on those days.

Methods

The samples included individuals with knee osteoarthritis (OA, N = 145) or type 2 diabetes mellitus (T2DM, N = 129) and their spouses. Participants reported on daily marital interaction quality, affect, and symptom severity (patients only) for 22 days (knee OA) or 24 days (T2DM). Separate multilevel models were run for patients and spouses, controlling for the partner's marital tension and negative affect as well as both partners' daily marital enjoyment and positive affect. We examined same-day and across-day associations.

Results

For individuals with T2DM or knee OA, more severe symptoms on days with more marital tension were due in part to their greater negative affect on those days. Individuals with knee OA who experienced more pain had more negative affect and marital tension the next day.

Conclusions

Negative marital interactions may exacerbate physical symptoms. Effects of daily marital tension likely accumulate over time and have long-term implications for health.

A Couples-Based Approach for Increasing Physical Activity Among Adults With Type 2 Diabetes: A Pilot Feasibility Randomized Controlled Trial

Purpose

The purpose of the study was to examine feasibility outcomes and obtain initial efficacy data on an intervention testing collaborative implementation intentions (IIs) for physical activity (PA) among participants with type 2 diabetes.

Methods

The study used a pilot randomized design and enrolled people with diabetes (PWD) and their partners (N = 40 couples, 80 individuals). PWD reported psychosocial measures, including self-efficacy for PA, diabetes partner investment in diabetes self-management, and PA-related social support. Accelerometers (objective) and the International Physical Activity Questionnaire (self-report) were used to assess PA.

Results

Participants in both experimental conditions reported being satisfied with the intervention and highly committed to their PA plans. Participants were able to follow instructions and completed the intervention in less than 30 minutes. Participants in the collaborative IIs condition reported a greater increase in PA-related social support (partial2= .185, P < .05) and self-reported recreational PA (partial2= .210, P < .05) at 6 weeks compared to the other 2 conditions. In this pilot study, there were no significant group differences on other psychosocial outcomes or for objective PA; however, time in light PA trended higher for the collaborative IIs condition compared to the other 2 conditions (partial2= .237, P = .056).

Conclusions

This study provides initial support for collaborative IIs for PA with PWD and their partners. This brief intervention was feasible and highly acceptable, and it may improve relationship dynamics around PA as well as ultimately increase PA.

Responsibility in healthcare across time and agents

It is unclear whether someone's responsibility for developing a disease or maintaining his or her health should affect what healthcare he or she receives. While this dispute continues, we suggest that, if responsibility is to play a role in healthcare, the concept must be rethought in order to reflect the sense in which many health-related behaviours occur repeatedly over time and are the product of more than one agent. Most philosophical accounts of responsibility are synchronic and individualistic; we indicate here what paying more attention to the diachronic and dyadic aspects of responsibility might involve and what implications this could have for assessments of responsibility for health-related behaviour.

A Couples-Oriented Intervention for Positive Airway Pressure Therapy Adherence: A Pilot Study of Obstructive Sleep Apnea Patients and Their Partners

Background: Partner involvement can influence positive airway pressure (PAP) therapy use among patients with obstructive sleep apnea (OSA). This study assessed the feasibility, acceptability, and preliminary efficacy of a couples-oriented education and support (CES) intervention for PAP adherence. Participants: Thirty newly diagnosed OSA patients and their partners were randomly assigned to one of three groups: an education and support intervention directed at both patient and partner (CES), an education and support intervention directed only at the patient (PES), or usual care (UC). Methods: Feasibility and acceptability were assessed through enrollment and posttreatment program evaluations, respectively. Assessments of sleep quality, daytime sleepiness, and daytime function were obtained from both patients and partners at baseline and 3 months after PAP initiation. Objective PAP adherence was assessed at 1 week, 1 month, and 3 months. Results: Recruitment and attrition data suggest adequate feasibility. All patients and partners in the CES group reported that the intervention was helpful. Patients in the CES and PES groups increased their PAP adherence over the first month of treatment, whereas PAP adherence decreased over this period in the UC group. For patients, large to medium effects for sleep quality (d = -1.01), daytime sleepiness (d = -0.51), and daytime function (d = 0.51) were found for the CES group. The PES and UC groups effect sizes were large to small for sleep quality (d = -0.94; d = -0.40), daytime sleepiness (d = -0.42; d = -0.82), and daytime function (d = 0.41; d = 0.57), respectively. For partners, large effects for daytime sleepiness (d = -1.31) and daytime function (d = 1.54) and small to medium effect for sleep quality (d = -0.31) were found for the CES group. Worsening of sleep quality (d = 0.65) and no change in daytime sleepiness or daytime function were found for the PES group. For the UC group, medium to large effects were found for sleep quality (d = -0.77), daytime sleepiness (d = -0.77), and daytime function (d = 0.65). Conclusions: The findings of this pilot study provide support for taking a couples intervention approach to improve PAP adherence.

Couple Interventions for Chronic Pain: A Systematic Review

OBJECTIVE

Couple interventions for chronic pain have been shown to more effectively reduce pain intensity for individuals with chronic pain (ICPs) than individual behavioral interventions or usual care. This systematic review identified randomized controlled trials of couple interventions to highlight strategies that could be incorporated into psychotherapy with ICPs and their romantic partners.

METHODS

The authors identified articles reporting randomized controlled trials of couple interventions for chronic pain. Three databases were searched (ie, PubMed, Embase, and PsycInfo), resulting in 18 studies and 22 articles.

RESULTS

Couple interventions resulted in statistically significant improvements in pain intensity compared with other conditions in 8% to 40% of the studies depending on the comparator group (i.e., control, individual intervention, another couple intervention), and in statistically significant improvements on a pain-related outcome compared with other conditions in 31% to 50% of the studies depending on the comparator group (ie, control, individual intervention, another couple intervention). Educating couples about pain was the most common strategy (83%). Jointly administered relaxation or meditation skills were included in nearly half of the interventions (48%). Many interventions taught cognitive-behavioral skills jointly to couples (39%) or to the ICP with partner encouragement (30%). Teaching couples how to request and provide assistance (30%), and encouraging partners to avoid reinforcing pain behaviors (39%), occurred frequently. ICPs and their partners were often asked to set goals (30%).

DISCUSSION

This review outlined strategies included in couple interventions for chronic pain that are derived from the cognitive-behavioral therapy, acceptance and commitment therapy, and operant behavioral traditions, but delivered relationally. Therapists working with ICPs and their partners may integrate these strategies into their practice to help couples who are managing chronic pain.

Close relationships as a contributor to chronic pain pathogenesis: Predicting pain etiology and persistence

RATIONALE

Chronic stress contributes to the pathogenesis of chronic pain. Yet, the role of close relationship stress in these pathways to pain is not fully understood.

OBJECTIVE

To delineate specific psychosocial pathways associated with chronic pain, specifically emphasizing close relationships for midlife adults. We tested whether relationship strain, relationship support, social integration, depression, anxiety, and pain severity predict chronic pain etiology and persistence over 10 years, highlighting specific associations for acute versus chronic pain.

METHOD

Using data from the National Survey of Midlife in the U.S. (MIDUS 2 and 3, collected in 2004-2006 and 2013-2014, respectively), we used logistic regression to test the etiology of new chronic pain (n = 1591) and persistence of pain for adults with acute (n = 352) and chronic pain (n = 367) conditions at baseline.

RESULTS

Of participants who reported they did not have chronic pain at baseline, the development of chronic pain 10 years later was significantly associated with baseline family strain (OR = 1.38, p < .01). For participants with acute pain at baseline, the transition of this pain to chronic a decade later was significantly associated with initial reports of pain interference (OR = 1.24, p < .001), family support (OR = 0.60, p < .05), and depression (OR = 1.20, p < .05). Persistent chronic pain was solely associated with baseline pain interference (OR = 1.21, p < .01).

CONCLUSIONS

Family strain is an important part of the chronic stress profile associated with chronic pain etiology, whereas family support is associated with a reduced risk of acute pain transitioning to chronic pain over time. Prioritizing family relationships in treatment approaches to pain may be an indicated, innovative approach to preventing pain development and escalation and requires systems training in healthcare.

Partners' Overestimation of Patients' Pain Severity: Relationships with Partners' Interpersonal Responses

Objectives

The present study examined whether concordance between patients' and their partners' reports of patient pain severity relates to partners' social support and behavioral responses in couples coping with chronic pain.

Methods

Fifty-two couples completed questionnaires about the patient's pain severity. Both dyad members also rated the partner's social support and negative, solicitous, and distracting responses toward the patient when in pain.

Results

Bivariate correlations showed moderate correspondence between patient and partner ratings of pain severity (r = 0.55) and negative (r = 0.46), solicitous (r = 0.47), and distracting responses (r = 0.53), but lower correspondence for social support (r = 0.28). Twenty-eight couples (54%) were concordant in their perceptions of patient pain; partners overestimated pain in 14 couples (27%), and partners underestimated pain in 10 couples (19%). Couple concordance in pain perceptions was not related to patients' reports; however, it significantly predicted partners' reports: Partners who overestimated pain reported giving more social support (β = 0.383, P = 0.016), fewer negative responses (β = -0.332, P = 0.029), and more solicitous responses (β = 0.438, P = 0.016) than partners who were in agreement or who underestimated pain.

Discussion

Partner overestimation of pain severity is associated with partner-reported but not with patient-reported support-related responses. This finding has important clinical implications for couple interventions in chronic pain.

(Un)Spoken realities of living with axial spondyloarthritis: a qualitative study focused on couple experiences

OBJECTIVE

Axial spondyloarthritis is a long-term rheumatic condition. The symptoms, including pain, can impact on the daily life routines and psychological well-being of individuals that are diagnosed with axial spondyloarthritis (axSpA). Partners are often a main source of support for individuals who manage a long-term condition and they can also be affected by the illness experience, often themselves reporting elevated levels of emotional distress. Few qualitative studies have explored the impact of axSpA on partner relationships. This study addresses the social context of axSpA by investigating the experiences for both individuals with axSpA and their partners.

DESIGN

Semistructured individual telephone interviews analysed using thematic analysis at a dyadic partner level.

SETTING

Participants were recruited from the social media pages of a UK-based axSpA-specific charity.

PARTICIPANTS

Nine heterosexual partner dyads (23-65 years), who were currently cohabiting, comprising nine individuals diagnosed with axSpA (n=6 females) and nine partners (n=3 females).

RESULTS

Three themes 'Perceived relational closeness', 'Playing third wheel to axSpA' and 'Tensions surrounding a carer-type role' were identified. The findings illustrate how living with axSpA can influence closeness between partners and dominate daily decisions, particularly surrounding leisure activities. Partners commonly adopted a carer-type role, despite many individuals with axSpA expressing desire for a greater sense of autonomy.

CONCLUSIONS

This study provides an important insight into the lived experiences of both individuals with axSpA and their partners. Findings highlight the social context of managing a long-term condition and suggest the need for including partners within consultations, and the need for support provision for partners.

Patient and partner illness appraisals and health among adults with type 1 diabetes

In a study of 199 couples in which one person had type 1 diabetes, we examined how patient appraisal of the diabetes as shared versus individual was associated with collaborative, supportive and unsupportive behavior and whether patient shared illness appraisal was most beneficial for health when it occurred in the context of supportive behavior. We assessed illness appraisal among patients with type 1 diabetes and their partners and had patients complete relationship and health measures. Results showed partners were more likely than patients to hold shared illness appraisals. Patients' shared appraisals were associated with more collaborative and instrumental support, more emotional support, less protective buffering, and more overprotective behavior. When patients and partners were consistent in their shared appraisals, support was highest. Regression analysis showed collaborative and instrumental support, as well as emotional support, was related to better psychological and physical health when patients held shared compared to individual illness appraisals.

Spousal understanding and marital satisfaction in pain patients and their spouses

The current study tested the hypotheses that knee osteoarthritis (OA) patients and spouses who report more spousal understanding of patient's pain would report greater marital satisfaction. A total of 124 couples completed interviews at three time points across 18 months. Results from dyadic analyses showed that patients who felt more understood by their spouse report, and have spouses who report, higher marital satisfaction concurrently. In addition, patients who felt more understood by their spouse reported higher marital satisfaction over time. Spouses' reports of understanding also had a significant influence on the patients' and their own marital satisfaction concurrently. Results highlight the importance of spouses understanding knee OA patients' pain for both dyad members' marital satisfaction.

The role of spousal support for dietary adherence among type 2 diabetes patients: a narrative review

Healthy eating is key to successful management of type 2 diabetes (T2D). As discussed in this narrative review, there are strong indications that spousal support is an important element affecting dietary adherence in T2D. To provide a synthesized review of this evidence, Google Scholar and PubMed were searched, 28 relevant studies were selected, and the results were narratively summarized. A framework for information synthesis was developed which categorized results into three major themes: how gender roles and spousal dynamics function in spousal support for dietary adherence, the role of race and ethnicity in the influence of spousal support on dietary adherence, and the extant interventional work specifically targeting spousal support for T2D. The reviewed studies indicate that gender role performance is the principal factor in the relationship between spousal support and dietary adherence in T2D, though race and ethnicity also contribute. Despite this evidence, interventions that specifically target spousal support to improve dietary adherence in T2D have had limited efficacy. A better understanding of the relationship between spousal support and dietary adherence, as well as a subsequent utilization of this information to create targeted and effective interventions, would be of great benefit to the field of diabetes management.

Five-year outcomes from a randomised controlled trial of a couples-based intervention for men with localised prostate cancer

OBJECTIVE

Psychosexual morbidity is common after prostate cancer treatment, however, long-term prospective research is limited. We report 5-year outcomes from a couples-based intervention in dyads with men treated for localised prostate cancer with surgery.

METHODS

A randomised controlled trial was conducted involving 189 heterosexual couples, where the man received a radical prostatectomy for prostate cancer. The trial groups were peer support vs. nurse counselling versus usual care. Primary outcomes were sexual adjustment, unmet sexual supportive care needs, masculine self-esteem, marital satisfaction, and utilisation of erectile aids at 2-, 3-, 4- and 5-year follow-up.

RESULTS

The effects of the interventions varied across the primary outcomes. Partners in the peer group had higher sexual adjustment than those in the usual care and nurses group at 2 and 3 years (P = 0.002-0.035). Men in usual care had lower unmet sexual supportive care needs than men in the peer and nurse groups (P = 0.001; P = 0.01) at 3 years. Women in usual care had lower sexual supportive care needs than women in the peer group at 2 and 3 years (P = 0.038; P = 0.001). Men in the peer and nurse group utilised sexual aids more than men in usual care; at 5 years 54% of usual care men versus 87% of men in peer support and 80% of men in the nurse group.

CONCLUSION

Peer and nurse-administered psychosexual interventions have potential for increasing men's adherence to treatments for erectile dysfunction. Optimal effects may be achieved through an integrated approach applying these modes of support.

Influence of Relationship Partners on Self-Efficacy for Self-Management Behaviors Among Adults With Type 2 Diabetes

Individuals with type 2 diabetes must engage in daily self-management behaviors to prevent complications. Given that management may be shared with a person's romantic partner, we examined both patients' and their partners' perceptions of relationship characteristics that were hypothesized to affect patients' self-efficacy for diabetes management. Adults with type 2 diabetes and their partners (n = 52 couples, 104 individuals) completed measures of three aspects of relationships that are theorized to affect self-efficacy: partner investment, partner support, and relationship satisfaction. Patients reported their self-efficacy for diabetes management and weekly frequency of diabetes self-management behaviors. A common fate modeling approach in which constructs were modeled as agreement between partner reports showed that relationship factors (investment, support, and satisfaction) significantly predicted patient self-efficacy (R ² = 0.49), which in turn predicted patient self-management behaviors. This model fit the data well [χ² (41) = 48.60, P = 0.19; comparative fit index (CFI) = 0.96; root mean square error of approximation = 0.06; and standardized root mean square residual = 0.07]. Interventions designed to support patients in their self-efficacy for self-management behavior may be improved through consideration of patients' romantic relationships.

Do family health conversations impact patients with glioblastoma multiforme and their family members?

AIMS AND OBJECTIVES

To assess the impact of family health conversations (FamHC) as a supplement to conventional care on health-related quality of life (HRQoL), family functioning (FFSS) and family hardiness or resilience (FHI) 4 and 14 weeks postoperatively among patients with glioblastoma multiforme and their family members.

BACKGROUND

There is a lack of knowledge about the efficiency of FamHC among families experiencing glioblastoma multiforme.

DESIGN

A quasi-experimental pre- and post-test design adhering to the STROBE (Strengthening the reporting of observational studies in epidemiology) guidelines for case-control studies. Patients and family members were included consecutively in the pretest period from November 2013-December 2014 for the control group (offered traditional care only), and in the post-test period from January 2015-December 2015 for the intervention group (offered traditional care and FamHC). For both groups, 4 and 14 weeks postoperative measurement were obtained.

METHODS

Differences in outcomes were assessed using a difference-in-difference regression analysis approach measuring difference across pre and post groups and across 4 and 14 weeks measurements.

RESULTS

The study does not reveal significant effects of FamHC (all p-values larger than 0.05) as measured by the three instruments WHOQOL-BREF, FFSS and FHI.

CONCLUSIONS

The present study was not able to show significant effects of FamHC. However, it cannot be left out that the intervention might be helpful and supportive at a later state of the illness trajectory.

RELEVANCE FOR CLINICAL PRACTICE

The study adds to the growing evidence-based knowledge on FamHC by questioning their potential use in different cultural contexts among families experiencing critical illness. Oncological nurses need to adapt this information to support their daily care for the patients and their close relatives. For future studies, it is recommended that the families themselves choose when the conversations should take place during the course of the illness.

Influence of significant others on work participation of individuals with chronic diseases: a systematic review

OBJECTIVE

It is widely recognised that significant others (SOs), such as a partner, family member or friend, can influence health outcomes of individuals with a chronic disease. However, not much is known about which specific cognitions (ie, illness perceptions and expectation of work ability) and behaviours (eg, emotional and practical support) of SOs influence work participation. Therefore, we aimed to identify cognitions and behaviours of SOs that are related to work participation of individuals with a chronic disease.

DESIGN

A systematic review and thematic synthesis.

DATA SOURCES

PubMed, Embase, PsycINFO, SocINDEX and Web of Science were searched until 28 March 2017.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included studies reporting on cognitions and behaviours of SOs related to work participation in populations with various chronic diseases.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted the data and performed a quality assessment using the Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project 2007 and a checklist for assessment of qualitative studies derived from the Cochrane Supplemental Handbook Guidance. Evidence was thematically synthesised.

RESULTS

Out of 5168 articles, 18 were included (15 qualitative and 3 quantitative) of moderate to high quality. Studies were on cancer, chronic pain, brain injuries and mental health disorders. After thematic synthesis 27 factors could be distinguished. Consistent evidence was found that SOs' positive and encouraging attitudes regarding work participation, encouragement and motivating behaviour and open communication with patients are facilitators for work participation. Consistently reported barriers were SOs' positive attitudes towards sickness absence and advise, encouragement or pressure to refrain from work.

CONCLUSIONS

Our findings show that several cognitions and behaviours of SOs can facilitate or hinder work participation of individuals with a chronic disease. Intervening on these factors by involving SOs in disability prevention and return to work intervention strategies may be beneficial. More prognostic studies are needed, as the current evidence is mostly based on qualitative studies.

Evaluating psychosocial contributions to chronic pain outcomes

The biopsychosocial model of pain dominates the scientific community's understanding of chronic pain. Indeed, the biopsychosocial approach describes pain and disability as a multidimensional, dynamic integration among physiological, psychological, and social factors that reciprocally influence one another. In this article, we review two categories of studies that evaluate the contributions of psychosocial factors to the experience of chronic pain. First, we consider general psychosocial variables including distress, trauma, and interpersonal factors. Additionally, we discuss pain-specific psychosocial variables including catastrophizing, expectations, and pain-related coping. Together, we present a diverse array of psychological, social, and contextual factors and highlight the need to consider their roles in the development, maintenance, and treatment of chronic pain conditions.

Living Life and Doing Things Together: Collaborative Research With Couples Where One Partner Has a Diagnosis of Dementia

The aim of this study is to identify relevant content for a self-management guide by using the outcomes of previous research in combination with knowledge and experiences from couples where one partner has a diagnosis of dementia. The study was carried out in three phases: (a) literature search of previous research related to well-being and couplehood in dementia; (b) interviews with couples with dementia based on the findings of the literature search; and (c) further authentication of the findings within expert groups of people with dementia and carers. For analysis of data, we used a hybrid approach of thematic analysis with combined deductive and inductive approaches. The findings of this study indicated that the four main themes "Home and Neighborhood," "Meaningful Activities and Relationships," "Approach and Empowerment," and "Couplehood" with related subthemes could be appropriate targets for a self-management guide for couples where one partner has a diagnosis of dementia.

Loneliness Mediates the Relationship Between Pain During Intercourse and Depressive Symptoms Among Young Women

Previous research suggests that women who experience pain during intercourse also experience higher rates of depressive symptoms. Loneliness might be one factor that contributes to this relationship. We hypothesized that women who experience more severe and interfering pain during intercourse would report higher rates of loneliness and higher rates of depressive symptoms. Further, we hypothesized that loneliness would mediate the relationship between pain during intercourse and depressive symptoms. A total of 104 female participants (85.6% white, 74.03% partnered, 20.9 [3.01] years old) completed an online survey including demographic information, PROMIS Vaginal Discomfort Measure, PROMIS Depression Measure, and Revised UCLA Loneliness Scale. Pearson correlations and bootstrapped mediation analysis examined the relationships among pain during intercourse, loneliness, and depressive symptoms. Pain during intercourse, loneliness, and depressive symptoms were all significantly correlated (p < .05). Results of the mediation analysis indicated that loneliness was a significant mediator of the relationship between pain during intercourse and depressive symptoms (indirect effect = 0.077; 95% CI 0.05-0.19). After accounting for loneliness, pain during intercourse was not significantly related to depressive symptoms, suggesting that loneliness fully mediated the relationship between pain during intercourse and depressive symptoms. These findings are consistent with previous studies highlighting that pain during intercourse is related to depressive symptoms. The current study adds to that literature and suggests that more frequent and severe pain during intercourse leads to more loneliness, which then leads to increased depressive symptoms. This line of work has important implications for treating women who experience depressive symptoms and pain during intercourse.

Distress is Interdependent in Patients and Caregivers with Newly Diagnosed Incurable Cancers

BACKGROUND

Individuals with advanced, incurable cancer often experience high physical and psychological symptom burden. Family and friend caregivers are at risk for emotional distress.

PURPOSE

The aim of the study is to investigate the interrelationship of distress in patient-caregiver dyads at the time of newly diagnosed incurable cancer.

METHODS

From May 2011 to July 2015, within 8 weeks of diagnosis of advanced lung or noncolorectal gastrointestinal cancer, 350 patients and 275 family caregivers were enrolled in a randomized controlled trial of early palliative care. Actor-partner interdependence modeling was used to examine relationships between dyad's self-reported anxiety and depressive symptoms on the Hospital Anxiety and Depression Scale at baseline.

RESULTS

Comparing patients with caregivers, patients reported more depressive symptoms (M _diff = .84; t[274] = 3.17, p = .002, d = .22) and caregivers reported more anxiety symptoms (M _diff =1.62, t[274] = 4.91, p < .001, d = .39). Dyads' anxiety symptoms were positively associated, as were depressive symptoms (rs = .21, ps ≤ .001). Actor-partner interdependence modeling showed that patients' anxiety symptoms were positively associated with their own depressive symptoms, with an equal effect for caregivers (actor effect βs = 0.52, ps < .001). Patients' own anxiety was concurrently positively associated with their caregivers' depressive symptoms, with an equal effect for caregivers to patients (partner effect βs=0.08, ps=.008).

CONCLUSIONS

In the context of newly diagnosed incurable cancer, caregivers experience more pronounced anxiety, while patients report greater depressive symptoms. Findings indicate that anxiety and depressive symptoms are interrelated among dyads facing newly diagnosed incurable disease. Results emphasize the importance of addressing distress in both patients and caregivers. Future research should discern when dyadic versus individual psychosocial interventions would be optimal.

TRIAL REGISTRATION NUMBER

The trial was registered with the ClinicalTrials.gov database (NCT02349412) https://clinicaltrials.gov/ct2/show/NCT02349412 .

The diabetes self-management educational programs and their integration in the usual care: A systematic literature review

The increasing prevalence of type 2 diabetes has highlighted the importance of evidence-based guidelines for effective prevention, management and treatment. Diabetes self-management education (SME) produces positive effects on patient behaviours and health status. We analyzed the literature to identify (i) the level of integration between usual care and SME programs and (ii) any possible differences across them in terms of outcomes. Searches were made on three databases - PubMed, Scopus and Web of Science - to identify relevant publications on diabetes SME to 2015, which also describe the provider of usual care. In total, 49 studies met the inclusion criteria. We identified three levels of integration (high, medium and low) between usual care and SME programs based on the level of involvement of usual care professionals within the SME programs. In most cases, the primary care physician was responsible for the diabetes patients. Patient health behaviors and/or outcomes improve in most of the studies, independently from the level of integration. However, findings suggest that when patients/participants could perceive that usual care provider is highly involved in SME delivery, educational programs produced results that appear to be more positive.

Foot care, 'spousal' support and type 2 diabetes: an exploratory qualitative study

OBJECTIVES

People with type 2 diabetes (T2DM) should check their feet and protect them against harm, but few do. Living with a spouse contributes to good foot care behaviour. This study explores awareness, perceived susceptibility of, and concern about, foot problems, and reported foot care behaviour, and ways in which a spouse may or may not contribute to foot care in T2DM.

METHODS

1:1 interviews were conducted with 6 individuals with T2DM. Half had a spouse half did not. There was one person at low, medium and high risk in each sample. Each spouse participated in a separate interview, and the dyads were interviewed together. Interviews were analysed using Applied Thematic Analysis.

RESULTS

All participants knew that diabetes was associated with foot problems. Not all people with T2DM thought that they were susceptible; spouses perceived greater susceptibility for the patient. This was unrelated to risk level. Most people with T2DM and all spouses engaged in behaviour to identify problems or protect feet, but rarely both. Spouses' attitude and behaviour did influence the patients' own behaviour. At times spouse support was perceived positively, and at times negatively.

CONCLUSION

Engaging spouses in foot care education may improve foot care behaviour.

Close relationships and the management of chronic illness: Associations and interventions

Self-management of a chronic illness involves not only monitoring symptoms, adhering to medication regimens, and keeping medical appointments but also making and maintaining difficult lifestyle changes. This article highlights correlational and intervention research suggesting family members are influential in children's and adults' illness management. The argument is made that a dyadic approach to chronic illness management that targets the influence of close relationships may yield more sustainable effects on patient behavior than has been achieved in the past. In particular, dyadic approaches aimed at helping patients and family members to find ways to collaborate in goal setting for these behaviors is recommended. Such dyadic interventions may also benefit family members who are ill or are at risk because of poor health behaviors. (PsycINFO Database Record

Recruitment of breast cancer survivors and their caregivers: implications for dyad research and practice

Breast cancer survivors' informal caregivers experience adverse health outcomes and could benefit from interventions. Studies of caregivers' participation in research, to date, have assumed heterosexuality. The aim of this study is to identify factors associated with caregiver participation among survivors with diversity in sexual orientation. We recruited breast cancer survivors into a telephone survey and asked them to invite a caregiver. Logistic regression identified factors associated with caregivers' participation. Among 297 survivors, 12 (4 %) had no caregivers, 82 (28 %) refused to provide caregiver information, 203 (68 %) provided caregiver contact, and 167 (56 %) had caregivers participate. Caregiver participation was more likely among sexual minority than heterosexual survivors (aOR: 1.89; 95 % CI: 1.08, 3.32), dyads with higher cohesion, and among caregivers who were partners. Caregiver participation was less likely among survivors with lower education and higher comorbidity. Findings provide insight into recruitment of diverse dyads into cancer survivorship research that will ultimately inform intervention design.

Resistance to change: Role of relationship and communal coping for coronary heart disease patients and their partners in making lifestyle changes

Background: Lifestyle behaviours are important risk factors for coronary heart disease (CHD) and, hence, motivation for lifestyle changes is suggested to be a key factor in the success of cardiac rehabilitation and secondary prevention programmes. The motivation for changing lifestyle among people with CHD may be influenced by those with whom they have long-term, intimate relationships. Aims: This study explores the role of the relationship between people with CHD and those closest to them in making lifestyle changes. This includes investigating if patients and partners experience autonomy, competence, and relatedness, and what role communal, i.e. relationship-centred coping serves in relation to patients’ health behaviour. Methods: The study is based on semi-structured, in-depth interviews with 10 couples; people who have experienced acute coronary syndrome, and their partners. Participants had diverse histories of disease and social backgrounds. A three-stage interview process was undertaken including focus group interviews, couple interviews and individual interviews. A thematic analysis, inspired by the self-determination theory and the interdependence theory, was conducted. Results: Communal coping is evident in various forms, and at different levels, among people with CHD and their partners. Satisfaction with new lifestyle, ownership of change, confidence in ability to change, and emotional distress are all factors that affect how couples deal with lifestyle changes in the aftermath of CHD. Conclusions: Rehabilitation efforts, aimed at lifestyle changes, need to address each individual, as well as the dyadic interaction within couples. Incorporating a dyadic perspective in the rehabilitation process may lead to a reduction in motivational barriers to lifestyle changes.

A Couple-Based Psychological Treatment for Chronic Pain and Relationship Distress

Chronic pain impacts individuals with pain as well as their loved ones. Yet, there has been little attention to the social context in individual psychological treatment approaches to chronic pain management. With this need in mind, we developed a couple-based treatment, "Mindful Living and Relating," aimed at alleviating pain and suffering by promoting couples' psychological and relational flexibility skills. Currently, there is no integrative treatment that fully harnesses the power of the couple, treating both the individual with chronic pain and the spouse as two individuals who are each in need of developing greater psychological and relational flexibility to improve their own and their partners' health. Mindfulness, acceptance, and values-based action exercises were used to promote psychological flexibility. The intervention also targets relational flexibility, which we define as the ability to interact with one's partner, fully attending to the present moment, and responding empathically in a way that serves one's own and one's partner's values. To this end, the intervention also included exercises aimed at applying psychological flexibility skills to social interactions as well as emotional disclosure and empathic responding exercises to enhance relational flexibility. The case presented demonstrates that healthy coping with pain and stress may be most successful and sustainable when one is involved in a supportive relationship with someone who also practices psychological flexibility skills and when both partners use relational flexibility skills during their interactions.

Can Women Facilitate Men's Prostate Cancer Screening Informed Decision-Making? The M-PACT Trial

The M-PACT study compared an all-male with a mixed-sex intervention to increase informed decision-making for prostate cancer screening among African-American men in church settings. We recruited 262 men in 18 churches randomized to the two intervention approaches. Trained and certified lay peer community health advisors in each church led a series of four men's health workshops on informed decision-making for prostate cancer screening. African-American male workshop participants completed baseline, post-workshop, and 12-month follow-up surveys. Contrary to our expectations, including women in the workshops did not result in increased intervention efficacy for the informed decision-making outcomes as both groups showed significant improvement over time in several study outcomes including stage of decision-making for prostate cancer screening, preference for role in decision-making, prostate cancer knowledge, and self-reports of prostate specific antigen testing. Finally, men who attended multiple workshops had better informed decision-making outcomes on several indicators. The current findings suggest mixed results from including women in this men's health educational intervention. Future work should consider optimal ways of providing family support for African-American men's health promotion.

Neurocognitive Impairment: Addressing Couple and Family Challenges

Conditions involving neurocognitive impairment pose enormous challenges to couples and families. However, research and practice tend to focus narrowly on immediate issues for individual caregivers and their dyadic relationship with the affected member. A broad family systems approach with attention to family processes over time is needed in training, practice, and research. In this paper, Rolland's Family Systems Illness model provides a guiding framework to consider the interaction of different psychosocial types of neurocognitive conditions and their evolution over time with individual, couple, and family life-course development. Discussion addresses key family and couple issues with mild-to-severe cognitive impairment and progressive dementias, including: communication, multigenerational legacies, threatened future neurocognitive disability, ambiguous loss, decisional capacity, reaching limits, placement decisions, issues for adult children and spousal caregivers, and the transformation of intimate bonds. Principles and guidelines are offered to help couples and families master complex challenges, deepen bonds, and forge positive pathways ahead.

Risk of Intimate Partner Violence and Relationship Conflict Following Couple-Based HIV Prevention Counseling: Results From the Harlem River Couples Project

Heterosexual transmission of HIV often occurs in the context of intimate sexual partnerships. There is mounting evidence that couple-based HIV prevention interventions may be more effective than individual-based interventions for promoting risk reduction within such relationships. Yet, concerns have been raised about the safety of couple-based prevention approaches, especially with regard to the risk of intimate partner violence against women. Although several international studies have examined the potential for adverse consequences associated with couple-based interventions, with inconsistent results, there is little data from U.S. studies to shed light on this issue. The current study analyzed data from a randomized trial conducted in New York City with 330 heterosexual couples to examine whether participation in couple-based or relationship-focused HIV counseling and testing (HIV-CT) interventions resulted in an increased likelihood of post-intervention breakups, relationship conflicts, or emotional, physical, or sexual abuse, compared with standard individual HIV-CT. Multinomial logistic regression was used to model the odds of experiencing change in partner violence from baseline to follow-up by treatment condition. A high prevalence of partner-perpetrated violence was reported by both male and female partners across treatment conditions, but there was no conclusive evidence of an increase in relationship dissolution or partner violence subsequent to participation in either the couple-based HIV-CT intervention or relationship-focused HIV-CT intervention compared with controls. Qualitative data collected from the same participants support this interpretation. HIV prevention interventions involving persons in primary sexual partnerships should be sensitive to relationship dynamics and the potential for conflict, and take precautions to protect the safety of both male and female participants.

Evaluation of a physical activity intervention for new parents: protocol paper for a randomized trial

Background

Identifying critical life transitions in people’s physical activity behaviors may illuminate the most opportune intervention apertures for chronic disease prevention. A substantive evidence base now indicates that parenthood is one of these critical transition points for physical activity decline. This study will examine whether a brief theory-based intervention can prevent a decline in physical activity among new parents over 6 months following intervention. This study protocol represents the first dyad-based physical activity initiative in the parenthood literature involving both mothers and fathers; prior research has focused on only mothers or only fathers (albeit limited), and has shown only short-term changes in physical activity.

This study will be investigating whether a theory-based physical activity intervention can maintain or improve moderate to vigorous intensity physical activity measured via accelerometry of new parents over a 6 month period following intervention compared to a control group.

Methods

This study is a 6-month longitudinal randomized controlled trial. Parents are measured at baseline (2 months postpartum) with two assessment points at 6 weeks (3.5 months postpartum) and 3 months (5 months postpartum) and a final follow-up assessment at 6 months (8 months postpartum). The content of the theory-based intervention was derived from the results of our prior longitudinal trial of new parents using an adapted theory of planned behavior framework to predict changes in physical activity.

Results

A total of 152 couples have been recruited to date. Sixteen couples dropped out after baseline and a total of 88 couples have completed their 6-month measures.

Discussion

If the intervention proves successful, couple-based physical activity promotion efforts among parents could be a promising avenue to pursue to help mitigate the declines of physical activity levels during parenthood. These findings could inform public health materials and practitioners.

Trial registration

This trial has been registered with the Clinical Trials Registry maintained by the National Library of Medicine at the National Institutes of Health on April 19, 2014. The registration ID is NCT02290808.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4874-7) contains supplementary material, which is available to authorized users.

The NIH Science of Behavior Change Program: Transforming the science through a focus on mechanisms of change

The goal of the NIH Science of Behavior Change (SOBC) Common Fund Program is to provide the basis for an experimental medicine approach to behavior change that focuses on identifying and measuring the mechanisms that underlie behavioral patterns we are trying to change. This paper frames the development of the program within a discussion of the substantial disease burden in the U.S. attributable to behavioral factors, and details our strategies for breaking down the disease- and condition-focused silos in the behavior change field to accelerate discovery and translation. These principles serve as the foundation for our vision for a unified science of behavior change at the NIH and in the broader research community.

An extended review of couple-centred interventions in dementia: Exploring the what and why - Part B

This scoping review is an extended version of a narrative review of couple-centred interventions in dementia shared in part A and the previous publication in this edition. The rationale for expanding study A emerged through the fact that most dyadic interventions have samples consisting of a majority of couples. The exclusion of interventions with samples of mixed relationships in part A therefore contributed to a narrow picture of joint dyadic interventions for couples in which one partner has a dementia. The aim of this second review is to explore the ‘what’ (types of interventions) and the ‘why’ (objectives and outcome measures) of dyadic interventions in which sample consists of a majority of couples/spouses and in which people with dementia and caregivers jointly participate.

Method

A five-step framework for scoping reviews guided the procedure. Searches were performed in Academic Search Premier, CINAHL, PsycINFO, PubMed, Scopus, and Web of Science.

Results

Twenty-one studies with various types of psychosocial interventions were included. The main outcome measure for people with dementia was related to cognitive function, respectively caregiver burden and depression for caregivers.

Conclusions

The findings of this extended review of joint dyadic interventions in dementia are in line with the findings of part A regarding the negative approach of outcomes, lack of a genuine dyadic approach, lack of tailored support, neglect of interpersonal issues and the overlook of the views of people with dementia. This review also recognises that measures of caregiver burden, as well as relationship quality should be considered in samples of mixed relationships due to the different significance of burden and relationship quality for a spouse as opposed to an adult child or friend.

A review of couple-centred interventions in dementia: Exploring the what and why - Part A

Introduction

Symptoms of dementia bring about challenges to couples’ relationships. Relationship-focused support has been highlighted to be of significant importance for sustained relationship quality and to reduce the negative impact of dementia on the dyadic relationship. This review aimed to explore the ‘what’ and ‘why’ of interventions aimed at couples where one partner has a diagnosis of dementia and in which the couple jointly participate.

Method

Searches were performed in Academic Search Premier, CINAHL, PsycINFO, PubMed, Scopus and Web of Science from January 2000 to August 2017.

Results

Six studies were included. Objectives for the person with dementia was related to cognitive function and for the care partner the objectives were related to well-being. The majority of the outcomes were mirrored by the objectives and focused on cognitive function for people with dementia and depression and relationship quality for care partners. Our findings indicate that people with dementia should be included in the assessment of the relationship in order to gain an overall picture of relationship dynamics and to increase tailored support in couple-centred interventions.

Conclusions

The findings of this review indicate that joint interventions for people with dementia and care partners are lacking a genuine dyadic approach where both partners’ views of their relationship are valued. In order to identify targets for support and to use the appropriate outcome measures, the quality of the relationship should be recognised and taken into account. Moreover, there is a lack of a salutogenic approach in couple-centred interventions in which couples’ strengths and resources can be identified and supported.

Communal Coping and Adjustment to Chronic Illness: Theory Update and Evidence

We present a theory of communal coping that describes an optimal pathway to patient adjustment among couples in which one person faces a chronic illness. Communal coping consists of a shared illness appraisal (i.e., person perceives illness as a joint rather than individual problem) and collaboration with a partner to manage the illness. We present a model of the communal coping process that links patient and partner shared illness appraisals to collaboration and a set of supportive interactions that might be reframed as collaboration in the presence of shared illness appraisals. We then outline a model that identifies potential antecedents of communal coping and mechanisms that link communal coping to patient illness adjustment (i.e., enhanced psychological well-being, improved health behaviors, better physical health) and partner psychological well-being. We review the empirical evidence for this model and conclude by identifying several moderator variables, noting potential limitations, and outlining future research directions.

Own and partner pain intensity in older couples: longitudinal effects on depressive symptoms

Chronic pain has been linked to depression among individuals and their partners. Yet, little is known about long-term mutual influences between pain intensity and depressive symptoms within couples as they age. Using a nationally representative U.S. sample of wives and husbands aged 50 and older (mean = 64.53, SD = 7.86), this study explored the links between own and partner pain intensity and depressive symptoms across an 8-year period. A total of 963 heterosexual married couples drawn from the Health and Retirement Study completed interviews biennially from 2006 to 2014. Dyadic growth curve models examined mutual associations within couples and controlled for sociodemographic characteristics, length of marriage, and marital quality, along with self-rated health, number of chronic health conditions, and functional disability. For wives and husbands, their own greater baseline pain intensity was significantly linked to their own higher levels of depressive symptoms. Unexpectedly, wives with greater baseline pain intensity reported decreases in their depressive symptoms over time. There were also partner effects such that husbands' greater pain intensity at baseline was associated with increases in wives' depressive symptoms over time. Findings highlight the importance of considering both individual and spousal associations between pain intensity and depressive symptoms in later life. Understanding how individual and couple processes unfold may yield critical insights for the development of intervention and prevention efforts to maintain mental health among older chronic pain patients and their spouses.

Couples' Shared Beliefs About Aging and Implications for Future Functional Limitations

Purpose of the Study

Individual beliefs are known to be predictive of health. This study examines the co-construction of couple norms and links couples' shared beliefs about aging to future individuals' and couples' functional limitations.

Design and Methods

Data from the 2008 and 2014 waves of the Health and Retirement Study (1,231 couples; age range = 51-90) were analyzed using latent variables that estimated shared and individual variance in beliefs about aging in 2008 and functional limitations at follow-up in 2014. Spouses' individual processes of physical activity and disease burden were modeled to contribute to couples' shared beliefs about aging and subsequent functional limitations. Models progressively controlled for indicators of partner selection, couples' shared health experiences, and similarities and differences in age.

Results

Couples' beliefs about aging predicted future functional limitations. The effect magnitude decreased but remained significant in all models. Physical activity predicted couples' future functional limitations but was largely explained by shared health experiences and similarities and differences in age for wives and husbands, respectively. Disease burden contributed to couples' shared beliefs about aging. Husbands' contributions were explained by partner selection, but wives' contributions remained significant in all models. The effect of couples' shared beliefs on change in couples' functional limitations was explained by couples' shared health experiences.

Implications

Beliefs about aging and health occur within the context of close relationships and shared experiences. Knowledge of couples' beliefs and health is necessary to support their individual and collective efforts to age successfully together.

Which characteristics of planning matter? Individual and dyadic physical activity plans and their effects on plan enactment

OBJECTIVE

Past research supports individual planning as an effective intervention strategy to increase physical activity in individuals. A similar strategy, dyadic planning, adds a planning partner who supports an individual's planning processes. Whether the two planning formats differ in terms of participants' entered plan content and whether and how different content characteristics are linked to plan enactment remains unknown. By investigating the content of generated plans, this study aimed at distinguishing plan characteristics of the two planning formats and examining their role as predictors of later plan enactment.

METHODS

Secondary analyses of a three-arm RCT with German couples (data collection between 2013 and 2015). Couples were assigned to an individual (IPC, n = 114) or dyadic planning condition (DPC, n = 111) and formulated up to 5 physical activity plans for a target person. Couples assigned to a control condition were not included as they did not generate plans. The following characteristics were distinguished and coded for each plan: number of planned opportunities, presence of a planned routine, planned cue- or activity-related specificity, activity-related intensity, and chronological plan rank. One week before (T0) and two weeks following (T2) the intervention (T1), increase vs. no increase of the planned activity was coded as a dichotomous plan enactment variable. Multilevel logistic regressions were fit.

RESULTS

Plan enactment was higher in dyadic than in individual planners. Findings indicated that routines (e.g., after work) were positively related to plan enactment, whereas a high specificity of when-cues (e.g., Friday at 6.30 p.m.) showed a negative relationship. None of the examined plan characteristics could explain differences in enactment between IPC and DPC.

CONCLUSIONS

Linking health behaviours to other behavioural routines seems beneficial for subsequent plan enactment. Dyadic planning was linked with higher enactment rates than individual planning. However, as mechanisms underlying this effect remain unclear, they should be investigated further.

Understanding leisure-time physical activity: Voices of people with MS who have moderate-to-severe disability and their family caregivers

Background

Physical activity (PA) is beneficial for all people, yet people affected by multiple sclerosis (MS) find regular PA challenging. These people may include individuals with the disease who have moderate‐to‐severe disability and their family caregivers. For researchers and clinicians to effectively promote PA among caregiver/care‐recipient dyads with moderate‐to‐severe MS, a comprehensive understanding of the shared PA experiences of these dyads would be beneficial.

Objective

We explored shared experiences of caregiver/care‐recipient dyads affected by moderate‐to‐severe MS about PA and directions for intervention.

Methods

Six focus groups with 23 people with moderate‐to‐severe MS and 12 family caregivers were conducted. Data were analysed using a constant comparative approach.

Results

Three major themes emerged as follows: (i) PA is a continuum, (ii) cycle of disengagement and (iii) cycle of adjustment. The first theme captured the dyads understanding that PA falls along a continuum ranging from highly structured to unstructured activities. Cycle of disengagement captured the experiences of dyads engaging in little or no PA. These dyads perceived internal and external issues as drivers of the cycle of disengagement, while availability of supportive programmes and services or people helped the dyads to break out of the cycle. When the cycle of disengagement was broken, the dyads described moving towards the cycle of adjustment, where they were able to learn skills and take action to incorporate PA into daily routines.

Conclusion

This research highlights the need to adopt an integrative approach that acknowledges the caregiver/care‐recipient dyad with moderate‐to‐severe MS as a focus for PA intervention.