Provider and recipient factors that may moderate the effectiveness of received support: examining the effects of relationship quality and expectations for support on behavioral and cardiovascular reactions

While You Are Sleeping: Marital Ambivalence and Blunted Nocturnal Blood Pressure

Marital relationships offer health benefits, including a lower risk of cardiovascular disease (CVD). However, quality of the relationship matters; ambivalent behaviors may increase CVD risk by affecting blunted nocturnal blood pressure (BP) dipping. This study tracked daytime and nocturnal SBP and DBP in 180 normotensive individuals (90 couples; participant mean age 25.04; 91.58% white) over a 24 h period using ambulatory blood pressure monitors to explore the impact of martial quality. Results showed that perceptions of spousal ambivalence were associated with blunted nocturnal BP dipping. Perceptions of one's own behavior as ambivalent also showed blunted nocturnal dipping. When in an ambivalent relationship, a gender interaction was found such that women were most likely to have blunted SBP dipping, but men were more likely to have blunted nocturnal DBP dipping. Overall, this study found an association between ambivalence and BP dipping, thus uncovering one virtually unexplored pathway by which marital relationships may have adverse effects on health.

Poor-Quality Daily Social Encounters, Daily Stress, and Subjective Cognitive Decline Among Older Adults

Background and Objectives

Although prior research has shown that social relationships and daily stress are strongly associated with cognitive function, few studies have explored the link between the quality of daily social encounters and subjective cognitive decline (SCD). The present study explores whether the quality of older adults' daily social encounters is associated with SCD through daily stress.

Research Design and Methods

This study used data from 254 adults aged 70 or older (M age  = 76.5 years, SD = 4.4; 67.7% women) who completed the Einstein Aging Study, a 2-week experience sampling study. Multilevel mediation analyses were conducted to account for daily measurements nested within individuals. We tested the indirect effect of the quality of daily social encounters on SCD through daily stress levels.

Results

There was a significant positive association between ambivalent and neutral social encounters and daily stress levels at both the within- and between-person levels. Between-person daily stress was, in turn, associated with greater SCD. Specifically, there was a significant indirect path from ambivalent social encounters to SCD through daily stress.

Discussion and Implications

This study contributes to a more detailed understanding of how the quality of daily social encounters can influence cognition via increased exposure to daily stress. The findings suggest that emotional support may be crucial to preserving perceptions of older adults' cognitive functioning.

The construction of a new Clinical Quality of Life Scale (CLINQOL)

Whilst the variables in quality of life and well-being can be separated into objective and subjective domains, there remains a dearth of multiple utility instruments that assess their impact upon quality of life. To address this, ten domains were identified in a preliminary exploratory literature search, and an exploratory review generated enough facets to represent each domain, with items developed to form a composite scale. A principal components analysis run on data collected from 210 participants produced seven factors: relationships, work, money, health, leisure, and life management, with the remaining four domains subsuming into a seventh composite subjective factor (mental state). Final items were collated into the new Clinical Quality of Life Scale (CLINQOL) and were tested against the Assessment of Quality of Life Instrument, the Personal Wellbeing Index-Adult, Positive and Negative Affect Scale, the Satisfaction with Life scale, and the Mindfulness Attention Awareness Scale. The CLINQOL demonstrated suitable reliability, with items within each category forming internally consistent subscales. The full scale score demonstrated satisfactory test-retest reliability and concurrent validity, correlating with all measures. Findings suggest that the CLINQOL captures critical clinical factors, and may be an acceptable instrument to assess quality of life and well-being.

Social Support and Depressive Symptoms in the Context of COVID-19 Lockdown: The Moderating Role of Attachment Styles

Objectives: COVID-19 sanitary measures (social distancing, school closures) have deeply impacted social life, support networks, and their protective role in mental health. The present study aims to understand how attachment styles influence the way individuals experience social support. Particularly, investigating its moderating role in the relationship between social support and depression.

Methods: An online survey was designed to clarify the role of adult attachment styles (ECR-S) in the perceived social support (MOSS) and self-reported depressive symptoms (BDI-SF) in the COVID-19 context.

Results: Positive social interactions was the most important dimension of social support for lower depression symptoms. Individuals attachment strategies have a moderating role in the relation between of social support and depression. Crucially, insecure attachment style wanes the positive impact of social support in depression.

Conclusion: Aligned with the existing literature, attachment security is an essential factor in our current understanding of relationships and mental health. Exploring specific and indivual attachment strategies might be a powerful tool to protect population’s mental healt.

Taking Stock and Moving Forward: A Personalized Perspective on Mixed Emotions

Research on mixed emotions is flourishing but fractured. Several psychological subfields are working in parallel and separately from other disciplines also studying mixed emotions, which has led to a disorganized literature. In this article, we provide an overview of the literature on mixed emotions and discuss factors contributing to the lack of integration within and between fields. We present an organizing framework for the literature of mixed emotions on the basis of two distinct goals: solving the bipolar-bivariate debate and understanding the subjective experience of mixed emotions. We also present a personalized perspective that can be used when studying the subjective experience of mixed emotions. We emphasize the importance of assessing both state and trait emotions (e.g., momentary emotions, general levels of affect) alongside state and trait context (e.g., physical location, culture). We discuss three methodological approaches that we believe will be valuable in building a new mixed-emotions literature-inductive research methods, idiographic models of emotional experiences, and empirical assessment of emotion-eliciting contexts. We include recommendations throughout on applying these methods to research on mixed emotions, and we conclude with avenues for future interdisciplinary research. We hope that this perspective will foster research that results in the organized accumulation of knowledge about mixed emotions.

Marital Quality and Well-Being Among Older Adults: A Typology of Supportive, Aversive, Indifferent, and Ambivalent Marriages

A large body of work has linked marital quality to the health and well-being of older adults, but there is a lack of agreement on how to best measure dimensions of marital quality. Drawing on a stress-process life course perspective, we construct a typology of marriage type that captures the synergistic relationship between positive and negative marital qualities and health. Using data from Wave 1 (2005/2006) and Wave 2 (2010/2011) of the NSHAP survey from the United States, we examine the association between supportive, aversive, ambivalent, and indifferent marriages for older adults that remained married over the study period on multiple indicators of well-being (depression, happiness, and self-rated health; N = 769 males and 461 females). Results suggest that older adults in aversive marriages reported lower happiness (men and women) and physical health (men). There was less evidence that those in ambivalent and indifferent marriages reported worse well-being.

The relationship between comorbidities in dementia patients and burden on adult-child primary caregivers: Does having a secondary caregiver matter?

Primary family caregivers of patients with dementia often experience high caregiver burden and significant decline in a range of health outcomes. The current study examined the relationship between medical comorbidities of inpatients with dementia and caregiver burden in adult-child primary caregivers, and the buffering effect of having a secondary caregiver on the relationship between patients' comorbidities and caregiver burden. The study is a secondary analysis of data from a cross-sectional observational study design. The sample comprised 477 dyads of inpatients with dementia and adult-child primary caregivers attending the neurological department of two grade A hospitals. All the inpatients were assessed with the Charlson Comorbidity Index (CCI) and the Mini-Mental State Examination (MMSE). All the adult-child primary caregivers were assessed with the Zarit Burden Interview (ZBI) and completed the questionnaires on socio-demographic data, caring hours, presence of secondary caregiver, and the level of impairment of the patient. Higher burden was associated with higher scores on the CCI and having a spouse of the patient as the secondary caregiver. A significant interaction occurred between the CCI and caregiver burden when having a spouse as the secondary caregiver, indicating the negative effect of the CCI on caregiver burden was greater when the spouse of the patient served as the secondary caregiver. In summary, the negative impact of patients' comorbidities on caregiver burden in adult-child primary caregivers was heightened when the secondary caregiver role was undertaken by the spouse of the patient with dementia. These results may inform programmes targeted to improve care arrangements for people with dementia and their caregivers.

Ambivalence in the Early Years of Marriage: Impact on Ambulatory Blood Pressure and Relationship Processes

BACKGROUND

Marriage is associated with lower cardiovascular morbidity and mortality, but quality matters. Marriages characterized by ambivalent behaviors (containing both highly positive and highly negative behaviors concurrently) may not confer the same cardiovascular benefits as characterized by purely positive behavior. Ambivalence is assumed to take time to develop but couples in the early years of marriage may already exhibit ambivalent behaviors and thus be at increased risk for future cardiovascular events.

PURPOSE

The purpose of this study was to determine the frequency of spouse and own ambivalent behavior, the impact on interpersonal (i.e., responsiveness, disclosure, affective interactions) processes, and ambulatory blood pressure (ABP) in individuals in the early years of marriage.

METHODS

In 84 young married couples, objective and subjective ambivalence, interpersonal functioning, and ABP over a 24-hr period were assessed.

RESULTS

As predicted, ambivalence developed early in marriage. Regarding interpersonal processes, spousal and own objective ambivalent behavior was associated with lower spousal responsiveness (p < .01), disclosure (p < .05), and more negative (p < .03) and less positive interactions (p < .001). Physiologically, ambivalent spousal behavior was associated with higher systolic blood pressure (p = .02) and higher diastolic blood pressure (p = .04). Measures of subjective ambivalence were congruent.

CONCLUSIONS

Early marriages already contain ambivalent behavior; in such cases, individuals may not receive the cardiovascular protection of a supportive marriage.

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.

Gender differences in short-term cardiovascular effects of giving and receiving support for health concerns in marriage

OBJECTIVE

Little is known about the cardiovascular effects of mutual emotional spousal support given for health concerns. We examined the hypotheses that: (a) mutual support (both spouses giving and receiving support) compared to one-sided or no support, would decrease blood pressure and heart rate in both spouses during a recovery period; and (b) wives would benefit more from mutual support than would husbands. A second aim was to examine gender differences in cardiovascular reactivity, distress, and closeness in response to receiving support regardless of mutuality.

METHOD

In 98 married couples (Age 50+), spouses discussed health concerns and were assigned randomly to one of four conditions: neither spouse received support (n = 26), only the wife received support from the husband (n = 22), only the husband received support from the wife (n = 23), or both received support (n = 27). Systolic and diastolic blood pressure and heart rate were measured during baseline, the discussions, and recovery. Distress, closeness, and support were self-reported. Support quality was observationally coded.

RESULTS

Mutual support did not affect cardiovascular reactivity. When husbands received support from wives, husbands' blood pressure and distress decreased, and both partners' closeness increased. When wives received support, husbands and wives felt closer, but both partners' heart rate remained elevated and wives felt more distressed.

CONCLUSIONS

Receiving support individually may be more important than receiving support mutually for older adult spouses coping with their health concerns. Also, support interventions for couples coping with health conditions should take into account that husbands receive greater benefits from spousal support than wives. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Close Relationships and Health: The Interactive Effect of Positive and Negative Aspects

Most health research focuses on the independent associations of positive or negative aspects of close relationships with health outcomes. A small but growing literature has begun to examine interactive effects of positive and negative aspects. These interactive effects frequently predict health independently or above-and-beyond main effects of either the positive or the negative aspects, suggesting unique relationship processes or emergent features of these close relationship patterns. Our goal in this review is to lay out the existing approaches to studying the interactive effects of positive and negative aspects of close relationships, and to review available evidence linking these interactive effects to health outcomes. We conclude by discussing important unresolved issues and highlighting critical directions for future research.

The quality of social networks predicts age-related changes in cardiovascular reactivity to stress

Although existing life span models suggest that positivity in relationships should benefit the health of older adults, much less is known about how relationships that contain both positive and negative aspects (i.e., ambivalent ties) might influence age-associated cardiovascular risk. Given the increased interpersonal stress associated with ambivalent ties, the SAVI model would predict that older adults might be more negatively influenced given age-related changes in physiological flexibility. In this study, the quality of an individual's social network (i.e., supportive, ambivalent, aversive) was used to predict cardiovascular reactivity during laboratory stress across a 10-month follow-up period in 108 participants between the ages 30 to 70. Results revealed evidence that the number of ambivalent network ties predicted greater increases in diastolic blood pressure reactivity. Importantly, there was an Age × Ambivalent Ties interaction in which the number of ambivalent ties was related to greater increases in systolic blood pressure reactivity primarily in older adults. These data are discussed in terms of the health implications of social networks across the life span. (PsycINFO Database Record

Spouse cancer caregivers' burden and distress at entry to home hospice: The role of relationship quality

High-quality relationships may be protective for family caregivers. This study focuses on relationship quality categories (supportive and ambivalent) in spouse caregivers in cancer home hospice. The goals of this article are to, first, describe relationship quality categories among end-of-life caregivers and, second, test the effects of relationship quality categories on caregiver burden and distress within a stress process model. Using questionnaire data collected at entry to home hospice, we found relationship quality categories were proportionally similar to those seen in noncaregiver older adults. Relationship quality significantly predicted caregiver burden, which completely mediated the relationship between caregiver relationship quality and distress. Caregivers whose social contexts place them at risk for greater distress may benefit from increased clinical attention or intervention.

Social stressors and cardiovascular response: influence of ambivalent relationships and behavioral ambivalence

OBJECTIVE

The protective influence of social relationships on health is well documented; however, not all relationships are positive and negative aspects of relationships may be detrimental. Relatively less is known about the relationships characterized by both positivity and negativity (i.e., ambivalence). The goal of this study was to examine the relative influence of ambivalence in relationship quality and social behavior on cardiovascular response.

METHODS

104 healthy young adults were randomly assigned to bring in either a supportive or ambivalent same-sex friend to the experiment. Participants were also randomly assigned to receive positive, negative, ambivalent or ambiguous feedback from their friend after giving a series of speeches. Cardiovascular response was obtained before, during, and after the social stressor (speech task).

RESULTS

Results indicate a significant effect of relationship type before, during, and after the stressor task. Adjusting for baseline, heart rate reactivity and anxiety was significantly higher among those assigned to ambivalent friends relative to those assigned to supportive friends during the stressor task (ps<.05). There was also a significant effect of behavioral feedback during the speech task, such that those receiving ambivalent messages had the greatest systolic blood pressure (SBP) and diastolic blood pressure (DBP) reactivity (p<.05); however, there was no interaction between relationship and feedback conditions. Those in the ambivalent friend condition also exhibited significantly higher SBP, DBP, and anxiety during the baseline and recovery periods (ps<.05).

CONCLUSIONS

These findings suggest that both relationship quality and the actions of relationships may have a significant influence on health-relevant physiology.

Spousal relationship quality and cardiovascular risk: dyadic perceptions of relationship ambivalence are associated with coronary-artery calcification

The quality of spousal relationships has been related to physical-health outcomes. However, most studies have focused on relationship positivity or negativity in isolation, despite the fact that many close relationships are characterized by both positive and negative aspects (i.e., ambivalence). In addition, most work has not accounted for the reciprocal nature of close-relationship processes that can have an impact on health. Using a sample of 136 older married couples, we tested whether actor-partner models of relationships that were either primarily positive or ambivalent (i.e., perceived as having both helpful and upsetting aspects) predicted measures of coronary-artery calcification. Results revealed an Actor × Partner interaction whereby coronary-artery calcification scores were highest for individuals who both viewed and were viewed by their spouse as ambivalent. These data are discussed in light of the importance of considering both positive and negative aspects of relationship quality and modeling the interdependence of close relationships.

Associations Between Secondary Caregivers' Supportive Behavior and Psychological Distress of Primary Spousal Caregivers of Cognitively Intact and Impaired Elders

PURPOSE OF THE STUDY

This study examined associations between the availability and types of supportive behavior provided by secondary caregivers and the psychological distress of primary spousal caregivers of cognitively intact and impaired elders.

DESIGN AND METHODS

A sample of 8,087 assessments using the validated Chinese version of the Minimum Data Set-Home Care of individuals applying for government-subsidized long-term care services from 2006 to 2009 in Hong Kong were selected based on inclusion criteria.

RESULTS

More than 70% of primary caregivers had secondary caregivers; the rate was slightly lower for those caring for moderately or severely cognitively impaired spouses. More than half of the primary spousal caregivers had secondary caregivers who provided both emotional and instrumental support. Emotional support provided by secondary caregivers had a negative association with primary caregivers' psychological distress when their care recipients were cognitively intact. When secondary caregivers provided both instrumental and emotional support, primary caregivers had a higher likelihood of psychological distress when care recipients had greater negative mood symptoms as compared to those who had less negative mood symptoms.

IMPLICATIONS

This is the first study that examined the association between availability and types of supportive behavior provided by secondary caregivers and the psychological distress of primary spousal caregivers of cognitively intact and impaired elders. The findings suggest a need to provide services that enhance the provision of emotional support from both secondary and primary caregivers to cognitively intact elders and support primary spousal caregivers to seek appropriate help according to the mood of care recipients.

Social relationships and health: is feeling positive, negative, or both (ambivalent) about your social ties related to telomeres?

OBJECTIVES

The quality of one's personal relationships has been linked to morbidity and mortality across different diseases. As a result, it is important to examine more integrative mechanisms that might link relationships across diverse physical health outcomes. In this study, we examine associations between relationships and telomeres that predict general disease risk. These questions are pursued in the context of a more comprehensive model of relationships that highlights the importance of jointly considering positive and negative aspects of social ties.

METHOD

One hundred thirty-six individuals from a community sample (ages 48 to 77 years) completed the social relationships index, which allows a determination of relationships that differ in their positive and negative substrates (i.e., ambivalent, supportive, aversive, indifferent). Telomere length was determined from peripheral blood mononuclear cells via quantitative polymerase chain reaction.

RESULTS

Participants who had a higher number of ambivalent ties in their social networks evidenced shorter telomeres. These results were independent of other relationship types (e.g., supportive) and standard control variables (e.g., age, health behaviors, and medication use). Gender moderated the links between ambivalent ties and telomere length, with these associations seen primarily in women. Follow-up analyses revealed that the links between ambivalent ties and telomeres were primarily due to friendships, parents, and social acquaintances.

CONCLUSION

Consistent with epidemiological findings, these data highlight a novel and integrative biological mechanism by which social ties may affect health across diseases and further suggest the importance of incorporating positivity and negativity in the study of specific relationships and physical health.

Subliminal activation of social ties moderates cardiovascular reactivity during acute stress

OBJECTIVE

The quality of one's personal relationships has been reliably linked to important physical health outcomes, perhaps through the mechanism of physiological stress responses. Most studies of this mechanism have focused on whether more conscious interpersonal transactions influence cardiovascular reactivity. However, whether such relationships can be automatically activated in memory to influence physiological processes has not been determined. The primary aims of this study were to examine whether subliminal activation of relationships could influence health-relevant physiological processes and to examine this question in the context of a more general relationship model that incorporates both positive and negative dimensions.

METHOD

We randomly assigned participants to be subliminally primed with existing relationships that varied in their underlying positivity and negativity (i.e., indifferent, supportive, aversive, ambivalent). They then performed acute psychological stressors while cardiovascular and self-report measures were assessed.

RESULTS

Priming negative relationships was associated with greater threat, lower feelings of control, and higher diastolic blood pressure reactivity during stress. Moreover, priming relationships high in positivity and negativity (ambivalent ties) was associated with the highest heart rate reactivity and greatest respiratory sinus arrhythmia decreases during stress. Exploratory analyses during the priming task itself suggested that the effects of negative primes on biological measures were prevalent across tasks, whereas the links to ambivalent ties was specific to the subsequent stressor task.

CONCLUSIONS

These data highlight novel mechanisms by which social ties may impact cardiovascular health, and further suggest the importance of incorporating both positivity and negativity in the study of relationships and physical health.