The health consequences of stress in couples: A review and new integrated Dyadic Biobehavioral Stress Model

Healthy couple, better sleep: Exploring connections and changes in couple relationship education participants

Considerable evidence suggests couple relationship education (CRE) programs are effective in improving couples' relationship functioning, yet few studies have examined the implications of CRE programs on indicators of physical health despite substantial research supporting links between relational and physical health. This study utilized a sample of 308 couples randomly assigned to a CRE curriculum to explore the dyadic links between conflict management and self-care skills (emphasized in CRE), stress, and sleep dysfunction concurrently. We prospectively tested whether changes in skills drove changes in sleep dysfunction or vice versa, for both self and partner. Results from a series of structural equation models indicated indirect links for men and women between conflict management and self-care skills and sleep dysfunction through lower stress level at program start. Dyadically, men's and women's better conflict management skills were associated with partners' lower stress, which was in turn associated with partners' lower sleep dysfunction. Men's better self-care skills were linked with partners' lower stress levels, which were linked with partners' lower sleep dysfunction. Tests of dyadic prospective cross-lagged effects among changes in sleep and changes in skills indicated that initial improvements in both partners' sleep predicted improvements in their own conflict management skills 1 year later. Initial improvements in women's conflict management skills predicted reduced sleep dysfunction for themselves. Additionally, for both partners, early changes in self-care predicted later reductions in sleep dysfunction. Dyadically, immediate improvements in men's self-care predicted reduced sleep dysfunction for their partner a year later. Implications for research and practice are discussed.

"I too have a responsibility for my partner's life": Communal coping among Malawian couples living with HIV and cardiometabolic disorders

RATIONALE

HIV and cardiometabolic disorders including hypertension and diabetes pose a serious double threat in Malawi. Supportive couple relationships may be an important resource for managing these conditions. According to the theory of communal coping, couples will more effectively manage illness if they view the illness as "our problem" (shared illness appraisal) and are united in shared behavioral efforts.

METHODS

This study qualitatively investigated communal coping of 25 couples living with HIV and hypertension or diabetes in Zomba, Malawi. Partners were interviewed separately regarding relationship quality, shared illness appraisal, communal coping, and dyadic management of illness.

RESULTS

Most participants (80%) were living with HIV, and more than half were also living with hypertension. Most participants expressed high levels of unity and the view that illness was "our problem." In some couples, partners expected but did not extend help and support and reported little collaboration. Communal coping and dyadic management were strongly gendered. Some women reported a one-sided support relationship in which they gave but did not receive support. Women were also more likely to initiate support interactions and offered more varied support than men. In couples with poor relationship quality and weak communal coping, dyadic management of illness was also weak. Partner support was particularly crucial for dietary changes, as women typically prepared meals for the entire family. Other lifestyle changes that could be supported or hindered by a partner included exercise, stress reduction, and medication adherence.

CONCLUSION

We conclude that gendered power imbalances may influence the extent to which couple-level ideals translate into actual communal coping and health behaviors. Given that spouses and families of patients are also at risk due to shared environments, we call for a shift from an illness management paradigm to a paradigm of optimizing health for spouses and families regardless of diabetes or hypertension diagnosis.

Personality traits and workplace bullying among contract trainee doctors in Malaysia

Introduction

Workplace bullying (WPB) among trainee doctors is a concerning problem in Malaysia. However, there is still limited understanding regarding the influence of trainee doctors' personality traits on WPB. Furthermore, the impact of contract employment status on WPB among trainee doctors is not yet well-defined. To address these gaps, this study was aimed to determine the prevalence of WPB among trainee doctors and to examine the association of sociodemographic characteristics, job characteristics, and personality traits with WPB among trainee doctors in Malaysia.

Methods

A multi-center cross-sectional study was conducted with 264 trainee doctors in Selangor, Malaysia. Eligible participants were provided with sociodemographic characteristics questionnaire, job characteristics questionnaire, WPB questionnaire, and the Big Five Inventory-10 (BFI-10). Chi-square tests were used to examine the association between: (i) sociodemographic characteristics and WPB, (ii) job characteristics and WPB; and (iii) personality traits and WPB. Multivariate logistic regression was performed to evaluate the association between the significant independent variables (as determined from Chi-square tests) and WPB.

Results

The prevalence of WPB was 45.1 %, with verbal abuse being the most common form of bullying (46.2 %). Chi-square test showed that only marital status and low agreeableness were significantly associated with WPB. Subsequently, multiple logistic regression demonstrated that being married (OR: 1.866; 95 % CI: 1.077-3.234) and low agreeableness (OR: 2.287; 95 % CI: 1.169-4.473) were significant predictors of WPB.

Conclusion

The high prevalence of WPB among trainee doctors could be attributed by marriage and low agreeableness personality traits in this population. In order to minimise WPB and maximise workforce potential, it is essential for healthcare institutions and medical training programmes to recognise this vulnerabilities and take steps to protect and support trainee doctors who are married and/or with low agreeableness personality trait.

Longitudinal associations between cognitive functioning and depressive symptoms among couples in the Mexican Health and Aging Study

OBJECTIVE

To examine the bidirectional associations between older adult spouses' cognitive functioning and depressive symptoms over time and replicate previous findings from the United States (US) in Mexico.

DESIGN

Longitudinal, dyadic path analysis with the actor-partner interdependence model.

SETTING

Data were from the three most recent interview waves (2012, 2015, and 2018) of the Mexican Health and Aging Study (MHAS), a longitudinal national study of adults aged 50+ years in Mexico.

PARTICIPANTS

Husbands and wives from 905 community-dwelling married couples (N = 1,810).

MEASUREMENTS

The MHAS cognitive battery measured cognitive function. Depressive symptoms were assessed using a modified nine-item Center for Epidemiologic Studies Depression Scale. Baseline covariates included age, education, number of children, limitation with any activity of daily living, limitation with any instrumental activity of daily living, and pain.

RESULTS

As hypothesized, there were significant within-individual associations in which one person's own cognitive functioning and own depressive symptoms predicted their own follow-up cognitive functioning and depressive symptoms, respectively. In addition, a person's own cognitive functioning predicted their own depressive symptoms, and a person's own depressive symptoms predicted their own cognitive functioning over time. As hypothesized, there was a significant partner association such that one person's depressive symptoms predicted more depressive symptoms in the partner.

CONCLUSION

Findings from this study of older Mexican couples replicates findings from studies of older couples in the US, showing that depressive symptoms in one partner predict depressive symptoms in the other partner over time; however, there was no evidence for cognition-depression partner associations over time.

Effectiveness of a marital relationship skills training intervention on marital adjustment among individuals in Hosanna Town, Southwest Ethiopia: A randomized-controlled trial

Marital distress increases the risk of morbidity and mortality by altering psychological and biological health, including cardiovascular and endocrine function. Numerous interventions have been developed to mitigate marital distress. However, most of these interventions had very specific content and were limited to certain segments of the population. This study was conducted to evaluate the effectiveness of a marital relationship skills training intervention on the marital adjustment of married people in Ethiopia. We conducted a randomized-controlled trial study on 80 married people with low marital satisfaction. We used STATA 14 statistical software to process the data. The results of an Independent sample's t test analysis showed that marital relationship skills training had a significant impact on the marital adjustment of distressed couples (p = 0.001, 95% confidence interval: 0.79-1.10). A marital relationship skills training intervention can effectively improve marital adjustment and can be used as a treatment for marital distress.

"We've Got This": Middle-Aged and Older Couples' Satisfying Relationships and We-Talk Promote Better Physiological, Relational, and Emotional Responses to Conflict

OBJECTIVE

Conflict poses multiple relational and health risks. Dyadic stress theories suggest satisfaction and communication alter cardiovascular and autonomic function, key pathways from troubled relationships to poor health. However, "we-talk," a positive communication pattern, can strengthen relationships and promote health. We examined how each spouse's satisfaction and we-talk were related to conflict's physiological, relational, and emotional toll.

METHODS

Married couples ( n = 107 couples, 214 individuals, ages 40-87 years) who were mostly White, highly educated, and higher-income Americans in different-gender relationships engaged in 20-minute conflict discussions while wearing monitors to assess heart rate variability (HRV). Spouses rated their closeness immediately after conflict and their conflict rumination 2 hours later. Conflict transcriptions measured we-talk, or the proportion of first-person plural pronouns (we, us, our).

RESULTS

Satisfied spouses or those in mutually satisfying relationships had higher HRV during conflict ( b = 0.0001, p = .049), felt closer immediately after conflict ( b = 0.07, p < .001), and ruminated less about the conflict 2 hours later ( b = -0.26, p = .026). Spouses' HRV was highest ( b = 0.0002, p = .002) and rumination was lowest ( b = -0.49, p = .019) when they or their partners were satisfied and used we-talk more often. Women's HRV ( b = 0.0001, p = .035) and rumination ( b = -0.01, p = .02) benefited when both spouses were satisfied, as did closeness when women were satisfied ( b = 0.10, p < .001). Men's closeness benefited when they ( b = 0.04, p = .003) or their wives ( b = 0.04, p = .002) were satisfied.

CONCLUSIONS

The combination of mutually satisfying relationships and we-talk was associated with better relational and health outcomes after conflict. These findings are important for middle-aged and older couples whose relationships are central to their health.

Dynamic associations between stress and relationship functioning in the wake of COVID-19: Longitudinal data from the German family panel (pairfam)

Individuals all across the world experienced significant disruptions in their personal and family life with the outbreak of the new coronavirus disease 2019 (COVID-19). The current study investigated dynamic associations between stress and relationship functioning over time in the face of the COVID-19 pandemic. Perceived stress, relationship satisfaction, and relationship quality (appreciation, intimacy, conflict) were reported by 1483 young to middle-aged participants who were in a romantic relationship and lived with their partner in 2018/2019 and in May-July 2020 (a few months after the onset of COVID-19). Data were analyzed using bivariate latent change score models. Relationship functioning (satisfaction, appreciation, intimacy) showed small decreases from before to during the pandemic. Contrary to expectations, levels of perceived stress also decreased on average from before to during the pandemic. Changes in relationship functioning were correlated with changes in stress over time, so that participants with greater decreases in relationship satisfaction, appreciation, and intimacy and greater increases in conflict from before to during the pandemic showed lesser decreases/greater increases in stress. Higher pre-pandemic relationship satisfaction was associated with greater decreases/lesser increases in stress from before to during the pandemic. Pre-pandemic levels of other measures of relationship functioning or stress were not associated with changes in outcomes over time. Results add to the literature demonstrating that stress is closely intertwined with the functioning of intimate relationships. Furthermore, they suggest that greater relationship satisfaction may serve as a protective factor for stressful life events.

Intimate Relationships and Coronary Heart Disease: Implications for Risk, Prevention, and Patient Management

Purpose of Review

Research and clinical services addressing psychosocial aspects of coronary heart disease (CHD) typically emphasize individuals, focusing less on the context of intimate relationships such as marriage and similar partnerships. This review describes current evidence regarding the role of intimate relationships in the development, course, and management of CHD.

Recent Findings

Having an intimate partner is associated with reduced risk of incident CHD and a better prognosis among patients, but strain (e.g., conflict) and disruption (i.e., separation, divorce) in these relationships are associated with increased risk and poor outcomes. These associations likely reflect mechanisms involving health behavior and the physiological effects of emotion and stress. Importantly, many other well-established psychosocial risk and protective factors (e.g., low SES, job stress, depression, and optimism) are strongly related to the quality of intimate relationships, and these associations likely contribute to the effects of those other psychosocial factors. For better or worse, intimate partners can also affect the outcome of efforts to alter health behaviors (physical activity, diet, smoking, and medication adherence) central in the prevention and management CHD. Intimate partners also influence—and are influenced by—stressful aspects of acute coronary crises and longer-term patient adjustment and management.

Summary

Evidence on each of these roles of intimate relationships in CHD is considerable, but direct demonstrations of the value of couple assessments and interventions are limited, although preliminary research is promising. Research needed to close this gap must also address issues of diversity, disparities, and inequity that have strong parallels in CHD and intimate relationships.

Physical Intimacy in Older Couples' Everyday Lives: Its Frequency and Links with Affect and Salivary Cortisol

OBJECTIVES

Physical intimacy is important for communicating affection in romantic relationships. Theoretical and empirical work highlights linkages between physical intimacy, affect, and physiological stress among young and middle-aged adults, but not older adults. We examine physical intimacy and its associations with positive and negative affect and cortisol levels in the daily lives of older couples.

METHOD

We applied actor-partner multilevel models to repeated daily life assessments of physical intimacy (experienced and wished) and affect obtained six times a day over seven consecutive days from 120 older heterosexual German couples (Mage= 71.6, SDage= 5.94). Physiological stress was indexed as total daily cortisol output, the area under the curve with respect to ground (AUCg).

RESULTS

Physical intimacy experienced and wished were reported at the vast majority of occasions, but to different degrees at different times. Within persons, in moments when participants experienced more physical intimacy, older women reported less negative affect, whereas older men reported more positive affect. Between persons, higher overall levels of physical intimacy experienced were associated with higher positive affect and less negative affect among women and with lower daily cortisol output among men. A stronger wish for intimacy was related to more negative affect among both women and men, and to higher daily cortisol output among men.

DISCUSSION

Physical intimacy is linked with mood and stress hormones in the daily life of older couples. We consider routes for future inquiry on physical intimacy among older adults.

Editorial commentary on the special issue emerging psychoneuroimmunology research: Future leaders in focus

The theme of this BBI-Health special issue is to promote the research, creativity and forward-thinking of future key opinion leaders in the field of psychoneuroimmunology (PNI). We asked contributing researchers to identify new ideas and spaces for innovation to map out the future trajectory of our discipline. This special issue provides global and diverse views from early career investigators focused on science, society, and/or policy, with an emphasis on diversity in all its aspects. The common thread weaving through the articles contained in this special issue is that all authors were invited to consider the future of PNI while they were experiencing the global COVID-19 lockdowns that slowed down or even prevented them from access to their “hands-on” research. The contributors vary from Master level to assistant professors, and all have already significantly contributed to the field of PNI. Each contributor has provided a photograph and short biography alongside their written perspectives. We hope that you will enjoy learning about their visions for the future of PNI and will join us with enthusiasm as we watch our field grow through the advancement of their scientific careers.

The gut connection: Intestinal permeability as a pathway from breast cancer survivors' relationship satisfaction to inflammation across treatment

BACKGROUND

Breast cancer survivors are prone to weakened gut barriers, allowing bacteria to migrate into the blood stream. Gut permeability fuels inflammation, which, among survivors, can elevate risk for comorbid disease development, cancer recurrence, and a poor quality of life; however, survivors' satisfying relationships can provide health benefits. This longitudinal study used a conceptual model addressing how intimate relationships is associated with health through changes in gut permeability and inflammation.

METHOD

Breast cancer survivors (n = 139, stages 0-IIIC) completed a baseline visit before treatment and two follow-up visits 6 and 18 months after treatment ended. Women who had an abnormal breast cancer test followed by a benign diagnosis completed visits within a comparable timeframe (noncancer patient controls; n = 69). All women completed questionnaires assessing their relationship satisfaction and provided blood samples to assess two bacterial endotoxin biomarkers, lipopolysaccharide-binding protein (LBP) and soluble CD14 (sCD14), as well as C-reactive protein (CRP) and interleukin 6 (IL-6).

RESULTS

Within-person multilevel mediation analyses showed that when a survivor's relationship satisfaction was higher than usual, her own LBP and LBP/sCD14 were lower, which was associated with lower than her own average CRP and IL-6 (95% CIs [-0.0104, -0.0002]). IL-6 was also higher when older survivors, but not younger survivors, experienced higher than usual intestinal permeability (p = .001). These effects of satisfying relationships held after accounting for cancer-related and behavioral factors. Post-hoc analyses showed LBP, sCD14, and LBP/sCD14 were associated with CRP for the cancer survivors, but only LBP and LBP/sCD14 were linked to CRP among the noncancer control patients.

CONCLUSION

The gut environment is a new promising candidate for understanding a relationship's long-term health impact, particularly among those with elevated health risks. Survivors may reap multiple physiological benefits from satisfying relationships.

More often than not, we're in sync: patient and caregiver well-being over time in stem cell transplantation

Background

Hematopoietic stem cell transplantation (HSCT) is an aggressive medical procedure which significantly impacts the shared emotional well-being of patients and family caregivers (FC). Prior work has highlighted the significant overlap in well-being among patients and FCs; however, how this interdependence may change over the course of HSCT has received less attention.

Methods

We conducted secondary analyses of a supportive intervention delivered to 154 FCs of HSCT patients and examined relationships at baseline, 6 weeks, 3 and 6 months post-HSCT. Actor Partner Interdependence Modeling examined patient quality of life (QOL) and FC anxiety/depression.

Results

The data did not fit a multigroup approach limiting our ability to test intervention effects; however, bivariate analyses indicated FC depression significantly correlated to patient QOL at baseline (r = − .32), 6 weeks (r = − .22) and 6 months post-HSCT (r = − .34; p’s < .05); whereas FC anxiety was only correlated with patient QOL at the first two timepoints (p’s < .05). There was an unexpected, partner effect such that worse patient QOL at 6-weeks significantly related to lower FC depression at 3-months (B = .193; p = .026) and changed direction with patient QOL at 3-months being related to more FC depression at 6-months (B = − .187; p = .001).

Conclusions

These findings highlight the significant, yet nuanced, interdependence of patient QOL and FC well-being during HSCT. Specifically, greater interdependence was observed between patient QOL and FC depression compared to FC anxiety, suggesting potential treatment targets for patients and their families.

Trial was registered at ClinicalTrials.gov Identifier: NCT02037568; first registered: January 16, 2014; https://clinicaltrials.gov/ct2/show/NCT02037568