Theory and modeling in the study of intimate relationships and health

A longitudinal investigation of marital dissolution, marital quality, and generalized anxiety disorder in a national probability sample

Generalized anxiety disorder (GAD) is a common psychiatric disorder that is associated with high levels of distress and impairment. The present study was conducted to examine the 10-year longitudinal associations between marital dissolution, three measures of marital quality, and GAD among married participants from the Midlife in the United States (MIDUS) survey, a probability sample of American adults aged 24-74 years. Results indicated that GAD at baseline was significantly and positively associated with incidence of marital dissolution during the 10-year follow-up and marital strain (i.e., negative partner interaction) at baseline was significantly and positively associated with incidence of GAD at the 10-year follow-up. These associations remained statistically significant after adjusting for demographic characteristics and neuroticism. In comparison, marital satisfaction and marital support (i.e., positive partner interaction) at baseline were not significantly associated with incidence of GAD, GAD at baseline was not significantly associated with any of the three measures of marital quality at follow-up, and marital dissolution during follow-up was not significantly associated with incidence of GAD. These findings suggest that negative interactions with one's partner may be a risk factor for GAD and that improving marital functioning may be important for the prevention and treatment of GAD.

Romance Behind the Screens: Exploring the Role of Technoference on Intimacy

Intimacy is essential for fulfilling romantic relationships. Although many factors can impact intimacy, the increased regular use of technological devices within our daily lives makes technoference an important one to consider. Technoference (i.e., interference in face-to-face interactions caused by the use of technological devices) is commonly associated with relationship difficulties, including conflict, dissatisfaction, and decreased relational well-being. However, less is known about the direct and indirect impact of technoference on intimacy among couples. We hypothesized that negative perceptions of a partner's technology use and poor communication satisfaction within a romantic relationship help explain the association between technoference and intimacy. University students (N = 141), who were in a romantic relationship of at least 6 months duration, completed online questionnaires assessing technoference, perceptions of their partner's technology use, communication satisfaction, and intimacy in their romantic relationship. PROCESS macro model 6 was used to test the serial mediation models. Results suggest that the relationship between technoference (general, partner's, and participant's) and intimacy is serially mediated by negative perceptions of partner's technology use and communication satisfaction. These findings can help to identify and inform strategies to maximize intimacy levels between couples, thus fortifying romantic relationships as a whole.

Socioeconomic stratification and trajectories of social trust during COVID-19

Extant theory suggests that crises such as the COVID-19 pandemic may change people's trust in others. A crisis-to-solidarity model suggests that people become more trusting, while a crisis-to-negative experience theory suggests that people lose trust, and a stability perspective predicts that social trust will largely remain unchanged. We argue that, when a crisis occurs, trust is likely to fall into distinct trajectories of change that will conform to these different perspectives, and placement into contrasting trajectories of change will be predicated on socioeconomic position. To test our argument, we use data from multiple waves of Canadian national surveys conducted from September 2019 to February 2021 and examine how two major forms of social trust-generalized trust and neighborhood trust-changed during the COVID-19 pandemic. A longitudinal latent class analysis (LLCA) shows increasing, decreasing, and stable trajectories of trust, which conform to each of the proposed patterns. We further show that individuals' baseline socioeconomic position is a strong indicator of the placement in these trajectories. Both forms of trust increased among individuals with higher socioeconomic positions while decreased among individuals with lower socioeconomic positions. This research contributes to the literature on the social context of trust by reconciling contrasting views of the consequences of crises for trust, and also in showing that the segmentation of changes in trust are proscribed by structures of social stratification.

Links of communal coping to relationship and psychological health in type 2 diabetes: actor-partner interdependence models involving role, sex, and race

BACKGROUND

Communal coping is one person's appraisal of a stressor as shared and collaboration with a partner to manage the problem. There is a burgeoning literature demonstrating the link of communal coping to good relationships and health among persons with chronic disease.

PURPOSE

We examined links of communal coping to relationship and psychological functioning among couples in which one person was recently diagnosed with type 2 diabetes. We distinguished effects of own communal coping from partner communal coping on both patient and spouse relationship and psychological functioning, as well as whether communal coping effects were moderated by role (patient, spouse), sex (male, female), and race (White, Black).

METHODS

Participants were 200 couples in which one person had been diagnosed with type 2 diabetes (46% Black, 45% female) within the last 5 years. Couples completed an in-person interview, participated in a discussion to address diabetes-related problems, and completed a postdiscussion questionnaire.

RESULTS

Own communal coping and partner communal coping were related to good relationship and psychological functioning. Interactions with role, sex, and race suggested: (i) partner communal coping is more beneficial for patients than spouses; (ii) own communal coping is more beneficial for men, whereas partner communal coping is more beneficial for women; and (iii) White patients and Black spouses benefit more from own communal coping than Black patients and White spouses.

CONCLUSION

These findings demonstrate the benefits of communal coping across an array of self-report and observed indices, but suggest there are differential benefits across role, sex, and race.

The correlation between intimate relationship, self-disclosure, and adaptability among colorectal cancer enterostomy patients

The postoperative physiological changes and psychological pressure of cancer patients affect the patient's adaptability to the disease, and thus affect the spousal intimate relationship. This study aimed to evaluate the correlation between spousal intimate relationship, self-disclosure, and adaptability among colorectal cancer (CCI) patients with enteric stoma.This cross-sectional study selected patients with CCI in Henan Province from February 2018 to October 2020. The Marital Adjustment Test (MAT), the Distress Disclosure Index scale, and the Ostomy adjustment inventory-20 scale were used to collect relevant data of the participants. A Pearson correlation analysis was used to test the correlation between variables, and multiple stepwise regression analysis was used to test the influence of general information on the intimate relationship, self-disclosure, and adaptability.Among the respondents, 42.6% had a spousal intimate relationship problem, 58.4% had a low or moderate level of self-disclosure, and 90.8% were at a low or moderate level of adaptation. Education background, self-care ability, and postoperative time were associated with a couple's intimate relationship. Average monthly household income, gender, and place of residence were associated with self-disclosure. Self-care ability, average monthly household income, postoperative time, and educational background were associated with adaptation.Healthcare workers should provide more health education training to guide CCI enterostomy patients to express their thoughts and feelings with each other increase self-disclosure, so as to enhance their intimate relationship then improve their adoption to ostomy, finally elevate their quality of life.

Intimate Relationships and Depression: Searching for Causation in the Sea of Association

This article provides a critical review of existing research on intimate (marriage or marriage-like) relationship distress and risk for depression. Using the meta-framework of research triangulation, we seek to synthesize research evidence across several different methodologies and study designs and to draw the most reliable conclusion regarding a potential causal association between relationship distress and depression. Focusing on existing correlational (i.e., observational), genetically informed, and intervention (i.e., experimental) research on the association between relationship distress and depression, we conclude that the existing body of research evidence supports the claim that relationship distress is a causal risk factor for depression. A secondary aim of the article is to highlight a variety of effective methods that, when viewed from the perspective of triangulation, enhance the pursuit of causal inference, including propensity score matching, target trial emulation, directed acyclic graph approach, and Mendelian randomization.

Do relationships provide the same levels of protection against heavy drinking for lesbian and bisexual women? An intersectional approach

PURPOSE

Sexual minority women (SMW; e.g., lesbian, bisexual) are more likely than heterosexual women to be heavy drinkers, with bisexual women showing the highest risk. There is ample literature demonstrating that intimate relationships protect against stress-related health risk behaviors in the general population. However, very little research has focused on SMW's relationships and far less is known about the relationships of SMW of color. Using intersectionality theory as our framework, we tested two competing models to determine whether the effects of minority sexual identity (lesbian, bisexual) and race/ethnicity (African American, Latinx, White) are: 1) additive, or 2) multiplicative in the associations between relationship status and heavy drinking.

METHODS

Data are from a diverse sample of cisgender sexual minority women (N = 641) interviewed in Wave 3 of the CHLEW study, a 20-year longitudinal study of SMW's health.

RESULTS

Findings from two- and three-way interactions provide mixed evidence for both the additive and multiplicative hypotheses; support for each varied by sexual identity and race/ethnicity. Overall, we found that Latinx SMW, particularly single and bisexual Latinx SMW report the highest rates of heavy drinking compared to their cohabiting and lesbian counterparts, respectively. African American single SMW reported significantly higher rates of heavy drinking compared to their cohabiting counterparts.

CONCLUSION

Our findings suggest that the protective qualities of SMW's intimate relationships vary based on sexual identity and race/ethnicity-and the intersections between them. These results highlight that research among SMW that does not take into account multiple marginalized identities may obscure differences.

PUBLIC SIGNIFICANCE

Little research has focused on health within sexual minority women's relationships, particularly among sexual minority women of color. Given the potential additive or multiplicative effects of multiple sources of oppression such as heterosexism, racism, and sexism, understanding the potential protective effects of relationships is important. Our findings demonstrate that the protective qualities of intimate relationships among SMW vary based on sexual identity and race/ethnicity - and the intersections between them.

Pathways to psychological wellbeing for patients with bladder cancer and their partners-in-care

PURPOSE

The goal of the current analyses was to describe pathways through which Psychological Wellbeing might be better understood for clinical participants with bladder cancer and their partners. This was achieved by applying Roy's Adaptation Model that provides a framework with which to understand responses to challenging circumstances that has proved useful in the study of a range of chronic conditions.

METHODS

The sample comprised 119 patients with a diagnosis of bladder cancer, and 103 supportive partners. Participants completed a self-report questionnaire comprising the Bladder Cancer Index, Mini-Mental Adjustment to Cancer Scale, Psychosocial Adjustment to Illness Scale, and sociodemographic details. For each sample, structural equation modelling was used to determine goodness of fit, guided by Roy's Adaptation Model.

RESULTS

For patients, increasing age and disease duration, the negative appraisal of health care, perceived poor functioning and elevated burden of disease provided pathways to Psychological Wellbeing. For partners, increasing age, being male, a negative health care experience, and perceived burden of disease were significant. However, for both groups a positive evaluation of family and social support was the key indicator of lower Psychological Wellbeing.

CONCLUSIONS

The models presented describe a suite of issues that could inform a nursing model of care to enhance the experience of living with bladder cancer for both patients and their supportive partners.

Mind the "Happiness" Gap: The Relationship Between Cohabitation, Marriage, and Subjective Well-being in the United Kingdom, Australia, Germany, and Norway

Many studies have found that married people have higher subjective well-being than those who are not married. Yet the increase in cohabitation raises questions as to whether only marriage has beneficial effects. In this study, we examine differences in subjective well-being between cohabiting and married men and women in midlife, comparing the United Kingdom, Australia, Germany, and Norway. We apply propensity score–weighted regression analyses to examine selection processes into marriage and differential treatment bias. We find no differences between cohabitation and marriage for men in the United Kingdom and Norway, and women in Germany. However, we do find significant differences for men in Australia and women in Norway. The differences disappear after we control for selection in Australia, but they unexpectedly persist for Norwegian women, disappearing only when we account for relationship satisfaction. For German men and British and Australian women, those with a lower propensity to marry would benefit from marriage. Controls eliminate differences for German men, although not for U.K. women, but relationship satisfaction reduces differences. Overall, our study indicates that especially after selection and relationship satisfaction are taken into account, differences between marriage and cohabitation disappear in all countries. Marriage does not lead to higher subjective well-being; instead, cohabitation is a symptom of economic and emotional strain.

Relationship Status and Drinking-Related Outcomes in a Community Sample of Lesbian and Bisexual Women

Although marriage tends to be protective against hazardous drinking among women in the general population, few studies have compared drinking rates, levels, or problems based on relationship status among sexual minority women (SMW; lesbian, bisexual). We examined associations between relationship status (committed relationship/cohabiting; committed/not cohabiting; single) and past-year drinking outcomes using data from a diverse sample of 696 SMW interviewed in wave 3 of the 17-year longitudinal Chicago Health and Life Experiences of Women study. The mean age of SMW in the sample was 40.01 (SD = 14.15; range 18-82). A little more than one-third (37%) of the sample was white, 36% was African American, and 23% Latina; 4% reported another or multi- race/ethnicity. Compared to SMW in committed cohabiting relationships, single SMW were significantly more likely to be heavy drinkers. SMW in committed non-cohabiting relationships were more likely to report alcohol-related problem consequences, and both single SMW and those in committed non-cohabiting relationships were more likely to report one or more symptoms of potential alcohol dependence. Findings underscore the importance of exploring relationship factors that may influence drinking and drinking-related problems among SMW.

[Effects of drug use and anxiety on premature ejaculation in a sample of Spanish drug addicts]

INTRODUCTION

Premature ejaculation may be due to many factors and one of them may be drug use.

AIMS

The main objective of this study is to show how drug abuse affects the ejaculatory response, keeping in mind the different substances consumed, the level of anxiety and the period of withdrawal.

METHOD

Two samples were used, one for men who were addicted to drugs (N=925) and one of non-consumers (N=82). Both samples were selected from 28 treatment centers. The Golombok Rust Inventory of Sexual Satisfaction (GRISS) questionnaire and the State Anxiety Trait Questionnaire (STAI) were used.

RESULTS

The results show that men with a history of consumption obtain higher percentages in premature ejaculation compared to non-users (44.3%> 15.9%) and also higher mean scores in anxiety (State Anxiety=19.83>11, 89; Trait Anxiety=25.66>12.39). These differences were statistically significant (P=.000). The results confirm that the withdrawal period does not improve ejaculatory response and having a partner does not work as a protective factor in premature ejaculation.

CONCLUSIONS

Men with a history of drug use are more likely to suffer from premature ejaculation and higher levels of anxiety, which does not improve during the period of withdrawal, leading to the belief that drug users have personality traits that facilitate premature ejaculation and/or that the neurological damages caused by the drugs contribute to a decrease in the intravaginal ejaculatory latency, issues that should be studied in future investigations.

Race-Ethnicity, Union Status, and Change in Body Mass Index in Young Adulthood

This study used data from three waves of the National Longitudinal Study of Adolescent to Adult Health (Add Health) and fixed-effects regression to consider whether associations between change in union status and change in BMI were moderated by race/ethnicity. The results indicated that intimate unions were differentially associated with gains in BMI along race/ethnic lines, especially for women. Compared to White women, marriage was associated with larger increases in BMI for Black, Hispanic and Multiracial women, and cohabitation was associated with larger increases for Black and Hispanic women. In contrast, both marriage and cohabitation were associated with less weight gain for Asian compared to White women. Among men, racial/ethnic differences in the relationship between union status and BMI were similarly patterned but less pronounced. The results suggest that, particularly for women, marital status-already its own source of stratification, further exacerbates racial/ethnic disparities in BMI from adolescence to young adulthood.

A couple-level analysis of participation in physical activity during unemployment

There is a well-documented negative correlation between unemployment and health. Yet, little research has examined how unemployment relates to participation in physical activity, and few researchers have considered how an individual's unemployment may affect the health of their spouse or partner. The purpose of this study is to answer three questions: 1. Is one's own unemployment associated with changes in physical activity participation? 2. Is one's partner's unemployment associated with changes in physical activity participation? 3. Do changes in physical activity behaviors associated with unemployment differ by gender? This study uses nationally representative, longitudinal data on couples in the United States, covering the period 1999–2013. These data, obtained from the Panel Study of Income Dynamics, are used to estimate fixed-effects models of the relationships between one's own, and one's partner's, unemployment and participation in physical activity. I find that for men unemployment is not associated with changes in physical activity time. For women, own unemployment is associated with increases in physical activity, whereas a partner's unemployment is associated with decreases in physical activity. I argue that unemployed women, unlike men, are able to take advantage of the increased availability of time through reduced labor supply to invest in their health during unemployment, which could have positive long-run consequences. Results suggest the importance of studying unemployment and health at the household level and suggest a need for further investigation into gender differences in unemployment and health.

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Limited research has examined how unemployment affects physical activity.

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Research examining how unemployment affects one's spouse is also limited.

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Study uses Panel Study of Income Dynamics data to investigate these issues.

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Unemployed men do not experience changes in physical activity.

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Women increase activity during unemployment but do less during partner unemployment.

The relative contributions of function, perceived psychological burden and partner support to cognitive distress in bladder cancer

OBJECTIVE

Bladder cancer is a genitourinary disease of increasing incidence. Despite improvements in treatment, outcomes remain equivocal with high recurrence rates. It is associated with poor psychosocial outcomes due to reduced functioning of the genitourinary system. The objective of these analyses was to query whether reported loss of function or the perception of psychological burden caused by this functional impedance was the key to understanding psychosocial outcomes.

METHODS

The sample comprised 119 participants with a confirmed diagnosis of bladder cancer. They completed a self-report questionnaire comprising the Bladder Cancer Index, Mini-mental Adjustment to Cancer Scale, Psychosocial Adjustment to Illness Scale and standard sociodemographic details. Simple mediation and serial mediation were used to explore the potential for psychological burden to mediate associations between loss of function and cognitive distress, and the potential additional contribution of positive partner support on these relationships. Age and duration of cancer were considered as covariates.

RESULTS

Simple mediation demonstrated that the association between function and cognitive distress was fully mediated by perceived psychological burden. Serial mediation, which allowed for the addition of partner support, again demonstrated full mediation, with partner support being the key predictive variable.

CONCLUSIONS

These analyses emphasise the importance of an appreciation of individuals' interpretation of the burden occasioned by bladder cancer and the role of a supportive partner. The implications for management discussions and support services in alleviating negative psychological outcomes in bladder cancer are highlighted. Copyright © 2015 John Wiley & Sons, Ltd.

Marital Status, Relationship Distress, and Self-rated Health: What Role for "Sleep Problems"?

This paper analyzes data from a nationally representative survey of adults in the United Kingdom (Understanding Society, N = 37,253) to explore the marital status/health nexus (using categories that include a measure of relationship distress) and to assess the role that sleep problems play as a potential mediator. Findings indicate how it is not just the "form" marital status takes but also the absence or presence of relationship distress that is essential to self-rated health. We demonstrate two further findings that: (1) sleep problems act as a mediator of the link between marital status/relationship distress and self-rated health, most notably for those in cohabiting relationships with medium/high distress or who have a history of relationship loss, and (2) the mediating role of sleep problems differs for divorced men and women.

Influence of substance use on the erectile response in a sample of drug users

Erectile dysfunction in men may be due to multiple causes, including anxiety and substance abuse. The main objective of this study is to know how it affects the continued use of addictive substances in the erectile response, taking into account not only the type of substances consumed, but also other variables that may influence on sexual response, such as the time of withdrawal, anxiety and sexual attitude. Two samples were used, one for males (n = 925) who had a history of substance use and another one for males (n = 82) with no history of substance abuse. Both populations were selected by a cluster sampling of 27 Spanish provinces. The GRISS, SOS and STAI questionnaires were used. The results indicate that men with a history of consumption obtained a higher percentage of dysfunction in the erectile dysfunction questionnaire GRISS scale than those who have a history of consumption (36.69% vs.15.85%) who also have higher scores on state anxiety (19.83 vs.11.89) and trait anxiety (25.66 vs.12.39) and lowest in erotophilia (86.85 vs. 97.29) was statistically significant difference. It is also proved that the time of withdrawal does not help ex drug users improve their erectile response.

Cigarette Smoking in Same-Sex and Different-Sex Unions: The Role of Socioeconomic and Psychological Factors

Cigarette smoking has long been a target of public health intervention because it substantially contributes to morbidity and mortality. Individuals in different-sex marriages have lower smoking risk (i.e., prevalence and frequency) than different-sex cohabiters. However, little is known about the smoking risk of individuals in same-sex cohabiting unions. We compare the smoking risk of individuals in different-sex marriages, same-sex cohabiting unions, and different-sex cohabiting unions using pooled cross-sectional data from the 1997-2010 National Health Interview Surveys (N = 168,514). We further examine the role of socioeconomic status (SES) and psychological distress in the relationship between union status and smoking. Estimates from multinomial logistic regression models reveal that same-sex and different-sex cohabiters experience similar smoking risk when compared to one another, and higher smoking risk when compared to the different-sex married. Results suggest that SES and psychological distress factors cannot fully explain smoking differences between the different-sex married and same-sex and different-sex cohabiting groups. Moreover, without same-sex cohabiter's education advantage, same-sex cohabiters would experience even greater smoking risk relative to the different-sex married. Policy recommendations to reduce smoking disparities among same-sex and different-sex cohabiters are discussed.