Marital quality and health: Implications for marriage in the 21st century

The impact of internet medical service on rural gender inequality in health opportunity: a cross-sectional study

BACKGROUND

The increasing popularity of Internet medical service may have alleviated the gender inequality in health opportunity faced by rural women. However, research to ascertain the association between Internet medical service and gender inequality in health opportunity is scarce. This study explored the impact of Internet medical service on gender inequality in health opportunity among rural women and the underlying mechanisms involved.

METHODS

A multistage stratified cross-sectional survey was conducted across six counties in three provinces in China, yielding 3,108 responses for a 97.13% response rate. The questionnaire was used to collect information on Internet healthcare use, health status, health behaviors, social activities and personal exercise, chronic disease status, and demographic and socio-economic characteristics of the participants. Based on Roemer's theory of equality of opportunity (EOP), we established a decomposition strategy for the fairness gap between genders, which we used for the measurement of the gender inequality in health opportunity Fixed effects models, propensity score matching (PSM), and least absolute shrinkage and selection operator (LASSO) regression were utilized to explore the impact of Internet medical service on rural gender inequality in health opportunity.

RESULTS

On average, rural women experienced a gender health fairness gap of 1.63. Internet medical service significantly mitigated this inequality (β = -0.0602, P = 0.0002), and this finding remained significant across propensity score matching (PSM) and LASSO regression analyses. Mechanistic analysis revealed that human capital positively moderates this effect (β = -0.0510, P < 0.01), while income (β = 0.0370, P < 0.001) and marital status (β = 0.2039, P < 0.001) have negative moderating effects.

CONCLUSIONS

By focusing on gender inequality in the digital era, this study highlights the mitigating role of Internet medical service on gender inequality in health opportunity in rural areas. This study proposes and validates the mechanisms through which Internet medical service alleviates gender inequality in health opportunity, suggesting that human capital amplifies this effect, while high personal income and marital status attenuate this effect. These findings contribute to understanding how the digital age can narrow gender health opportunity equality, providing support for future interventions aimed at promoting health equity and gender equality.

The Consumption of Non-Sugar Sweetened and Ready-to-Drink Beverages as Emerging Types of Beverages in Shanghai

BACKGROUND

The Chinese beverage industry is experiencing rapid growth, particularly in the popularity of non-sugar sweetened beverages (NSSs) and ready-to-drink beverages (RSBs). This study aimed to assess current consumption patterns and determinants of various beverage types among retail visitors.

METHODS

A total of 44 observation points, including 22 supermarkets and 22 convenience stores, were randomly selected across Shanghai. At each location, at least 100 individuals were recruited to participate. Data were collected using an electronic self-administered questionnaire.

RESULTS

The consumption rates of total beverages, sugar-sweetened beverages, NSSs, and RSBs were 57.70%, 56.94%, 19.60%, and 29.50%, respectively; the median consumption amounts among the drinking population were 162.57 mL/day, 137.98 mL/day, 32.85 mL/day, and 32.85 mL/day, respectively. The consumption proportions of NSSs and RSBs ranked 2nd and 3rd. The multifactorial analyses showed that people aged 6-18 years consumed more beverages (p < 0.05). Males were more likely to consume sugar-sweetened beverages and NSSs, but females were more likely to consume RSBs (p < 0.05). Higher educated people and bachelors were more likely to consume beverages (p < 0.05).

CONCLUSIONS

The emerging beverage categories, NSSs and RSBs, warrant attention due to their significant consumption rates. Tailored intervention strategies should be considered for demographic groups varying by age, gender, and educational attainment.

Neutrophil-to-lymphocyte ratio as a predictor of cardiovascular mortality in cancer survivors

This study aims to evaluate the neutrophil-to-lymphocyte ratio (NLR) as a predictive biomarker for cardiovascular mortality among cancer patients, utilizing data from the National Health and Nutrition Examination Survey (NHANES). From the NHANES dataset (2007-2018), we analyzed 4974 cancer survivors, investigating the prognostic significance of NLR for all-cause, cardiovascular, and cancer-specific mortality. Survival outcomes were analyzed using Cox regression and Kaplan-Meier methods. Optimal NLR cutoffs were identified as 2.61 for differentiating the higher NLR group from lower NLR group. Elevated NLR levels significantly correlated with increased all-cause mortality (HR 1.11, 95% CI 1.07-1.14, P < 0.001) and cardiovascular mortality (HR 1.14, 95% CI 1.08-1.21, P < 0.001) in adjusted models. Subgroup analyses revealed that age, sex, smoking status, and hypertension significantly influence NLR's association with cardiovascular mortality. Specific cancers including breast, prostate, non-melanoma skin, colon and melanoma experience increased all-cause and cardiovascular mortality in the higher NLR group compared to lower NLR group. Elevated NLR is a significant predictor of increased mortality in cancer patients, particularly for cardiovascular outcomes. These findings support that NLR acts as a pivotal prognostic tool with significant implications for clinical practice in the realm of cardio-oncology.

Divorce and physical health: A three-level meta-analysis

Divorce is often considered a major and stressful life transition. Given that divorcees are overrepresented in primary care and there is a association between individuals' physical health and psychological adjustment, potential post-divorce health problems are of concern. Yet, empirical evidence is lacking on the magnitude of the overall physical health risk after divorce, on possible differences across specific pathologies, and on factors that may increase or reduce this risk. The current meta-analysis addresses these issues. We identified 94 studies including u = 248 relevant effect sizes, based on N = 1,384,507 participants. Generally, compared to married individuals, divorcees showed significantly worse self-reported health (OR = 1.20, [1.08-1.33]), experienced more physical symptoms (OR = 1.34, [1.17-1.53]), and had a higher risk for diabetes (OR = 1.18 [1.05-1.33]), joint pathologies (OR = 1.24, [1.14-1.34]), cardiovascular (OR = 1.24, [1.09-1.41]) and cerebrovascular conditions (OR = 1.31, [1.14-1.51]), and sexually transmitted diseases (OR = 2.48, [1.32-4.64]). However, they had no increased risk of hypertension, hypercholesterolemia, cancer and cancer development, disabilities or limitations, or cognitive pathologies. Nor did divorcees significantly differ from married individuals when aggregating all pathologies to measure overall physical health problems (OR = 1.14, [0.85 to 1.54]). Yet, moderation analyses revealed that being female, unemployed, childless, or having a lower education constitutes a higher risk for overall physical health problems after divorce. The same applied to having a heavy alcohol consumption, lack of exercise, and being overweight. Our meta-analysis shows that divorcees are at heightened risk of certain pathologies, with sexually transmitted diseases as a particular post-divorce hazard. These findings call for more awareness among counsellors and physicians on divorcees' health conditions and the characteristics that make divorcees even more vulnerable to health problems.

Psychoneuroimmunology in multiple myeloma and autologous hematopoietic stem cell transplant: Opportunities for research among patients and caregivers

Multiple myeloma (MM) is an incurable cancer and is the leading indication for autologous hematopoietic stem cell transplantation (HSCT). To be eligible for HSCT, a patient must have a caregiver, as caregivers play a central role in HSCT preparation and recovery. MM patients remain on treatment indefinitely, and thus patients and their caregivers face long-term challenges including the intensity of HSCT and perpetual therapy after transplant. Importantly, both patients and their caregivers show heightened depressive and anxiety symptoms, with dyadic correspondence evidenced and caregivers' distress often exceeding that of patients. An extensive psychoneuroimmunology (PNI) literature links distress with health via immune and neuroendocrine dysregulation as well as biological aging. However, data on PNI in the context of multiple myeloma - in patients or caregivers - are remarkably limited. Distress in MM patients has been associated with poorer outcomes including higher inflammation, greater one year post-HSCT hospital readmissions, and worse overall survival. Further, anxiety and depression are linked to biological aging and may contribute to the poor long-term health of both patients and caregivers. Because MM generally affects older adults, individual differences in biological aging may represent an important modifier of MM biology and HSCT treatment outcomes. There are a number of clinical scenarios in which biologically younger people could be prescribed more intensive therapies, with potential for greater benefit, by using a personalized cancer therapy approach based on the quantification of physiologic reserve. Further, despite considerable psychological demands, the effects of distress on health among MM caregivers is largely unexamined. Within this context, the current critical review highlights gaps in knowledge at the intersection of HSCT, inflammation, and biological aging in the context of MM. Research in this area hold promise for opportunities for novel and impactful psychoneuroimmunology (PNI) research to enhance health outcomes, quality of life, and longevity among both MM patients and their caregivers.

Sociodemographic predictors of parenting stress among mothers in socio-economically deprived settings in rural and urban Kenya and Zambia

Parental stress occurs when parenting demands exceed the resources available to cope with parenting. Previous research has identified household wealth, educational level, marital status, age, and number of dependent children as predictors of parental stress. However, limited evidence exists from sub-Saharan Africa. This study investigated the sociodemographic predictors of parenting stress among mothers in Kenya and Zambia. This cross-sectional study utilised baseline secondary data from parenting intervention programs implemented in Kisumu County (rural Kenya), Nairobi County (Urban Kenya), and Chisamba District (rural Zambia). Out of 913 caregivers recruited for the parenting program, 844 with complete data were included in the analysis. The mean age was 1.0 (SD = 0.7) years. Parental stress was measured using the Parental Stress Score (PSS) tool and demographic questionnaires were used to collect demographic information. Mean PSS were compared across study sites, and a multiple linear regression model was used to examine associations between sociodemographic predictors (household income, educational level, marital status, maternal age, child age, and number of children aged < 5 years) and PSS, adjusting for clustering and other predictors. From the results, the mean PSS in rural Kenya was 37.6 [SD = 11.8], in urban Kenya was 48.4 [SD = 4.2], and in rural Zambia was 43.0 [SD = 9.1]. In addition, the significant association between PSS and mothers' income and educational level was only observed in Kenyan study sites (income: Kenya rural β = -0.40, p < 0.001**; Kenya urban, β = - 0.33, p = .02*; Zambia rural, β = - 0.01, p = 0.7) education: Kenya rural, β = - 0.25, p = .005**; Kenya urban, β = - 0.14, p = 0.07; Zambia rural, β = 0.04, p = 0.3). However, marital status, mother's age, child's age, and the number of children below five years were not associated with PSS. The results revealed that mothers' income and education level were negatively associated with PSS, indicating that higher socioeconomic status can buffer the effects of parental stress.Trial registration Pan African Clinical Trials Registry ( https://pactr.samrc.ac.za/ ) database (ID Number: PACTR20180774832663 Date: 26/July/2018; (ID number: PACTR201905787868050 Date: 06/May/2019.

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.

Exposure to secondary traumatic stress and its related factors among emergency nurses in Saudi Arabia: a mixed method study

BACKGROUND

Emergency department (ED) nurses are exposed to the risk of secondary traumatic stress (STS), which poses a threat not only to nurses' health and psychological well-being but also adversely affects the execution of their professional duties. The quality and outcome of their nursing services are negatively affected by STS.

PURPOSE

The purpose of this study is to comprehensively investigate the prevalence and intensity of Secondary Traumatic Stress (STS) among Emergency Department (ED) nurses. It aims to identify and analyze the socio-demographic, occupational, and psychological factors that influence the severity and variation of STS experienced by these nurses.

METHODS

The study utilized a sequential explanatory mixed methods approach, including two phases. Phase 1 employed a cross-sectional study design, utilizing a convenience sample of 181 nurses to explore the levels of STS and the factors associated with it. Following this, Phase 2 was structured as a qualitative descriptive study, which involved conducting semi-structured interviews with a purposefully selected group of ten ED nurses. Data collection took place at three major hospitals in Saudi Arabia during the period from January to June 2022.

RESULTS

A total of 181 participants were included in the study. The mean STSS score reported by the nurses was 51 (SD = 13.23) out of the maximum possible score of 85, indicating severe STS among ED nurses. Factors associated with an increase in the levels of STS among ED nurses included being female, older in age, married, possessing higher education and experience, having a positive relationship with colleagues, receiving organisational support, and dealing with a higher number of trauma cases. Several themes emerged from the qualitative interviews including: ED Characteristics: Dual Impact on STS, Emotional Resonance and Vulnerability, Personal Life Stressors, The Ability to Cope, and Social Support.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

Future strategies and interventions targeting STS should be prioritized to effectively manage its impact on ED nurses. It is crucial to develop targeted interventions that address the specific factors contributing to STS, as identified in this study. Additionally, these findings aim to enhance awareness among nursing administrators, managers, and supervisors about the critical factors associated with STS. This awareness is essential for accurately assessing and developing interventions that mitigate STS among nursing staff.

A compassion-based treatment for couples with the female partner suffering from current depressive disorder: A randomized-controlled trial

BACKGROUND

Studies have shown that depression and interpersonal relationships are interdependently connected and that including the intimate partner in treatment for depression has beneficial effects. Given evidence that compassion is both an interpersonal quality and a promising treatment target, the goal of this study was to examine the effects of a compassion-based, contemplative treatment for couples employing a multi-method approach for evaluation.

METHODS

In a pre-post-follow-up design, n = 53 different-sex couples including women with current depression were randomly assigned to a 10-week-long CBCT®-fC (Cognitively-Based Compassion Training/intervention for couples) or treatment-as-usual (TAU) condition. Multi-level linear regression models and post-hoc contrasts were calculated to determine changes in depressive symptoms, mindfulness and self-compassion, interpersonal functioning and neuroendocrine markers collected during a partnership appreciation task (PAT) in the laboratory before and after CBCT-fC treatment.

RESULTS

While CBCT-fC led to a comparable decrease of depressive symptoms as TAU, the training specifically increased self-compassion and mindfulness versus TAU. Interestingly, interpersonal functioning did not improve, which was also reflected in participants' preferred self-focus in-between-session practices, instead of practices with interpersonal focus. There were no group-specific changes in psychobiological stress-marker reactivity.

CONCLUSIONS

CBCT-fC was effective in decreasing current depressive symptomatology and increasing mindfulness, and self-compassion. Especially the motivation to participate, such as improving interpersonal functioning, should be addressed and intrinsic motives of the partners to be involved. In highly burdened individuals, self-regulation may need to be improved before co-regulation can be addressed, which would requiring longer treatments. Facilitating factors for engaging in the practice between-sessions seem meaningful.

Psychometric properties of dyadic data from the Marital Quality Scale of Indonesian Javanese couples

BACKGROUND

Researchers have demonstrated that various measurement concepts and dimensions depend on context and timing.

OBJECTIVES

The current study aimed to determine the psychometric properties of the Javanese couples' marital quality scale based on validity and reliability METHODS: In total 840 participants or 420 marital dyad from Java, Indonesia, were involved in this study. The psychometrics properties scale was analyzed using exploratory and confirmatory factor analysis, convergent and discriminant analysis, and composite reliability.

RESULTS

The exploratory factor analysis found relationship quality to consist of support, physical proximity, warmth, communication, acceptance and respect, role sharing, and responsibility factors. Well-being quality consists of happiness, harmony, and problem-solving. The fit of the measurement model was obtained using confirmatory factor analysis. The fit model was also found in the husband's and wife's groups, with no differences between them. The high correlations between wife-husband factors also proved the validity based on convergent and discriminant evidence. The reliability coefficient was high for each dimension and construct.

DISCUSSION

This analysis shows that the marital quality scale developed has information on psychometric properties that can be useful for researchers and the practicians using the marital quality instrument of Javanese couples in particular.

Understanding social attachment as a window into the neural basis of prosocial behavior

The representation and demonstration of human values are intimately tied to our status as a social species. Humans are relatively unique in our ability to form enduring social attachments, characterized by the development of a selective bond that persists over time. Such relationships include the bonds between parents and offspring, pair bonds between partners and other affiliative contacts, in addition to group relationships to which we may form direct and symbolic affiliations. Many of the cognitive and behavioral processes thought to be linked to our capacity for social attachment-including consolation, empathy, and social motivation, and the implicated neural circuits mediating these constructs, are shared with those thought to be important for the representation of prosocial values. This perspective piece will examine the hypothesis that our ability to form such long-term bonds may play an essential role in the construction of human values and ethical systems, and that components of prosocial behaviors are shared across species. Humans are one of a few species that form such long-term and exclusive attachments and our understanding of the neurobiology underlying attachment behavior has been advanced by studying behavior in non-human animals. The overlap in behavioral and affective constructs underlying attachment behavior and value representation is discussed, followed by evidence from other species that demonstrate attachment behavior that supports the overlapping neurobiological basis for social bonds and prosocial behavior. The understanding of attachment biology has broad implications for human health as well as for understanding the basis for and variations in prosocial behavior.

Attachment across the lifespan: Examining the intersection of pair bonding neurobiology and healthy aging

Increasing evidence suggests that intact social bonds are protective against age-related morbidity, while bond disruption and social isolation increase the risk for multiple age-related diseases. Social attachments, the enduring, selective bonds formed between individuals, are thus essential to human health. Socially monogamous species like the prairie vole (M. ochrogaster) form long-term pair bonds, allowing us to investigate the mechanisms underlying attachment and the poorly understood connection between social bonds and health. In this review, we explore several potential areas of focus emerging from data in humans and other species associating attachment and healthy aging, and evidence from prairie voles that may clarify this link. We examine gaps in our understanding of social cognition and pair bond behavior. Finally, we discuss physiologic pathways related to pair bonding that promote resilience to the processes of aging and age-related disease. Advances in the development of molecular genetic tools in monogamous species will allow us to bridge the mechanistic gaps presented and identify conserved research and therapeutic targets relevant to human health and aging.

The long-term outcomes of patients with negative prolonged ambulatory electroencephalography tests: A cross-sectional follow-up study

Background

Ambulatory electroencephalography (AEEG) recording is an essential aid for detecting interictal discharges and providing a clinical diagnosis. This study aimed to describe long-term outcomes among a cohort of patients who yielded negative results on AEEG at the time of assessment and identify factors associated with contemporary quality of life (QOL) and ultimate epilepsy diagnosis.

Methods

This cross-sectional telephone follow-up study was conducted in June-November 2021 at the Neurology Department in a metropolitan hospital in Sydney, Australia.

Results

In total, 47 of 105 eligible (45%) participants were enrolled. Overall, 21 (45%) participants had been diagnosed with epilepsy at a 12-year follow-up. Taking anti-seizure medication, having experienced a seizure event, and having marriage and education-related characteristics were associated with an epilepsy diagnosis. QOL was found to be associated with age, employment status and history of experience of a seizure event. QOL and an epilepsy diagnosis were not shown to be statistically related.

Conclusions

Nearly half of the participants had received an epilepsy diagnosis at long-term follow-up, despite having tested negative on AEEG at the time of assessment. Prolonged AEEG testing is an important tool to aid the diagnostic process. However, clinical examination, including accurate history taking, is vital in establishing an epilepsy diagnosis.

Marital status and living apart affect sleep quality in male military personnel: a study of the China's Navy during COVID-19

Background

Marital status is a robust sociodemographic predictor of sleep. Having to live apart from spouse may have different implications than those of cohabitants or singles, especially in military personnel. Further research on this group will help provide knowledge in advance and facilitate early targeted interventions.

Methods

An online questionnaire study was conducted from July to November 2021. A total of 1,832 male military personnel completed the questionnaire. The marital status was measured by a self-reported single choice question. Pittsburgh sleep quality index (PSQI), Epworth Sleepiness Scale (ESS) and The Dysfunctional Beliefs and Attitudes about sleep scale (DBAS-16) were used to measure sleep-related outcomes. Inverse probability weighting (IPW) was applied to reduce the effects of confounding. Logistic regression was used to analyze the relationship between marital status and sleep and explore the impact of living together or not.

Results

After inverse probability weighting, the prevalence of poor sleep quality, sleepiness and dysfunctional beliefs were 16.1, 20.1 and 7.1%, respectively. One-way ANOVA results for the means of both groups were statistically significantly different, except for the sleep latency and sleep disturbance dimensions of PSQI. Participants who were married were more likely to have poor sleep quality (OR: 1.408, 95% CI: [1.10, 1.80]), to have daytime sleepiness (OR: 1.560, 95% CI: [1.27, 1.92]) and to develop dysfunctional beliefs and attitudes (OR: 2.497, 95% CI: [1.65, 3.80]) than those who were unmarried. Further analysis showed that the odds of developing poor sleep quality and DBAS in participants who married but living apart were significantly bigger than those unmarried (OR: 1.548 and 3.991, respectively.), while there were no significant differences in the odds of daytime sleepiness (OR: 0.738, p = 0.050). Age was a protective factor for the development of bad sleep outcomes, while family economic was an independent risk factor.

Conclusion

Marital status appear important for sleep quality, daytime sleepiness and sleep beliefs. The effect of living apart or not should be considered separately as an important predictor of sleep.

Associations of self-reported skin symptoms with age, sex, and living with a partner: Findings from a representative survey in view of the biomedical and the biopsychosocial model

Introduction

Social and demographic characteristics are crucial determinants of health. The objective of this contribution is to study the associations of skin symptoms and sociodemographic variables in the general population, and to discuss these findings in view of the biomedical and the biopsychosocial models of skin diseases.

Methods

A national face-to-face household survey with a representative sample of the German general population assessed 19 self-reported skin symptoms (N = 2,487). Associations with age, sex, and living situation (alone vs. with partner) were analyzed using logistic regression analyses.

Results

The frequencies of pimples and biting of the nails decreased by approximately 30% per age decade, and oily skin, the feeling of disfigurement, excoriations, and sun damages decreased by 8%-15% per age decade. Dryness of the skin increased by 7% per decade. Sensitive skin and dryness were approx. twice as likely in females as in males. Dryness of the skin, itch, and excoriations were 23%-32% more frequent in participants living without a partner.

Discussion

The biomedical model explains some of the findings well (e.g., reduction of pimples with age). The interpretation of other results is facilitated by the biopsychosocial model (e.g., association of living without a partner and itch). This suggests a stronger integration of psychological and social factors into the understanding and treatment of symptoms of the skin.

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.

Physio-psycho-social interaction mechanism in dyadic health of young and middle-aged stroke survivors and their spousal caregivers: a longitudinal observational study protocol

INTRODUCTION

In recent years, stroke has become more common among young people. Stroke not only has a profound impact on patients' health but also incurs stress and health threats to their caregivers, especially spousal caregivers. Moreover, the health of stroke survivors and their caregivers is interdependent. To our knowledge, no study has explored dyadic health of young and middle-aged stroke survivors and their spousal caregivers from physiological, psychological and social perspectives. Therefore, this proposed study aims to explore the mechanism of how physiological, psychological and social factors affect dyadic health of young and middle-aged stroke survivors and their spousal caregivers. The findings of this study will provide implications for developing interventions to improve dyadic health of this growing population.

METHODS AND ANALYSES

We will collect data from 57 dyads of young and middle-aged stroke survivors and their spousal caregivers during hospitalisation and at 1, 3, 6, 9 and 12 months after discharge. Questionnaires will be used to collect participants' demographic information, stress, depression, anxiety, benefit finding, social support, mutuality and quality of life. The following physiological reactions will be collected at baseline, including interleukin 6, tumour necrosis factor-alpha and salivary cortisol.

ETHICS AND DISSEMINATION

The study was approved by the ethics review committee of life sciences of Zhengzhou University (No. ZZUIRB2020-53). Prior to being enrolled in the study, participants will be given full and detailed information about the possible risks involved, the informed consent process, confidentiality, the study procedure and secure data storage. Participants will be guaranteed that they can withdraw from the study at any time without providing a reason or leading to any consequences. Both oral and written informed consent will be obtained from all participants. The findings of this proposed study will be disseminated through peer-reviewed journals and academic conferences.

The association between marital quality and diabetes mellitus: A systematic review

Background and Aims

Marital relationship and its quality are among the major psychological factors affecting the multiple aspects of a person's health status. Chronic diseases are also among the factors that affect various aspects of the lives of millions of people including their marital quality status. One of the most important underlying chronic diseases is diabetes. Since the correlation between diabetes mellitus and marital quality has been neglected, this systematic review, as the first one, aims to investigate the association between marital quality and diabetes mellitus.

Methods

A comprehensive search was conducted among three databases (Medline, Scopus, and Web of Science) until September 2021, which resulted in 189 articles. After assessing the studies based on the inclusion criteria, 14 studies were included.

Results

The included studies were divided into two general groups. The first group consisted of 3 articles examining the effect of factors related to diabetes on marital quality, and the second group included 11 articles studying the effect of marital quality on diabetes and its factors. In general, the articles investigating the impact of diabetes-related factors on marital quality showed that diabetes has negative impacts on levels of marital quality. Also, the articles investigating the impact of marital quality on diabetes-related factors, showed that higher marital quality is associated with a lower risk of developing diabetes, a better quality of life in patients with diabetes, and better adherence to diabetes care regimen. The results regarding diabetes management were conflicting. Gender was mentioned as an important modulator in some of the investigated relationships.

Conclusion

Marital quality remarkably influences diabetes-related factors and is itself affected by the condition resulting from diabetes in individuals with diabetes mellitus. However, further studies are required due to the limited number of studies investigating this correlation.

The Role of Attachment and Dyadic Coping in Shaping Relational Intimacy: Actor-Partner Interdependence Model

People's attachment styles play a fundamental role in shaping their intimate relationships. Anxiously attached individuals have a strong need for closeness but a poor ability to obtain the closeness they seek. In contrast, people high in avoidance tend to avoid intimacy in close relationships. Dyadic coping can strengthen the bond between partners, and develop empathy, commitment, sensitivity, and responsiveness to the partner's needs, which may be the basis of shaping intimacy and closeness. The effects of attachment on relational intimacy were examined, using the actor-partner interdependence model and data from 144 heterosexual couples, aged 26 to 60. Both partners completed measures of attachment, intimacy as a relationship satisfaction dimension, and dyadic coping. The results showed that men's attachment-related avoidance is related to their own intimacy; also, the avoidant attachment of both spouses is related to each other's intimacy. The effect of having children on intimacy was significant for men; the effect of financial situation on intimacy was significant for women. Moreover, problem-focused common dyadic coping appeared to have a significant moderating effect on the relationship between attachment-related avoidance and intimacy. Adult attachment and dyadic coping significantly contributed to partners' relational intimacy.

Associations between wives' and husbands' attitudes towards women's economic participation and depressive symptoms, poor subjective health, and unemployment status in married women: A Korean longitudinal study (2014–2020)

Introduction

Previous research has investigated the relationship between an individuals' gender role attitudes (GRAs) and their psychological health. We hypothesized that holding traditional GRAs or having a husband who holds traditional GRAs may adversely affect a woman's health.

Methods

Data were obtained from a nationally representative longitudinal survey. Women's negative attitudes towards women's economic participation and husbands' negative attitudes towards their wives' economic participation were measured. The associations between the two and depressive symptoms, poor subjective health, and unemployment status in married women was estimated using a generalised estimating equation. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated.

Results

Women's negative attitudes towards women's economic participation was associated with depressive symptoms (OR [95% CI]: 1.19 [1.09–1.31]), poor subjective health (1.14 [1.04–1.25]) and unemployment status (1.10 [1.05–1.15]) in married women. In addition, there were significant associations between husbands' negative attitudes towards their wives working and depressive symptoms (1.41 [1.23–1.60]), poor subjective health (1.69 [1.48–1.92]), and unemployment (1.80 [1.69–1.92]) in their wives. The effect was strongest when both wives and their husbands have negative attitudes. In addition, the models considering cumulative years of negative attitudes showed that wives holding negative attitudes towards women's economic participation for 3 years or more was associated with depressive symptoms (1.70 [1.42–2.04]), poor subjective health (1.28 [1.04–1.57]), and unemployment status (1.39 [1.22–1.58]). Similarly, husbands' holding 3 years or more of negative attitudes towards their wives' economic participation was associated with depressive symptoms (1.32 [1.02–1.72])), poor subjective health (1.81 [1.40–2.35]), and unemployment status (9.02 [7.97–10.21]) in their wives.

Conclusions

Our results show that one's own or one's husband's attitude towards women's economic participation affects not only the employment status of married women but also their mental and subjective health. Policymakers should implement policies that encourage positive attitudes towards women's economic activities.

•

Traditional gender role attitudes increase the odds of depressive symptoms.

•

Traditional gender role attitudes increase the odds of poor subjective health.

•

Husbands who oppose their wives working increase their wives' risk for depression.

•

Husbands who oppose their wives working increase their wives' risk for poor health.

•

A longer duration of traditional or negative attitudes increases the impact.

Concurrent randomized control trials of the 1-year efficacy of two couple relationship education programs: ELEVATE and Couples Connecting Mindfully

A long-standing university-community partnership used a longitudinal randomized control trial to implement and evaluate two couple relationship education (CRE) curricula, ELEVATE and Couples Connecting Mindfully (CCM), among an economically and racially diverse population of adult couples. Married and non-married couples (n = 929 couples) completed baseline surveys and were randomly assigned to either one of the two program groups or to the control group by implementation site. Follow-up surveys were collected at 2 months, 6 months, and 1 year after baseline. Using an intent-to-treat approach, growth curve modeling comparisons of trajectories indicated program effects at 1 year post-baseline in key outcome areas. Both the ELEVATE and the CCM group reported significant gains in couple relationship skills, couple quality, and family harmony over time compared to the control group that experienced either no change or declines. Further, the ELEVATE group also demonstrated positive program effects on measures of mental health and sleep quality. An assessment of the central premise of CRE indicated that the immediate post-program improvements in couple relationship skills predicted later couple quality for both program groups. This study indicates that both ELEVATE and CCM can be considered evidence-based CRE programs for use with a broad population of couples.

Exploring the Effects of Gender Differences and Widowhood Status on the Days Spent in Poor Health: A Secondary Data Analysis from India

The majority of research in India has focused on the impact of widowhood on health status and health care use, while little emphasis has been paid to the number of days spent in poor health among widowed population compare to other marital categories. Thus, the current study explores the relationship between widowhood and days spent with poor health outcomes among adults in India. Additionally, gender differences in the relationship between widowhood and days with poor health outcomes are further studied.The research employed nationally representative cross-sectional data from the 75th round (2017-2018) of the National Sample Survey (NSS). To investigate the associations of marital status (married vs widowed) and other factors with days spent in poor health, a negative binomial regression model was used. Additionally, the interaction model of age and widowhood was estimated separately for men and women.The findings suggest that widowed individuals had consistently prolonged days with an illness, limited activity, and confinement to bed. After adjusting for socioeconomic and demographic characteristics, the findings suggested that widowed women (IRR = 1.141, 95% Confidence interval = 1.01-1.29) were more likely to spend days with limited acitivities than married women. The marital status-age interaction indicated that older widowed women were more likely to have days of restricted activity and confinement to bed than married women, but such link is absent for men.In India, the elderly widow often spends her days confined to bed and prolonged days with limited activity. Policymakers and practitioners in public health should develop effective policies and programmes to enhance the health and well-being of widowed women, particularly those from socioeconomically disadvantaged backgrounds.

Alcohol Use and Blood Pressure Among Older Couples: The Moderating Role of Negative Marital Quality

OBJECTIVES

Spouses often have concordant drinking behaviors and important influences on one another's cardiovascular health. However, little is known about the implications of dyadic drinking patterns for blood pressure, and the marital factors that confer risk or resilience. This article examined links between alcohol use and blood pressure within individuals and opposite-sex couples over time, and whether those links vary by negative marital quality among older adults.

METHODS

Participants were from the nationally representative longitudinal Health and Retirement Study that included 4,619 respondents in 2,682 opposite-sex couples who participated in at least 2 of the waves from 2006 to 2016. Participants reported the number of drinks they typically consume per week, negative marital quality, and had their blood pressure measured via a cuff.

RESULTS

Analyses revealed that greater drinking was associated with increased systolic blood pressure among both husbands and wives. Furthermore, husbands who drank more had higher blood pressure when wives drank more alcohol, whereas there was no association between husbands' drinking and blood pressure when wives drank less alcohol. Interactions with negative marital quality showed that drinking concordance may be associated with increased blood pressure over time in more negative marriages.

DISCUSSION

Findings indicated that spousal drinking concordance, although often associated with positive marital quality, may have negative long-term health effects.

Sociodemographic determinants of multimorbidity in Brazilian adults and older adults: a cross-sectional study

BACKGROUND

Multimorbidity due to non-communicable chronic diseases (NCDs) constitutes a significant challenge for healthcare systems. To attenuate its impacts, it is essential to identify the sociodemographic determinants of this condition, which can discriminate against population segments that are more exposed.

OBJECTIVE

To identify associations between multimorbidity conditions and sociodemographic indicators among Brazilian adults and older adults.

DESIGN AND SETTING

Cross-sectional telephone-based survey in 26 Brazilian state capitals and the federal district.

METHODS

The Vigitel 2013 survey was used, with data collected via a questionnaire. The outcome was multimorbidity (2, 3 or 4 NCDs), and the exposures were sociodemographic indicators (age, sex, skin color, marital status and education). The analysis consisted of multinomial logistic regression (odds ratio), stratified by age.

RESULTS

Among adults, multimorbidity comprising two, three or four diseases was associated with advancing age (P < 0.001); two and three diseases, with having a partner (P = 0.004 and P < 0.001, respectively); and two, three or four diseases, with lower education (P < 0.001). Among older adults, two, three or four diseases were associated with female sex (P < 0.001); three diseases, with living with a partner (P = 0.018); two diseases, with black skin color (P = 0.016); and two or three diseases, with lower education (P < 0.001).

CONCLUSIONS

To control and prevent multimorbidity, strategies for individuals with existing chronic diseases, with partners and with lower education levels are needed. Particularly for adults, advancing age should be considered; and for older adults, being a woman and having black skin color.

Assessment of prevalence, knowledge of polycystic ovary syndrome and health-related practices among women in klang valley: A cross-sectional survey

BACKGROUND

Polycystic ovary syndrome (PCOS) is a common metabolic and reproductive disorder affecting women of childbearing age. Its symptoms associated with androgen excess and menstrual abnormalities have great impact on the quality of life in women with PCOS. Data on the knowledge of PCOS and health-related practices among Malaysian women is scarce. This study aimed to determine the prevalence, knowledge and health-related practices of PCOS among women in Klang Valley, Malaysia.

METHOD

A descriptive cross-sectional study was conducted among women in Klang Valley, Malaysia using a self-administered questionnaire. Participants were conveniently recruited through online platforms. Questionnaire consisted of four sections. The knowledge scores ranged from 0-20 where < 10 was classified as poor knowledge. Health-related practices scores ranged from 10-50, with score <30 was classified as poor practice. Descriptive statistics was used to report demographic characteristics. Inferential statistics was used to report the differentiation, association, and correlations of the variables.

RESULTS

A total of 410 respondents participated in this survey. The finding revealed that 43 (10.49%) respondents had medical diagnosis of PCOS, 11 (2.68%) were diagnosed with PCOS based on signs and symptoms, and 135 (32.93%) were suspected with PCOS. Nearly half of the respondents had poor knowledge (47.30%) and poor practice (47.60%) of PCOS. Also, 46 (11.22%) respondents reported abnormal scalp hair loss and 30 (7.32%) respondents had diabetes. Educational levels and PCOS history were significantly associated with PCOS knowledge. Respondents with healthcare related educational background demonstrated good knowledge (p<0.01). Majority of respondents (n= 328, 80%) were unable to control their diets on weekends. Married participants and aged between 40 to 45 women showed better practice of PCOS.

CONCLUSION

Nearly half of the respondents had poor knowledge and health-related practices towards PCOS. Women with suspected or diagnosed PCOS should seek immediate medical help as early diagnosis and treatment for PCOS are beneficial in improving their quality of life.

Coping strategies patterns to buffer the psychological impact of the State of Emergency in Spain during the COVID-19 pandemic's early months

Coping style represents the cognitive and behavioral patterns to manage particular demands appraised as taxing the resources of individuals. Studies report associations between certain coping styles and levels of adjustment of anxious symptomatology and emotional distress. The main objective of this study was to analyze behavioral co-occurrent patterns and relationships in the coping strategies used to deal with psychological distress displayed by the Spanish adult population during the first State of Emergency and lockdown of the COVID-19 pandemic. This is a cross-sectional study that uses selective methodology complemented with an indirect observational methodology, with a nomothetic/punctual/unidimensional design. We collected 996 surveys from 19 out of the 22 autonomous regions in Spain. We focused the analysis on sociodemographic variables, cumulative incidence of the COVID-19 disease and psychological distress variables. We performed two different inferential analyses: Lag sequential analysis to define the participant coping patterns, and polar coordinate analysis to study the interrelationship of the focal behavior with conditioned behaviors. We found behavioral co-occurrent patterns of coping strategies with problem avoidance being found as the coping strategy most frequently engaged by participants. Interestingly, the problem avoidance strategy was not associated with lower anxious symptomatology. By contrast, emotion-focused strategies such as express emotions and social support were associated with higher anxious symptomatology. Our findings underscore the importance of furthering our understanding of coping as a way to aid psychological distress during global public health emergencies.

Attachment Orientations, Sexual Behavior, and Relationship Satisfaction in Young, Mixed-Sex Couples: A Dyadic Approach

We examined if and to what degree attachment orientations of both partners moderate the link between different behavioral characteristics of the sexual relationship and relationship satisfaction in the early stages of romantic attachment. A sample of 126 young, mixed-sex couples (N = 252, mean age = 23.3, SD = 2.4; average relationship duration = 1.9 years, SD = 0.9) filled out questionnaires assessing attachment anxiety and avoidance, a range of intimate and sexual couple behaviors, and relationship satisfaction. Exploratory factor analyses revealed two behavioral factors: Intimate behavior (kissing, cuddling) and sexual behavior (oral sex, coitus). Although frequency of sexual behavior was not directly associated with relationship satisfaction, we found a significant positive interaction with anxious attachment, indicating that higher frequencies of sexual behavior were associated with greater self-reported relationship satisfaction in more anxiously attached individuals. Exploration of the effects of intimate behaviors on relationship satisfaction revealed significant positive associations as well, but, unexpectedly, only for avoidantly attached individuals. These results call for a dyadic and differentiated approach to the study of sexuality in couples and are in line with prior findings that the impact of intimate and sexual behaviors on relationship satisfaction varies depending on attachment orientations.

Move to health-a holistic approach to the management of chronic low back pain: an intervention and implementation protocol developed for a pragmatic clinical trial

BACKGROUND

The prevalence of chronic pain conditions is growing. Low back pain was the primary cause of disability worldwide out of 156 conditions assessed between 1990 and 2016, according to the Global Burden of Disease Study. Conventional medical approaches have failed to identify effective and long-lasting approaches for the management of chronic pain, and often fail to consider the multiple domains that influence overall health and can contribute to the pain experience. Leading international organizations that focus on pain research have stated the importance of considering these other domains within holistic and multidisciplinary frameworks for treating pain. While the research behind the theoretical link between these domains and chronic pain outcomes has expanded greatly over the last decade, there have been few practical and feasible methods to implement this type of care in normal clinical practice.

METHODS

The purpose of this manuscript is to describe an implementation protocol that is being used to deliver a complex holistic health intervention at multiple sites within a large government health system, as part of a larger multisite trial for patients with chronic low back pain. The Move to Health program developed by the US Army Medical Command was tailored for specific application to patients with low back pain and begins by providing an empirical link between eight different health domains (that include physical, emotional, social, and psychological constructs) and chronic low back pain. Through a six-step process, a health coach leverages motivational interviewing and information from a personal health inventory to guide the patient through a series of conversations about behavioral lifestyle choices. The patient chooses which domains they want to prioritize, and the health coach helps implement the plan with the use of SMART (Specific, Measurable, Attainable, Realistic, Time-bound) goals and a series of resources for every domain, triaged from self-management to specialist referral.

DISCUSSION

Complex interventions described in clinical trials are often challenging to implement because they lack sufficient details. Implementation protocols can improve the ability to properly deliver trial interventions into regular clinical practice with increased fidelity.

TRIAL REGISTRATION

Implementation of this intervention protocol was developed for a clinical trial that was registered a priori (clinicaltrials.gov #NCT04172038).

The Development of the Love and Respect Marriage Scale

The constructs of love and respect have been known to be essential ingredients contributing positively to marital satisfaction, but to-date they have mostly been measured using separate scales. However, given the overlap between both constructs this study set out, using self-report methodologies, to develop a comprehensive scale which measures both love and respect known as The Love and Respect Marriage Scale. Using a nonclinical community Singapore sample (n = 400), an initial item pool was developed, and through exploratory factor analysis, a robust factor structure emerged that consisted of eight subscales and 46 items. This factor structure was shown to be a consistent and cross-culturally acceptable model using samples from USA, n = 396, South Africa, n = 390, Nigeria, n = 364, and India, n = 306. Good reliability values were achieved. Construct, convergent, divergent, and incremental validity were also demonstrated as comparisons were made with shorter established marriage scales. Implications and advantages of a longer marital scale were discussed.Supplemental data for this article is available online at https://doi.org/10.1080/0092623X.2021.1963362 .

Dissatisfaction with Married Life in Men Is Related to Increased Stroke and All-Cause Mortality

The objectives of this study were to assess the association between marital satisfaction and specific and all-cause mortality, and to examine whether this association is independent of other known risk factors for early mortality. In this prospective cohort, male Israeli civil servants and municipal employees (n = 8945) underwent an extensive appraisal of health and behavioral patterns and were followed for more than three decades. Cox proportional hazards analysis was used to estimate the relative risks for stroke and all-cause mortality over time across marital satisfaction categories. During the 32 years of follow-up, 5736 (64.1%) died. Dissatisfaction with married life was related to increased long-term risk of stroke (HR = 1.94; 95%CI, 1.41–2.90) and all-cause mortality (HR = 1.21; 95%CI, 1.04–1.41). The latter association was of a similar order of magnitude to other known risk factors for early mortality, such as people with a history of smoking (HR = 1.37; 95%CI, 1.30–1.48) compared to people who have never smoked and for physically inactive participants (HR = 1.21; 95%CI, 1.14–1.37) compared to physically active participants. The results of our study suggest that marital dissatisfaction may predict an elevated risk of all-cause mortality. Assessing marital satisfaction and measuring the health benefits of marital education programs for couples should be implemented as part of health promotion strategies for the general population.

Romantic partner presence and physiological responses in daily life: Attachment style as a moderator

The present study investigated whether the presence of a romantic partner in daily life is associated with attenuated sympathetic nervous system responses. Additionally, romantic attachment style was tested as a moderator. For one day, 106 heterosexual young adult dating couples wore ambulatory sensors that monitored electrodermal activity (EDA) - an index of sympathetic arousal. Couples reported whether they were together or apart for every hour of the data collection day. Men and women exhibited lower EDA during hours in which their partner was present compared to hours in which they were absent. Additionally, romantic attachment style moderated this association; those who had low anxious attachment showed a stronger attenuating effect of partner presence compared to those with higher anxious attachment. Similarly, those who had low avoidant attachment showed heightened effects of partner presence compared to those with higher avoidant attachment. Romantic partner presence may facilitate everyday health-promoting physiological processes.

Anxiety and Its Associated Factors During the Initial Phase of the COVID-19 Pandemic in Indonesia

Introduction: Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus which has not been identified previously in humans. The disease leads to respiratory problems, systemic disorders, and death. To stop the virus transmission, physical distancing was strongly implemented, including working and school from home (WFH & SFH). The limitation altered daily routines and needs advanced to adapt. Many have felt uncomfortable and this could have triggered anxiety symptoms. This study aimed to evaluate the proportion of significant anxiety symptoms and its association with COVID-19-related situations in an Indonesian context during the initial months of the pandemic. Methods: An online community survey was distributed through social media and communication platforms, mainly WhatsApp, targeting people >18 years old in Indonesia. Anxiety symptoms were assessed using Generalized Anxiety Disorder-7 (Indonesian Version). Demographical data and information on social situation related to the COVID-19 pandemic were collected. The proportion of clinically significant anxiety symptoms was calculated and the association with demographic and social factors was assessed using chi square test (χ2) and logistic regression for multivariate analysis. Results: Out of 1215 subjects that completed the survey, 20.2% (n = 245) exhibited significant anxiety symptoms. Several factors, such as age (AOR = 0.933 CI 95% = 0.907-0.96), sex (AOR = 1.612 CI 95% = 1.097-2.369), medical workers (AOR = 0.209 CI 95% = 0.061-0.721), suspected case of COVID-19 (AOR = 1.786 CI 95% = 1.001-3.186), satisfaction level of family support (AOR = 3.052 CI 95% = 1.883-4.946), and satisfaction level of co-workers (AOR = 2.523 CI 95% = 1.395-4.562), were associated with anxiety. Conclusion: One out of five Indonesian people could have suffered from anxiety during the COVID-19 pandemic. The riskiest group being young females, people who had suspected cases of COVID-19, and those with less satisfying social support. Nevertheless, health workers were found to have a lesser risk of developing anxiety. Accessible information and healthcare, social connection, supportive environment, and mental health surveillance are important to prevent bigger psychiatric problems post-pandemic.

CD38 is associated with bonding-relevant cognitions and relationship satisfaction over the first 3 years of marriage

Although there are numerous benefits to having a satisfying romantic relationship, maintaining high levels of relationship satisfaction is difficult. Many couples experience declines in relationship satisfaction in the early years of marriage, and such declines predict not only relationship dissolution but also poor mental and physical health. Several recent studies indicate that genetic variation on the CD38 gene (CD38), at the single nucleotide polymorphism (SNP) rs3796863, is associated with cognitions and behaviors related to pair bonding; we thus leveraged longitudinal data from a sample of newlywed couples (N = 139 genotyped individuals; 71 couples) to examine whether rs3796863 is associated with relationship maintenance processes and, in turn, relationship satisfaction in the early years of marriage. Replicating and extending prior research, we found that individuals with the CC genotype (vs. AC/AA) of rs3796863 reported higher levels of gratitude, trust, and forgiveness and that trust mediated the association between rs3796863 and marital satisfaction. Moreover, the benefits conferred to CC individuals lasted over the first 3 years of marriage. To our knowledge, this is the first study to examine the link between variation in CD38 rs3796863 and marital functioning over time.

Pathways of the family stress model in midlife on physical health in later adulthood

The current study examined economic adversity and physical health outcomes in line with the family stress model (FSM) for husbands and wives in enduring marriages. Data came from 243 husbands and wives who participated from early middle to later adulthood. Assessments included observational and self-report measures. Economic hardship and economic pressure were assessed in early middle adulthood. Feelings of hostility and observed harsh couple interaction were examined in middle adulthood, and physical impairment was assessed in later adulthood. Results indicated that economic hardship related to economic pressure. In addition, economic pressure indirectly related to physical impairment via hostility and harsh couple interaction. For husbands, economic pressure was also directly associated with their own physical impairment in later adulthood. Finally, economic pressure was indirectly associated with husband to wife harsh couple interaction through wife hostility. Similarly, economic pressure was indirectly associated with wife to husband harsh couple interaction through husband hostility. Results suggest that economic adversity as experienced in early middle adulthood has long-term health consequences into later adulthood. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

[Actor and Partner Effects of Couple's Daily Stress and Dyadic Coping on Marital Satisfaction]

PURPOSE

This study aimed to identify the actor and partner effects of daily stress and dyadic coping on marital satisfaction using the Actor-Partner Interdependence Mediational Model (APIeM).

METHODS

Participants were 314 couples who met the study's eligibility criteria. Data were collected from March to April 2016 through apartment and cooperative company communities in Seoul. Two APIeMs of positive and negative dyadic coping were analyzed using SPSS 20.0 and Mplus 7.4. All measures were self-administered.

RESULTS

Daily stress and positive and negative dyadic coping in both spouses had direct actor effects on their marital satisfaction. Daily stress in both spouses had an indirect actor effect on marital satisfaction through their positive and negative dyadic coping. The husband's daily stress had an indirect partner effect on the wife's marital satisfaction through his positive dyadic coping, while the wife's positive dyadic coping had a direct partner effect on the husband's marital satisfaction. The husband's daily stress had an indirect partner effect on the wife's marital satisfaction through his negative dyadic coping, while the wife's negative dyadic coping had a direct partner effect on the husband's marital satisfaction.

CONCLUSION

Dyadic coping is an effective way to deal with couple's daily hassles as it increase their satisfaction in marriage.

Marital Quality and Salivary Telomere Length Among Older Men and Women in the United States

Objective: The link between marital quality and cellular aging remains underexplored. This study examined how both positive and negative marital quality were associated with salivary telomere length among partnered adults in the United States over the age of 50°years. Methods: Data were from the 2008 Health and Retirement Study (N = 3203). Ordinary least squares regression was used to estimate the link between marital quality and telomere length. Results: While neither positive nor negative marital quality was significantly associated with telomere length among older women, positive and negative marital quality had an interacting effect on telomere length among men. Specifically, when negative marital quality was low, higher positive marital quality was associated with shorter telomere length, whereas when negative marital quality was high, higher positive marital quality was associated with longer telomere length. Discussion: The findings speak to the complex nature of intimate partnerships and the implications of these partnerships for cellular aging processes.

Optimism, pessimism, and health biomarkers in older couples

OBJECTIVE

Studies have demonstrated the importance of optimism in predicting perceived general health. However, the handful of studies focusing on cardiovascular biomarkers show inconsistent effects. Additionally, no study examined whether spousal levels of optimism and pessimism affect an individual's biological markers of cardiovascular health. Thus, our objectives were to examine whether partners' optimism and pessimism affect individual biological markers, differentiating between between-dyad associations and within-dyad predictive processes.

METHODS

Three waves of the Health and Retirement Study collected in 2006, 2010, and 2014 were used to test actor and partner effects of optimism and pessimism on C-reactive protein (CRP) and high-density lipoprotein. Multilevel longitudinal actor-partner models were used to examine the contribution of a partner's optimism and pessimism to each biomarker, adjusting for respondent's age, sex, depression, body mass index, daily activity levels, and a summary score of respondent's doctor-diagnosed chronic conditions.

RESULTS

Partners' pessimism and optimism levels were moderately associated. Results for within-person effects were all non-significant, both within and across waves. Associations at the between-person level were also non-significant, with the exception of a positive association between husbands' pessimism and their own CRP, and husbands' optimism and their wives' CRP.

CONCLUSIONS

Results suggest that optimism and pessimism may not play a pertinent role in within variability of biomarkers of cardiovascular diseases and have a minor role in predicting to between-person variability of biomarkers of cardiovascular diseases.

Aging Together in Enduring Couple Relationships: A Life Course Systems Perspective

This article introduces and demonstrates the use of an integrated life course systems perspective to advance the study of the aging processes of couples in enduring relationships. This objective is accomplished by bridging the life course and systems perspectives to conceptualize the couple as a functioning system and to locate couple dynamics within a longitudinal life course context in order to identify multilevel relational mechanisms that explain partners' aging outcomes in their broader socioeconomic and longitudinal context. Informed by this integrated theoretical perspective, testable hypotheses related to aging processes are derived, and analytical methodologies that can advance the research on couple aging processes are demonstrated. Identifying these relationship-health processes and contextual considerations provides insight into leverage points for the development and implementation of prevention and intervention efforts to facilitate positive aging outcomes. Directions for further theoretical and analytical advances in the area of couple aging are discussed.

Perceived neighborhood disorder and psychological distress among Latino adults in the United States: Considering spousal/partner relationship

It has been well-established that neighborhood disorder and disadvantage are detrimental to mental health and psychological well-being. There has been growing research interest in minority stress issues, however, less is known about how perceived neighborhood disorder matters for psychological well-being among Latino adults in the United States. Analyzing data from National Latino Asian American Study, 2002-2003, the present study investigates the relationships among perceived neighborhood disorder, spousal/partner relationships (i.e., spousal/partner strain and support), and psychological distress. The findings indicated that perceived neighborhood disorder and spousal/partner strain were positively associated with increased psychological distress, whereas spousal/partner support had no protective effect against psychological distress. Moreover, mediation analysis showed that the association between perceived neighborhood disorder and psychological distress was partially mediated by spousal/partner strain (i.e., 15.13%), not spousal support. Finally, moderation analysis revealed that the presence of spousal/partner strain exacerbated the relationship between perceived neighborhood disorder and psychological distress. Conversely, the absence of spousal/partner strain appeared to buffer the adverse impact of neighborhood disorder on psychological distress. These findings highlighted the ill effect of problematic neighborhood environments on the quality of the spousal/partner relationship and subsequently Latino's psychological well-being.

Health risk behaviors in elderly Brazilian widowers

The objective of this study was to compare the prevalence of health risk behaviors among elderly widowers with that of elderly partnered males, as well as single or divorced/separated men. Additionally, we set out to examine the prevalence of risk behaviors in elderly widowered men according to age, education level, and race/skin color. A cross-sectional study was conducted with elderly men (≥ 60 years) who were interviewed through the Surveillance System of Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel) in 2016 (n=5,384) and 2017 (n=5,801). The Vigitel survey includes representative samples of adults residing in the capitals of Brazilian states and the Federal District, and of those surveyed, 886 were widowers. Identified risk behaviors included physical inactivity during leisure time, irregular consumption of fruits, vegetables and legumes, smoking and alcohol abuse. The prevalence of smoking was lower among partnered elderly men [PR=0.68, CI95% (0.52-0.90)] than among widowers. There were no differences in the prevalence of other risk behaviors between widowers and other groups. When only widowers were taken into account, there was significant association of risk behaviors with age and educational level, but not with race/skin color.

Caring for a spouse with advanced cancer: similarities and differences for male and female caregivers

Most caregiving literature has focused on women, who have traditionally taken on caregiving roles. However, more research is needed to clarify the mixed evidence regarding the impact of gender on caregiver/patient psychological outcomes, especially in an advanced cancer context. In this paper, we examine gender differences in caregiver stress, burden, anxiety, depression, and coping styles, as well as how caregiver gender impacts patient outcomes in the context of advanced cancer. Eighty-eight patients with advanced cancer and their caregivers completed psychosocial surveys. All couples were heterosexual and most caregivers were women (71.6%). Female caregivers reported significantly higher levels of perceived stress, depression, anxiety, and social strain compared with male caregivers, and female patients of male caregivers were more likely to use social support as a coping style compared with male patients of female caregivers. These findings highlight the potential differences between male and female caregivers' needs and psychological health.

A Dyadic Investigation of Relationship Dynamics and Depressive Symptoms in HIV-Affected Couples in Malawi

Depression is the leading cause of disability worldwide with health implications for people living with HIV. Primary partnerships like marriage could be protective against depression but may worsen depression depending on the relationship quality. We examined depression and its association with relationship dynamics in a cross-sectional sample of 211 HIV-affected married couples in Malawi. We fit multivariable multilevel linear regression models for depressive symptoms. Men and women reported similar levels of depressive symptoms; 28% had a score indicative of probable depression. Almost half of couples had at least one partner with probable depression. In the adjusted models, equality (B = - 0.22; p < 0.01) and unity (B = - 0.94; p < 0.05) were associated with fewer depressive symptoms while individuals with more experiences of physical (B = 0.81; p < 0.01), sexual (B = 0.87; p < 0.01), and emotional violence (B = 1.52; p < 0.001) had higher levels of depressive symptoms. Couples-based interventions aiming to improve relationships may address depression, especially in settings with inadequate mental health services.

Marital Power and Depressive Symptoms among Older Mexican Adults

An extensive body of research documents marital status differences in health among older adults. However, few studies have investigated the heterogeneity in depressive symptomatology among older married adults living in developing countries. Our study investigates the interplay of gender and marital power dynamics for mental health among older Mexican adults. Our sample includes older married couples in the 2015 Wave of the Mexican Health and Aging Study (n=3,621 dyads). We use seemingly unrelated regression to model the association between self-reported distributions of decision-making power within marriages and depressive symptoms for husbands and wives. For approximately 41 per cent of couples, the husband and wife both reported an equal distribution of power in the marriage. Compared to those who reported an equal power distribution, husbands and wives who reported an imbalance of power (having more power or less power than their spouse) reported more depressive symptoms. Levels of depressive symptoms were higher in marriages characterised by an unequal balance of power. The relationship between equality in power and depressive symptoms is not explained by health care needs or living arrangements. Marital quality is an important factor for understanding depressive symptoms among older Mexican adults.

Quantifying Interpersonal Dynamics for Studying Socio-Emotional Processes and Adverse Health Behaviors

OBJECTIVE

We introduce a new statistical software R package, rties, that simplifies the use of dynamic models for investigating interpersonal emotional processes. We demonstrate the package by using it to test whether emotional dynamics in romantic couples can predict, or are predicted by, shared unhealthy behaviors (SUBs).

METHODS

We use data from 74 romantic couples discussing their health behaviors. The conversations were videotaped and rated for evidence that the couples engaged in unhealthy behaviors that benefitted the relationship in some way (e.g., increasing closeness). Participants also provided video-prompted continuous recall of their emotional experience during the conversation. We use the rties package to estimate the parameters for inertia-coordination and coupled-oscillator models of the couples' emotional experience. Those parameter estimates are then used as predictors and outcomes of the couple's SUB.

RESULTS

The coupled-oscillator model accounted for 17% of the variance in unhealthy behavior, with both partner's amplification predicting higher unhealthy behavior (women: B = 0.95, SE = 0.31, t(63) = 3.06, p = .003, 95% confidence interval = 0.25-1.45; men: B = 0.9, SE = 0.29, t(63) = 3.09, p = .003, 95% confidence interval = 0.32-1.47). These results suggest that co-dysregulation, an unstable interpersonal pattern of amplified emotional oscillations is associated with more SUBs. In contrast, the dynamics assessed with inertia coordination were not associated with behavior.

CONCLUSIONS

The new rties package provides a set of relatively easy-to-use statistical models for representing and testing theories about interpersonal emotional dynamics. Our results suggest that emotional co-dysregulation may be a particularly detrimental pattern for health.

Child marriage and relationship quality in Ethiopia

Child marriage is prevalent in Africa, with almost 40% of girls being married before age 18. Although child marriage is linked to a range of adverse outcomes, including intimate partner violence, little is known about the quality of these marriages in terms of the levels of communication, trust, equality, intimacy, conflict, marital satisfaction or happiness. We used both quantitative and qualitative data to examine how exact age at first marriage influenced multiple domains of relationship quality in Ethiopia. Our analysis was based on household survey data from 3396 currently married or recently divorced women aged 18-45, 32 in-depth interviews and 8 participatory focus groups in two regions. The regression results show a strong negative effect of marriage at or before age 12 on relationship quality across multiple domains. The qualitative data suggest a more pervasive effect on marital quality, with the lack of ability to choose whom they married and reduced agency emerging as particularly important factors influencing marital quality. This relationship may be direct or indirect, potentially mediated by factors such as intimate partner violence. Interventions intending to mitigate the effects of child marriage should include components that aim to improve the quality of spousal relationships, particularly in terms of communication and negotiation skills.

Oxytocin Modulates the Cognitive Appraisal of the Own and Others Close Intimate Relationships

Close and intimate relationships are important promoters of health. Oxytocin and its association with social cognition have been investigated in a large number of studies, especially highlighting the neuropeptide's involvement in attachment behavior and intimate relationships. However, mixed findings on exogenous oxytocin application have led to the focus on moderators and mediators, suggesting that the effects are depended on specific factors - namely context and salience. The objective of the current study was to assess the effect of intranasal oxytocin on social appraisal of own and others' close intimate relationship characteristics. Different characteristics of relationships, including trust or closeness, between romantic couples (unknown and own) were assessed using the Couple Appraisal Task. In a randomized controlled double-blind cross-over within subject design, N = 71 healthy men and women were investigated after receiving first intranasal oxytocin and 2 weeks later placebo, or vice versa. We found an oxytocin-induced increase in the positive appraisal of one's own overall relationship characteristics but not in the evaluation of the relationship of others. The present study - one of the first of its kind administrating oxytocin in a repeated measures cross-over design - adds further evidence to the mediating role of oxytocin in social cognition, specifically with regard to romantic relationship characteristics.

Restrictions, Power, Companionship, and Intimacy: A Metasynthesis of People With Intellectual Disability Speaking About Sex and Relationships

Examining literature that tells us what people with intellectual disability (PWID) think and feel about their sexual lives may enable families and professionals to offer a more person-centered approach to education and support. Examining the voices of many individuals across several studies may provide more convincing evidence about the experiences of these individuals-turning a solo into a chorus. Thus, the purpose of this article is to describe the results of a metasynthesis of qualitative studies highlighting the voices of PWID with respect to relationships and sexuality. Combining the results of 16 qualitative studies, 271 participants with intellectual disability were interviewed individually or in focus groups about their feelings and experiences regarding intimate relationships. Studies were conducted across Europe, in Australia, China, and in the United States. A little more than half of the participants were male; ages ranged from 13 to 89. Results revealed two competing themes of control and desire. Participants across studies desired friendships and close interpersonal relationships, yet were restricted from developing these relationships by policies, program staff, and family members.

The German version of the Quality of Marriage Index: Psychometric properties in a representative sample and population-based norms

The Quality of Marriage Index (QMI) is a 6-item internationally widely-used instrument assessing relationship satisfaction. This study aimed to evaluate (1) the psychometric properties of the German version in a representative sample of the German general population (N = 1431) as well as (2) effects of gender and age on relationship satisfaction. All participants were in a relationship. The German QMI demonstrates good item characteristics and excellent reliability (α = .94). The proposed one-factor solution was replicated. Differences in scoring on the QMI showed that males scored higher than females and differences between younger and older participants were found. The findings suggest that the German version of the QMI is suitable to reliably measure relationship satisfaction and may therefore be used as a brief screening instrument in a variety of settings and research questions. A cross validation in a sample of couples seeking help for relationship difficulties should be considered in future research. The limited number of items and the one-factor-solution do not suggest this instrument as a fine-tuned assessment tool for different dimensions of relationship satisfaction.