Relationship quality and educational attainment links to development of cardiometabolic morbidity and multimorbidity across middle adulthood

The prevalence of cardiometabolic morbidity (e.g., high blood pressure, heart attack, stroke, type 2 diabetes) and multimorbidity development (2 or more cardiometabolic morbidities) are rapidly growing in the US. Cardiometabolic morbidity and multimorbidity are linked to poor well-being outcomes, high healthcare costs, and mortality. There is little known about cardiometabolic multimorbidity health disparities, particularly regarding mutable factors that might be targeted in future health interventions. In the present study, using a biopsychosocial framework (Biobehavioral Family Model), we examine whether cardiometabolic morbidity and multimorbidity development are linked to premorbid family and marital relationships and if it differs depending on socioeconomic status (i.e., educational attainment) using three waves of Midlife in the US (N = 4951). We assessed cardiometabolic development with three conceptualizations: number of cardiometabolic morbidities (i.e., count variable), individual cardiometabolic morbidities (i.e., diabetes, high blood pressure, stroke, heart attack), and severity of cardiometabolic multimorbidity (e.g., 3+ vs. zero morbidities). Family strain increased the number of cardiometabolic morbidities (OR = 1.17) and the severity of multimorbidity (e.g., 3+ morbidities: OR = 1.38). People with a high school education experienced family support as a buffer to the negative health impact of education level. Generally, marital quality appeared less impactful on cardiometabolic morbidity and multimorbidity development compared to family strain. Positive and negative family characteristics appear to function differently across educational attainment. These findings indicate that adults' non-intimate family relationships predict important outcomes such as diabetes, heart attack, stroke, and cardiometabolic multimorbidity and should be considered targets for preventative health interventions.

Family Support and Type 2 Diabetes Self-management Behaviors in Underserved Latino/a/x Patients

BACKGROUND

Latino/a/x families experience persistent Type 2 diabetes mellitus (T2DM) disparities, including higher rates of diagnosis and mortality due to disease complications than their non-Hispanic White counterparts. Though greater social support is associated with improved disease outcomes for Latino/a/x patients with diabetes, research has yet to identify the specific pathways through which social support, and specifically family support, influences self-management.

PURPOSE

This study tested a theoretical model highlighting the mechanisms and pathways linking social support and physical health. Specifically, self-efficacy and depression were tested as psychological pathways connecting family support to diabetes self-management behaviors and diabetes morbidity in Latino/a/x patients with T2DM.

METHODS

Data from 177 patients were analyzed using structural equation modeling. Measures included diabetes-specific family support needed and received, depressive symptoms, self-efficacy in diabetes management, diabetes self-management behaviors, health appraisal, and hemoglobin A1c.

RESULTS

Greater diabetes-specific family support was significantly associated with more frequent engagement in diabetes self-management behaviors, both directly (p < .001) and through diabetes self-efficacy's partial mediation of this relationship (p = .013). Depression was not significantly associated with either family support (support received, p = .281; support needed, p = .428) or self-management behaviors (p = .349).

CONCLUSIONS

Family support and diabetes self-efficacy may be important modifiable psychosocial factors to target via integrated care interventions aimed at supporting Latino/a/x patients with T2DM. Future research is needed to test empirically based, culturally adapted interventions to reduce T2DM-related health disparities in this population.

The Good, the Bad, and the Variable: Examining Stress and Blood Pressure Responses to Close Relationships

Social relationships influence physical health, yet questions remain regarding the nature of this association. For instance, when it comes to predicting health-relevant processes in daily life, few studies have examined (a) the relative importance of both positive and negative relational experiences, and (b) variability in relational experiences (in addition to mean levels). To address these gaps, we conducted a daily study (N = 4,005; ~ 30,000 observations) examining relationships, stress, and physiology in daily life. Heart rate and blood pressure were assessed using an optic sensor and integrated with an app-based study. Results demonstrated that higher mean levels of positive and lower mean levels of negative relational experiences predicted lower stress, better coping, and better physiological functioning in daily life, such as lower systolic blood pressure reactivity. Greater variability in negative (but not positive) relational experiences predicted lower stress, better coping, and lower systolic blood pressure reactivity.

Relationship quality and physical health: Responsiveness as an active ingredient predicting health across the lifespan

A growing body of research has established responsiveness as a robust predictor of physical health. Here, we evaluate the extent to which this work establishes partner responsiveness as an active ingredient- a specific component within the broader construct of relationship quality that accounts for a demonstrated association between relationship quality and health. We review work demonstrating that responsiveness predicts a wide range of physical health outcomes, above and beyond other facets of relationship quality, and that it moderates the effects of other protective processes and risk factors. Finally, we discuss how new methodological and interdisciplinary approaches can provide generalizable, causal, and mechanistic evidence to further validate responsiveness as an active ingredient linking relationships and health.

Associations among Financial Well-Being, Daily Relationship Tension, and Daily Affect in Two Adult Cohorts Separated by the Great Recession

Financial well-being may be an important context for daily emotional reactivity to relationship tension (e.g., arguments) whose salience varies across historical time or as a function of exposure to economic downturns. This study investigated how emotional reactivity, operationalized as daily fluctuations in negative and positive affect associated with the occurrence of daily relationship tension, varied by financial well-being among those who were and were not exposed to the Great Recession of 2008. Two matched, independent subsamples of partnered individuals from the National Study of Daily Experiences completed identical 8-day diary protocols, one before the Great Recession (n = 587) and one after (n = 351). Individuals reported higher negative affect and lower positive affect on days when relationship tension occurred. Further, results indicated that negative affect reactivity, but not positive affect reactivity, was moderated by both financial well-being and cohort status. For the pre-recession cohort, negative affect reactivity was stronger among those with lower financial well-being. However, among the post-recession cohort, financial well-being did not moderate negative affect reactivity to relationship tension. Findings highlight the utility of considering major societal events, such as economic downturns, to understand variability in emotional reactivity to day-to-day relationship tension in the context of financial well-being, as the salience of financial well-being in the ways relationship tension and negative affect are related on a daily basis appears to vary by historical context.

The indirect influence of 'invisible' support on pulmonary function among adults with chronic obstructive pulmonary disease

Individuals living with chronic obstructive pulmonary disease (COPD) often require support from family or friends. We examined whether invisible support - support that is provided but goes unnoticed - is related to pulmonary function, and whether this association is mediated by depressive symptoms and illness perceptions. Sixty-six dyads of individuals with COPD and their informal caregivers reported on receipt and provision of support, respectively. Those with COPD completed measures of depressive symptoms, illness perceptions and pulmonary function. Although invisible support was not directly related to pulmonary function, mediation analyses revealed a combined indirect effect through lower depressive symptoms and less negative illness perceptions. Interventions teaching skillful delivery of support to caregivers may reduce depressive symptoms and threatening illness cognitions, which may contribute to improvements in symptom burden among patients with COPD.

Social Wellbeing in Cancer Survivorship: A Cross-Sectional Analysis of Self-Reported Relationship Closeness and Ambivalence from a Community Sample

Improvements in early screening and treatment have contributed to the growth of the number of cancer survivors. Understanding and mitigating the adverse psychosocial, functional, and economic outcomes they experience is critical. Social wellbeing refers to the quality of the relationship with partners/spouses, children, or significant others. Close relationships contribute to quality of life and self-management; however, limited literature exists about social wellbeing during survivorship. This study examined positive and negative self-reported changes in a community sample of 505 cancer survivors. Fourteen items assessed changes in communication, closeness with partner/children, stability of the relationship, and caregiving burden. An exploratory factor analysis was conducted using a robust weighted least square procedure. Differences by sociodemographic and clinical characteristics were investigated. Respondents were mostly male, non-Hispanic white, and ≥4 years since diagnosis. Two factors, labeled Relationship Closeness and Ambivalence, emerged from the analysis. Women, younger survivors, individuals from minority groups, and those with lower income experienced greater negative changes in social wellbeing. Variations by treatment status, time since diagnosis, and institution were also reported. This contribution identifies groups of cancer survivors experiencing affected social wellbeing. Results emphasize the need to develop interventions sustaining the quality of interpersonal relationships to promote long-term outcomes.

Loneliness in Older Indian Dyads

BACKGROUND

Loneliness has been recognised as a major public health concern in older adults in developed nations, with little focus on low- and middle-income countries such as India. While the protective nature of social relationships on loneliness has been explored in the context of marriage, typically these benefits are examined in individual spouses rather than within the marital dyad.

METHODS

A sample of 398 opposite-sex married Indian couples (mean age 54.8 years) was obtained from the pilot wave of the Longitudinal Aging Study in India (LASI) conducted in 2010. These cross-sectional data were analysed using the Actor-Partner Interdependence Model, with one's own and one's partner's cognitive function, functional limitations, depressive symptoms, employment status and contact with friends included as predictors of loneliness.

RESULTS

There were no gender differences in the pattern of associations. Depression was positively associated with loneliness with actor and partner effects being significant. One's partner being employed was associated with less loneliness.

CONCLUSIONS

The sample showed low levels of depression, loneliness, and reduced functionality; however, depression still predicted one's own and one's partner's loneliness. Future work using longitudinal data could examine the role of employment in loneliness, particularly within the context of gender roles.

Romantic Partners Are Similar in Their Well-Being and Sociopolitical Attitudes but Change Independently Over Time

Similarity within romantic couples forms one component of the formation and maintenance of relationships, meaning that, romantic partners’ views about themselves and the world are theorized to converge over time. We advance prior research on romantic couple similarities using cross-sectional or time-lagged designs, testing convergence with dyadic trajectories of change—how changes in one person relate to changes in their partner. Dyadic growth curve models assessed initial similarities, and longitudinal convergence, for 35 measures of well-being and individual differences in 171 mixed-gender couples from a national longitudinal study (the New Zealand Attitudes and Values Survey). Results indicated consistent average-level similarities between romantic partners, a few instances of short-term convergence in sociopolitical views, and the consistent pattern that changes in people occurred independently to their partners. Findings advance theory on romantic interdependence by emphasizing the perspective that romantic partners’ convergence occurs as subjective experience rather than externally measured unification.

Partner influences on ICT use variety among middle-aged and older adults: The role of need for cognition

This exploratory study examined both individual and dyadic predictors of variety of ICT use. Need for cognition is associated with engaging in a variety of intellectually stimulating practices and a prominent individual difference predictor of the types of ICTs people use. Participants were a subset of 542 heterosexual couples (N = 1084 individuals; 50% women; M age = 63.65; 83.9% Caucasian) from the Health and Retirement Study with access to the internet. Individuals high in need for cognition were more likely to use ICTs for a variety of reasons. Being married to someone high in need for cognition was associated with a greater variety of ICT ownership, ICTs for financial/transactional activities, and ICTs for miscellaneous reasons (e.g., research), although these effects were relatively small and the evidence for partner effects was relatively weak according to the distribution of p-values. Partner effects were not significant for social technology or internet-enabling ICTs; cross-partner interactions provided suggestive evidence for compensating for lower levels of individual need for cognition. Findings are discussed in relation to the relational and contextual determinants of ICT use in older adulthood.

Good Theories in Need of Better Data: Combining Clinical and Social Psychological Approaches to Study the Mechanisms Linking Relationships and Health

The study of intimate relationships and health is a fast-growing discipline with numerous well-developed theories, many of which outline specific interpersonal behaviors and psychological pathways that may give rise to good or poor health. In this article, we argue that the study of relationships and health can move toward interrogating these mechanisms with greater precision and detail, but doing so will require a shift in the nature of commonly used research methods in this area. Accordingly, we draw heavily on the science of behavior change and discuss six key methodologies that may galvanize the mechanistic study of relationships and health: dismantling studies, factorial studies, experimental therapeutics, experimental mediation research, multiple assessments, and recursive modeling. We provide empirical examples for each strategy and outline new ways in which a given approach may be used to study the mechanisms linking intimate relationships and health. We conclude by discussing the key challenges and limitations for using these research strategies as well as novel ideas about how to integrate this work into existing paradigms within the field.

The Dyadic Health Influence Model

Relationship partners affect one another's health outcomes through their health behaviors, yet how this occurs is not well understood. To fill this gap, we present the Dyadic Health Influence Model (DHIM). The DHIM identifies three routes through which a person (the agent) can impact the health beliefs and behavior of their partner (the target). An agent may (a) model health behaviors and shape the shared environment, (b) enact behaviors that promote their relationship, and/or (c) employ strategies to intentionally influence the target's health behavior. A central premise of the DHIM is that agents act based on their beliefs about their partner's health and their relationship. In turn, their actions have consequences not only for targets' health behavior but also for their relationship. We review theoretical and empirical research that provides initial support for the routes and offer testable predictions at the intersection of health behavior change research and relationship science.

Does secure base script knowledge mediate associations between observed parental caregiving during childhood and adult romantic relationship quality and health?

Increasingly, attachment representations are being assessed via secure base script knowledge - the degree to which individuals show awareness of the temporal-causal schema that summarizes the basic features of seeking and receiving effective support from caregivers during times of need. Limited research has assessed the links between secure base script knowledge and aspects of adult functioning and the role that secure base script knowledge may play in accounting for associations between early caregiving quality and adulthood functioning. We used follow-up assessments of the NICHD Study of Early Child Care and Youth Development cohort (N = 585) to examine whether secure base script knowledge at age 18 years: (a) is associated with later romantic relationship quality, depressive symptoms, and body mass index (BMI) at age 26 years, and (b) mediates expected associations between the quality of maternal and paternal sensitivity across the first 15 years of life and age-26 outcomes. More access to, and elaborated knowledge of the secure base script predicted less extreme hostility with romantic partners, and better emotional and physical health. Moreover, secure base script knowledge mediated the links between early maternal and paternal sensitivity and both later romantic partner hostility and depressive symptoms, but not BMI.