Communal Coping in Couples With Health Problems

The development and psychometric examination of the partner investment in health scale

OBJECTIVE

Relationship partners' impacts on health are not fully captured by existing measures. A measure that applies to a prevention context and accounts for both partners' perspectives is needed. This work developed and assessed the psychometric properties of the novel Partner Investment in Health scale (PI-H).

DESIGN

A cross-sectional design assessed participants (N = 261) using an online survey. Exploratory factor analyses were used to determine the PI-H factor structure.

MAIN OUTCOME MEASURES

Items assessed the person's investment in their partner's health and their perception of their partner's investment in their health.

RESULTS

A 2 factor structure underlying 24 items on the PI-H scale was supported. Factors represented 1) the respondent's investment and 2) the respondent's perception of their partner's investment. The PI-H significantly correlated with related measures (e.g. relationship satisfaction, dyadic and communal coping; p < .05).

CONCLUSION

A full PI-H scale, two subscales, and a short version of the scale (8 items) are presented. Correlations demonstrated convergent validity and suggested the PI-H is distinct from existing constructs. Theoretical implications and applications are discussed.

Family-Focused Facilitated Fitness: Feasibility and Acceptability of a Couple-Based Physical Activity Intervention for Hematopoietic Cell Transplant Recipients and Their Caregiving Partners

Reductions in physical activity (PA) are common among patients following hematopoietic cell transplantation, and a risk factor for poor physical functioning. PA among spouses/cohabiting partners, who frequently serve as the patient's primary caregiver, may also be reduced due to caregiving demands and limited bandwidth for self-care. In addition, the patient-caregiver relationship can be compromised, and communication patterns disrupted. All PA interventions in the hematopoietic cell transplantation setting have focused entirely on patients, ignoring an opportunity to synergistically engage and benefit the caregiver as well. We sought to test feasibility and acceptability of a couple-based intervention entitled Family-Focused Facilitated Fitness (FFFF), designed to improve PA as assessed by daily step counts among both patients undergoing hematopoietic cell transplantation and their caregivers. Guided by interdependence and communal coping perspectives, FFFF is an 8-week, remotely-delivered intervention that provides training in communication skills and joint problem-solving to help patients and caregivers support one another in PA. Participants are also given a Fitbit to track their steps and weekly individualized step prescription based on the 75th percentile ranked value of their last 7 recorded daily step counts. A priori benchmarks for feasibility and acceptability in this single-arm pilot were as follows: 50% of eligible couples would agree to participate, 70% of couples would attend all 8 sessions, 80% of participants would provide valid Fitbit wear data 4/7 days/ week, and among sessions reviewed for treatment fidelity, 85% of treatment protocol elements would be covered. Couples were recruited prior to transplant. Among 26 couples approached and deemed eligible, 17 enrolled (65% agreement) and completed baseline assessment. Three couples later withdrew after transplantation but prior to receiving the intervention, resulting in 14 couples commencing the intervention, on average 21 days post-transplant. Four couples subsequently discontinued due to medical complications (n = 3) or caregiver schedule (n = 1). Among the 10 couples who completed the intervention, the percentage of participants meeting our benchmark of valid Fitbit wear at least 4 days per week was 85% in week 1, 90% in weeks 2 to 7, and 80% in week 8. Treatment fidelity was 95% on average across 24 sessions reviewed (3 cases). Treatment satisfaction scores were uniformly high across multiple dimensions, with all means above 4 on the 1 to 5 scale. Daily step counts among those attending all 8 intervention sessions increased from 2249 ± 302 steps/day in week 1 to 4975 ± 1377 steps/day in week 8 among patients, and from 8676 ± 3760 steps/day in week 1 to 9838 ± 3723 steps/day in week 8 among caregivers. Qualitative feedback indicated perceived mental and physical health benefits of the program. Participants also offered suggestions for adaptations to accommodate medical setbacks and constraints. All a priori feasibility benchmarks were met or exceeded. Results offer promise for utility of the program to engage and leverage patient-caregiver dyads to increase PA following transplant. An investigation using a randomized controlled design will be necessary to adequately examine change over time relative to control and its possible impact on clinical and patient-reported outcomes.

Development of a common dyadic coping scale in couples facing breast cancer: the importance of open communication

OBJECTIVE

Couples' joint coping is important in managing the impact of breast cancer. However, measures assessing couples' communication as a way of coping are insufficient. This study aimed to generate a self-report valid and reliable measure of couples' coping with a particular focus on communication.

METHOD

We used baseline data of 343 couple dyads who participated in a randomized clinical trial targeting marital communication. Women were diagnosed with early-stage breast cancer in the past eight months; couples were married or in an intimate relationship for at least six months, could read and write English, and lived within 100 miles of the study center. An expert panel selected items with conceptual fit from the Mutuality and Interpersonal Sensitivity Scale (MIS) that was originally designed to evaluate marital communication about breast cancer.

RESULTS

Exploratory and confirmatory factor analyses supported a 12-item measurement model with four factors: Keeping the communication open with each other about breast cancer (4 items), Sharing a positive outlook on breast cancer (2 items), Avoiding discussion of negative thoughts and feelings about breast cancer (3 items), and Spending sufficient time together talking about breast cancer (3 items). Reliability ranged from 0.76 to 0.87 for women and 0.70 to 0.83 for spouses.

CONCLUSION

This new measure has potential application in clinical practice and future research to assess couple's joint coping efforts especially through communication.

A Systematic Review of Dietary Interventions for Cancer Survivors and Their Families or Caregivers

Family or caregiver engagement has the potential to support healthy dietary changes among cancer survivors. However, little is known about these family- or caregiver-involved dietary interventions and their effects. This systematic review aimed to identify the behavior change techniques (BCTs) used in dietary interventions for cancer survivors and their families or caregivers and to synthesize intervention effects on dietary and health outcomes. Following the PRISMA guidelines, we conducted systematic searches in three databases and identified 12 trials (16 peer-reviewed manuscripts) for inclusion in this review. Data were extracted from these manuscripts and the BCT taxonomy was used to identify the BCTs. A total of 38 BCTs were identified from 12 trials, 13 of which were used in at least half of the 12 trials. Ten studies reported significant intervention effects on health outcomes (e.g., adiposity) and six suggested significant improvements in dietary behaviors (e.g., fruit and vegetable intake). Overall, this review found that family- or caregiver-involved interventions for cancer survivors significantly improved dietary and health outcomes. Future research should identify BCTs particularly for dietary changes and develop effective dyadic strategies to facilitate diet-related interactions between survivors and their families or caregivers to enhance their engagement in healthy diets.

The effects of a couple-based gestational diabetes mellitus intervention on self-management and pregnancy outcomes: A randomised controlled trial

AIMS

To estimate the effectiveness of the Couples Coping with Gestational Diabetes Mellitus (GDM) Programme on GDM self-management and pregnancy outcomes.

METHODS

A randomised controlled trial among pregnant women with suboptimal GDM self-management and their partners was undertaken. Couples recruited from three hospitals in China were randomly allocated to either intervention (n = 70) or control (n = 70) conditions. Couples in the intervention group underwent the couple-based intervention (GDM education, shared illness appraisals, initiation of collaborative action and consolidation of collaborative action). Women in the control group received individual GDM education. Data were analysed using the independent samples t-test, chi-square test, and generalised estimating equations.

RESULTS

GDM knowledge for the women and their partners and GDM self-management significantly improved in both the intervention and control groups, with stronger improvement in the intervention group. Women in the intervention group gained significantly less weight than those in the control group (11.2 kg ± 2.8 kg vs 13.1 kg ± 2.6 kg, p = 0.008). Infant birth weights were significantly lower in the intervention group (3.2 kg ± 0.3 kg vs 3.4 kg ± 0.4 kg, p = 0.008). There were no significant differences in other pregnancy outcomes.

CONCLUSIONS

The Couples Coping with GDM Programme was associated with improvements in GDM knowledge of women and their partners and in women's self-management, and with lower gestational weight gain and infant birth weight.

Relational sanctification, communal coping, and depression among African American couples

Despite the common use of religious buffers, African Americans are disproportionately affected by depressive symptoms. Communal coping may serve as one factor in helping religious African American couples alleviate the symptoms of depression. This study examines the association between relational sanctification and depressive symptoms as mediated by the communal coping of 467 African American married and cohabiting couples. Data from the sampled couples were analyzed using a common fate model, and analyses revealed higher scores on the measure of sanctification were associated with more communal coping; more communal coping was associated with fewer depressive symptoms among women and men, and communal coping acted as a mediator between relational sanctification and depressive symptoms in both partners. Findings from this study underscore the importance of considering how the religiosity and cooperative action of African American couples relate to depressive symptoms.

The worse we feel, the more intensively we need to stick together: a qualitative study of couples' emotional co-regulation of the challenge of multimorbidity

Introduction

Being faced with multimorbidity (i.e., being diagnosed with at least two chronic conditions), is not only demanding in terms of following complicated medical regimes and changing health behaviors. The changes and threats involved also provoke emotional responses in the patients but also in their romantic partners. This study aims at exploring the ways of emotional co-regulation that couples facing multimorbidity express when interviewed together.

Method

N = 15 opposite sex couples with one multimorbid patient after an acute health crisis that led to hospitalization were asked in a semi-structured interview about how they found ways to deal with the health situation, what they would recommend to other couples in a similar situation, and how they regulated their emotional responses. Interviews were analyzed qualitatively following open, axial, and selective coding, as in the grounded theory framework.

Results

Emerging categories from the romantic partners' and the patients' utterances revealed three main categories: First, overlapping cognitive appraisals about the situation (from fighting spirit to fatalism) and we-ness (construing the couple self as a unit) emerged as higher order factor from the utterances. Second, relationship-related strategies including strategies aimed at maintaining high relationship quality in spite of the asymmetric situation like strengthening the common ground and balancing autonomy and equity in the couple were often mentioned. Third, some couples mentioned how they benefit from individual strategies that involve fostering individual resources of the partners outside the couple relationship (such as cultivating relationships with grandchildren or going outdoors to nature).

Discussion

Results underline the importance of a dyadic perspective not only on coping with disease but also on regulating the emotional responses to this shared challenging situation. The utterances of the couples were in line with earlier conceptualizations of interpersonal emotion regulation and dyadic perspectives on we-disease. They broaden the view by integrating the interplay between individual and interpersonal regulation strategies and underline the importance of balancing individual and relational resources when supporting couples faced with chronic diseases.

Shared Responsibility and Network Collaboration in Caregiving

Communal coping may benefit caregivers, but most communal coping research focuses on dyads. Using an egocentric network design, we examine caregivers' we-talk-a linguistic marker of shared responsibility-and caregiver reports of 1) network member involvement in collaborative care roles and 2) met/unmet expectations across typically developing and rare disease contexts. We-talk was linked to involvement in direct care and support, but links of we-talk to decision-making varied based on network member closeness; we-talk was linked to meeting expectations for decision-making only. There were no differences across context, suggesting shared responsibility is linked to collaborative roles across caregiving contexts.

Links of daily shared appraisal and collaboration to support, mood, and self-care in type 2 diabetes

Research has increasingly recognized the links of communal coping-a shared appraisal of a stressor and collaborative action to manage it-to positive adjustment outcomes in chronic illness. However, past literature rarely examines if these two components have unique links to relationship and health outcomes, if one component is more strongly linked than the other component to these outcomes, or if the two components interact to influence outcomes. Additionally, the impact of shared appraisal and collaboration may depend on the source-the patient or the romantic partner. In a study of 200 patients with newly diagnosed type 2 diabetes and their spouses, daily reports of shared appraisal and collaboration, mood, support interactions, and patient self-care were collected over 14 consecutive days. Multi-level modeling showed that both patient and spouse reports of shared appraisal and collaboration were linked independently to support interactions and better mood for patients and spouses, while collaboration alone was linked to self-care. Further, collaboration was generally more strongly linked to behavioral outcomes-support and self-care-than shared appraisal, while links to mood were similar for shared appraisal and collaboration. Shared appraisal and collaboration also interacted such that shared appraisal was particularly beneficial for those who reported low collaboration. Finally, results suggested one's own reports of shared appraisal and collaboration were more strongly linked to outcomes than partner reports. Overall, these findings demonstrate unique impacts of daily shared appraisal and collaboration on adjustment to chronic illness for patients and spouses.

Coping with multiple chronic conditions among Chinese older couples: A community of shared destiny

Multiple chronic conditions (MCCs) affect patients and their spouses. We explored the experience of Chinese older couples living with MCCs to gain deeper understanding of how they cope with MCCs as dyads. A qualitative research design using semi-structured in-depth interviews was conducted. Sixteen couples (≥60 years) were included and a thematic analysis was undertaken using NVivo software. Four themes under an overarching theme "A community of shared destiny" were identified: (i) various changes and impacts in normal life; (ii) perceived dynamic stress and dyadic challenges of MCCs; (iii) acceptance and reflection on MCCs influenced by aging and fatalism; (iv) mutual support and dyadic adjustment based on a shared destiny. Coping with MCCs was a dyadic and periodic journey for older couples. They perceived themselves as a community of shared destiny. Our findings are important for healthcare professionals to develop targeted interventions for older couples living with MCCs.

The role of partner support for health behaviours in people living with and beyond cancer: A qualitative study

OBJECTIVE

This study aimed to qualitatively explore how partner support for health behaviours is perceived, received, and utilised in people living with and beyond cancer (LWBC).

METHODS

Semi-structured audio interviews were conducted with 24 participants, 15 men and nine women, living with and beyond breast, prostate, and colorectal cancer. Inductive and deductive Thematic Analysis was used to analyse the data.

RESULTS

Three key themes with six subthemes were identified relating to partner support for health behaviours: (1) Interdependence (Reciprocity, Overt Control, Influence & Motivation) (2) Concordance (Shared Attitudes & Health Beliefs, Shared Health Behaviour) and (3) Communal Coping (Communal Orientation towards Health and Decision Making, Co-operative Action in Health Behaviour).

CONCLUSIONS

Partner support plays a unique and significant role in the health behaviours of people LWBC. Partners play a collaborative role in managing health and facilitating health behaviours, while the high level of concordance in couples may represent a potential barrier to change via the reinforcement of maladaptive health beliefs and behaviours.

IMPLICATIONS FOR CANCER SURVIVORS

Overall, findings demonstrate that partners should be considered and included where possible when designing future behaviour change interventions for people LWBC.

Communal coping and its association with marital relations and psychological outcomes among healthcare professionals during the COVID-19 pandemic

Background

Communal coping is a type of interdependency in which couples dealing with a health threat share assessment of a threat and respond together to the stress. The present study investigated communal coping in the COVID-19 pandemic and its association with psychological and relational outcomes among healthcare professionals.

Methods

In the present cross-sectional survey study, 242 healthcare professionals from hospitals and health centers were recruited via convenience sampling between August and October 2020. Communal coping with working conditions during the COVID-19 pandemic, dyadic adjustment, psychological distress, and fear of COVID-19 along with demographic and professional characteristics were assessed via an online survey.

Results

Multivariable linear regression showed that dyadic adjustment (β = 0.73), psychological distress (β = 0.16), fear of COVID-19 (β = 0.11), and support gap (β = -0.04) were significant independent variables associated with communal coping among healthcare professionals.

Conclusion

Healthcare professionals coped communally within the family in dealing with working conditions during the COVID-19 pandemic. Dyadic adjustment was the strongest predictor of communal coping among healthcare professionals.

Families Playing Animal Crossing Together: Coping With Video Games During the COVID-19 Pandemic

The COVID-19 pandemic was stressful for everyone, particularly for families who had to supervise and support children, facilitate remote schooling, and manage work and home life. We consider how families coped with pandemic-related stress using the video game Animal Crossing: New Horizons. Combining a family coping framework with theorizing about media as a coping tool, this interview study of 27 families (33 parents and 37 children) found that parents and children individual coped with pandemic-related stress with media. Parents engaged in protective buffering of their children with media, taking on individual responsibility to cope with a collective problem. Families engaged in communal coping, whereby media helped the family cope with a collective problem, taking on shared ownership and responsibility. We provide evidence for video games as coping tools, but with the novel consideration of family coping with media.

Coping Styles in Patients with Parkinson’s Disease: Consideration in the Co-Designing of Integrated Care Concepts

Integrated care models may help in designing care for Parkinson’s disease (PD) that is more efficient and patient-centered. However, in order to implement such models successfully, it is important to design these models around patients’ needs and preferences. Personality traits and coping styles play a well-studied important role in patients’ disease perception and their utilization of medical and social services to cope with their disease. There is evidence that coping styles remain largely unchanged over the course of PD; coping styles are defined in the early stages of life and extend over the entire lifespan of the patient. Therefore, it seems necessary to consider aspects of the personality traits and coping styles of PD patients in the development and implementation of care models. We postulate that by taking patients’ personality traits and coping styles into account, care models for PD can be designed in a more individualized and, thus, more effective way. This paper, structured in three main sections, attempts to structure the uptake of patients’ coping styles in the co-design of integrated care models. However, further studies are needed to better develop tailored care concepts to the needs of people living with PD and their individual coping styles.

Observed dyadic collaboration among couples coping with type 1 diabetes

Previous research linking collaboration to relationship and health outcomes has relied almost exclusively on individual self-report and failed to take into consideration the dyadic nature of collaboration. We enrolled couples (n = 193) in which one person had Type 1 diabetes (52% female; 91% non-Hispanic white) into the study and asked them to discuss a diabetes-related issue of high concern for 8 min. These videotaped interactions were coded for dyadic collaboration. Mood was measured before and after the discussion. After the discussion, patients and partners reported support provided and received during the discussion. Results showed that observed dyadic collaboration was related to improvements in mood and greater support exchanges for both patients and partners when self-reported collaboration was statistically controlled. Gender moderated the effects on partners, such that benefits of dyadic collaboration were stronger for women than men. Future research may benefit from including collaborative elements into couple-focused interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Family interventions for adults living with type 2 diabetes mellitus: A qualitative meta-synthesis

OBJECTIVE

Review and synthesize qualitative research on family interventions for adults living with type 2 diabetes.

METHODS

A qualitative metasynthesis was conducted. Analysis used imported concepts from realist evaluation - context, mechanisms, and outcomes.

RESULTS

Six studies met inclusion criteria in this qualitative systematic review. Powerful mechanisms were identified that occur outside the family intervention in the context of ethnic, racialized, and geographically defined groups. Many similarities were noted across contexts, such as low income. Mechanisms of interventions focused primarily on family member education. Outcomes were focused more on improving self-care behaviors, rather than family-oriented outcomes.

CONCLUSION

Systemic issues affecting social determinants of health set the context for family interventions for type 2 diabetes. When designing these interventions, intersectionality, scarcity, and family functioning may need to be considered.

PRACTICE IMPLICATIONS

Emphasis on education of family members may not be effective in improving diabetes outcomes, as many powerful mechanisms exist outside of these interventions.

Perceptions of partner social control: accuracy, bias, and daily experience

OBJECTIVE

We examined accuracy and bias in people's perceptions of their romantic partner's daily social control attempts of daily health behaviours and how misperceptions of partner daily social control are related to both partners' daily experiences.

DESIGN

106 cohabiting couples from the community reported on their own and their partner's daily social control attempts (i.e., persuasion, pressure) and their daily experiences (i.e., positive and negative affect, autonomy, relationship satisfaction) across 14 consecutive days (N = 2377 reports). Multilevel path models examined tracking accuracy, projection, and mean-level bias in perceptions of partner health social control attempts, and associations between mean-level bias and daily experiences.

RESULTS

Perceptions of provider influence contained significant tracking accuracy, projection, and mean-level accuracy in provider use of social control. Underperceptions of persuasion were associated with negative outcomes for the perceiver and no outcomes for the provider. Overperceptions of persuasion were associated with negative outcomes for providers and marginally higher positive affect for perceivers. Misperceptions of pressure were associated with negative outcomes for both perceivers and providers.

CONCLUSION

Results suggest that social control may have the most benefit and least harm to both partners when people accurately perceive the mean-levels of such influence attempts on their health behaviours.

Partner and Relationship Predictors of Longitudinal Physical Activity Trajectories Among Individuals with Osteoarthritis Using Latent Class Growth Analysis

BACKGROUND

Physical activity reduces osteoarthritis symptoms, yet many individuals with the disease are insufficiently active.

PURPOSE

We identified physical activity trajectories over 12 months of individuals with osteoarthritis and examined how their cohabiting spouses'/partners' baseline physical activity and relationship factors affected trajectory membership.

METHODS

In this longitudinal observational study, we collected data from 168 adults with knee/hip osteoarthritis. We used latent class growth curve analysis to identify physical activity trajectories and logistic regression to predict trajectory membership using partners' physical activity, relationship satisfaction, and communal coping (belief that both partners are responsible for osteoarthritis management). Measures, including objectively assessed physical activity, were collected at baseline from the couple, who then received an educational class on physical activity and social support. Objectively assessed physical activity was also collected from individuals with osteoarthritis at 1 week, 3 months, 6 months, and 12 months post-baseline.

RESULTS

Three trajectories were identified: stable active, increaser, and stable sedentary (24%, 40%, 37% of participants, respectively). Individuals with osteoarthritis with partners who were more active and who believed they alone were responsible for their osteoarthritis were more likely to follow the stable active (versus stable sedentary) trajectory. Those with partners who were less active and had higher relationship satisfaction were more likely to follow the increaser (vs. stable active) trajectory.

CONCLUSIONS

Findings demonstrate the importance of considering partner and relationship factors in physical activity interventions for couples.

Adjustment of Couples to the Transition to Retirement: The Interplay of Intra- and Interpersonal Emotion Regulation in Daily Life

Background: Retirement is a central transition in late adulthood and requires adjustment. These processes not only affect the retired individuals but also their romantic partners. The aim of this study is to investigate the interplay of intrapersonal emotion regulation (rumination) with interpersonal regulation processes (disclosure quality). Furthermore, the associations of daily retirement-related disclosure with adjustment symptoms in disclosing and the listening partner will be investigated. It is expected that the effects of disclosure alter after providing the couples with a self-applied solitary written disclosure task in order to support their intrapersonal emotion regulation. Methods: In this dyadic online-diary study, 45 couples (N = 45) with one partner perceiving the adjustment to a recent retirement as challenging reported rumination, perceived disclosure quality (repetitive, focused on negative content, hard to follow, disclosing partner open for common/authentic), retirement-related disclosure, and ICD-11 adjustment symptoms preoccupation and failure to adapt were assessed at the end of the day over 14 days. In the middle of this assessment period, couples performed a modified online-expressive writing about their thoughts and feelings regarding the transition to retirement. Results: The double-intercept multilevel Actor-Partner Interdependence Models (APIM) reveal that on days with more daily rumination, the spouse perceived that disclosure of the retiree is more difficult to follow, more negative, and repetitive. In contrast, the retiree perceived less authenticity and openness to comments during disclosure on days when the spouse reports more rumination. Retirement-related disclosure showed no within-couple association with failure to adapt but actor effects on preoccupation. Moreover, a partner effect of disclosure of the retirees on the preoccupation of spouses could be observed. This contagious effect of the retiree disclosure, however, disappeared during the week after writing. Conclusion: Our results support the notion that disclosure processes are altered during maladaptive intrapersonal emotion regulation processes. This in turn seems to lead to less effective interpersonal regulation and contagious spilling over of symptoms. Supporting intrapersonal emotion regulation seems to have the potential to allow more favorable interpersonal regulation processes and to free interpersonal resources for an individual adjustment. This has implications for further planning of support for couples facing life transitions and aging-related changes.

Consideration of Future Consequences Influences Involvement in Romantic Partners' Health

This study examined the influence of people's short-term (e.g., convenience) and long-term (e.g., maintain weight) motives toward their romantic partner's health on their provision of health-related social control and autonomy support for their partner's health behaviors, as well as their indifference toward their romantic partner's health. Data from a sample of cohabiting couples (N = 212) were analyzed using multilevel path models. Results showed having more long-term motives for a partner's health lead to increased provisions of autonomy support and social control, and less indifference toward the partner's health, especially when the partner had lower long-term health motives themselves. In contrast, having more short-term motives for a partner's health was associated with providing less social control and autonomy support and showing more indifference toward the partner's health. Thus, people motivated to improve their partner's long-term health engage in more behaviors meant to improve their romantic partner's health choices, particularly when the partner has low motivation to regulate their own health behaviors.

Social Sharing of Emotions and Communal Appraisal as Mediators Between the Intensity of Trauma and Social Well-Being in People Affected by the 27F, 2010 Earthquake in the Biobío Region, Chile

The psychosocial impacts of natural disasters are associated with the triggering of negative and positive responses in the affected population; also, such effects are expressed in an individual and collective sphere. This can be seen in several reactions and behaviors that can vary from the development of individual disorders to impacts on interpersonal relationships, cohesion, communication, and participation of the affected communities, among others. The present work addressed the psychosocial impacts of the consequences of natural disasters considering individual effects via the impact of trauma and community effects, through the perception of social well-being, the valuation of the community and the social exchange of emotions. The aim of this study was to assess the relationship between individual reactions (i.e., intensity of trauma) and the evaluation of social and collective circumstances (i.e., social well-being) after the earthquake of 27F 2010 in Chile, through collective-type intervention variables not used in previous studies (i.e., social sharing of emotions and community appraisal). For this purpose, a descriptive, ex post facto correlational and cross-sectional methodology was carried on, with the participation of 487 people affected by the 2010 earthquake, 331 women (68%) and 156 men (32%), between 18 and 58 years old (M = 21.09; SD = 5.45), from the provinces of Ñuble and Biobío, VIII region, Chile. The measurement was carried out 4 years after the earthquake and the results show that greater individual than collective involvements were found, mainly in the coastal zone of the region. The mediation analysis showed that the relationship between the intensity of the trauma and social well-being occurs through a route that considers social sharing of emotions and community appraisal. These results indicate that the overcoming of individual affectations to achieve social well-being occurs when in the immediate post-disaster phases the affected communities activate shared emotional and cognitive processes, which allow them to jointly face subsequent threats and abrupt changes.

Constructing We-ness: A Communal Coping Intervention for Couples Facing Chronic Illness

Communal coping occurs when relationship partners view a stressful health problem as "ours," rather than yours or mine, and take collaborative action to deal with it. Although research employing linguistic (we-talk) and other measures of communal coping demonstrates relevance to a variety of chronic illnesses, the literature offers little about how clinicians can actively promote we-ness and teamwork to help patients and their partners achieve the health benefits this appears to confer. This paper highlights clinical and supporting scientific features of a narrative intervention designed to foster communal coping by couples in which one partner has a chronic illness. The illustrative illness is diabetes, but with modification the protocol is suitable for other chronic conditions as well. Grounded in systemic and narrative models of problem maintenance and change, the communal coping intervention represents a distillation of research and clinical experience with family consultation over several decades. In contrast to more directive and educational approaches, the intervention consists entirely of questions, with no direct suggestions or instruction about how patients, partners, or couples should change. These questions comprise 8 sequential modules (Coping Challenges, Trajectory and Focus, Illness as External Invader, You as a Couple, Past Teamwork in Overcoming Adversity, Present and Future Teamwork, Obstacles to Teamwork, and Wrap-Up), described here in manual-like detail.

The Association Between Cardiac Illness-Related Distress and Partner Support: The Moderating Role of Dyadic Coping

Managing cardiac illness is not easy because it dramatically disrupts people's daily life and both the patient and his/her spouse are at risk for experiencing distress, which, in turn, may affect the support provided by the partner as caregiver. The partner, in fact, is the main source of support, but his/her support may sometimes be inadequate. In addition, dyadic coping (i.e., the way partners cope together against stress and support each other in times of difficulty) could likely be a moderating factor. The main aim of the present study was to examine the role that dyadic coping (DC, in terms of positive, negative, and common dyadic coping responses) plays in moderating the link between patient and partner cardiac illness-related distress (in terms of anxiety and depression) and partner support (in terms of overprotection, hostility, and partner support for patient engagement). The study included 100 married couples faced with cardiac illness who completed a self-report questionnaire. We analyzed our data in PROCESS using multiple regressions in order to assess the moderating effects of DC responses in the relationship between the couple's cardiac illness-related distress and partner support. With regard to patient distress, results showed that higher levels of patient anxiety and depression were linked with ineffective partner support (i.e., overprotection and hostility). With regard to partner distress, higher levels of partner depression were linked with hostility; higher levels of partner depression and anxiety were associated with less partner support for patient engagement. Moreover, the association between distress and partner support was moderated by the quality of DC. In particular, low positive DC represented a risk factor for both the patient and the partner during a cardiac illness, as low positive DC exacerbated the link between patient and partner distress and less effective partner support styles. Also, higher levels of negative DC were risky for couples: The association between distress and less adequate partner supportive behaviors was stronger in the case of higher negative DC. These results imply a need for psychosocial interventions for couples in cardiac illness, especially for couples lacking relational competences, such as positive dyadic coping.

A Postcard From Italy: Challenges and Psychosocial Resources of Partners Living With and Without a Chronic Disease During COVID-19 Epidemic

The new Coronavirus (COVID-19) has been declared a global pandemic by the World Health Organization (WHO). The sudden outbreak of this new virus and the measure of lockdown adopted to contain the epidemic have profoundly changed the lifestyles of the Italian population, with an impact on people's quality of life and on their social relationships. In particular, due to forced and prolonged cohabitation, couples may be subject to specific stressors during the epidemic. In addition, living with a chronic health condition may add specific challenges to the ones posed by the epidemic itself. The present cross-sectional study aimed to provide a picture of the challenges as well as the resources for both individual and relational well-being of Italian individuals in a couple relationship (N = 1921), with a specific attention to the comparison between individuals living with and without a chronic disease. Results showed that people with a chronic disease had lower psychological well-being and more fears and worries about the COVID-19. People with a chronic disease perceived fewer resources than healthy people. Moreover, the challenges are shown to be associated with less psychological well-being and high pessimism about the future. Instead individual, relational, and social resources play a protective role during the pandemic for both healthy and chronically ill people.

Learning a new way of living together: a qualitative study exploring the relationship changes and intervention needs of patients with cardiovascular disease and their partners

OBJECTIVES

Cardiovascular disease (CVD) not only affects the patient, but has implications for the partner. Emerging evidence suggests that supportive couple relationships enhance CVD outcomes and reduce patient and partner distress. To date, however, little research has been done to address the couple relationship as a potentially important component of cardiac care. This article examines the impact of CVD on the couple relationship and assesses the perceived needs and desired intervention components of patients with CVD and their partners.

DESIGN

Qualitative study using directed and conventional content analysis.

SETTING

Single-centre, tertiary cardiac care hospital that serves a population of 1.4 million in the Champlain region of Ontario, Canada.

PARTICIPANTS

Patients with CVD and their partners (n=32, 16 couples) participated in focus groups. Patients were mainly male (75%), white (87.5%), aged 64.4 years (range 31-81 years), with varied cardiac diagnoses (50% coronary artery disease; 18.75% valve disease; 18.75% heart failure; 12.5% arrhythmia).

RESULTS

Five categories were generated from the data reflecting changes within the couple relationship as a result of CVD: (1) emotional and communication disconnection; (2) overprotection of the patient; (3) role changes; (4) adjustment to lifestyle changes; and (5) positive relationship changes. Three categories were constructed regarding intervention needs and desired resources: (1) practical resources; (2) sharing with peers; and (3) relationship enhancement.

CONCLUSIONS

Overall, the data suggest that there were profound changes in the couple relationship as a result of CVD, and that there is considerable need to better support the caregiving spouses and the couple as a unit. These results call for interventions designed to provide instrumental support, peer-sharing opportunities and relationship quality enhancement to help couples cope with CVD. Future studies should examine whether couples-based programming embedded into cardiac rehabilitation can be effective at improving relationship quality and reducing patient and partner stress in the aftermath of a cardiac event.

A qualitative inquiry on religious married men's perceptions of relationship dynamics during everyday sickness

The purpose of this study was to evaluate men's perceptions of self-dynamics and partner dynamics during common everyday sickness. Five focus group interviews (N = 44) were conducted, each lasting approximately 120 minutes. The data were analyzed using a generic qualitative approach which identified two larger themes and several sub-themes: sickness appraisals and appraisal communication (gender differences in symptom appraisal and minimization of own and partner's sickness) and coping and support strategies (individual coping, one-way provision of support, and coping together). It seems acute sickness creates shared stressors for both partners but differentially impacts each based on gender and family roles.

Couples Adjusting to Multimorbidity: A Dyadic Study on Disclosure and Adjustment Disorder Symptoms

Background

Multimorbidity is challenging not only for the patient but also for the romantic partner. Strategies for interpersonal emotion regulation like disclosing to the partner are supposed to play a major role in the psychosocial adjustment to multimorbidity. Research has often focused on disease-related disclosure, even though disclosing thoughts and feelings related to mundane, everyday life occurrences might also play a role in coadjustment. The current dyadic study aimed at investigating the association between these two types of interpersonal regulation strategies and adjustment disorder symptoms, following the new ICD 11 criteria in multimorbid patients and their partners.

Methods

Shortly after being hospitalized due to an acute health crisis, N = 28 multimorbid patients (average age 70 years) and their partners filled in questionnaires on disclosure in the couple, adjustment disorder criteria of the ICD 11 (“preoccupation,” “failure to adapt”), and sleep problems.

Results

Both patients and their partners did show similarly high levels of preoccupation and failure to adapt indicating adjustment problems to the complex health situation. The adjustment symptoms of both partners correlated between r = 0.22 and 0.45. Regression based on Actor-Partner Interdependence-Models revealed that own mundane disclosure was related to less adjustment symptoms in the patients. Beyond that, a partner effect was observed, revealing a negative association between partners’ illness-related disclosure and the patients’ level of preoccupation. For the partners, mundane disclosure of the partner was associated with less preoccupation, failure to adapt, and reported sleep problems above and beyond own disclosure reports. Furthermore, there was an actor effect of disease-related disclosure on less sleep problems for the partners.

Conclusion

These results support an interpersonal view on adjustment processes to physical disease. Disclosure as a way of regulating the relationship and emotional responses might play a relevant role here, which seems to be different for patients and their partners. Further research is needed to shed more light on the differential role of disease-related and mundane everyday disclosure for psychosocial adjustment in couples confronted with health challenges.

Understanding communal coping among patients and informal caregivers with heart failure: A mixed methods secondary analysis of patient-caregiver dyads

BACKGROUND

Dyads that view illnesses as shared stressors ("shared appraisal"), and collaboratively respond to it, have better outcomes. This process, known as communal coping, has received little attention in heart failure (HF).

OBJECTIVES

To examine communal coping among patient-caregiver dyads managing HF.

METHODS

We conducted semi-structured interviews with 34 dyads. Shared appraisal was measured using we-ratio, as calculated with Linguistic Inquiry Word Count. We-ratio was divided into "high" and "low" for patients and caregivers, and concordance was examined. Thematic analyses were used to explore collaboration.

RESULTS

Caregivers had higher we-ratios than patients (p=.005); 29.6% and 33.3% dyads were concordant on high and low "we-ratio," respectively. In thematic analyses, we found that 1) dyads collaborated around diet, appointments, and medications, but less around physical activity; 2) dyads collaborated across all illnesses, not just HF; and 3) dyads concordant on high we-ratio reported stronger collaborations.

CONCLUSIONS

Communal coping varied by shared appraisal and collaboration. Understanding this variability may help develop tailored self-management interventions.