Effects of Receiving Pain-Related Support on Psychological Well-Being: The Moderating Roles of Emotional Responses to Support

OBJECTIVES

We investigated whether receiving greater pain-related instrumental support is associated with poorer psychological well-being among chronic pain patients who report less positive (e.g., grateful) or more negative (e.g., angry) emotional responses to support.

METHODS

We conducted regression analyses, utilizing data from two waves of interviews with 152 knee osteoarthritis patients. Three indicators of psychological well-being were examined: depressive symptoms, positive affect, and negative affect.

RESULTS

Receiving greater support was associated with poorer psychological well-being at baseline, as well as higher depressive symptoms and negative affect at the 18-month follow-up, only among patients with low positive emotional responses to support. Furthermore, receiving greater support was related to poorer psychological well-being at baseline only among patients with high negative emotional responses to support.

DISCUSSION

Care recipients' less positive emotional responses to support may be a risk factor for poorer psychological well-being in both the short- and long-term, when receiving greater support.

New Opportunities for Advancing Dyadic Health Science in Gerontology

As dyadic health science enters a golden age, important conceptual, theoretical, and technical challenges remain. This forum review brings together perspectives on the burgeoning dyadic literature from several subdisciplines within aging research. We first define key concepts and terms so that interested researchers can navigate the complex and various ways in which dyadic health research is conducted. We discuss exciting scientific advances and close by identifying crucial challenges and considerations that coincide with important future directions for the field.

Patient Responses to the Term Pain Catastrophizing: Thematic Analysis of Cross-sectional International Data

Pain catastrophizing is understood as a negative cognitive and emotional response to pain. Researchers, advocates and patients have reported stigmatizing effects of the term in clinical settings and the media. We conducted an international study to investigate patient perspectives on the term pain catastrophizing. Open-ended electronic patient and caregiver proxy surveys were promoted internationally by collaborator stakeholders and through social media. 3,521 surveys were received from 47 countries (77.3% from the U.S.). The sample was mainly female (82.1%), with a mean age of 41.62 (SD 12.03) years; 95% reported ongoing pain and pain duration > 10 years (68.4%). Forty-five percent (n = 1,295) had heard of the term pain catastrophizing; 12% (n = 349) reported being described as a 'pain catastrophizer' by a clinician with associated high levels of feeling blamed, judged, and dismissed. We present qualitative thematic data analytics for responses to open-ended questions, with 32% of responses highlighting the problematic nature of the term. We present the patients' perspective on the term pain catastrophizing, its material effect on clinical experiences, and associations with negative gender stereotypes. Use of patient-centered terminology may be important for favorably shaping the social context of patients' experience of pain and pain care. PERSPECTIVE: Our international patient survey found that 45% had heard of the term pain catastrophizing, about one-third spontaneously rated the term as problematic, and 12% reported the term was applied to them with most stating this was a negative experience. Clinician education on patient-centered terminology may improve care and reduce stigma.

The Social Context of Partnered Older Adults' Insomnia Symptoms

The current study included an examination of social factors that mitigate or exacerbate insomnia symptoms among older adults who are married or living with a partner. We first examined the unique effects of spousal support and strain on insomnia symptoms and then evaluated the degree to which extramarital social factors (e.g., friend support) moderated spousal influences. Data came from Waves 2 and 3 of the National Social Life, Health, and Aging Project. Our sample consisted of 495 participants who were either married or cohabitating with a partner (M age in years = 69.84, SD = 8.08). Spousal strain-but not support-predicted higher insomnia symptoms 5 years later. Spousal influences on sleep, however, were moderated by extramarital factors in nuanced ways. Findings highlight the importance of taking into account older adults' wider social context when examining the ways in which sleep is sensitive to positive and negative aspects of marital quality.

Dyadic Links Between Health Changes and Well-Being: The Role of Non-Spousal Confidants

Although the marital relationship is often the primary source of emotional support in adulthood, sole reliance on the spouse to discuss health-related issues may be harmful to the well-being of both partners. The first aim of this study was to examine whether declines in health during later life would be associated with poorer psychological well-being in self and partner. We further investigated whether declining health would have a stronger impact on own and partner psychological well-being in the absence of non-spousal health confidants. Longitudinal actor-partner interdependence models (APIMs) were used to test both hypotheses with dyadic data from Wave 2 (2010-2011) and Wave 3 (2015-2016) of the National Social Life, Health, and Aging Project (NSHAP). Contrary to prediction, increased anxiety following spousal declines in gait speed and cognitive function occurred for those whose spouse did (rather than did not) have additional health confidants. A much fuller understanding is needed in regard to whether close relationships provide resources or present unwanted complications to dyadic coping, and the processes by which effects occur.

Rumination and Sleep Quality Among Older Adults: Examining the Role of Social Support

OBJECTIVES

Although the adverse link between rumination and sleep quality is well established, much of the literature neglects the role of social factors. This study examined the role of older adults' perceived social support from spouses and from family/friends in modifying the association between trait rumination and sleep quality. Existing hypotheses suggest that social support may play 3 unique roles, each tested within the current study: (H1) support may act as a protective factor that buffers negative effects of rumination on sleep quality, (H2) support may curtail rumination and, in turn, promote sleep quality, and (H3) rumination may erode support and, in turn, undermine sleep quality.

METHOD

Data came from 86 partnered older adults in independent-living or retirement communities (Mage = 75.70 years). We utilized 3 waves of interview data collected annually between 2017 and 2019. The first hypothesis was tested using moderation in multilevel models; the second 2 hypotheses were evaluated with prospective associations using multilevel mediation.

RESULTS

Negative effects of high-trait rumination on time-varying sleep quality were attenuated among those who reported high, stable levels of support from their spouses. Perceived family/friend support did not yield the same protective effect. There was no evidence that support preempted, or was eroded by, rumination.

DISCUSSION

Perceived spousal support may act as a psychosocial resource that mitigates negative effects of trait rumination on older adults' sleep quality. Interventions aimed at mitigating maladaptive outcomes of rumination on sleep quality for older adults should consider spousal support as a key target.

Effects of Parental Childhood Abuse on Daily Stress Processes in Adulthood

Extensive evidence suggests that exposure to childhood abuse can lead to harmful health effects across a lifetime. To contribute to the literature, the current study examined whether and how a history of parental childhood abuse affects exposure to and severity appraisal of daily stressors in adulthood, as well as emotional reactivity to these stressors. We analyzed 14,912 daily interviews of 2,022 respondents from the second wave of the National Study of Daily Experiences. Multilevel modeling was utilized to analyze nested data, in that each person provided repeated measures of daily experience for eight consecutive study days. Results showed that more frequent experience of maternal childhood abuse was associated with more severe appraisal of daily stressors. In addition, adults with more frequent maternal childhood abuse exhibited greater emotional reactivity to daily stressors. The current study provides evidence that a history of parental childhood abuse may serve as a vulnerability factor in the process of experiencing and responding to stressful events encountered in daily life. Future research should further explore the long-term health effects of daily stress and emotional experience among adults with a history of parental childhood abuse. Interventions for these adults should focus on promoting emotional resilience in the face of daily stress.

Daily social interactions related to daily performance on mobile cognitive tests among older adults

The lack of social contact or good social relationships has been linked with cognitive decline and higher risk for Alzheimer’s disease and related dementias. One important but unexamined question is how daily social interactions relate to older adults’ cognitive function in daily life. The present study examined how changes in daily social interactions related to fluctuations in older adults’ performance on mobile cognitive tests from day to day. Using an ecological momentary assessments approach, 312 older adults (aged 70 to 90 years) completed surveys on social interactions and mobile cognitive tests five times a day for 16 consecutive days using smartphones. Multilevel modeling was used for analyses. Results demonstrated that having more daily social interactions, especially more pleasant social interactions, related to better cognitive performance the same day and over the subsequent two days. Cognitive performance, however, did not predict subsequent changes in social interactions across days. At the between-person level, older adults who had more (vs. less) frequent interactions with close partners on average, especially with their friends, had better cognitive performance. Finally, the average levels of social interactions also moderated the within-person associations between daily social interactions and the same-day cognitive performance. In sum, results from this study highlight the importance of having pleasant social interactions and frequent interactions with friends for older adults’ cognitive function in daily life, and have important implications for future behavioral interventions targeting certain features of daily social interactions to reduce risk of cognitive decline and Alzheimer’s disease and related dementias.

Perceived Gratitude, Role Overload, and Mental Health among Spousal Caregivers of Older Adults

OBJECTIVES

We investigated whether spousal caregivers' greater perception of being appreciated by their partner for their help was associated with caregivers' better mental health, and whether caregivers' higher role overload was related to their poorer mental health. We further evaluated whether spousal caregivers' greater perceived gratitude buffered the association between their role overload and mental health.

METHOD

We examined 306 spousal caregivers of older adults with chronic illness or disability, drawn from the 2011 National Health and Aging Trends Study and National Study of Caregiving. We defined mental health as better psychological well-being and less psychological distress (i.e., fewer depressive and anxiety symptoms). Hierarchical regression models were estimated to test hypotheses.

RESULTS

Greater perceived gratitude was associated with better psychological well-being, and higher role overload was related to poorer psychological well-being and greater psychological distress. In addition, greater perceived gratitude buffered the associations between role overload and anxiety symptoms as well as psychological well-being.

DISCUSSION

Findings suggest that spousal caregivers' role overload may be a strong risk factor for their poorer mental health, especially when caregivers feel less appreciated by their partner. Couple-oriented interventions to improve spousal caregivers' mental health could be aimed at reducing their role overload and enhancing perceived gratitude.

Short- and Long-term Effects of Support Visibility on Support Providers' Negative Affect

OBJECTIVES

Seminal research with spouses of chronic pain patients indicates that providing patients with instrumental support can be either costly or beneficial for spouses' well-being. Drawing from the invisible support literature, this study evaluated the extent to which patients' recognition of spouses' support moderated daily and long-term associations between spouses' support provision and negative affect.

METHOD

Data came from a sample of spouses (N = 145) of knee osteoarthritis (OA) patients, and the patients themselves. Participants completed a baseline interview, 22 days of daily diaries, and two follow-up interviews 6 and 18 months after baseline. Multilevel models were estimated to test study hypotheses.

RESULTS

As expected, support visibility moderated daily and long-term associations between spouses' instrumental support provision and negative affect. Spouses reported elevated levels of negative affect in response to providing patients with extra care and attention, but only when their support was not recognized (i.e., reported) by patients.

DISCUSSION

Findings from the current study pinpoint support visibility as a protective factor that may mitigate negative short- and long-term effects of spousal instrumental support provision on spouses' negative affect. Promoting patients' awareness of their spouses' support may offset negative emotional consequences of caregiving in the context of chronic health stressors.

Features of daily social interactions that discriminate between older adults with and without mild cognitive impairment

OBJECTIVES

Detecting subtle behavioral changes in everyday life as early signs of cognitive decline and impairment is important for effective early intervention against Alzheimer's disease. This study examined whether features of daily social interactions captured by ecological momentary assessments could serve as more sensitive behavioral markers to distinguish older adults with mild cognitive impairment (MCI) from those without MCI, as compared to conventional global measures of social relationships.

METHOD

Participants were 311 community dwelling older adults (aged 70 to 90 years) who reported their social interactions and socializing activities five times daily for 14 consecutive days using smartphones.

RESULTS

Compared to those with normal cognitive function, older adults classified as MCI reported less frequent total and positive social interactions and less frequent in-person socializing activities on a daily basis. Older adults with and without MCI, however, did not show differences in most features of social relationships assessed by conventional global measures.

DISCUSSION

These results suggest that certain features of daily social interactions (quality and quantity) could serve as sensitive and ecologically valid behavioral markers to facilitate the detection of MCI.

The Influence of Family and Friend Confidants on Marital Quality in Older Couples

OBJECTIVES

Relationships with confidants play an important role in older adults' health and well-being. Particularly, family and friend confidants could significantly support or interfere with older adults' marital relationships. This study used a dyadic approach to examine the influence of the structural features of both spouses' family and friend confidant networks on older couples' marital quality over 5 years.

METHODS

Analyses used dyadic data from Wave 2 (2010-2011) and Wave 3 (2015-2016) interviews of the National Social Life, Health, and Aging Project (NSHAP), a nationally representative sample of community-dwelling older adults. Longitudinal actor-partner interdependence models were used to examine the influence of spouses' family and friend confidant networks on couples' marital quality.

RESULTS

Having a larger friend confidant network or closer connections with friend confidants predicted greater marital quality for wives and husbands 5 years later. Larger family confidant networks of both spouses predicted greater marital quality for wives over time. However, husbands reported worse marital quality over time if wives reported having closer connections with their own family confidants at baseline.

DISCUSSION

This study demonstrates the importance of family and friend confidant networks for older couples' marital quality and highlights the benefits of having a larger or closer friend confidant network. Future research should examine mechanisms that account for the effects of spouses' family and friend confidant networks on older couples' marital quality.

Daily pain catastrophizing predicts less physical activity and more sedentary behavior in older adults with osteoarthritis

Musculoskeletal disorders such as knee osteoarthritis (OA) are the primary cause of chronic pain in older adults. Recommended self-management strategies for knee OA include staying physically active in the face of pain, but many patients avoid activities they are capable of doing. The overall purpose of this study was to examine the extent to which daily pain catastrophizing, a maladaptive coping strategy, could influence OA patients' physical activity and sedentary behavior. The current study used data from 143 older knee OA patients who completed electronic daily diaries for 22 days and wore an accelerometer to capture physical activity and sedentary behavior. At the beginning of each day, patients reported their pain catastrophizing regarding the day ahead. Results from multilevel models demonstrated that on mornings when patients catastrophized more than usual about their pain in the day ahead, they spent more time in sedentary behavior and engaged in fewer minutes of moderate to vigorous physical activity that day. Cross-day lagged analyses further showed that the effect of morning pain catastrophizing on subsequent sedentary behavior extended to the next day. More time spent in sedentary behavior, in turn, contributed to greater pain catastrophizing the next morning. These findings support the mechanistic role of daily pain catastrophizing in the avoidance of physical activity for older OA patients, and suggest that effective interventions for pain catastrophizing may also reduce sedentary behavior and enhance physical activity, with longer-term benefits for pain management, physical function, and overall health.

Family Caregiving for Older Adults

Family members are the primary source of support for older adults with chronic illness and disability. Thousands of published empirical studies and dozens of reviews have documented the psychological and physical health effects of caregiving, identified caregivers at risk for adverse outcomes, and evaluated a wide range of intervention strategies to support caregivers. Caregiving as chronic stress exposure is the conceptual driver for much of this research. We review and synthesize the literature on the impact of caregiving and intervention strategies for supporting caregivers. The impact of caregiving is highly variable, driven largely by the intensity of care provided and the suffering of the care recipient. The intervention literature is littered with many failures and some successes. Successful interventions address both the pragmatics of care and the emotional toll of caregiving. We conclude with both research and policy recommendations that address a national agenda for caregiving.

Older adults' social network and support and its association with physical activity

The purpose of this study was to describe older adults' social network and support during a physical activity intervention and its association with physical activity. Mixed methods were used for this secondary analysis of existing data from a physical activity intervention. Seventy-three participants who completed a session by telephone on using support comprised the sample. Participants reported on average approximately eight individuals in their social network. Half reported support for physical activity from a spouse/partner, adult child, or friend. Those who perceived support for self-reported physical activity tended to have greater improvements on average from baseline for mean daily minutes of physical activity than those with no perceived support. Four-fifths developed a plan for a spouse/partner, friend, adult child, or sibling to provide physical activity support. Participants reported that the session was helpful and increased their confidence in using support; over one-quarter intended to use support after the intervention ended.

Different Types of Childhood Experience with Mothers and Caregiving Outcomes in Adulthood

OBJECTIVE AND BACKGROUND

The current study examines the types of childhood experiences with mothers (i.e., maternal abuse, affection, discipline) among caregivers of aging mothers, and investigates whether membership in specific latent classes, particularly maternal maltreatment, is associated with psychological functioning among caregivers.

METHOD

Using data from the Midlife in the United States (MIDUS), we used the Bolck, Croon, and Hagenaars (BCH) approach of latent class analysis (LCA) to predict distal outcomes.

RESULTS

We identified four latent classes (prevalence rate noted): "Affectionate and authoritative" (65%), "affectionate and permissive" (11%), "emotionally abusive and neglectful" (8%), and "emotionally/physically abusive and authoritative" (16%). Caregivers in the "emotionally/physically abusive and authoritative" class endorsed high probabilities of both maternal affection and abuse and were most negatively affected across the three psychological functioning outcomes (i.e., self-rated mental health, psychological distress, and psychological well-being).

CONCLUSION AND IMPLICATIONS

In support of the life course perspective, our findings emphasized the importance of examining adult children caregivers' early life experiences with aging mothers and how those experiences can impact the psychological effects of caregiving. This study suggests specific practice implications; for example, assessment tools for evaluating caregiver burden should consider life course factors such as caregivers' childhood experiences with aging parents.

Daily Sedentary Behavior Predicts Pain and Affect in Knee Arthritis

BACKGROUND

Sedentary behavior (SB), which has been linked with numerous adverse health outcomes, is prevalent among adults with osteoarthritis (OA). The associations between SB and daily physical and psychological health outcomes for OA patients, however, have received little attention.

PURPOSE

Using accelerometer and self-report data, the current study examined how the amount of time OA patients spent in SB was associated with their pain and affect in daily life, independent of physical activity.

METHODS

Over 22 days, 143 older adults (mean age = 65 years) with knee OA wore an accelerometer to measure SB and physical activity, and also reported their pain and affect three times a day using a handheld computer. Multilevel analyses were conducted to examine the prospective within-person associations between SB and subsequent pain or affect within the same day and across days, independent of physical activity.

RESULTS

The time spent in SB daily predicted less pain but worse affect at the end of that day, above and beyond the effects of physical activity, as well as demographics and individual differences in general health and depression. Moreover, cross-day lagged analyses indicated that time spent in SB on 1 day predicted higher negative affect the next morning. Finally, the average level of SB was also associated with worse average affect at the between-person level.

CONCLUSIONS

SB may be related to less pain in the short term but detract from patients' emotional well-being. Future intervention should aim to reduce daily SB to improve OA patients' emotional well-being.

Perceived Patient Pain and Spousal Caregivers' Negative Affect: The Moderating Role of Spouse Confidence in Patients' Pain Management

Objectives: This study examined whether older patients' greater daily pain perceived by their spouses was associated with spouses' higher daily negative affect. We further investigated whether spouses' lower confidence in patients' ability to manage pain exacerbated the daily association between perceived patient pain and spouses' negative affect. Method: We used baseline interviews and a 22-day diary of knee osteoarthritis patients and their spouses (N = 144 couples). Multilevel models were estimated to test hypotheses. Results: Daily perceived patient pain was not associated with spouses' daily negative affect. However, spouse confidence significantly moderated the association. Only spouses with lower confidence in patients' pain management experienced higher negative affect on days when they perceived that patients' level of pain was higher than usual. Discussion: Findings suggest that spousal caregivers' lack of confidence in patients' pain management may be a risk factor for spouses' affective distress in daily life.

Daily Links Between Sleep and Anger Among Spouses of Chronic Pain Patients

OBJECTIVES

This study identified daily associations between sleep, emotion, and marital functioning in the context of chronic pain. Because spouses' sleep is compromised on nights when patients experience more pain, we set out to identify implications of spouses' sleep for their own emotion (anger) upon waking and marital interaction (marital tension) throughout the rest of the day. We further considered whether spouses' critical attitudes about patients' pain-related coping exacerbated associations between their sleep, morning anger, and marital tension.

METHOD

Data came from a study of knee osteoarthritis patients (50+ years old) and spouses (N = 138 couples) who completed daily diaries across 22 days. Multilevel models were estimated to test hypotheses.

RESULTS

Spouses woke up angrier on mornings when they reported that their sleep was more unrefreshing than usual. This association was stronger among more critical spouses. Morning anger resulting from unrefreshing sleep, however, did not predict marital tension throughout the rest of the day.

DISCUSSION

Findings highlight the potential value of intervention efforts aimed at promoting spouses' sleep quality in an effort to offset negative emotional consequences that may undermine spouses' and patients' adjustment in the context of chronic pain.

AFFECTIONATE TOUCH AND RELATIONAL, MENTAL, AND PHYSICAL WELL-BEING IN OLDER COUPLES: A NATIONAL LONGITUDINAL STUDY

Recent theories suggest that non-sexual physical contact with close others plays a key role in promoting health and well-being in adulthood. However, the impact of non-sexual physical contact in later life, especially the affectionate touch between romantic partners, has been largely unexplored. Using two waves of dyadic data (N=953 couples, Mage=71 years) from National Social Life, Health, and Aging Project (NSHAP), we examined whether shared affectionate touch between spouses prospectively predicted both partners’ relational, mental and physical well-being five years later, independent of sex activity. Dyadic analyses results indicated that frequency of shared affectionate touch with the partner predicted increases in spouses’ own relationship satisfaction, life satisfaction and mental health, but not in physical health, over five years. No interpersonal (i.e., partner) effect of shared affectionate touch was found. Findings underscore the unique role of non-sexual physical contact between spouses in promoting relational and mental well-being for older couples.

Parental childhood maltreatment and the later-life relationship with parents

The aims of the current study were to examine the long-term effects of childhood maltreatment on current relationships with parents and whether the quality of current relationships with parents mediates the associations between childhood maltreatment and psychological health in late adulthood. Using 2 decades of longitudinal data from the Wisconsin Longitudinal Study, multilevel structural equation modeling was employed to examine the associations between reports of childhood maltreatment, aspects of current relationships with parents (i.e., perceived closeness, contact frequency, and exchange of social support), and psychological well-being/distress of adult children. Key results indicated that reports of maternal childhood abuse and neglect predicted lower levels of perceived closeness with aging mothers, which were subsequently associated with reduced psychological well-being of adult children. We did not find evidence of mediation between reports of paternal childhood abuse/neglect, current relationships with fathers, and psychological outcomes. Our findings suggest a significant linkage between childhood and later-life intergenerational relationships. Adults who were maltreated by their mother as children may continue to experience challenges in this relationship. Further research is needed to examine how these past and current relational dynamics affect caregiving experiences and outcomes. In addition, when intervening with adults with a history of childhood maltreatment, practitioners should evaluate contemporary relationship quality with the abusive mother and help address any unresolved emotional issues with the parent. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Daily Marital Tension and Symptom Severity in Older Adults With Diabetes or Osteoarthritis

Background

Greater marital quality is associated with better psychological and physical health. The quality of daily marital interactions is likely to be especially important for individuals with chronic illness, but this question has received little attention.

Purpose

Using data from two diary studies, the current study examined whether individuals with chronic illness would experience more severe symptoms on days with more marital tension due in part to greater negative affect on those days.

Methods

The samples included individuals with knee osteoarthritis (OA, N = 145) or type 2 diabetes mellitus (T2DM, N = 129) and their spouses. Participants reported on daily marital interaction quality, affect, and symptom severity (patients only) for 22 days (knee OA) or 24 days (T2DM). Separate multilevel models were run for patients and spouses, controlling for the partner's marital tension and negative affect as well as both partners' daily marital enjoyment and positive affect. We examined same-day and across-day associations.

Results

For individuals with T2DM or knee OA, more severe symptoms on days with more marital tension were due in part to their greater negative affect on those days. Individuals with knee OA who experienced more pain had more negative affect and marital tension the next day.

Conclusions

Negative marital interactions may exacerbate physical symptoms. Effects of daily marital tension likely accumulate over time and have long-term implications for health.

Psychological Adjustment of Aging Vietnam Veterans: The Role of Social Network Ties in Reengaging with Wartime Memories

It is projected that by 2020 there will be 8.7 million veterans over the age of 65 years, more than half (64%) of whom served during the Vietnam War. The effects of military service on mental health and well-being may be more pronounced later in life among those who served in Vietnam than prior cohorts of veterans. Many veterans confront and rework their wartime memories later in life in an attempt to find meaning and coherence, engaging in a process referred to as Later-Adulthood Trauma Reengagement (LATR). LATR often occurs in the context of other stressors that are a normative part of aging, such as role transitions (e.g., retirement), declines in physical health, and the death of close others (e.g., spouses), perhaps because these events trigger reminiscence. Importantly, LATR may result in either positive (e.g., acceptance) or negative (e.g., distress) psychological outcomes. It has been suggested that the presence of social/environmental resources, including socioemotional support, may aid veterans in successfully navigating LATR. We, therefore, review relevant areas of research to delineate the role that various layers of social context may play in -helping - or hindering - aging Vietnam veterans as they navigate LATR in the context of normative late-life stressors. We conclude by offering fruitful directions for future research and applied implications for intervention efforts.

The Role of Current Family Relationships in Associations Between Childhood Abuse and Adult Psychological Functioning

OBJECTIVES

Childhood abuse has long-term negative effects on adult psychological well-being. This study examined whether and how adults with a history of childhood abuse may experience poor psychological functioning partly due to aspects of current family relationships.

METHOD

We estimated multilevel mediation models using 3 waves of longitudinal data from 3,487 participants in the study of Midlife Development in the United States. Outcomes measured included negative affect, life satisfaction, and psychological well-being. We included aspects of family relationships as mediators: perceived support, perceived strain, frequency of contact, and hours of providing instrumental and emotional support.

RESULTS

Multilevel mediation models showed that childhood verbal and physical abuse negatively affected diverse aspects of family relationships in later adulthood (i.e., less perceived support, more perceived strain, less frequent contact, and fewer hours of providing instrumental support). We also found that less perceived support and more family strain significantly mediated the associations between childhood abuse and all 3 psychological functioning outcomes.

DISCUSSION

Childhood abuse appears to hinder perceived availability of family support in adulthood, which may undermine the psychological functioning of adults with a history of childhood abuse. To improve their psychological health, interventions should focus on facilitating supportive and functional family relationships.

Social interactions and physical symptoms in daily life: quality matters for older adults, quantity matters for younger adults

Objective: The present study examined how the different attributes of daily social interactions (quality and quantity) were associated with physical health, and how these associations vary with age. Method: Using an ecological momentary assessment approach, participants from an adulthood lifespan sample (n = 172; aged 20-79 years) reported their social interactions five times daily, and physical symptoms and symptom severity at the end of each day, for one week. Main outcome measures: Number of physical symptoms and physical symptom severity. Results: There was a within-person main effect of the quality (positivity), but not the quantity (frequency), of social interactions on the number of reported physical symptoms and their severity. Moderation analyses further revealed that the quality of daily social interactions predicted fewer physical symptoms for older adults, but not for younger adults; in contrast, the frequency of social interactions predicted less severe physical symptoms for younger adults, but not for older adults. Finally, the reported severity of physical symptoms predicted less frequent but more positive social interactions the next day. Conclusions: Our findings point to the bidirectional associations between social interactions and health and highlight the importance of considering individuals' developmental context in future research and interventions.

Spousal understanding and marital satisfaction in pain patients and their spouses

The current study tested the hypotheses that knee osteoarthritis (OA) patients and spouses who report more spousal understanding of patient's pain would report greater marital satisfaction. A total of 124 couples completed interviews at three time points across 18 months. Results from dyadic analyses showed that patients who felt more understood by their spouse report, and have spouses who report, higher marital satisfaction concurrently. In addition, patients who felt more understood by their spouse reported higher marital satisfaction over time. Spouses' reports of understanding also had a significant influence on the patients' and their own marital satisfaction concurrently. Results highlight the importance of spouses understanding knee OA patients' pain for both dyad members' marital satisfaction.

A Couples-Oriented Intervention for Positive Airway Pressure Therapy Adherence: A Pilot Study of Obstructive Sleep Apnea Patients and Their Partners

Background: Partner involvement can influence positive airway pressure (PAP) therapy use among patients with obstructive sleep apnea (OSA). This study assessed the feasibility, acceptability, and preliminary efficacy of a couples-oriented education and support (CES) intervention for PAP adherence. Participants: Thirty newly diagnosed OSA patients and their partners were randomly assigned to one of three groups: an education and support intervention directed at both patient and partner (CES), an education and support intervention directed only at the patient (PES), or usual care (UC). Methods: Feasibility and acceptability were assessed through enrollment and posttreatment program evaluations, respectively. Assessments of sleep quality, daytime sleepiness, and daytime function were obtained from both patients and partners at baseline and 3 months after PAP initiation. Objective PAP adherence was assessed at 1 week, 1 month, and 3 months. Results: Recruitment and attrition data suggest adequate feasibility. All patients and partners in the CES group reported that the intervention was helpful. Patients in the CES and PES groups increased their PAP adherence over the first month of treatment, whereas PAP adherence decreased over this period in the UC group. For patients, large to medium effects for sleep quality (d = -1.01), daytime sleepiness (d = -0.51), and daytime function (d = 0.51) were found for the CES group. The PES and UC groups effect sizes were large to small for sleep quality (d = -0.94; d = -0.40), daytime sleepiness (d = -0.42; d = -0.82), and daytime function (d = 0.41; d = 0.57), respectively. For partners, large effects for daytime sleepiness (d = -1.31) and daytime function (d = 1.54) and small to medium effect for sleep quality (d = -0.31) were found for the CES group. Worsening of sleep quality (d = 0.65) and no change in daytime sleepiness or daytime function were found for the PES group. For the UC group, medium to large effects were found for sleep quality (d = -0.77), daytime sleepiness (d = -0.77), and daytime function (d = 0.65). Conclusions: The findings of this pilot study provide support for taking a couples intervention approach to improve PAP adherence.

Capturing patients' symptom expression and spouses' cardiovascular responses continuously: The feasibility of examining a mechanism of disease risk in the home

INTRODUCTION

Spousal caregivers face increased cardiovascular risks; lab studies suggest that autonomic reactivity to patients' physical suffering may play a role. To evaluate this mechanism in daily life, our pilot study characterized the feasibility of recruiting couples for a multimethod, in-home assessment. We examined the usability of the resulting data in an effort to link spousal cardiovascular changes to patient pain expression during couples' everyday interactions.

METHOD

For two 48-hr periods, individuals with rheumatoid arthritis (RA) and their partners wore heart monitors while audio-recordings captured couples' in-home interactions. Interbeat intervals were subsetted in 1-, 2-, and 5-min windows before and after each pain expression. Pre-post difference scores in high-frequency heart rate variability (HF-HRV) and heart rate were examined.

RESULTS

Of the 17 screened RA patients, 11 were ineligible, and 3 partners declined. The 3 participating couples completed all study activities. The resulting 288 hr of recordings were coded for patients' RA symptom expression, which varied from none to an average of 11 times daily. One couple had sufficient data for physiological analysis: Contrary to prediction, spouse HF-HRV significantly increased after patient symptom expression.

CONCLUSIONS

Recruitment rates mirrored other couples studies, and enrolled couples complied with study procedures. In-home conversations were reliably coded and successfully linked to spousal ongoing cardiovascular activity. Preliminary findings highlight the importance of optimal sampling windows and suggest symptom expression as a relevant process for some spouses but not others. We offer recommendations for efficiently scaling up the method in future studies. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Close relationships and the management of chronic illness: Associations and interventions

Self-management of a chronic illness involves not only monitoring symptoms, adhering to medication regimens, and keeping medical appointments but also making and maintaining difficult lifestyle changes. This article highlights correlational and intervention research suggesting family members are influential in children's and adults' illness management. The argument is made that a dyadic approach to chronic illness management that targets the influence of close relationships may yield more sustainable effects on patient behavior than has been achieved in the past. In particular, dyadic approaches aimed at helping patients and family members to find ways to collaborate in goal setting for these behaviors is recommended. Such dyadic interventions may also benefit family members who are ill or are at risk because of poor health behaviors. (PsycINFO Database Record

Age differences in adults' daily social interactions: An ecological momentary assessment study

Prevailing research has suggested that social relationships get better with age, but this evidence has been largely based on studies with lengthy reporting intervals. Using an ecological momentary assessment approach, the present study examined age differences in several characteristics of social interactions as reported in near-real time: the frequency, quality, and partner type. Participants (N = 173) ages 20-79 years reported their social interactions at 5 random times throughout the day for 1 week. Results revealed that age was associated with higher frequency of interacting with family and lower frequency of interacting with peripheral partners. These age effects, however, became nonsignificant after accounting for contextual factors such as race, gender, education, employment status, family structure, and living arrangement. In contrast, a curvilinear relationship best characterized age differences in both positive and negative ratings of daily social interaction quality, with middle-aged adults reporting the lowest positive ratings and older adults reporting the lowest negative ratings among all ages. Contextual factors did not account for these patterns of age differences in interaction quality. Furthermore, the intraindividual variability of interaction frequency with peripheral partners, partner diversity, and interaction quality (positivity and negativity) was lower among older adults than among younger adults. Findings from the present study portray a nuanced picture of social interactions in daily life and advance the understanding of social interactions across the life span. (PsycINFO Database Record

Disclosure and holding back: Communication, psychological adjustment, and marital satisfaction among couples coping with osteoarthritis

This study examined two types of illness-related communication (disclosure and holding back) and their associations with psychological adjustment and marital satisfaction in patients with knee osteoarthritis (OA) and their spouses. A sample of 142 couples reported on disclosure and holding back of OA-related concerns, marital satisfaction, and depressive symptoms at two time points across 1 year. Results from dyadic analyses indicated that holding back was associated with decreases in one's own marital satisfaction for patients and spouses and increases in one's own depressive symptoms for spouses over 1 year. In addition, increases in disclosure were associated with increases in marital satisfaction for patients and spouses over time. Holding back and disclosure did not have significant interpersonal effects on the partner's psychological adjustment or marital satisfaction. These results provide support for the hypothesized intrapersonal effects of disclosure and holding back on marital satisfaction and psychological adjustment over time for both OA patients and their spouses, and highlight the importance of open communication for dyadic coping among couples dealing with chronic illness. (PsycINFO Database Record

Covariation in couples' nightly sleep and gender differences

OBJECTIVES

For most partnered adults, sleep is not an individual-level behavior-it is a shared health behavior with a partner. This study examined whether perceived nightly sleep duration and sleep quality covaried within couples and whether the unique influence of partner sleep on individual sleep differed by gender.

DESIGN

Eight consecutive days of diary data.

PARTICIPANTS

US hotel employees and their spouses/partners (N=76 from 38 couples, 600 daily observations).

MEASUREMENTS

Each day, couples separately reported their previous night's sleep duration (in hours) and sleep quality (1=very unsatisfactory to 5=very satisfactory). Analyses adjusted for sociodemographic, family, work, and day-level characteristics.

RESULTS

Dyadic multilevel modeling revealed positive covariation in nightly sleep duration within couples. After controlling for the effects of contextual covariates, partner influence on individual sleep duration was more apparent in men's sleep. When a female's sleep duration was longer or shorter than usual, their male partner's sleep duration was also longer or shorter than usual, respectively. However, a female's sleep was not significantly predicted by her male partner's sleep duration after taking into account the effects of her sleep on the male partner's sleep and contextual covariates. Sleep quality covaried on average across days between partners, and this association did not differ by gender.

CONCLUSIONS

Our results demonstrate positive covariation in sleep duration and sleep quality within couples. Couples' sleep duration covaried night-to-night, and their sleep quality covaried on average across days. A male's sleep duration is predicted by the female partner's sleep duration but not vice versa. Future research should examine health consequences of couple sleep covariation.

Rest-activity rhythm and sleep characteristics associated with depression symptom severity in strained dementia caregivers

Depression is associated with disturbances to sleep and the 24-h sleep-wake pattern (known as the rest-activity rhythm: RAR). However, there remains a need to identify the specific sleep/RAR correlates of depression symptom severity in population subgroups, such as strained dementia caregivers, who are at elevated risk for major depressive disorder. We assessed the cross-sectional associations of sleep/RARs with non-sleep depression symptom severity among 57 (mean age: 74 years, standard deviation: 7.4) strained dementia caregivers who were currently without clinical depression. We derived sleep measures from polysomnography and actigraphy, modelled RARs using a sigmoidally transformed cosine curve and measured non-sleep depression symptom severity using the Hamilton Depression Rating Scale (HRDS) with sleep items removed. The following sleep-wake measures were associated with greater depression symptom severity (absolute Spearman's correlations ranged from 0.23 to 0.32): more time awake after sleep onset (WASO), higher RAR middle level (mesor), relatively shorter active periods (alpha), earlier evening settling time (down-mesor) and less steep RARs (beta). In multivariable analysis, high WASO and low RAR beta were associated independently with depression symptom severity. Predicted non-sleep HDRS means (95% confidence intervals) in caregivers with and without these characteristics were: normal WASO/beta = 3.7 (2.3-5.0), high WASO/normal beta = 5.5 (3.5-7.6), normal WASO/low beta = 6.3 (3.6-8.9) and high WASO/low beta = 8.1 (5.3-10.9). Thus, in our sample of strained caregivers, greater sleep fragmentation (WASO) and less sustained/sharply segregated resting and active periods (low RAR beta) correlate uniquely with depression symptom severity. Longitudinal studies are needed to establish whether these independent sleep-wake correlates of depression symptoms explain heightened depression risk in dementia caregivers.

Daily Spousal Responsiveness Predicts Longer-Term Trajectories of Patients' Physical Function

Everyday interpersonal experiences may underlie the well-established link between close relationships and physical health, but multiple-timescale designs necessary for strong conclusions about temporal sequence are rarely used. The current study of 145 patients with knee osteoarthritis and their spouses focused on a novel pattern in everyday interactions, daily spousal responsiveness-the degree to which spouses' responses are calibrated to changes in patients' everyday verbal expression of pain. Using couple-level slopes, multilevel latent-variable growth models tested associations between three types of daily spousal responsiveness (empathic, solicitous, and punishing responsiveness), as measured during a 3-week experience-sampling study, and change in patients' physical function across 18 months. As predicted, patients whose spouses were more empathically responsive to their pain expression showed better physical function over time compared with those whose spouses were less empathically responsive. This study points to daily responsiveness, a theoretically rooted operationalization of spousal sensitivity, as important for long-term changes in patients' objective physical function.

Morning self-efficacy predicts physical activity throughout the day in knee osteoarthritis

OBJECTIVE

The purpose of this study was to examine the within-day and cross-day prospective effects of knee osteoarthritis (OA) patients' self-efficacy to engage in physical activity despite the pain on their subsequent physical activity assessed objectively in their natural environment.

METHOD

Over 22 days, 135 older adults with knee OA reported their morning self-efficacy for being physically active throughout the day using a handheld computer and wore an accelerometer to measure moderate activity and steps.

RESULTS

Morning self-efficacy had a significant positive effect on steps and moderate-intensity activity throughout that day, above and beyond the effects of demographic background and other psychosocial factors as well as spouses' support and social control. The lagged effect of morning self-efficacy on the next day's physical activity and the reciprocal lagged effect of physical activity on the next day's self-efficacy were not significant. Positive between-person effects of self-efficacy on physical activity were found.

CONCLUSIONS

Future research should aim to better understand the mechanisms underlying fluctuations in patients' daily self-efficacy, and target patients' daily self-efficacy as a modifiable psychological mechanism for promoting physical activity. (PsycINFO Database Record

The Effects of Lack of Joint Goal Planning on Divorce over 10 Years

Given the negative consequences of divorce on health and well-being, it is important to try to identify its predictors. In the current study we used data from the National Survey of Midlife Development (N = 2801) to examine the longitudinal effects of lack of joint goal planning with a romantic relationship partner on divorce over a 10-year period. Multilevel regression analyses showed that lack of joint planning with the relationship partner was associated with a 19% increase in the odds of divorce, even when controlling for various demographic (i.e., age, gender, relationship length, number of children in the household), individual (i.e., neuroticism, positive affect, negative affect, physical symptoms, planning), and relationship (i.e., marital empathy, partner strain, partner disagreement, marital satisfaction, commitment). These results demonstrate the importance of considering one's partner when making decisions and plans for the future, given that it has clear implications for relationship dissolution.

Activity Restriction and Depressive Symptoms in Older Couples

OBJECTIVE

The present study aimed to clarify the circumstances under which activity restriction (AR) is associated with depressive symptoms among patients with osteoarthritis (OA) and their spouses.

METHOD

A total of 220 older adults with OA and their caregiving spouses participated in the study. The actor-partner interdependence model (APIM) was used to examine the associations between AR stemming from patients' OA and the depressive symptoms of patients and spouses. The potential moderating role of marital satisfaction also was examined.

RESULTS

After accounting for pain severity, health, and life stress of both patients with OA and spouses, higher AR was associated with more depressive symptoms for both patients and spouses. In regard to partner effects, patients whose spouse had higher AR reported more depressive symptoms. In addition, the association of spouses' and patients' AR and their own depressive symptoms was moderated by their marital satisfaction. For both patients and spouses, the associations between their own AR and depressive symptoms were weaker for those with higher levels of marital satisfaction compared with those with lower levels of marital satisfaction.

DISCUSSION

This pattern of findings highlights the dyadic implications of AR and the vital role of marital satisfaction in the context of chronic illness.

Involving Family in Psychosocial Interventions for Chronic Illness

Interactions with close family members have consequences for the emotional and physical well-being of individuals who are dealing with a chronic physical illness. Therefore, inclusion of a close family member in psychosocial interventions for chronic illnesses is a logical treatment approach that has the potential to boost the effects of intervention on the patient and also benefit the family member. However, randomized, controlled studies indicate that such family-oriented interventions generally have small effects. The efficacy of these treatment approaches might be enhanced by targeting specific interactions that emerging research identifies as promoting or derailing healthy behaviors and by better incorporating strategies from family caregiver interventions. In addition, family-oriented interventions should be more fully evaluated, by assessing the benefits for both patients and family members. Future research in this area can tell us much about how and when to involve family in treatment of specific chronic illnesses and, in turn, may inform conceptual models of the impact of family interactions on health.

Spouse confidence and physical function among adults with osteoarthritis: The mediating role of spouse responses to pain

OBJECTIVE

This study of adults with osteoarthritis and their spouses examined spouse responses to patients' pain as mediators of the associations between spouse confidence in patients' ability to manage arthritis and improvements in patients' physical function and activity levels over time.

METHOD

Participants were 152 older adults with knee osteoarthritis and their spouses. In-person interviews were conducted with patients and spouses (separately) at 3 time points: baseline (Time[T] 1), 6 months after baseline (T2), and 18 months after baseline (T3). At each time point, patients reported their self-efficacy for arthritis management, functional limitations, and time spent in physical activity; spouses reported their confidence for patients' arthritis management and their empathic, solicitous, and punishing responses to patients' pain. Multiple mediation regression models were used to examine hypothesized associations across 2 distinct time frames: 6 months (T1-T2) and 12 months (T2-T3).

RESULTS

Across 6 months, spouse confidence was indirectly related to improvements in patients' functional limitations and activity levels through increased empathic responses to patient pain. Across 12 months, spouse confidence was indirectly related to improvements in patients' functional limitations and activity levels through decreased solicitous responses to patient pain.

CONCLUSIONS

This study adds to the literature on spousal influences on health by identifying 2 spouse behaviors that help to explain how spouse confidence for patients' illness management translates into improvements in patients' physical health over time. Findings can inform the development of couple-focused illness management interventions aiming to increase the positive influence of the spouse on patients' health behaviors and outcomes. (PsycINFO Database Record

Patient and Partner Experiences With Obstructive Sleep Apnea and CPAP Treatment: A Qualitative Analysis

Few studies have investigated factors associated with continuous positive airway pressure (CPAP) treatment for sleep apnea from the patients' and their partners' perspective. This qualitative research study explored patients' and partners' experiences of CPAP and facilitators and barriers to CPAP use, and elicited suggestions for a first-time CPAP user program. Data from 27 participants were collected via four sleep apnea patient and four partner focus groups. Qualitative content analysis identified five themes: knowledge of sleep apnea, effects of sleep apnea, effects of CPAP, barriers and facilitators of CPAP, and ideas for a new user support program. Patients and partners emphasized the importance of partner involvement in the early CPAP treatment period. These data suggest consideration of a couple-oriented approach to improving CPAP adherence.

COMT and OPRM1 Genotype Associations with Daily Knee Pain Variability and Activity Induced Pain

BACKGROUND

Osteoarthritis (OA) of the knee is a common and increasingly prevalent condition that is one of the primary causes of chronic pain. Staying physically active protects against disability from knee OA but is also very challenging. A critical but unexamined question is whether patients at greatest risk for becoming less active are those with a genetic predisposition for greater sensitivity to daily pain.

AIMS

We examined day-to-day variability in knee OA pain for patients with different variants of catechol-O-methyltransferase (COMT) and mu-opioid receptor (OPRM1) single nucleotide polymorphisms (SNPs), and whether patients with a specific genotype experience more pain following daily physical activity. We predicted that patients having one or more copies of the Met158 allele of COMT rs4680 (A-A or A-G) and one or more copies of the Asp40 allele of OPRM1 rs1799971 (A-G or G-G) would show greater pain variability. We expected to see the same pattern for these SNPs with regard to moderation (i.e., exacerbation) of the activity-pain association.

METHODS

A total of 120 knee OA patients reported on their pain 3 times per day over 22 days using handheld computers, and wore an accelerometer to capture daily physical activity. Multilevel modeling was used to examine the magnitude of within-person variability in pain by genetic group. We also examined whether lagged, within-patient associations between level of activity in the afternoon (i.e., minutes of moderate intensity activity, and number of steps) and knee pain at the end-of-day were moderated by between-patient differences in genotype.

RESULTS

Regarding OPRM1 rs1799971 (Asn40Asp), patients with two copies of the Asn40 allele showed the greatest day-to-day pain variability. Regarding COMT rs4680 (Val158Met), patients with the Val/Val genotype showed the greatest pain variability and also experienced the greatest increase in pain as a result of physical activity. A similar pattern of findings across bi-directional temporal lags was consistent with a negative feedback loop between daily physical activity and pain according to genotype. Consistent with some previous studies, there were no significant between-person differences in daily pain when comparing patients according to COMT rs4680, or OPRM1 rs1799971.

CONCLUSION

This study provides preliminary evidence that patients with certain genotypes for COMT rs4680 and OPRM1 rs1799971 (G-G and A-A, respectively) experience more variability in their day-to-day pain and exacerbation of pain after daily physical activity compared to patients with other genotypes. Our findings should be replicated in larger study populations.

IMPLICATIONS

Previous clinical research has focused primarily on differences in average level of pain between patients with and without a specific genotype. Assessment of within-person variability through repeated measurements in daily life enhances the reliability, power, and ecological validity of phenotypic measurement.

The effects of daily mood and couple interactions on the sleep quality of older adults with chronic pain

We examined the effect of daily negative and positive mood on the sleep quality of knee osteoarthritis (OA) patients (N = 152) and whether a partner's daily responses to a patient's pain behaviors moderated these associations. Patients and their partners completed a baseline interview and 22 daily diary assessments. After controlling for demographic characteristics, OA severity, comorbidities, medication use, relationship satisfaction, and depressed mood, multilevel modeling analyses demonstrated main effects of negative and positive mood on sleep quality indicators. Mood and partner responses interacted such that high solicitous and punishing responses strengthened the association between negative mood and worse sleep. Further, high solicitous responses increased the degree of association between low positive mood and poor sleep, and empathic responses combined with positive mood were associated with better sleep. Results demonstrate that daily negative and positive mood fluctuations can interact with partner responses to affect sleep quality among older adults with chronic pain.

Effects of change in arthritis severity on spouse well-being: The moderating role of relationship closeness

The severity of a patient's illness may be detrimental for the psychological well-being of the spouse, especially for those in a particularly close relationship. Using 2 waves of data collected from a sample of 152 knee osteoarthritis (OA) patients and their spouses, we examined associations between change in patients' illness severity and change in 3 indicators of spouses' well-being (positive affect, depressive symptoms, and life satisfaction) over a 6-month period. We also tested the hypothesis that spouses' perceived relationship closeness with the patient would moderate these associations. Consistent with our prediction, a high level of relationship closeness exacerbated the negative impact of increases in patient illness severity on spouses' positive affect and depressive symptoms over 6 months. Spouses' life satisfaction declined when patients became more ill, regardless of level of relationship closeness. Our findings highlight the value of examining change in illness as a predictor of change in spouse well-being and the potential downside of relationship closeness for couples living with chronic illness.

The role of social networks in adult health: introduction to the special issue

The goal of this special issue is to highlight recent research examining the role of social networks in adults' physical health.

The personal importance of being independent: associations with changes in disability and depressive symptoms

OBJECTIVE

This study examined the role of independence centrality (the personal importance of being functionally independent) in adapting to functional disability in persons with spinal cord injury (SCI). We assessed how changes in disability related to changes in depressive symptoms, the association between independence centrality and depressive symptoms, and the role of independence centrality in moderating the association between changes in disability and changes in depressive symptoms.

METHOD

Using data from a randomized controlled trial, we focused on 173 survivors of SCI who completed baseline and 12-month follow-up measures of independence centrality, disability (activities of daily living and instrumental activities of daily living needs), and depressive symptoms.

RESULTS

Consistent with our predictions, increased disability was related to increased depressive symptoms, and higher independence centrality was associated with more depressive symptoms at baseline. Consistent with the life span theory of control, SCI survivors with high independence centrality experienced more depressive symptoms when disability increased, but less depressive symptoms when disability decreased. Survivors of SCI with low independence centrality were less affected by changing levels of disability.

CONCLUSION

Persons with SCI with high independence centrality have higher levels of depressive symptoms and are more responsive to changes in functional status. Given the functional status trajectories of survivors of SCI, having low independence centrality may be adaptive because it facilitates disengagement from unattainable goals.

Caregiver attributions for late-life depression and their associations with caregiver burden

Late-life depression (LLD) has detrimental effects on family caregivers that may be compounded when caregivers believe that depressive behaviors are volitional or within the patient's capacity to control. In this study we examined three person-centered caregiver attributions that place responsibility for LLD on the patient (i.e., character, controllability, and intention), and the impact of such attributions on levels of general caregiver burden and burden specific to patient depressive symptoms. Participants were 212 spouses and adult children of older adults enrolled in a depression treatment study. Over one third of caregivers endorsed character attributions, which significantly predicted greater levels of both general and depression-specific burden. Intention attributions were significantly associated with general burden, but not depression-specific burden. Contrary to our expectation, controllability attributions did not predict either type of burden. Our findings suggest that the assessment of family caregiver attributions for LLD may be useful in identifying caregivers at risk for burden and subsequent health effects, as well as those who may need education and support to provide effective care to a vulnerable population of older adults.

Daily verbal and nonverbal expression of osteoarthritis pain and spouse responses

The current study applied a model of pain communication to examine the distinction between verbal and nonverbal pain expression in their prediction of punishing, empathic, and solicitous spouse responses to patient pain. It was hypothesized that on days when patients engaged in more nonverbal expression, spouses would respond more positively (ie, with less punishing and more solicitous and empathic behavior). The same pattern was predicted for verbal expression. In addition, it was expected that associations between patient nonverbal pain expression and positive spouse responses would be strengthened, and that the association with punishing responses would be weakened, on days when levels of verbal pain expression were higher than usual, regardless of daily pain severity. In a 22-day diary study, 144 individuals with knee osteoarthritis and their spouses completed daily measures of pain expression, spouse responses, health, and affect. The predicted positive main effect of nonverbal expression on empathic and solicitous responses was supported by the data, as was the positive main effect for verbal pain expression. Results from moderation analyses partially supported our hypothesis in that patients' nonverbal pain expression was even more strongly related to empathic and solicitous spouse responses on days of high verbal pain expression, and patients were buffered from spouse punishing responses on days when both nonverbal and verbal expression were high. These findings suggest that pain expression in both verbal and nonverbal modes of communication is important for positive and negative spousal responses.

Magnitude and causes of bias among family caregivers rating Alzheimer disease patients

OBJECTIVE

Family caregivers generally underestimate the health and well-being of Alzheimer disease (AD) patients when compared to patients' self-assessments. The goals of this study were to identify caregiver, patient, and contextual factors associated with caregiver rating bias.

METHODS

One hundred five patients with AD, along with their family caregivers, were assessed twice by trained interviewers 1-year apart. In separate interviews, caregivers were asked to rate the quality of life and suffering of their patient relative, and patients provided self-ratings using the same structured instruments. Multivariate cross-sectional and longitudinal analyses were used to identify predictors of caregiver-patient discrepancies.

RESULTS

Caregivers consistently reported significantly higher levels of suffering and lower levels of quality of life than patients. Caregiver psychological well-being and health status accounted for a substantial portion of the difference in caregiver and patient ratings in both cross-sectional and longitudinal analyses. Caregiver depression and burden were consistently positively associated with the magnitude of caregiver-patient discrepancy, and caregiver health status was negatively associated with the size of the discrepancy.

CONCLUSIONS

Caregiver assessments of dementia patients may determine the type and frequency of treatment received by the patient, and caregivers' ability to reliably detect change in patient status can play a critical role in evaluating the efficacy of therapeutic interventions and pharmacologic agents. Clinicians and researchers working with dementia patients who rely on caregiver reports of patient status should be sensitive to the health and well-being of the caregiver and recognize that caregiver assessments may be negatively biased when the caregiver's own well-being is compromised.