"WOOP is my safe haven": A qualitative feasibility and acceptability study of the Wish Outcome Obstacle Plan (WOOP) intervention for spouses of people living with early-stage dementia

OBJECTIVES

As symptoms emerge and worsen in people living with dementia, their spouses can benefit from behavioral interventions to support their adjustment as a care partner. The Wish Outcome Obstacle Plan (WOOP) intervention improves the well-being of spouses of people living with dementia early in the disease course, but intervention mechanisms and opportunities for improvement are unclear. The present study gave voice to spouses who participated in a trial of WOOP, describing how WOOP was incorporated into their lives and how it could be improved for future implementation.

METHOD

For this qualitative study, we conducted longitudinal semi-structured interviews among 21 spouses of people living with dementia (three interviews over three months; 63 interviews total). Codebook thematic analysis was performed.

RESULTS

Three meta-themes were derived: (1) assessing baseline strengths and limitations of WOOP, (2) learning from experience, and (3) fine-tuning and sustaining WOOP. Participants described how WOOP addressed their interpersonal and emotional stressors, their responses to behaviors of the person living with dementia, and their relationship quality. Considerations for future intervention delivery (e.g., solo vs. in group settings) and instructions (e.g., encouraging writing vs. thinking through the four steps of WOOP) were identified as areas of improvement.

CONCLUSIONS

WOOP was described as a practical, feasible, and desirable intervention for spouses at the early stages of their partner's dementia. Participants made WOOP easier to incorporate in their everyday lives by adapting the design into a mental exercise that they used as needed. Suggestions from participants specified how to make the everyday use of WOOP more feasible, sustainable, and applicable in a variety of contexts.

TRIAL REGISTRATION

ClinicalTrials.gov HIC 2000021852.

An integrated model: marital effect on adolescent behavioral problems through siblings

Introduction

Few studies have simultaneously focused on the effects of marital conflict and marital intimacy on adolescent development, and little is known about the role of sibling relationships. Thus, this study examined the association between marital relationships and adolescent behavioral problems, including depressive symptoms and aggressive behavior. At the same time, we explored the mediating role of sibling hostility and sibling affection and the moderating effect of birth order in multichild families in China.

Methods

Participants included 842 adolescents (Mage = 12.60, 46.2% boys) from Henan Province. Marital relationship, sibling relationship, birth order, depressive symptoms and aggressive behavior were assessed by a self-administered questionnaire. SEM was then used to examine the role of sibling relationships and birth order in the association between marital relationship and adolescent behavioral problems.

Results

Our results showed that marital intimacy was negatively correlated with depressive symptoms and aggressive behavior, while marital conflict was positively correlated with them. Marital intimacy was associated with depressive symptoms and aggressive behavior through both sibling hostility and sibling affection. Marital conflict was indirectly associated with depressive symptoms and aggressive behavior through sibling hostility. In addition, the first-born adolescents were more sensitive to marital intimacy.

Discussion

Given that the occurrence of adolescent behavioral problems is more common in contemporary society, our findings suggest that establishing a more intimate and warmer family atmosphere and promoting positive interactions between siblings may help control adolescent mental health problems.

Development and psychometric properties of the Couple Interaction Pattern Scale

This study developed the Couple Interaction Pattern Scale (CIPS) based on the interpersonal theory, comprising five subscales: friendly complementary (FC), hostile complementary (HC), mutual hostile-dominant (MHD), friendly-dominant eliciting hostile-submissive (FDHS), and hostile-dominant eliciting friendly-submissive (HDFS). The psychometric properties of the CIPS were examined through three independent studies. Study one conducted item reduction and preliminary analysis using a sample of 662 married individuals, with an additional 80 married individuals for test-retest reliability assessment. Study two validated the scale through 1207 married individuals. In study three, the effect of couple interaction pattern (CIP) on marital quality was analyzed among 310 newlywed couples using the actor-partner interdependence model (APIM). Results supported the construct validity, acceptable internal consistency, and test-retest reliability of the CIPS. Besides, concurrent validity was also proved by associations with conflictual communication patterns, marital quality, stability, emotional connection, and perceived partner support. APIM analysis also supported the association between CIP and marital quality.

How men with alcohol use disorder perceive communication, couple satisfaction, relational boredom, and quality of life compared to wives: Findings from a hospital-based study

In India, use of alcohol between 10 and 70 years is increasing significantly as per the Government of India, Ministry of Social Justice & Empowerment. Chronic alcohol use in men can potentially disrupt their relationships with their wives in several ways, leading to poor communication, trust issues, emotional disconnection, physical abuse, financial strain, and neglecting responsibilities. These factors may reduce the quality of life of the couple and negatively impact the couple's overall well-being. This cross-sectional study assesses the communication, couple satisfaction, relational boredom, and quality of life of wives with alcoholic husbands admitted to inpatient psychiatry services (patients: n = 30; wives: n = 30). A social demographic data sheet, self-perceived communication in couples, couple satisfaction, relational boredom scale, and the World Health Organization's quality of life scales were used to collect data. All participants were chronic alcohol users and had used alcohol for over 10 years. The mean scores of couple satisfaction (p < .001) and quality of life were greater among husbands. In contrast, wives scored significantly higher in communication (p < .001) and relational boredom (p < .001) compared to husbands with alcohol use disorder. Furthermore, communication, couple satisfaction, relational boredom, and quality of life domains were negatively correlated (p < .001). In contrast, communication and relational boredom were positively correlated (p < .001). Men with alcohol use disorder perceived a satisfactory relationship and higher quality of life than did their wives.

Evaluation of a pregnancy programme to enhance older primiparas' physical and mental health and marital relationships after childbirth: A non-randomized clinical trial

AIM

This study evaluated a pregnancy programme designed by us to stabilize older primiparas' physical and mental health and strengthen their marital relationships.

DESIGN

A non-randomized controlled trial study of two groups; an intervention and control group.

METHODS

Ultimately the scores of 15 participants assigned to an intervention group and 15 assigned to a control group were analysed. Participants responded to sociodemographic questions, the Edinburgh Postnatal Depression Scale (EPDS), a postpartum physical fatigue questionnaire, wives' satisfaction with husbands' support questionnaire and Quality Marriage Index (QMI). Data were collected during pregnancy and at one and 3 months after childbirth.

RESULTS

The participating wives' EPDS scales significantly decreased after the postpartum course in the intervention group. Participating in the programme significantly raised husbands' awareness of their wives' physical burdens 1 month after childbirth. The subscale 'housework support/wives' satisfaction with husbands' support', 3 months after childbirth, did not decline. It is suggested that this programme could strengthen marital relationships because the husbands' understanding of their spouses' physical burdens after childbirth led to an improvement in the wives' satisfaction with their spouses' housework support. Participation in the pregnancy programme may strengthen the marital relationship. This study recommends appropriate nursing support for pregnant couples to improve their physical and mental health.

[Association between father's involvement with his wife/partner during pregnancy and father-to-infant bonding failure]

Objectives　Bonding failure is lack of parental emotional relationship between a parent and their infant. This study aims to investigate the association between father's involvements with their partner during pregnancy.Methods　A total of 1,957 partners of pregnant women who had visited three maternity hospitals in Sapporo from May 2016 to December 2017 were included in the study. Self-administered questionnaires were distributed to participants at 2,435 weeks gestation and at 6-8 weeks postpartum. The fathers who responded to both the questionnaires were included in the analysis. The participants' relationship with their partners during pregnancy was rated using two questions- whether they help their partner with personal care and household chores, and whether they consult with their partner. Answers for both questions were given on a scale of 0 to 4. A total score of 6-8 points was defined as a high-score group, 3-5 points as a mid-score group, and 0-2 points as a low-score group. Bonding failure was evaluated using the Japanese version of the Mother-Infant Bonding Scale (MIBS-J). The cut-off value was the score that included the top 10% with the highest degree of bonding disorder. A logistic regression was used to analyse the association between involvement with a partner during pregnancy and bonding failure. The confounding variables were father's age, household income, father's average working hours, previous pregnancy, history of abortion/a stillbirth/the death of the child, and partner's prepartum depression during pregnancy.Results　391 fathers responded to the initial questionnaire, and 86.4% of them filled out the second questionnaire up to 2 months postpartum, 10.6% up to 3 months, 2.5% up to 4 months, and 1.0% up to 5 months. Of these, 375 were included, excluding those with missing questionnaire items. 255 fathers were in the high score group of the involvement with partner during pregnancy, 48 had bonding failure, 35 had LA, and 17 had AR. The OR based on the high score group of involvement with partner during pregnancy for bonding failure was 4.81 (1.88-12.33) for mid-score group, and 6.89 (1.40-33.93) for low-score group, and for LA, 2.21 (0.97-5.04) for mid-score group, and 6.40 (1.54-26.68) for low-score group; however, AR showed no respectively significant association (trend P 0.0005, 0.0053, 0.6859).Conclusions　The results suggest that a father's unfavorable involvement with his partner affects the bonding with their infant. This suggests that involvement with a partner during pregnancy is an important factor in preventing bonding failure in fathers.

Theory of brain complexity and marital behaviors: The application of complexity science and neuroscience to explain the complexities of marital behaviors

The extant theories on the quality and stability of marital relationships have some difficulties in explaining some of the complexities of marital behaviors. The present article is an initial attempt to explain the complexities of marital behaviors based on the science of complexity and neuroscience. This article proposes a new theoretical framework relying on this simple argument that marital behaviors, as one of the most complex human behaviors, are the product of one's brain's complex adaptive system (CAS). Hence, to understand the complexities of marital behaviors, a movement toward familiarity with the brain's CAS involved in marital behaviors needs to be started. The article presents the theory of brain complexity and marital behaviors (BCM) and outlines its assumptions, concepts, and propositions. Then, BCM is compared with the extant theories on happy and stable marriage, and finally, it was concluded by discussing the testability and the potential application of the theory. This article might inspire interdisciplinary studies of marital relationships, complex systems, and neuroscience and may have considerable practical implications.

Sexual dysfunction, depression, and marital dissatisfaction among Brazilian couples

BACKGROUND

Health professionals treating sexual dysfunction and relational dissatisfaction recognize that they are multifactorial phenomena, and depression can be bidirectionally associated with both.

AIM

The purpose of this study was to investigate sexual dysfunction in heterosexual couples in relation to the quality of their marital relationship and depression symptoms.

METHODS

The sample consisted of 100 heterosexual couples recruited in Brazil. Both partners of each couple completed the Golombok-Rust Inventory of Sexual Satisfaction and the Golombok-Rust Inventory of Marital Satisfaction, which were translated and adapted, and the Beck Depression Inventory, which was validated for the Brazilian population. Both partners completed their questionnaires separately, and the couple's surveys were linked to preserve conjugal data for dyadic analysis. The Actor-Partner Interdependence Model was used to understand how sexual dysfunction in couples is related to depression and relationship quality among and between partners.

RESULTS

Sexual dysfunction was found to be strongly associated with dissatisfaction in the relationship (husbands, β = 0.57, P < 0.001; wives, β = 0.60, P < 0.001), and a positive association was found between depressive symptoms and marital dissatisfaction (husbands, β = .32, P < .001; wives β = .40, P < .001).

CLINICAL IMPLICATION

The results suggest that it is important for health professionals to be aware of the dyadic impact of struggles with both sex and the relationship and the presence of depression symptoms in patients who seek care for sexual complaints or depression and who are in a marital relationship.

STRENGTHS AND LIMITATIONS

The different results found for men and women may shed light on the biopsychosocial dimensions of human sexuality. When treated as a purely physical experience, sex is myopic. In this study we demonstrated psychosocial aspects associated with gender and sexuality, and the partner's variables were found to have a greater impact on women than they did on the men. A limitation of this study is that the sample is not generalizable as it is not demographically representative of all socioeconomic groups in Brazil. Furthermore, the participants in this sample did not have clinical levels of depression, so the results cannot be extended to couples in which one or both spouses have depressive disorder.

CONCLUSION

It was found that sexual dysfunction is strongly associated with the quality of the couple relationship, and that the quality of relationship plays a mediating role between depression and marital quality, especially for the women.

A Systematic Review of the Correlation Between Marital Relationship and Breastfeeding Self-Efficacy, and Duration of Breastfeeding

Background: Breastfeeding as an important key to sustainable development strategies is the best nutrition for ensuring healthy growth and development in the first 1,000 days of life. Objective: The current systematic review and meta-analysis were conducted to evaluate the correlation between marital relationship satisfaction and breastfeeding self-efficacy and duration of breastfeeding. Method: A systematical search was carried out in main electronic databases (PubMed, Scopus, Embase, ProQuest, and Web of Science) and gray literature until June 2022. The study's risk of bias was assessed using the Newcastle-Ottawa risk-of-bias tool. Publication bias was evaluated using a funnel plot, and Begg's and Egger's tests. The degree of heterogeneity was assessed using the I² test. To estimate common effect size r coefficient (r) and confidence intervals (95% CIs), random-effect models were fitted, and the results were presented using forest plots. Results: In total, 13 studies with 5,843 subjects were included in the meta-analysis. Overall, the pool estimates show a positive correlation between marital relationship satisfaction, and breastfeeding self-efficacy (r = 0.27, 95% CI (0.09-0.50), p = 0.024), but this relationship was not found in the term of breastfeeding duration (r = 0.11, 95% CI [-0.01 to 0.23], p = 0.079). The heterogeneity of studies was high (I² = 95.2%) Conclusion: Our finding confirms a positive and moderate level of correlation between marital relationship satisfaction and breastfeeding self-efficacy. It is suggested to conduct more studies to reach appropriate conclusions regarding marital relationship satisfaction and breastfeeding duration.

[Associations between Maternal Postpartum Depression and Psychosocial Factors Including Marital Relationship and Social Support]

OBJECTIVES

We aimed to investigate the psychosocial factors for postpartum depression as indicated by a high score of the Edinburgh Postnatal Depression Scale (EPDS), including marital relationship and social support. Relevant factors for antenatal depression were also analyzed.

METHODS

Thirty-five wife-and-husband pairs who visited University Hospital A for the wife's antenatal health check-up participated in a questionnaire survey using the Japanese version of the EPDS. Social support from the wife's husband, kins, and others including friends at the third trimester of pregnancy and 1 month after birth was assessed. The Marital Love Scale (MLS) was also used, and two marital relationship questions were asked regarding the husband's and wife's considerate actions toward each other during pregnancy. Binary logistic regression analysis was conducted to determine adjusted associations between higher EPDS scores (≥5 for postpartum depression and ≥7 for antenatal depression) and indicators for social support and marital relationships.

RESULTS

The most relevant factor for higher postpartum EPDS scores was a higher antenatal EPDS score, followed by the couple's poor communication skills (the wife did not feel any appreciation from her husband) during pregnancy and no support from the wife's husband during the postpartum period. The wife's poor marital communication skills and the husband's low MLS scores during pregnancy were associated (borderline significance) with the wife's higher antenatal EPDS scores.

CONCLUSIONS

A good marital relationship before birth and support by the husband after birth may be important for preventing postpartum depression.

Association between infertility factors and perceived relationship quality in infertile couples

BACKGROUND

Infertility is a crisis in the life of couples that could affect their relationships. The present study was conducted to evaluate the relation between infertility factors and the quality of marital relationship in infertile couples who were referred to the Fertility and Infertility Center of Isfahan.

MATERIALS AND METHODS

The present study was conducted cross-sectional on 131 infertile couples who were referred to the Fertility and Infertility Center of Isfahan and had the inclusion criteria and were selected using convenient sampling method. Data gathering tool for the present study was Perceived Relationship Quality Components (PRQC). All the data were analyzed using SPSS software version 21. Analysis was conducted using descriptive and inferential statistics (independent t-test and one-way analysis of variance). The level of significance was set at 0.05 for all the statistical tests.

RESULTS

The mean score of PRQC for women and men was 84.05 and 88.46, respectively, and their difference was statistically significant. There was a significant relation between the score of PRQC in women (P = 0.028) and men (P = 0.030) with the infertility factor. Results showed that the mean score of perceived quality of different aspects of the marital relationship was significantly lower when the infertility factor was female (P < 0.05). In women aspects of "satisfaction" (P = 0.024) and "commitment" (P = 0.011) and in men aspect of "love" (P = 0.004) from the perceived aspects of relationship had a significant relation with the infertility factor.

CONCLUSIONS

Perceived quality of different aspects of marital relationship had a significant relation with infertility factor in infertile couples. Results of the present study showed that when infertility had female causes, the quality of relationship was more affected. Therefore, in infertility counseling, simultaneous counseling for both spouses with emphasis on women, along with treatments, should be considered.

The Impact of Neurogenic Lower Urinary Tract Symptoms and Erectile Dysfunctions on Marital Relationship in Men with Multiple Sclerosis: A Single Cohort Study

Aims: Multiple sclerosis (MS) is an autoimmune and neurodegenerative disease that is characterized by a great variety symptoms. Most MS patients suffer from neurogenic lower urinary tract symptoms (nLUTS) and erectile dysfunctions (ED). The aim this study is to assess the impact of nLUTS and ED on marital relationships in MS patients. Materials and Methods: MS male patients that arrived for our attention were prospectively enrolled in the study. All of the patients were evaluated on an Expanded Disability Status Scale (EDSS), an IIEF-5 for sexual function, an ICIQ-MLUTS for urinary function, and a Dyadic Adjustment Scale (DAS) for marital relationships. The data were analyzed using descriptive and inferential statistical tests in STATA/MP14. Results: The data of 57 male MS patients were eligible. The mean age was 45 (13.7) years, the mean disease duration was 15.49 (7.86) years, and the mean EDSS score was 3.5 (1.89). In total, 33 (57.89%) MS patients reported urine incontinence, of those, 24 (42.11%) reported UUI. The mean DAS score was 74.40 (34.58). The mean IIEF-5 score was 12.40 (8.05). The mean ICIQ-MLUTS score was 71.94 (41.06). The DAS and ICIQ-MLUTS scores were negatively correlated (r = −0.30, p < 0.001). The DAS and IIEF-5 were moderately correlated (r = 0.47, p < 0.001). The DAS and EDSS were strongly correlated (r = −0.72, p < 0.001). A univariate analysis showed that increasing age (p < 0.001), a longer disease duration (p = 0.029), a higher EDSS score (p < 0.001), and a higher ICIQ-MLUTS score (p < 0.001) were all significantly associated with lower DAS scores. Conclusions: This study demonstrated the large negative impact that nLUTS and ED due to MS have on patients’ marital relationships, highlighting the importance of a multidisciplinary approach in MS patients.

Pathways from economic hardship to couple conflict by socioeconomic status during COVID-19 in Korea

Objective

The purpose of this study was to examine the direct and indirect relationships among economic hardship, economic strain, emotional stress, and couple conflict for married Koreans during the COVID-19 pandemic. In particular, we investigated whether these pathways were different between lower and higher socioeconomic status (SES) groups.

Background

Due to the global economic downturn brought on by COVID-19, many couples experienced economic hardship including increased household debt, job loss, and reduced work hours. This context provides a valuable opportunity to test the family stress model (FSM) of romantic relationships, which explains the indirect pathways from economic hardship to couple-level outcomes.

Method

We collected the data using an online survey in May 2020, when the Seoul metropolitan area experienced the first surge of COVID-19 cases. The sample came from 605 married Korean adults (282 women, 323 men) and was analyzed using multigroup path analysis.

Results

Among the three markers of economic hardship, increased household debt had a stronger association with couple conflict for lower SES respondents directly and indirectly through elevated economic strain and emotional distress. The total effects of job loss and reduced work hours on more frequent couple conflict were stronger for the higher SES group.

Conclusion

The process from the three markers of economic hardship to couple conflict was different depending on socioeconomic resources.

Implications

Family practitioners need to consider SES variations and to work with financial counselors to better support couples with both economic and relationship difficulties.

The marital relationship and health-related quality of life of prostate cancer patients and their spouses: A prospective, longitudinal study

AIMS

This study aims to measure any changes in the marital relationship during the first year after a diagnosis of prostate cancer, identify the demographic characteristics that influenced such changes, and measure changes related to health-related quality of life (HRQoL).

BACKGROUND

Knowledge is limited on the impact of a diagnosis of prostate cancer on the marital relationship and HRQoL of patients and their spouses.

DESIGN

A 1-year longitudinal study.

METHODS

Data were collected from five Finnish hospitals between October 2013 and January 2017. Of the 350 recruited couples (N = 700), 179 patients and 166 spouses completed the Marital Questionnaire and the RAND 36-Item Health Survey 1 year after diagnosis.

RESULTS

No major changes were found in the marital relationship during the follow-up period. The spouses reported statistically significant changes in their marital relationships, but the patients did not. Furthermore, changes in the marital relationship were not associated with the patients' HRQoL. Among spouses, emotional well-being was associated with changes in the marital relationship.

CONCLUSION

The marital relationship was relevant in terms of the spouses' HRQoL during the first year after a diagnosis of prostate cancer. Nurses and other healthcare providers should assess counselling and support provided to spouses individually.

The experience of being a spouse of a person with dementia in respect to their marital relationship in Japan

BACKGROUND AND PURPOSE

While the marital relationship with partners with dementia has an impact on spousal carers' well-being, the spousal understandings or expectations of their marital relationship have not been fully identified. As the marital relationship is formed by individual backgrounds including society, culture and psychological status, the aim of this study was to identify the experience of being the spouse of a person with dementia in the context of their marital relationship. The study was conducted in Japan.

RESEARCH DESIGN

To identify spousal experience of being, Heideggerian perspectives of interpretive phenomenology were applied.

STUDY SAMPLE

Seven couples aged over 65 years, each comprising one partner with dementia who received home nursing, and their spouse participated in this study.

DATA COLLECTION

The couples were observed, and semi-structured interviews were conducted.

DATA ANALYSIS

Interpretive data analysis based on the Hermeneutic circle of Heideggerian perspectives was applied.

RESULTS

In the findings, the experience of being a spouse, contextualised by spousal understandings of marital relationship, was formed through seven themes. The main context for spousal understanding of their marital relationship was helping each other as husband and wife, and this relationship was seen as natural and unchanging. It reflected on spousal potentiality of being, that is, living together indefinitely as before. Spouses tried to provide suitable care for their partners using memories while preserving a sense of identity, maintaining external relationships and accepting unanticipated internal responsibility.

CONCLUSIONS

In conclusion, fulfilling unmet needs could help spouses to ease intense care load, which re-acknowledges their own and their partner's identity, and their relationship by reminiscing their past.

Not All Daydreaming Is Equal: A Longitudinal Investigation of Social and General Daydreaming and Marital Relationship Quality

Preliminary evidence suggests that daydreaming about other people has adaptive value in daily social lives. To address this possibility, we examined whether daydreaming plays a role in maintaining close, stable relationships using a 1-year prospective longitudinal study. We found that individuals' propensity to daydream about their marital partner is separate to general daydreaming. In contrast to general daydreaming, which was associated with lower subsequent relationship investment size (i.e., magnitude and importance of resources attached to a relationship) in the marital partner, partner-related social daydreaming led to a greater subsequent investment size. Additionally, attachment styles moderated these effects. The effect of daydreaming regarding investment size was found only in securely attached individuals. This research advances the emerging field of social daydreaming and highlights self-generated thought as a critical tool that can help people navigate the complex social world.

Parents in couple therapy: An intervention targeting marital and coparenting relationships

This article describes the treatment framework and core therapeutic principles of the integrative brief systemic intervention (IBSI), a manualized six-session intervention intended for parents seeking couple therapy. IBSI aims to work on the couple's presenting problem, considering its specific impact in the marital and coparenting domains. The basic premise of IBSI is to consider that, when working with couples who have children, therapeutic work on their coparenting alliance may be used as a lever, as both parents may be particularly motivated to improve their relationship for their children's benefit. Increasing the coparenting alliance may then facilitate work on deeper conflicts within the marital relationship. The core therapeutic principles of IBSI are: (1) joining with the couple as romantic partners and a coparenting team from the start of the therapeutic process; (2) supporting the parents in increasing their awareness regarding their children's behavior and emotional experiences when facing their parents' conflicts; and (3) working on the spill- and cross-over effects between marital and coparenting relationships (i.e., exploring how conflict or positivity spills over from one relationship to the other or crosses over from one partner to the other). Therapeutic work following these main therapeutic principles is expected to improve the quality of both relationships. A clinical case is provided to illustrate the core therapeutic principles of IBSI.

Marital Adjustment and Marital Conflict in Individuals Diagnosed with ADHD and Their Spouses

INTRODUCTION

Attention deficit and hyperactivity disorder (ADHD) can cause many problems in adulthood, particularly in close interpersonal relationships and marriage. The aim of this study was to investigate the differences in patterns of the marital relationship between healthy couples and couples with one member previously diagnosed with ADHD.

METHODS

The sample of the study included the ADHD group consisting of 28 couples one of whom was diagnosed with ADHD; and the comparison group consisting of 28 healthy couples who were reached through snowball sampling. All couples had been married for at least one year and their ages range from 22 to 61. Wender Utah Rating Scale, Adults ADHD Self-Report Scale, Marital Conflict Questionnaire, Marital Adjustment Scale, Conflict Resolution Styles Scale in Romantic Relationship, and The Birtchnell Partner Evaluation Scale were used as data collection tools.

RESULTS

Analysis results showed that adults diagnosed with ADHD and their spouses had more unfavorable patterns in their marriages with regard to the level of conflict, marital adjustment, conflict resolution styles, and reciprocal evaluations when compared to the comparison group.

CONCLUSION

ADHD can lead to the termination of marriages when it is not recognized and not treated properly. In consideration of this fact, it is thought that this study will provide information about the recognition of ADHD in adults who apply with especially marital problems and directing them to appropriate treatment.

The Impact of Bipolar Disorder on Couple Functioning: Implications for Care and Treatment. A Systematic Review

If there is an abundant literature on the impact of bipolar illness on the family and/or caregivers of patients, few studies have addressed its impact on marital relationship and couple functioning. Uncovering information relating specifically to this topic may be particularly relevant due to the unusually high divorce rate among individuals with bipolar disorder. We therefore conducted a systematic literature search to evaluate the existing data on bipolar disorder and marital issues, with a special focus on the help and support that can be provided by mental health professionals in this regard. We identified quantitative studies with pre-defined outcomes as well as qualitative investigations trying to understand the experiences of partners. A total of 27 articles were included in the review. The literature was found to capture the impact of bipolar disorder on partners as well as on the marital relationship itself or the children. Bipolar illness has a negative impact on the lives of partners including self-sacrifice, caregiver burden, emotional impact, and health problems. This negative impact can be aggravated by a lack of care and a lack of information from health personnel. The negative impact on the relationship includes volatility in the relationship, stigmatization, dissatisfaction with sexual life, and lower rates of childbearing. Negative impacts are likely to favor disease relapses for the patient. Children may also be negatively impacted. However, the illness may sometimes have positive impacts such as personal evolution, strengthening relationship, or new hope and perspectives. Based on these findings, the interventions of mental health professionals should be aimed at minimizing the negative impacts while favoring the positive ones.

Couple relationship problems-a task for the general practitioner? A cross-sectional survey from Norway

BACKGROUND

A healthy couple relationship is a predictor of good health. There is a lack of knowledge about what role family and couples counselling should have in general practice.

OBJECTIVES

To identify the prevalence of patients who have talked, or want to talk, with their general practitioner (GP) about their couple relationship, to investigate what characterizes these patients and to explore whether they believe that couple relationship problems should be dealt with in general practice.

METHODS

We conducted a cross-sectional survey in 70 general practices in Norway during spring 2019. A questionnaire was answered by 2178 consecutive patients (response rate 75%) in GP waiting rooms. Data were examined using frequencies and linear and logistic regression models.

RESULTS

We included 2097 responses. Mean age was 49.0 years and 61.3% were women. One in four (25.0%) had already talked with their GP about couple relationship problems, while one in three (33.5%) wanted to talk with their GP about their couple relationship problems. These patients more frequently had experience of divorce, poor self-rated health, an opinion that their couple relationship had a significant impact on their health and lower couple relationship quality when adjusted for age, sex, present marital status and children living at home. We found that 46.4% of patients believed that GPs should be interested in their couple relationship problems.

CONCLUSION

Relationship problems are frequently addressed in general practice. GPs should be prepared to discuss this issue to facilitate help for couples earlier than they might otherwise expect.

Relationship communication and the course of psychological outcomes among couples coping with localised prostate cancer

OBJECTIVE

How couples communicate about cancer is an important predictor of psychological outcomes for men diagnosed with localised prostate cancer and their spouses. We examined the predictive role of disclosure, responsiveness, mutual avoidance, and holding back on depressive symptoms, psychological adjustment, cancer-specific distress, and cancer concerns.

METHODS

Eighty-one prostate cancer patients and their spouses completed measures of communication at baseline and measures of four psychological outcomes at baseline, five, 12, and 26 weeks after baseline. Dyadic growth models tested the effects of time and role on each outcome over time.

RESULTS

Higher disclosure and responsiveness predicted better psychological outcomes. Less mutual avoidance and holding back predicted poorer psychological outcomes. Across communication variables, individuals who engaged in poorer communication initially had poorer psychological outcomes that improved over time, whereas individuals who engaged in better communication initially maintained their more positive standing without change or changed in the positive direction. For all outcomes, those with better communication still had better psychological outcomes at six months.

CONCLUSION

Couples' cancer-specific relationship communication predicts their psychological outcomes. More research is needed to identify effective interventions, including a longer therapy course, individual communication training, or greater focus on addressing barriers to sharing and responsiveness.

Similarities in cognitive abilities in older couples: a study of mutual influences

Objective: Similarities between spouses in cognitive functions have been mainly explained by the assortative mating phenomenon and the convergence for age and education. The mutual influence between spouses is another explanation particularly relevant in the elderly population. Today, it remains difficult to determine whether cognitive similarities exclusively result from the convergence effect or from the mutual influence. Using a novel methodology, the present study aimed to assess the impact of the marital relationship on cognitive similarities among elderly couples.Methods: 1723 couples from the Three-City Cohort Study were classified in two groups of couples with homogeneous and heterogeneous age and education. We also constituted two groups of pseudo-couples by a random association of individuals, with homogeneous and heterogeneous age and education. Dyadic analyses were conducted in the four groups, regarding the similarities in lexicosemantic abilities, executive functions, memory and global cognitive functioning.Results: Similarities were found on lexicosemantic abilities both in mate-assorted couples and in couples heterogeneous in age and education but no similarity was found in pseudo-couples.Discussion: Beyond the convergence effect, the fact that the spouses co-construct their lifestyles may contribute to cognitive similarities in the lexicosemantic domain.

Partner relationship quality predicts later postpartum depression independently of the chronicity of depressive symptoms

OBJECTIVE

Given the lifelong implications of extended postpartum depression (PPD), research is needed to examine the social factors implicated in its development (such as relationship quality) and associated predictors. This study sought to examine the association of partner relationship quality (PRQ) and decline of sexual life (DSL) with maternal PPD at 12-15 months after childbirth.

METHODS

Prospective study of 294 low-income postpartum women. A structured questionnaire and the Patient Health Questionnaire-9 (PHQ-9) captured responses for the main outcome variable and covariates.

RESULTS

The prevalence of the main outcome (PPD at 12-15 months) was 19.1%. Using logistic regression models, low PRQ (risk ratio [RR] = 1.58, 95%CI 1.01-2.49) and DSL (RR = 1.97, 95%CI 1.23-3.15) were associated with PPD at 12-15 months even after controlling for perinatal depression.

CONCLUSIONS

Late PPD (12 to 15 months after giving birth) is very common among low-income women, and is independently associated with different aspects of the couple's relationship. Improving PRQ may prevent late PPD. Future investigations are warranted.

Psychosocial Determinants of Marital Satisfaction Among Gynecologic Cancer Survivors in Malaysia

Introduction: Marital issues among gynecologic cancer survivors are common but complex. This study aimed to investigate the relationship between sociodemographic and clinical factors, including sexual dysfunction and marital satisfaction among Malaysian gynecologic cancer survivors. Methods: A cross-sectional survey of married women with gynecologic cancers was conducted at a Malaysian university hospital. Sociodemographic and clinical data were gathered. Sexual dysfunction was measured using the Malay Version Female Sexual Function Index (MVFSFI), while marital satisfaction was evaluated with the Malay Version Golombok Rust Inventory for Marital Satisfaction (MVGRIMS). Results: A total of 116 patients participated in this study. The median age was 59.0 years (Interquartile range, IQR: 49.0-67.0 years); the median duration of marriage was 32 years (IQR: 20.0-40.8 years). 80.2% had a secondary and lower level of education. 37.9% of study subjects (n = 44) reported poor-and below-levels of marital satisfaction, which was equivalent to MVGRIMS transformed scores of >5. The median FSFI total score was 49.9 (IQR: 2.0-63.0). MVGRIMS transformed score correlated significantly with all MVFSFI sub-scores. In logistic regression, lower educational levels were associated with poor marital satisfaction [primary, (adjusted Odds Ratio) aOR = 12.67, 95% CI: 1.40-114.87; secondary: aOR = 11.52, 95% CI: 1.39-95.72], while higher MVFSFI total score reduced the likelihood of poor marital satisfaction (aOR = 0.979, 95% CI: 0.964-0.994). Conclusion: Both sexual dysfunction and low education level may affect marital satisfaction among gynecologic cancer survivors. Targeted efforts focusing on sex education for patients may help to improve marital satisfaction.

The psychosocial impact of premature ovarian insufficiency on male partners and their perceptions of the disease

Premature ovarian insufficiency (POI) is affecting about 1% women of reproductive age. However, current studies have primarily focused on women with the views of male partners greatly absent from the literature. We conduct this research to investigate the psychosocial effect of POI on male partners and their perceptions of the disease.52 male partners of POI patient (experiment group) and 52 controls (control group) were available for analysis. Anxiety, depression, and marital relationship were assessed for male partners in both groups. A questionnaire about perceptions of POI was completed by the experiment group. Male partners of POI patient experienced greater levels of anxiety (10.96 versus 4.88; P < 0.01) and depression (12.23 versus 5.19; P < 0.01) compared with controls. In addition, they experienced worse marital relationship in several aspects than their counterparts. The findings also demonstrate that most POI patient male partners had inadequate and inaccurate knowledge about their partners' disease, which may be the results of insufficient professional counseling from health-care practitioners. Moreover, their understanding level of the disease was correlated to anxiety (r = -0.64; P < 0.01), depression (r = -0.38; P < 0.01), and communication (r = 0.28; P < 0.05).The study highlights the need for health-care services, as well as support and professional information resources aimed at POI patients' male partners.

Evaluation of anxiety, depression and marital relationships in patients with migraine

BACKGROUND AND PURPOSE

The aim of this study was to evaluate the frequency and characteristics of attacks in patients with migraine, to determine the effects of anxiety or depressive symptoms, and to evaluate the marital relationships of patients with migraine.

METHODS

Thirty patients who were admitted to the neurology outpatient clinic of our hospital between July 2018 and October 2018 and were diagnosed with migraine according to the 2013 International Headache Society (IHS) diagnostic criteria were included in this cross-sectional study. Age, sex, headache frequency and severity, depressive traits, marital satisfaction and anxiety status were examined. We used the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Maudsley Marital Questionnaire (MMQ) and Visual Analogue Scale (VAS) for measuring relevant parameters.

RESULTS

The mean severity of migraine pain according to VAS scale was 6.93 ± 1.41 and the mean number of migraine attacks was 4.50 ± 4.24. The mean BDI score of the patients was 12.66 ± 8.98, the mean MMQ-M score was 19.80 ± 12.52, the mean MMQ-S score was 13.20 ± 9.53, the mean STAI-state score was 39.93 ± 10.87 and the mean STAI-trait score was 45.73 ± 8.96. No significant correlation was found between age, number of migraine attacks, migraine duration, migraine headache intensity, and BDI, STAI and MMQ scores (p>0.05). But there was a positive correlation between MMQ-S and scores obtained from the BDI and STAI-state scales (p<0.05).

CONCLUSION

In this study more than half of the migraine patients had mild, moderate or severe depression. A positive correlation was found between sexual dissatisfaction and scale scores of depression and anxiety.

A Comparison of Neurocognitive Decline in Older Adults in Same-Sex and Opposite-Sex Relationships

BACKGROUND

Individuals from sexual minorities experience health inequalities that have detrimental impacts on their health, especially in the elderly, by exacerbating care needs and symptoms of chronic conditions such as Alzheimer's disease (AD). Neurocognitive decline due to AD in the sexual minority population remains under-investigated. However, being in a relationship may mitigate the risk of experiencing cognitive impairment.

OBJECTIVE

The aim of this study was to investigate whether cognitive decline and brain atrophy may differ in people from sexual minorities.

METHODS

Clinical data for this study were selected from the National Alzheimer's Coordinating Center's Uniform Data Set and structural MRI data collected across 14 Alzheimer's Disease Centers. Eighty participants including 20 patients with AD and 20 healthy controls (HC) in same-sex relationships were identified and matched to groups of participants (20 AD and 20 HC) in opposite-sex relationships. The effects of diagnosis and relationship were investigated on all measures.

RESULTS

No diagnosis-by-relationship interactions were found on any variable. However, post hoc analyses revealed that the opposite-sex group had grey matter atrophy mainly in medio-temporal areas. In the same-sex group, atrophy also extended to pre-frontal and cingulate areas. The severity of neuropsychiatric symptoms correlated with volume of pre-frontal and insular/temporal areas only in the same-sex group.

CONCLUSION

Neurocognitive decline due to AD may express similarly across individuals, independently of relationship type, thus suggesting a protective role of relational status. However, the same-sex group appeared to be more likely to experience at least one neuropsychiatric symptom and to have atrophy extending to fronto-limbic areas.

Mexican Immigrant Fathers' Recognition of and Coping with Maternal Depression: The Influence of Meaning-Making on Marital and Co-Parenting Roles among Men Participating in a Family Intervention

Fathers play a critical role in recognizing and responding to maternal depression and providing support to the family during the mothers' illness and recovery. Our study adopted a dualmethod approach consisting initially of sample interviewing with 10 Mexican immigrant fathers, about their partner's depression and recovery, co-parenting, and fathers' coping. Fathers, their partners, and children participated in a family intervention to support the mother's recovery and address the needs of the family. Approximately 12 months from sample interviews and 8 months after the intervention, we conducted in-depth case studies with three of those fathers to explore how their recognition, support, and coping evolved. Results from interviews across time points present fathers' initial and evolving understanding of maternal depression, while a case study example reflects how fathers' recognition of their partners' depression changed, as did their marital and family interactions, as they shifted attribution of their partners' depression from a controllable state to one of illness. Receipt of accurate information about depression increased fathers' recognition of depression and allowed them to expand traditional gender norms to take an active role in supporting their partners and children. Fathers' experiences were not without emotional cost, with many men recounting anxiety, shame, loneliness, and helplessness. This study underscores the importance of including fathers in interventions and research on maternal depression in immigrant families, and it offers recommendations for culturally grounded familyfocused, interventions.

Intrapersonal and interpersonal facilitators of forgiveness following spousal infidelity: A stress and coping perspective

OBJECTIVE

Forgiveness includes processes that involve a decision to stop bitterness and thoughts of revenge (i.e., decisional forgiveness), which further motivates the forgiver towards the restoration of positive emotions (i.e., emotional forgiveness). Using stress and coping framework, this study investigated intrapersonal and interpersonal facilitators of decisional and emotional forgiveness in a Chinese marital context.

METHOD

Participants were 154 respondents who had experienced or were experiencing spousal infidelity.

RESULTS

Solidarity-oriented personality and perceived partner's reconciliation motivation facilitated benign attributions and empathy, then facilitated higher levels of decisional forgiveness, which promoted emotional forgiveness. Strength of marital bond before the infidelity directly predicted higher levels of emotional forgiveness.

CONCLUSIONS

Our findings provide evidence for the differentiated decisional and emotional forgiveness processes after spousal infidelity and delineate different coping mechanism that triggers them, thus lending culturally appropriate evidence for clinicians who work with clients facing spousal infidelity.

Understanding parent-child relationship as a developmental process: Fluctuations across days and changes over years

Toward advancing the understanding of relations among family relationships when children transition into adolescence, this study investigated whether parent-child relationship (PCR) quality assessed at the daily level changed developmentally and/or fluctuated due to daily experiences. Specifically, this study examined (a) whether parents' daily perceptions of marital relationship (MR) quality were associated with their own and/or their partners' PCR on the same day and the following day, and (b) whether relations among these daily influences changed over a 2-year period as children developed. Participants recruited included 237 2-parent families with preadolescent or adolescent children (52% girls). Both fathers and mothers completed daily diaries about MR and PCR for 15 consecutive days each year for 3 consecutive years. Results indicated that daily PCR did not change developmentally but was subject to day-to-day variations based on parents' daily MR: parents' distressed MR was related to their own lower emotional quality in PCR on the same day (supporting the spillover hypothesis), but higher emotional quality in PCR on the next day (supporting the compensatory hypothesis). Compensatory association was also found between father-reported average MR and mother-reported daily PCR. Furthermore, the same-day spillover and cross-day compensatory effects tended to decrease developmentally, as children transitioned into adolescence. The findings illustrated the interdependent, changing, and dynamic patterns of family relationships and underscored the importance of differentiating between father-child and mother-child relationship. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Parents' psychological well-being when a child has cancer: Contribution of individual and family factors

OBJECTIVE

The aim of this study was to examine the contribution of individual (positive reappraisal) and family factors (parenting satisfaction, couple relationship quality, and family life difficulty) to the psychological well-being (PWB) of parents of children/adolescents diagnosed with cancer.

METHODS

This cross-sectional study was conducted at two pediatric oncology wards in Portugal. Two-hundred and five parents of pediatric patients with cancer completed self-report questionnaires assessing the use of positive reappraisal as a coping strategy, parenting satisfaction, relationship quality, family life difficulty, and PWB. Sociodemographic and clinical data were also assessed.

RESULTS

Standard multiple regression analysis showed a significant contribution of both individual- and family-level factors to parents' PWB. Specifically, the use of positive reappraisal as a coping strategy, parenting satisfaction, and relationship quality were associated with higher PWB; conversely, family life difficulty was linked to lower PWB. Sociodemographic (child's age and family's socioeconomic status) and clinical variables (time since diagnosis and treatment status) were not associated with PWB.

CONCLUSIONS

The present study identified potential resources for parents' adaptation to this stressful situation, contributing with insightful conclusions for both research and clinical practice. Screening and addressing both individual- and family-level aspects may be crucial to foster parents' well-being when a child is diagnosed with cancer.

Close relationships, individual resilience resources, and well-being among people living with HIV/AIDS in rural China

The systems framework of resilience has suggested that resilient factors external to or within the individual and their interactions can contribute to positive adjustment in at-risk populations. However, the interplays of resilience resources at different levels have seldom been investigated in health psychology, particularly in people living with HIV/AIDS (PLWHA). This study aimed to examine the mediating role of individual resilience resources in the associations between marital and family relationships and well-being in PLWHA. A sample of 160 Chinese PLWHA were interviewed to complete measures on marital relationship, family relationship, individual resilience resources, and general, physical, and mental well-being. Results showed that better marital relationship and family relationship were associated with higher levels of individual resilience resources and well-being indicators. Mediation analysis with path analysis showed significant mediating effects of individual resilience resources between marital and family relationships and general, physical, and mental well-being. By highlighting marital and family relationships as external resources of resilience and their roles in increasing individual resilience factors which thereby contribute to the well-being of PLWHA, our findings support the systems framework of resilience. There are implications for resilience enhancement interventions with the aim of improving PLWHA's well-being by including interpersonal strategies of strengthening the protective role of marital and family relationships, which will in turn facilitate the resilience process.

Couples' psychological adjustment to twin parenthood: mode of conception (spontaneous versus assisted reproduction) and gender differences

Aim

To examine whether mode of conception and gender are associated with parents’ psychological adjustment across the transition to twin parenthood.

Background

There is limited knowledge on the psychological adjustment of couples to twin parenthood during pregnancy and early postpartum, especially for fathers. The available research suggests that first-time mothers of twins conceived by assisted reproduction techniques (ART) may experience lower psychosocial well-being than mothers of spontaneously conceived (SC) twins.

Methods

A total of 41 couples expecting twins, 25 of whom conceived spontaneously and 16 conceived by assisted reproduction techniques, completed measures of depressive and anxiety symptoms, marital relationship, attitudes to sex, and attitudes to pregnancy and the baby.

Findings

ART parents showed a decline in marital relationship quality, no changes in attitudes to pregnancy and the baby and no changes in attitudes to sex over the postpartum. In contrast, SC parents did not change their perception of the marital relationship, reported more positive attitudes to pregnancy and the baby, and more positive attitudes to sex over the postpartum. Compared with the other groups (SC mothers and fathers, ART fathers), ART mothers exhibited a higher increase in depressive and anxiety symptoms from pregnancy to postpartum and only anxiety symptoms exhibited a decline trend over the postpartum. These findings suggest that ART parents may experience more psychological difficulties during the transition to twin parenthood than SC parents. ART mothers, in particular, appear to be more at risk of high levels of postpartum depressive symptoms.

Exploring the impact of marital relationship on the mental health of children: Does parent-child relationship matter?

This study aimed to examine the associations between marital relationships and parent-child relationships on children's mental health. Participants included 19,487 students from the 2013-2014 baseline China Education Panel Survey. Structural equation modeling was applied to analyze the data and results revealed that marital and parent-child relationships positively affected children's mental health. Parent-child relationship also played a mediating role between marital relationship and children's mental health. The unique contributions of this study and its theoretical and practical implications were discussed.

Why don't you share your satisfaction with me?

BACKGROUND

Healthy spousal communication of marital and sexual expectations is one of the most important factors to improve the quality of sexual relations in marriage.

OBJECTIVES

This paper has attempted to explore women's expectations of men for having pleasurable sex in a monogamous and steady sexual relationship within the context of Iran.

METHODS

In this qualitative study, 20 interviews were conducted in Tehran from December 2013 to May 2014. Participants were recruited using purposive sampling, face-to-face, in-depth, and semistructured interviews. The collected data were analyzed using qualitative conventional content analysis. The research was designed with regard to Lincoln and Guba's four major rigor criteria in qualitative investigation.

RESULTS

Women's expectations for having enjoyable sex were classified in two areas: (1) marital components and (2) sexual components. Marital components included romantic relationships, attention, respect and admiration, appreciation, man's loyalty, and having compatibility. Sexual components included enough sexual skills, good sexual function, and commitment to equity in sex.

CONCLUSIONS

This research helps to identify women's expectations for having a gratifying sexual relationship and thus contributes to enhanced sexual satisfaction, as well as marital stability and continuity.

The Impact of a Video-Mediated Communication on Separated Perinatal Couples in Japan

Japanese communication relies heavily on nonverbal cues and context. The purpose of this study was to examine the impact of video-mediated communication (VMC) on communication satisfaction and marital relationships in young couples separated during the perinatal period as they honor the Japanese tradition of Satogaeri Bunben. Couples were assigned to the VMC treatment group ( n = 14) or control group ( n = 13). A mixed-methods approach to data collection and analysis was used. Longitudinal quantitative analysis from the Primary Communication Inventory and Intimate Bond Measure revealed significant differences between the Husband groups. Primary Communication Inventory and Intimate Bond Measure were strongly correlated regardless of group. Qualitative analysis of participant diaries revealed the addition of visual cues helped create a sense of "virtual co-presence," which was both positive and negative. In conclusion, VMC appears to improve communication in the separated Japanese perinatal couples, especially through the addition of visual cues provided with VMC.

An assessment of marital adjustment in patients with rheumatoid arthritis

Aim To investigate marital adjustment in patients with rheumatoid arthritis and factors affecting this. Methods A total of 32 patients diagnosed with Steinbrocker class 1-2 rheumatoid arthritis and 32 healthy individuals from a similar age group were included. Sociodemographic characteristics, the Beck Depression Inventory (BDI), short-form 36(SF-36) and the dyadic adjustment scale (DAS) were evaluated in both groups. A visual analogue scale (VAS), the disease activity score 28(DAS28) and a health assessment questionnaire (HAQ) were also investigated in the patient group. Results Mean ages were 46.5±9.2 years in the patient group and 47.7±8.1 in the control group (p=0.5). No significant difference was determined between the two groups in terms of sociodemographic characteristics. No statistically significant correlation was observed between erythrocyte sedimentation rate (ESR), patient and physician global VAS, DAS28, HAQ and morning stiffness and DAS total score. Comparison of DAS subunits revealed a significant difference in dyadic satisfaction and affectional expression in the patient and control groups (p=0.046 and p=0.037). A statistically significant negative correlation was observed between duration of the disease and marital adjustment (p=0.01;r= -0.58). Conclusion Due to its progressive and prolonged course rheumatoid arthritis can also affect individuals' social relationships besides restricted daily living activities. Activation of rheumatoid arthritis did not affect marital adjustment in this study, but adjustment decreased with duration of the disease.

Sexual satisfaction among involuntarily childless women: A cross-cultural study in Italy and Brazil

Infertility has been negatively associated with sexual satisfaction. This study aimed to estimate the relation of infertility to sexual satisfaction from a cross-cultural perspective, comparing Italian and Brazilian women. Between June 2012 and January 2013, 528 women seeking assisted reproduction technology (ART) treatment in Italy (39%) or Brazil (61%) completed self-reports of sexual satisfaction (ISS) and infertility-related stress in the marital domain (IRS). IRS was the same across countries. ISS differed, with 34.31% of the Italians and 43.52% of the Brazilians being sexually dissatisfied at a clinical level (ISS score >30). Multiple logistic regression models showed that being sexually dissatisfied at a clinical level was associated with lower education and higher IRS among Italian women, regardless of having a diagnosed cause of infertility. It was instead associated with higher IRS only among the Brazilian women who had a diagnosed cause of infertility. These findings suggest that, regardless of nationality, sexual satisfaction and infertility-related stress need to be addressed in the treatment of infertile women turning to ART. However, as factors associated with these dimensions vary across countries, interventions to promote sexual satisfaction among infertile women should be adapted to their specific socio-cultural context.

A scope of the problem: Post-deployment reintegration challenges in a National Guard Unit

BACKGROUND

More Reserve and Guard members have been activated in the past few years than in any other time in history. In addition to the high rates of psychological and behavioral challenges among military personnel, there are other equally important post-deployment reintegration challenges. Post-deployment reintegration challenges are particularly important to Reserve and Guard members, who transition rapidly from civilian-military-civilian.

OBJECTIVE

This study aims to describe the scope of challenges that a battalion of National Guard members (NGM) report experiencing after returning from a one-year deployment to Iraq.

METHOD

This article reports data from a sample of 126 NGM who recently returned from a one-year deployment to Iraq. The scope of post-deployment problems at baseline, 3- and 6-month post-deployment are presented.

RESULTS

Overall, the rates of post-deployment psychological and behavioral problems were elevated upon returning from deployment and remained fairly constant for up to 6 months post-deployment. Approximately 30% of respondents were unsatisfied with their relationship and upwards of 30% reported family reintegration challenges.

CONCLUSIONS

Comparisons with similar research and implications for prevention and improvement of post-deployment quality of life are addressed.

'It is not expected for married couples': a qualitative study on challenges to safer sex communication among polygamous and monogamous partners in southeastern Tanzania

Background

Behavioral change approaches for human immunodeficiency virus (HIV) prevention in Tanzania encourage married partners to observe safe sex practices (condom use, avoidance of, or safe sex with multiple partners). To implement this advice, partners need to communicate with each other about safer sex, which is often challenging. Although social-structural factors are crucial in understanding sexual behavior, only a few studies focus on understanding safer sex dialogue in a broader social context.

Design

Drawing on the WHO-Commission on the Social Determinants of Health (WHO-CSDH) framework, this study explored key social-structural constructs for studying health in the context of improving safer sex dialogue between polygamous and monogamous partners. Twenty-four in-depth interviews (IDIs) and six focus group discussions (FGDs) with 38 men and women aged 18–60 years were conducted in Ifakara town located in Kilombero district, Tanzania. The study was nested within the community health surveillance project MZIMA (Kiswahili: ‘being healthy’). Partners’ experiences of safer sex dialogue in polygamous and monogamous relations were investigated and the challenges to safer sex dialogue explored.

Results

The study revealed that open safer sex dialogue in marriage is limited and challenged by social norms about marriage (a view that safer sex dialogue imply that partners are ‘not really’ married); marital status (a belief that safer sex dialogue is not practical in polygamous marriages, the elder wife should be exempted from the dialogue since she is at lower risk of engaging in extramarital affairs); relationship quality (marital conflicts, extramarital affairs, trust, and sexual dissatisfaction); and gender power relations (the notion that females’ initiative to discuss condom use and HIV couple counseling and testing may lead to conflict or divorce).

Conclusions

Implementing safer sex practices requires interventions beyond promotion messages. HIV prevention interventions in Tanzania should be carefully adapted to the local context including respective social norms, gender systems, marital context and relationship uncertainties as aspects that facilitate or hinder safer sex dialogue between partners. The WHO-CSDH framework could be strengthened by explicitly integrating relationship quality, marital status, and social norms as additional determinants of health.

Life course outcomes for women with different alcohol consumption trajectories: A population-based longitudinal study

INTRODUCTION AND AIMS

Relatively little is known about the consequences for women of sustained higher levels of alcohol consumption. We examine three outcomes (marital relationship, reproductive health and well-being) for women with different alcohol consumption trajectories over 21 years.

DESIGN AND METHODS

Data were from a prospective cohort study in Brisbane, Queensland (n = 3337). Group-based trajectory modeling measured women's alcohol consumption trajectories spanning 21 years. Outcomes were measured using a self-report questionnaire at the 27-year follow-up.

RESULTS

Four trajectories of women's alcohol consumption were identified: abstaining, low-stable drinkers, moderate-escalating drinkers and heavy-escalating drinkers. Abstaining predicts positive outcomes measured at the 27-year follow-up such as being married, never having a divorce, never having multiple partners, and fewer pregnancy terminations. Moderate and heavy-escalating trajectories predict being unmarried, having multiple partners, having fewer children, having a termination of a previous pregnancy, and reporting lower levels of well-being at the 27-year follow-up.

DISCUSSION AND CONCLUSIONS

The escalating-trajectory group is of particular interest as membership of this group is associated with a wide range of adverse life course outcomes by the 27-year follow-up. The consequences of moderate and heavy-escalating alcohol trajectories in a community sample of women whose pattern of alcohol consumption do not reach clinical criteria of problem drinking have not previously been described. Women with these sustained patterns of alcohol consumption are an appropriate target group for intervention programs. programs. [TranNT, Clavarino A,WilliamsGM,Najman JM. Life course outcomes for women with different alcohol consumption trajectories: A population-based longitudinal study. Drug Alcohol Rev 2016;35:763-771].

Male psychological adaptation to unsuccessful medically assisted reproduction treatments: a systematic review

BACKGROUND

Similarly to women, men suffer from engaging in fertility treatments, both physically and psychologically. Although there is a vast body of evidence on the emotional adjustment of women to infertility, there are no systematic reviews focusing on men's psychological adaptation to infertility and related treatments.

OBJECTIVE AND RATIONALE

The main research questions addressed in this review were 'Does male psychological adaptation to unsuccessful medically assisted reproduction (MAR) treatment vary over time?' and 'Which psychosocial variables act as protective or risk factors for psychological maladaptation?'

SEARCH METHODS

A literature search was conducted from inception to September 2015 on five databases using combinations of MeSH terms and keywords. Eligible studies had to present quantitative prospective designs and samples including men who did not achieve pregnancy or parenthood at follow-up. A narrative synthesis approach was used to conduct the review.

OUTCOMES

Twelve studies from three continents were eligible from 2534 records identified in the search. The results revealed that psychological symptoms of maladjustment significantly increased in men 1 year after the first fertility evaluation. No significant differences were found two or more years after the initial consultation. Evidence was found for anxiety, depression, active-avoidance coping, catastrophizing, difficulties in partner communication and the use of avoidance or religious coping from the wife as risk factors for psychological maladjustment. Protective factors were related to the use of coping strategies that involve seeking information and attribution of a positive meaning to infertility, having the support of others and of one's spouse, and engaging in open communication about the infertility problem.

WIDER IMPLICATIONS

Our findings recommend an active involvement of men during the treatment process by health care professionals, and the inclusion of coping skills training and couple communication enhancement interventions in counselling. Further prospective large studies with high-quality design and power are warranted.

Living with bipolar disorder: the impact on patients, spouses, and their marital relationship

OBJECTIVES

Patients with bipolar disorder are characterized by an unusually high divorce rate. As such, the purpose of the present study was to uncover information relating specifically to the impact of bipolar disorder on patients and spouses individually, and on the marital relationship from the perspectives of both patients and spouses.

METHODS

Eleven patients with bipolar disorder and ten spouses were interviewed separately about the impact of bipolar disorder on their lives and on their marital relationship. Data were analyzed using the grounded theory method.

RESULTS

The impact of bipolar disorder for spouses included self-sacrifice, caregiving burden, emotional impact, and a sense of personal evolution. The impact of bipolar disorder on patients included an emotional impact, responsibility for self-care, and struggling socially and developmentally. When comparing patient and spouse perspectives on the impact of the disorder, neither the patient nor the spouse was able to accurately assess the impact of the disorder on their partner's lives. The impact of bipolar disorder on the relationship included volatility in the relationship, strengthening the relationship, weakening the relationship, and family planning.

CONCLUSIONS

The research indicated that patients and partners alike struggle with the tremendous impact of bipolar disorder on their lives and on their relationships. Given the high rates of divorce and volatility in these relationships, healthcare professionals can provide (or refer to) emotional and practical support both to patients and spouses on their own, and as a couple in their clinics.

The quality of the interparental relationship does not moderate the etiology of child conduct problems

BACKGROUND

Although there is a clear phenotypic relationship between the quality of the interparental or marital relationship and child conduct problems (CP), the etiology of this association is as yet unclear. One possibility is that this association takes the form of a genotype-environment interaction (G × E), whereby the quality of the interparental relationship acts to moderate the etiology of child CP. The current study sought to evaluate this possibility.

METHOD

We examined multiple measures and informant reports of the quality of the interparental relationship in a sample of more than 700 child twin families from the Michigan State University Twin Registry (MSUTR). Analyses consisted of a series of latent G × E models.

RESULTS

The 'no moderation' model provided the best fit to the data in nearly all cases, findings that collectively provide strong evidence against the possibility that the etiology of CP is moderated by the quality of the interparental relationship.

CONCLUSIONS

Our findings suggest that, contrary to implicit (and sometimes explicit) assumptions in the field, it is not the case that every environmental risk (or protective) factor exacerbates (or suppresses) genetic influences on CP. Future research should seek to delineate the specific environmental experiences that do serve as etiologic moderators of CP, and to clarify how this G × E interplay might change over the course of development.

Meaningfulness of service and marital satisfaction in Army couples

The vast numbers of military service members who have been deployed since 2001 highlights the need to better understand relationships of military couples. A unique consideration in military couples is the concept of meaningfulness of service, or the value service members and their partners place on military service in spite of the sacrifices it requires. In a sample of 606 Army couples, the authors used path analysis to examine how male service members' and female spouses' perceived meaningfulness of service added to the prediction of marital satisfaction in both members of the couple, when accounting for service members' PTSD symptoms. Spouses' perceived meaningfulness of service was linked with higher marital satisfaction in spouses, regardless of service member's perceived meaningfulness of service. Service members' perceived meaningfulness of service was also associated with increased marital satisfaction in service members, but only when their spouses also perceived higher meaningfulness. There were no significant interactions between service members' PTSD and either partner's perceived meaningfulness. Implications for enhanced attention to spousal perceptions of meaningfulness of service are discussed.

Partners' attributions for service members' symptoms of combat-related posttraumatic stress disorder

The association of service members' combat-related PTSD with partners' distress is weaker when spouses/partners believe that service members experienced more traumatic events during deployment. Also, when simultaneously examining partners' perceptions of all PTSD symptoms, perceptions of reexperiencing symptoms (the symptoms most obviously connected to traumatic events) are significantly negatively related to distress in partners. These findings are consistent with the notion that partners may be less distressed if they make external, rather than internal, attributions for service members' symptoms. The present study explicitly tests this possibility. Civilian wives of active duty service members completed measures regarding their own marital satisfaction, their perceptions of service members' combat exposure during deployments, their perceptions of service members' symptoms of PTSD, and their attributions for those symptoms. External attributions were significantly positively associated with perceptions of combat exposure (rp=.31) and reexperiencing symptoms (β=.33) and significantly negatively associated with perceptions of numbing/withdrawal symptoms (rp=-.22). In contrast, internal attributions were significantly negatively associated with perceptions of reexperiencing symptoms (β=-.18) and significantly positively associated with perceptions of numbing/withdrawal symptoms (β=.46). Internal attributions significantly moderated the negative association of PTSD symptoms with marital satisfaction, such that the association strengthened as internal attributions increased. These findings are the first explicit support for an attributional understanding of distress in partners of combat veterans. Interventions that alter partners' attributions may improve marital functioning.

Distress in spouses of service members with symptoms of combat-related PTSD: secondary traumatic stress or general psychological distress?

Combat-related posttraumatic stress disorder (PTSD) is linked with elevated psychological distress in service members'/veterans' spouses. Researchers use a variety of terms to describe this distress, and recently, secondary traumatic stress and secondary traumatic stress disorder (STS/STSD) have become increasingly commonly used. Although STS/STSD connotes a specific set of symptoms that are linked to service members'/veterans' symptoms, researchers often use general measures of distress or generically worded measures of PTSD symptoms to assess STS/STSD. To determine how often scores on such measures appear to be an accurate reflection of STS/STSD, we examined responses to a measure of PTSD symptoms in 190 wives of male service members with elevated levels of PTSD symptoms. Wives rated their own PTSD symptoms, and then answered questions about their attributions for the symptoms they endorsed. Fewer than 20% of wives who endorsed symptoms on the PTSD measure attributed these symptoms completely to their husbands' military experiences. Moreover, compared with wives who attributed symptoms only to events in their own lives, wives who attributed symptoms completely or partially to their husbands' military experiences had a greater overlap between some of their responses on the PTSD measure and their responses to a measure of general psychological distress. These results suggest that most wives of service members/veterans with PTSD experience generic psychological distress that is not conceptually consistent with STS/STSD, although a subset does appear to endorse a reaction consistent with this construct. Implications of these findings for intervention and research with this vulnerable population are discussed.

The relative risk and timing of divorce in families of children with an autism spectrum disorder

We compared the occurrence and timing of divorce in 391 parents of children with an autism spectrum disorder (ASD) and a matched representative sample of parents of children without disabilities using a survival analysis. Parents of children with an ASD had a higher rate of divorce than the comparison group (23.5% vs. 13.8%). The rate of divorce remained high throughout the son's or daughter's childhood, adolescence, and early adulthood for parents of children with an ASD, whereas it decreased following the son's or daughter's childhood (after about age 8 years) in the comparison group. Younger maternal age when the child with ASD was born and having the child born later in the birth order were positively predictive of divorce for parents of children with an ASD. Findings have implications for interventions focused on ameliorating ongoing and long-term marital strains for parents of children with an ASD.

Men's extramarital sex, marital relationships and sexual risk in urban poor communities in India

The objectives of this paper are to (1) understand the nature of men's extramarital sexuality in three low income communities in Mumbai, India; (2) explore the associations between marital relationships and extramarital sex; and (3) assess the implications of the research results for intervention. Results are based on survey data collected from 2,408 randomly selected men from the three study communities and a matched subset of 260 randomly selected men and their wives who responded to a female version of the men's survey. These surveys produced a unique data set, which allows sociodemographic, attitudinal and behavioral variables from husband and wife and variables that are the product of husband and wife interaction to be utilized to predict men's extramarital sex through multiple sequential logistic regression analysis. Results indicate that men's extramarital sex is significantly associated with husband's and wife's age, wife's perception of domestic violence, husband's education and place of birth, husband's alcohol use, wife's willingness to engage in marital sex, and types of marital sexual acts. These results confirm the need to move from the individual to the couple as the unit of research and the need for intervention to reduce the risk of HIV/STI transmission within marriage both in India and internationally.