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PubMed2000

Marital quality and psychological adjustment to widowhood among older adults: a longitudinal analysis.

OBJECTIVES: This study examined whether psychological adjustment to widowhood is affected by three aspects of marital quality--warmth, conflict, and instrumental dependence-assessed prior to the loss. METHODS: The Changing Lives of Older Couples (CLOC) is a prospective study of a two-stage area probability sample of 1,532 married individuals aged 65 and older. The CLOC includes baseline data on marital quality and mental health and data on grief, anxiety, and depression collected 6, 18, and 48 months after spousal loss. RESULTS: Widowhood was associated with elevated anxiety among those who were highly dependent on their spouses and lower levels of anxiety among those who were not dependent on their spouses. Levels of yearning were lower for widowed persons whose relationships were conflicted at baseline and higher for those reporting high levels of marital closeness and dependence on their spouses. Women who relied on their husbands for instrumental support had significantly higher levels of yearning than men who depended on their wives. DISCUSSION: The findings contradict the widespread belief that grief is more severe if the marriage was conflicted and suggest a more complex relationship between bereavement and characteristics of the marriage.

Adaptation, Psychological↗
PubMedDate not supplied

Adjustment of husbands and wives to breast cancer.

PURPOSE: The purpose of this descriptive study was to explore selected elements within the spousal relationship on fear of recurrence and emotional distress among women treated for breast cancer within the past 3 years and their husbands. DESCRIPTION OF STUDY: Fifty-eight married couples completed questionnaires designed to investigate the association between three relationship elements and adjustment (fear of recurrence and emotional distress) among husbands and wives. The relationship elements investigated were 1) adaptability and cohesion of the couple; 2) perceptions of support from the spouse; and 3) communication about the illness. The influence of the wife's age, treatment, and time since treatment also were considered. RESULTS: Both husbands and wives reported similar perceptions of dyadic functioning, level of support received from the spouse, and extent of communication about the illness. Interdependent elements within the couple relationship were associated with both fear of recurrence and emotional distress. Overall, the amount of communication about the illness explained the most variance in adjustment for both spouses, with communication increasing as fear of recurrence increased. There was some suggestion that current or past membership in a support group was related both to more communication by wives and to husbands' greater satisfaction with communication. For wives, age was the demographic variable most highly correlated with adjustment; the younger the wife, the greater was her fear of recurrence. Significant emotional distress was observed in a small subset of husbands. In addition, when either the husband or wife scored in the top 25% of the sample on fear of recurrence, the fear of recurrence score for the corresponding spouse was elevated in only two cases. This same pattern was true for emotional distress. CLINICAL IMPLICATIONS: This study adds to a growing body of information supporting the need to view women who have had breast cancer and their spouses as a unit. Four areas for heightened clinical assessment were noted; 1) greater fear of recurrence in younger women; 2) significant emotional distress in a small number of husbands; 3) the demonstration of compensation mechanisms by one spouse when the other is experiencing elevated fear of recurrence or emotional distress; and 4) an increased fear of recurrence in association with increased communication about the illness. Further investigation is necessary to determine whether communication between spouses is directed at problem solving or is an expression of emotional distress.

Adaptation, Psychological↗
PubMed1992

Brief group psychotherapy for the spousally bereaved: a controlled study.

A consecutive sample of mid- and late-life bereaved spouses were randomly assigned to treatment and no-treatment groups. Two hypotheses were tested: (1) that brief group psychotherapy during the early stages of loss would facilitate adjustment assessed by measures of mental health, positive psychological states, social role, and mourning; and (2) that positive effects would be maximized for subjects who were more distressed psychologically. Although group participants, compared with untreated controls, did over 1 year show modest improvement on role functioning and positive psychological states, overall the study failed to find substantial support for the two major hypotheses. Both experimental and control groups showed improvement over the year, particularly on measures of mental health and mourning. Differential benefit was not observed for the high-risk group.

Adaptation, Psychological↗
PubMedDate not supplied

Psychologic distress among spouses of patients undergoing cardiac rehabilitation.

OBJECTIVE: The goal of this study was to identify common sources of distress in spouses of patients undergoing cardiac rehabilitation and to compare spouses classified as being in distress and those classified as nondistressed on demographic variables, their experiences of stress, coping strategies employed, marital intimacy, and level of family functioning. The study aimed to describe the needs of spouses with respect to possible interventions. DESIGN: A cross-sectional analysis was used. SETTING: The study was located at the University of Ottawa Heart Institute Prevention and Rehabilitation Centre's cardiac rehabilitation program. OUTCOME MEASURES: Scores on the Brief Symptom Inventory, Heart Disease Hassles Scale, Coping Strategies Inventory, Miller Intimacy Scale, and McMaster Family Assessment Device were used as outcome measures. RESULTS: Two hundred thirteen female spouses of patients undergoing cardiac rehabilitation participated in this study. Sixty-six percent of the spouses met the criteria for distress. This was more common in younger spouses (51.99 +/- 9.94 years) than in older spouses (55. 74 +/- 10.54 years) (t = -2.45; P =.013). Distressed spouses used disengagement coping strategies significantly more than the nondistressed spouses (t = 6.91; P =.0001). Distressed spouses also reported significantly less intimacy in their marriages (t = -3.99; P =.0001) and poorer family functioning (t = 5.86; P =.0001). The most prevalent symptoms of psychologic distress included feeling tense, having trouble falling asleep and feeling easily hurt. The most prevalent stressors were as follows: (1) worries about treatment, recovery, and prognosis (75.5%); (2) moodiness of the patient (66.7%); (3) worries about the patient returning to work and about money (38.8%); (4) sexual concerns (36.7%); and (5) helplessness or apathy on the part of the patient and increased spousal responsibility (36.1%). CONCLUSIONS: Spouses of patients undergoing cardiac rehabilitation should be screened for psychologic distress, and those in distress should be offered interventions focused on assisting them to deal with specific stressors related to their experience with a spouse with heart disease. Interventions indicated include stress-management techniques and encouraging the use of engagement coping strategies. In addition, marital and family concerns need to be directly addressed in support interventions.

Adaptation, Psychological↗
PubMed1992

Electroencephalographic sleep in spousal bereavement and bereavement-related depression of late life.

Although spousal bereavement in late life is common and frequently leads to major depression, the boundary between bereavement without a depressive syndrome and bereavement-related depression has been insufficiently studied from a physiological perspective. Because other forms of depression are associated with physiological changes, including sleep, we have attempted to clarify the relationship of bereavement and bereavement-related depression by investigating electroencephalographic (EEG) sleep in 31 elderly volunteers with recent spousal bereavement, stratified by the presence (n = 15) or the absence (n = 16) of major depression (Research Diagnostic Criteria). Entry into the study was limited to volunteers without a personal history of psychiatric disorder. As hypothesized, bereaved subjects with major depression had significantly lower sleep efficiency, more early morning awakening, shorter rapid eye movement (REM) latency, greater REM sleep percent, and lower rates of delta wave generation in the first nonREM (NREM) period, compared with bereaved subjects without depression. Furthermore, the sleep of bereaved subjects with single-episode major depression resembled that of elderly patients with recurrent unipolar major depression (n = 15) on measures noted above. Sleep in bereavement without depression was similar to that of 15 healthy control subjects (neither bereaved nor depressed). These findings suggest that the current DSM-III-R concept of uncomplicated bereavement is not confirmed, as the sleep patterns of subjects who develop a depressive syndrome in the context of bereavement, many of whom might be considered to have "uncomplicated bereavement" by DSM-III-R standards, are identical to sleep patterns found in major depressive episodes. To our knowledge, this is the first study of EEG sleep in spousal bereavement with and without major depression.

Aged↗
PubMed2002

Spousal communication and family planning behavior in Navrongo: a longitudinal assessment.

The poor performance of most family planning programs in the 1980s, especially in sub-Saharan Africa, generated concern among researchers and led to a quest for explanations. In most countries, the alienation of men from participation in these programs was subsequently identified as one of the major causes, a finding that led researchers to redirect their attention to couples instead of individuals as the focus of such programs. Lack of spousal communication about family planning was identified as one reason for the low level of contraceptive use among women. Subsequent research has persistently demonstrated a positive relationship between spousal communication and contraceptive use. Most prior studies on this topic have been based on cross-sectional data, so that whether the identified relationships are causal remains unclear. Does communication, in fact, predict contraceptive use, or does the use of contraceptives generate communication among couples? This study addresses the question of causality by using longitudinal data from the Navrongo Health Research Centre panel survey. Results from both cross-sectional and longitudinal analysis demonstrate that spousal communication does, indeed, predict contraceptive behavior, even when other factors are controlled.

Adolescent↗
PubMed1996

Older couples' decision making on health issues.

The purpose of this qualitative study was to determine the process of spousal influence as it relates to health-promotion behaviors and the concept desire to change spousal health behaviors. Fifty-nine elderly couples in long-term marriages were recruited through three senior centers; participants were asked to respond to five open-ended questions. The majority of couples said that they made health decisions jointly; wives tended to be the primary deciders in the even that a health decision had to be made. Most people, but particularly wives, desired to change something about their spouses' health behavior; a variety of strategies were used in the attempt to change spousal behavior. Aging or illness in the self or spouse were identified as precipitants of increased desire to change the spouses' health behavior over time.

Aged↗
PubMed1995

Elderly spousal caregivers: knowledge of cancer care, perceptions of preparedness, and coping strategies.

1. Care of a chronically ill or frail elderly individual is increasingly a normative family function, with negative and positive outcomes for those family members providing care. 2. Practitioners in nursing must be aware of the impact stress can have on family members when one member has been diagnosed with cancer. Nurses must assess potential caregivers' knowledge, skills, and preparedness in order to assist them in assuming their caregiving roles. 3. Nurses are in an ideal situation to provide the needed assessments and to develop individualized interventions that can support the efforts and care provided by the family caregiver.

Adaptation, Psychological↗
PubMed1987

Familial aggregation in physical fitness, coronary heart disease risk factors, and pulmonary function measurements.

In order to test for the presence of familial aggregation in physical fitness and coronary heart disease risk factors, body fat, submaximal power output, muscular strength, muscular endurance, blood pressure, pulmonary functions, and several blood biochemical variables were measured in 304 nuclear families living in the Quebec city area. Analysis of variance indicated a larger between-family than within-family variation for all the variables. When all members of nuclear families were considered, intraclass correlations ranged from 0.21 to 0.34 (P less than or equal to 0.01). Interclass correlations computed for various pairs of relatives revealed significant parent-child and sibling correlations for all the variables (0.14 less than or equal to r less than or equal to 0.55; P less than or equal to 0.01). On the other hand, spousal correlations tended to be lower but significant (0.10 less than or equal to r less than or equal to 0.30; P less than or equal to 0.05) for all variables except subcutaneous fat and hemoglobin concentration. These results suggest that heredity and common lifestyle shared by members of nuclear families are responsible for the familial aggregation of physical fitness, coronary heart disease risk factors, and pulmonary functions. The findings also support the notion of considering the nuclear family as a unit of intervention in the application of preventive measures aimed at the reduction of several risk factors.

Adolescent↗
PubMed1992

Gender differences in dementia management plans of spousal caregivers: implications for occupational therapy.

Occupational therapists treating older people with Alzheimer disease know that they must also consider the others who are affected by the disease, the informal caregivers. Intervention is most effective when it enables both the impaired person and the primary caregiver to manage the secondary symptoms of dementia. Unfortunately, little is understood about how caregivers approach and carry out their tasks and about why male and female caregivers respond differently to their caregiving role in terms of depression, burden, stress, and substance abuse. This paper discusses the effects of gender on dementia management plans of spousal caregivers. Husbands and wives have different approaches to caregiving; each approach has consequences. Male caregivers adopt a task-oriented approach to their duties and carry out their activities in a linear fashion; female caregivers use a parent-child approach and nest activities inside one another in a constant stream of work. Two cases are presented to illustrate gender differences in dementia management plans. Implications for occupational therapy include suggestions for supporting men and women in their caregiving role, modulating the negative consequences of caregiving, and conducting research to demonstrate the efficacy of an occupational therapy approach.

Caregivers↗
PubMedDate not supplied

Married couples' perspectives on prostate cancer diagnosis and treatment decision-making.

Prostate cancer is a disease of men. But for married men, it is commonly and quite reasonably expected that their wives will be significantly involved in dealing with the disease and its treatment. Yet, there are few data on how wives perceive the diagnosis and their role in responding to it. This study explores men's and their wives' perceptions of the prostate cancer diagnosis and their role in treatment decision-making. We conducted separate focus group interviews with seven married men with metastatic prostate cancer and their wives. The accounts of receiving the diagnosis and deciding on treatment that were told by the men differed in significant ways from the stories told in the wives' groups. We found that many men do not share their prostate-related health problems with their wives and some men choose their treatment without much spousal consideration. Our findings suggest that physicians may be in a position to influence how men and their wives interact in reaching a treatment decision.

Aged↗
PubMed2004

Nocturnal sleep disturbances and daytime dysfunction in patients with Parkinson's disease and in their caregivers.

BACKGROUND: The role of aging, disease, medications, and mood disturbances in sleep disturbances (SD) in patients with Parkinson's disease (PD) is poorly understood, and the impact of SD on the quality of life of their caregivers (CG) largely undocumented. OBJECTIVES: To evaluate the pattern and determinants of disturbed sleep in PD patients complaining of SD, and in their primary CG. METHODS: A prospective evaluation of 40 non-demented patients with PD complaining of SD and 23 of their primary CG (all were spouses) was conducted using Pittsburgh Sleep Quality Index, Zung's self-rating depression and anxiety scales, Parkinson's Impact Scale (PIMS) (only for PD), and an additional sleep questionnaire. RESULTS: Eighty-four percent of patients were 'poor sleepers' with global sleep scores (GLSc) > 5. Other abnormalities were: excessive daytime sleepiness-57.5%, excessive daytime fatigue-72.5%, depression-51.5%, anxiety-63.1%, and abnormal PIMS score-83.8%. There was no correlation between the degree of sleep dysfunction and the age, severity, duration of PD or its treatment. Several component sleep scores correlated with anxiety scores, PIMS score with depression, and, subjects with GLSc > or = 10 had higher mean anxiety index. Daytime dysfunction (97.5%) was mainly associated with reduced enthusiasm, rather than excessive sleepiness. Among CG, 40% had a GLSc > 5, 21% had depression, and 10.5% had anxiety. Their depression, anxiety and sleep scores correlated with those of their spouses. CONCLUSIONS: PD patients with significant SD may represent a subset of patients with early, progressive degeneration of sleep centres, rather than an enhanced aging process. They are more susceptible mood disturbances, which correlate with the severity of sleep dysfunction. Sleep and mood disturbances also adversely affect the quality of life of spousal caregivers.

Adult↗
PubMed2004

Match makers and deal breakers: analyses of assortative mating in newlywed couples.

We conducted a comprehensive analysis of assortative mating (i.e., the similarity between wives and husbands on a given characteristic) in a newlywed sample. These newlyweds showed (a) strong similarity in age, religiousness, and political orientation; (b) moderate similarity in education and verbal intelligence; (c) modest similarity in values; and (d) little similarity in matrix reasoning, self- and spouse-rated personality, emotional experience and expression, and attachment. Further analyses established that similarity was not simply due to background variables such as age and education and reflected initial assortment (i.e., similarity at the time of marriage) rather than convergence (i.e., increasing similarity with time). Finally, marital satisfaction primarily was a function of the rater's own traits and showed little relation to spousal similarity.

Adult↗
PubMed2005

Problem-solving and distress in prostate cancer patients and their spousal caregivers.

GOALS OF WORK: Prostate cancer, the most common life-threatening cancer among American men, increases risk of psychosocial distress and negatively impacts quality of life for both patients and their spouses. To date, most studies have examined the relationship between patient coping and distress; however, it is also likely that what the spouse does to cope, and ultimately how the spouse adjusts, will affect the patient's adjustment and quality of life. The present study examined the relationships of spouse problem-solving coping, distress levels and patient distress in the context of prostate cancer. The following mediational model was tested: Spouses' problem-solving coping will be significantly inversely related to patients' levels of distress, but this relationship will be mediated by spouses' distress levels. PATIENTS AND METHODS: One hundred seventy-one patients with prostate cancer and their spousal caregivers were assessed for mood; spouses were assessed for problem-solving coping skills. Structural equation modeling was used to test model fit. MAIN RESULTS: The model tested was a good fit to the data. Dysfunctional spousal problem-solving was a significant predictor of spouse distress level but constructive problem-solving was not. Spouse distress was significantly related to patient distress. Spouse dysfunctional problem-solving predicted patient distress, but this relationship was mediated by spouse distress. The same mediational relationship did not hold true for constructive problem-solving. CONCLUSIONS: Spouse distress mediates the relationship between spouse dysfunctional coping and patient distress. Problem-solving interventions and supportive care for spouses of men with prostate cancer may impact not only spouses but the patients as well.

Adaptation, Psychological↗
PubMed2004

Emotional well-being in recently bereaved widows: a dynamical systems approach.

A dynamical systems approach was used to model the intraindividual variability in emotional well-being following conjugal loss. Well-being in a sample of 19 recently bereaved older adult widows was measured every day for 3 months. The pattern of variability of well-being was hypothesized to be an oscillating process that damps across time (i.e., large swings followed by a gradual damping). Results indicated that there was significant patterned variability in the emotional well-being adjustment that can be modeled by a linear oscillator model (R2=.77), in addition to an overall positive trend. Applying dynamical systems analyses to capture variability and subsequent well-being trajectories following spousal loss is an important step in delineating the complex adjustment to widowhood.

Adaptation, Psychological↗
PubMed1996

Mortality after death of spouse in relation to duration of bereavement in Finland.

STUDY OBJECTIVES: (1) To assess the extent to which death of a spouse causes excess mortality by controlling for the effects of confounding and other sources of bias. Three possible sources of bias are considered: accidents common to spouses, common socioeconomic environment, and common lifestyles. (2) To assess the duration specific effects of death of a spouse on mortality. DESIGN AND SETTING: Prospective study of mortality in Finland among all 35-84 year old married Finnish men and women (1,580,000 people). Baseline sociodemographic measurement from the 1985 census records. Follow up by computerised record linkage to death certificate registers for the period 1986-91 (about 116,000 deaths, of which almost 10,000 among the bereaved) using personal identification codes. RESULTS: (1) After controlling for confounding effects, excess mortality was 17% in men and 6% in women. (2) Excess mortality was higher for short durations than long durations of bereavement. (3) Excess mortality after bereavement was higher in men than women. CONCLUSIONS: Controlling for confounding does not seem to have a crucial modifying effect on the relationship between spousal bereavement and mortality. It seems that death of a spouse has a causal effect on mortality. However, although spousal bereavement is a major stressful life event, this causal effect seems to be relatively small and short lived.

Accidents↗
PubMed1996

Misclassification of smoking habits as a source of bias in the study of environmental tobacco smoke and lung cancer.

The relationship of environmental tobacco smoke to lung cancer risk in lifelong non-smokers is commonly studied using marriage to a smoker as the index of exposure. As smokers tend to marry smokers, relative risk estimates will be biased if some current or former smokers are misclassified as lifelong non-smokers. This paper shows how various factors affect the magnitude of the bias and describes a method for obtaining misclassification-adjusted relative risk estimates. Application of the method to U.S. and Asian data for women suggests misclassification is an important determinant of the slight excess risk observed in non-smokers married to smokers. Reasons why our conclusions differ from those of others are discussed, as are other difficulties in interpreting the association between spousal smoking and lung cancer risk.

Adult↗