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PubMed2003

[Long-term life changes and stress sequelae for spouses of stroke patients].

OBJECTIVE: This study investigates the long-term effect of stroke on the quality of life and health of patients' spouses. METHOD: Twenty-six spouses of stroke patients were interviewed by means of standardized questionnaires and qualitative interviews. The study participants had been living with the consequences of stroke for 3 years on average when the interviews were carried out. RESULTS: A stroke is often followed by considerable changes in everyday life and by role shifts within the relationship. In particular, depressive and aggressive changes in the patient's behaviour are experienced as burdensome. In addition to impairments in quality of life, psychological and psychosomatic troubles can also from the burden experienced. Depressive symptoms are the main factor in these negative consequences: the more a patient is assessed as depressive, the more his/her spouse reports health problems and poor quality of life. DISCUSSION: Long-term changes in everyday life and partnership can bring about significant chronic burden for the spouses of stroke patients. Hence, offers of support and counseling are required not only in the acute and post-acute stages of stroke, but also after inpatient rehabilitation has ended.

Activities of Daily Living↗
PubMed1999

Social interaction and support related to mood and locus of control in cervical and endometrial cancer patients and their spouses.

The purpose of the study was to investigate possible relationships between quantitative and qualitative social support measures and mood in cervical (n = 30) and endometrial (n = 30) cancer patients and their spouses before and after treatment. Furthermore, the experience of locus of control was studied in light of mood and social support in women after treatment. The first interview with the patients was conducted on the day before the women started treatment, a second interview, 6 months later and a third one, 12-15 months after the initiation of treatment. The interviews with the spouses were conducted on the telephone before the initiation of their partners' treatment and 12-15 months later. Social support was assessed by the Interview Schedule for Social Interaction (ISSI), the Beck Depression Inventory (BDI) was used to measure the level of depressive symptomatology, and the locus of control orientation was assessed by the Locus of Control (LOC) scale. Women with cervical cancer reported BDI values that were significantly higher than in the endometrial group both before and after treatment. Women with cervical cancer also showed a significantly higher level on the BDI score on both occasions than did the corresponding group of spouses. The scores for ISSI were within normal limits in both groups of women. Furthermore, LOC was significantly correlated with adequacy of social interaction in women when controlled for social desirability, whereas LOC was unrelated to BDI. No significant correlations were found among the spouses concerning social network variables and dysphoric mood. The necessity of developing models for the psychological and behavioural risk assessment and for the elaboration of adequate treatment strategies is emphasized.

Adult↗
PubMed2006

The relationship between threat appraisal and social constraints in cancer survivors and their spouses.

: Social constraints stem from unsupportive social environments and are associated with reluctance to discuss stressor-related thoughts and feelings. Support deterioration and erosion models provide a framework for explaining how a cancer patient's threat appraisal contributes to a spouse's inadvertent constraint on the patient's emotional expression. Also, based on social comparison theory and the convoy model, a discrepancy in threat appraisal between patient and spouse may create social constraints. Contrary to social cognitive processing theories, we hypothesized that threat appraisals may be an antecedent of social constraints, rather than a consequence. Cancer patients (n=75) and their spouses (n=75) completed questionnaires assessing cancer-related threat appraisals and perceived spousal social constraints at two time points. Cross-lagged panel design results suggested that patient appraisal precedes and predicts patients' perception of social constraints. However, patient and spouse appraisals did not significantly interact in predicting spousal constraints. Limitations and implications are discussed.

Adult↗
PubMed2002

Self-reported problems: a comparison between PTSD-diagnosed veterans, their spouses, and clinicians.

This study investigated self-reported problems in a sample of help-seeking Vietnam veterans, comparing the veteran's own view with clinician and spouse perspectives, with the aim of examining convergence in reports across different informants. Veterans with PTSD (N = 459) were asked to list and rate their five most serious problems. Spouses and treating clinicians completed the same questionnaire in relation to the veteran. Rates of endorsement for each problem area, and levels of agreement between raters, were calculated. Veterans, spouses, and clinicians were all likely to rate anger as a high priority, with veterans also likely to nominate anxiety and depression. Spouses were likely to nominate more observable behavioural problems such as interpersonal difficulties and avoidance, while clinicians were likely to nominate indications of psychopathology, such as anxiety, depression, and intrusive thoughts. Agreement across raters was generally high, although interpretation of agreement levels was complex.

Anger↗
PubMed1997

The effects of pre-coronary angioplasty education and counselling on patients and their spouses: a preliminary report.

The effect of a pre-coronary angioplasty education and counselling program on knowledge and psychological status of patients and on knowledge and quality of life/coping status of their spouses was evaluated. Forty patients and their spouses participated in a pre-coronary angioplasty education and counselling program and 40 served as controls. Knowledge, psychological status and quality of life/coping status were assessed prior to coronary angioplasty and at a mean of four and 11 months post-coronary angioplasty. At four months, improved knowledge and reduced anxiety were found for patients in the experimental group. At 11 months, spouses in the experimental group showed continued improvement in quality of life compared to those in the control group. It was concluded that pre-coronary angioplasty education and counselling can impact favourably upon knowledge in patients and quality of life in spouses.

Adaptation, Psychological↗
PubMed1996

Spouse enabling of alcohol abuse: conception, assessment, and modification.

This article presents a conception of spouse enabling of partner alcohol abuse, a review of its dysfunctions, and an approach to assessment and modification to reduce spouse enabling behavior. Based on experience with its use in unilateral family therapy with many spouses of treatment-refusing alcohol abusers, procedural guidelines, treatment methods, two case examples from a crossover experimental dyad, and clinical results for the two cases in the dyad are described. Also presented are practice issues, characteristics of spouse enabling as they relate to disenabling intervention, and areas of possible application of the disenabling program.

Adult↗
PubMed2002

Spouse caregivers' perceptions of influence of dementia on marriage.

OBJECTIVES: To investigate what kind of changes spouse caregivers of demented patients experience after the onset of dementia (a) in the general atmosphere, happiness, and relations of marriage and (b) in the sexual side of marriage. DESIGN: Semistructured telephone interviews of spouse caregivers of demented patients. SETTING: Community-living demented patients and their spouse caregivers in eastern Finland. PARTICIPANTS: The spouse caregivers of 42 demented patients recruited from a previous intervention study. MEASURES: The questionnaire covered different areas of marriage from the time before and after the onset of dementia. RESULTS: A statistically significant decline had occurred in extent of happiness (p = .012), in equal relations (p = .001), and in patients' expressions of sexual needs (p < .001) when compared the time before and after dementia. Twenty-five (60%) of the caregivers reported that the demented patient had shown at least one negative sexual behavioral change during the course of dementia. Seven male patients (24%) had shown the behavioral symptom of constantly expressing need for making love. One in 10 caregivers had experienced positive sexual behavioral changes. In one third of the patients, the expressions of tenderness towards the caregiver had increased. Dementia did not affect significantly the general atmosphere of the marriage. Out of those still in home care, at 3 years from the onset of dementia, 19 couples (46%) continued to practice intercourse, at 5 years the number was 15 couples (41%), and at 7 years it had declined to 7 couples (28%). CONCLUSIONS: Dementing illness has a major negative impact on many dimensions of marriage. However, there are also positive changes and preserved aspects of marriage. Dementia seems to have a surprisingly little impact on whether the couple continues to have intercourse when compared with the general aging population.

Activities of Daily Living↗
PubMed1998

Depression in elderly spouse pairs.

OBJECTIVE: This study aimed to investigate the prevalence of depression in aged spouse pairs and the associations between the occurrence of depression in one spouse (respondent) and the variables representing the respondent himself/herself and his/her partner. METHOD: Elderly (65 years or older) male (N = 176) and female (N = 176) spouses who constituted married couples that had participated in the epidemiological study on depression in old age conducted in Ahtäri, Finland, in 1989-1990 made up the study series. The data were collected by postal questionnaires, interviews, and clinical investigations. Depression was determined according to the DSM-III criteria. RESULTS: Both husband and wife were depressed in 5.7% of the married couples. The husband was depressed and the wife was nondepressed in 10.2% of the couples; and the wife was depressed and the husband nondepressed in 10.8% of the couples. Among male respondents, poor physical health of the respondent, poor marital or family relations felt by the respondent, poor family relations felt by the marital partner, and a loss of the father by the marital partner while the partner was under 20 years of age were independently related to depression. Lowered functional abilities of the respondent was the only factor independently associated with the occurrence of depression in female respondents. CONCLUSIONS: The coexistence of depression in both elderly spouses is not uncommon. The results also give some evidence to suggest that the vulnerability for the development of depression in the wives may have some effects on the development of depression in elderly men.

Activities of Daily Living↗
PubMed2001

Do cardiovascular risk factors in men depend on their spouses' occupational category?

OBJECTIVE: To analyse the relationships between major cardiovascular risk factors in French men and their spouses' occupational category (OC), taking their own OC into account. DESIGN: A large sample of volunteers working in the French National Electricity and Gas Company (GAZEL). As a check of the robustness, the same analysis was performed in a population-based survey (French multinational MONItoring of trends and determinants in CArdiovascular disease (MONICA) registers). SETTING: Any site of the company in France. Representative sample from the population of the three registers (Lille, Strasbourg, Toulouse). PARTICIPANTS: 9486 and 534 men respectively, in working activity, living in couple and aged 40 to 50 years. MAIN OUTCOME MEASURES: Self-reported arterial hypertension, diabetes, hypercholesterolemia, leisure time sedentary lifestyle, smoking status, body mass index (BMI) and alcohol consumption. RESULTS: In the GAZEL study, diabetes, smoking status, and alcohol consumption in men were associated with their own OC. In contrast, spouses' OC was independently associated with men's hypertension, hypercholesterolemia, sedentary lifestyle, and BMI: men whose spouses were unoccupied or workers have higher risk factors levels. In the MONICA study, the results were mostly comparable, at least for hypercholesterolemia, sedentary lifestyle, smoking status and alcohol consumption. CONCLUSION: Spouses' OC was independently associated with several cardiovascular risk factors in men. These results might indicate that socioeconomic status of the couple, and not only individual characteristics, should be taken into account for a better understanding of cardiovascular risk.

Adult↗
PubMed1999

Spousal negative responses to cancer patients: the role of social restriction, spouse mood, and relationship satisfaction.

This cross-sectional study examined perceptions of spousal negative behaviors in 219 cancer patients. A mediational model was proposed to explain why a spouse might respond negatively to an ill partner because of greater restriction on activities as functional impairment increases. A moderating effect of the spouse's marital satisfaction assessed 3 months before other study measures was also proposed. Results provided support for the proposed model. The relationship between increasing patient functional impairment and spousal negative behaviors was medicated by greater restriction in spouse activities, as well as spousal negative mood. A marginally significant moderating effect for marital satisfaction was found. Although these results must be replicated with a prospective study, the findings begin to shed light on why spouses might respond in negative ways to an ill partner.

Adult↗
PubMed1995

Depressive symptoms across older spouses and the moderating effect of marital closeness.

Independent interviews with husbands and wives from 317 community-dwelling older couples showed that depressive symptoms in 1 spouse had a significant impact on depressive symptoms in the other spouse, after controlling for potentially confounding respondent sociodemographic and health status variables. Relationship quality moderated the influence, with spouse depressive symptoms contributing more of the variance to a respondent's symptoms when a couple were close than when they were not and closeness to a spouse buffering the potentially depressive effects of a respondent's own frailty and financial distress. Husband's own variables explained more of the variance in his symptoms when the couple were not close than when they were, and closeness to his wife increased a husband's vulnerability to the impact of the wife's health status.

Aged↗
PubMed2001

Forgotten partners of international assignments: development and test of a model of spouse adjustment.

The authors developed and tested a model of spouse adjustment to international assignments in a sequence of qualitative and quantitative investigations. From in-depth interviews with expatriate spouses, half of whom had either positive or negative experiences living abroad, the authors identified several potentially important sources of adjustment. These constructs were integrated with others from identity theory and earlier research on expatriates to develop a conceptual model of spouse adjustment. The model was tested by collecting multisource questionnaire data from 221 international assignee couples working in 37 countries. Correlation and regression analyses revealed several important relationships between individual, interpersonal relationship, and environmental sources of identity, and the adjustment of expatriate spouses.

Adaptation, Psychological↗
PubMed2006

Does who you marry matter for your health? Influence of patients' and spouses' personality on their partners' psychological well-being following coronary artery bypass surgery.

Research suggests that presurgical personality attributes influence postsurgical well-being in both patients and their spouses in the context of coronary artery bypass grafting (CABG) surgery. The authors hypothesized that a spouse's characteristics would influence a partner's psychological well-being, regardless of whether he or she was the patient or the caregiver. In this study, 111 male patients and their caregiver spouses completed measures of neuroticism, optimism, perceived marital satisfaction, and depression prior to elective CABG. Follow-up was conducted at 18 months. As expected, higher caregiver presurgical neuroticism predicted higher patient depressive symptoms at follow-up, with caregiver's concurrent 18-month affect controlled for. Likewise, higher patient presurgical neuroticism predicted higher caregiver depressive symptoms at follow-up. Additionally, higher patient presurgical depressive symptoms and lower presurgical optimism contributed to greater caregiving burden. Relationship satisfaction moderated these effects. These results suggest that partners' personality traits are important determinants of both patients' and their caregiving spouses' well-being.

Adult↗
PubMed2000

'I don't have any other choice': spouses' experiences of placing a partner in a care home for older people in Sweden.

The main aim of this paper is to consider the experiences of Swedish spouses who have placed a partner in a care home for older people. Data were gathered from semi-structural interviews with 14 spouses (11 wives and 3 husbands) who had been involved in a care home placement within the previous 6 months. The results reported here are from the first component of a larger grounded theory study, the aim of which is to explore, describe and understand the experience of care home placement from a variety of perspectives and to identify the implications for policy and practice in Sweden. The focus here is on the experience of spouses, relating to the decision-making process, the move into care and subsequent contact with the care home. Four themes emerged from the data - making the decision, making the move, adjusting to the move and reorientation. The results show a lack of planning for the elder person's entry to a care home, and professional dominance of this stage of the process. The largely ambivalent emotional responses to the move that spouses experience and the difficulties in initiating and sustaining relationships with staff in the home are discussed in the light of previous research.

Activities of Daily Living↗
PubMed2002

[Financial burden on caregivers of schizophrenic patients: a comparison between parents and spouses].

OBJECTIVE: The aim of this study was to compare financial burden of parents and spouses, whose relative is suffering from schizophrenia. The first article (part I) draws attention to quantitative analysis. METHOD: 51 parents and 52 spouses filled in the questionnaire about illness related expenses and financial loss; additionally they were asked to estimate the experienced burden on a subjective dimension. RESULTS: Direct cash expenditures on behalf of the patients' illness were reported by 63 % spouses and 69 % parents. Above all, the patient's reduced ability to work was seen as main cause for long-term loss of family income. In general economic disadvantages were not considered as burdensome. DISCUSSION: Although most parents and spouses of schizophrenic patients experience illness related financial disadvantages, it seems that these costs were usually not defined as serious problem. For a better understanding of this finding further analysis of the subjective perspective on perceived financial burden is needed (see part II).

Adult↗
PubMed2005

[Everyday burden of mentally ill people's spouses -- client orientated approaches in relatives' support].

OBJECTIVE: Regarding clinical practice groups for relatives of mentally ill people mostly are conceptualized depending on the type of disorder the patient is suffering from. However, results of research on burden of caregivers indicate aspects of burden which do not seem to be associated with the patients' disorder. METHOD: As part of a study on the burden of caregiving to mentally ill family members in-depth interviews as well as diary writing over a 12 weeks period were carried out with 6 spouses of patients suffering from schizophrenia or depression. RESULTS: Differences in the burden of caregiving do not seem to be related to the type of the patients' diagnosis. Aspects of partnership dominated the interviews and diary writing of the spouses. In all cases substantial parts of experienced burden are related to the spouses' efforts to share mastering of the illness with the patient. CONCLUSIONS: The hypothesis of specific aspects regarding the type of the patients' disorder related to spouses caregiver burden can not be supported by the results of this study. However, our results seem to encourage aspects of relationship within the development of support programs for relatives of mentally ill people.

Adult↗
PubMedDate not supplied

Life events as correlates of burden in spouse caregivers of persons with Alzheimer's disease.

The first goal of this study was to examine the occurrence and appraised distress of 20 stressful life events in 175 spouse caregivers (mean age = 68.6) of persons with Alzheimer's disease and 92 age- and gender-matched controls (mean age = 68.5). The second goal was to determine whether, in the caregivers, life stressors were related to burden after controlling for caregiver age, gender, satisfaction with social supports, and care-recipient cognitive and activities of daily living functioning. Caregivers and controls had similar occurrences and appraisals for all but 3 events, which occurred more frequently in caregivers (i.e., "changes in your spouse's health," "changes in your relationship with your spouse," and "changes in the way you friends and family treat you (social relations)"). Only "changes in finances" was appraised as more distressing by caregivers. Six events explained burden in the regressions: "victim of crime," "age discrimination," "serious family arguments (not including spouse)," "change in caregiver's health," "trouble with Medicaid/Medicare or Social Security," and "move to retirement home (associated with less burden)." Age discrimination was related to burden only for the caregivers of the most impaired care recipients. Also, caregivers who experienced health problems and who had been victims of crimes were the most burdened. Caregivers are not immune to problems experienced by older adults, and these problems may exacerbate caregiver burden. Clinicians should consider the overall context of a caregiver's life when evaluating burden.

Aged↗
PubMed2005

Lifeworld perspectives on assistive devices: lived experiences of spouses of persons with stroke.

The purpose of this study was to explore how spouses of persons with a disability following stroke describe their lived experiences regarding assistive devices in everyday life. A phenomenological lifeworld approach was used and conversational interviews were conducted with 12 spouses. Their lived experiences of assistive devices were explored in relation to four lifeworld existentials intertwined in everyday life. The results showed that lived body concerns aspects of feelings, habits, and incorporation of the devices with one's own body. The devices are, from the spouses' perspective, a prerequisite for their partner with stroke living at home. Successively the devices are incorporated into the couples' homes, and they provide a new view of the environment, aspects related to lived space. The devices bring about a changed relation to lived time, related to past, present, and future. Further, lived human relation concerns changed relationships to husbands/wives with stroke, including a great responsibility due to the devices and their usage. The results also included stigmatizing aspects and a twofold relationship to health professionals regarding participation in decisions about prescribing assistive devices. Understanding the unique meaning of assistive devices from the spouses' perspective is vital for occupational therapists prescribing such devices.

Adult↗