The effects of dyadic strength and coping styles on psychological distress in couples faced with prostate cancer

Dyadic adjustment and coping styles have been shown to predict levels of psychological distress following cancer diagnoses. This study examined the relationship between coping and distress in couples faced with prostate cancer, considering dyadic functioning as a third variable that potentially moderated or mediated the relationship. To investigate its influence on the success of patients' and spouses' coping efforts, both moderational and mediational models were tested using couples' composite dyadic adjustment scores. Only the moderational model was supported for patients: dyadic strength moderated the effects of avoidant coping and intrusive thinking on mood disturbance. Despite maladaptive coping, patients that were members of stronger dyads reported less distress than those in more dysfunctional relationships. Findings suggest that the relationship between coping and distress depends on the quality of dyadic functioning. Being part of a strong dyad may serve as a buffering factor, implying the need for psychosocial intervention for couples in maladjusted relationships.     

Coping and Adjustment in Children with Cancer: A Meta-Analytic Study

The current meta-analysis assessed the efficacy of coping strategies on psychological and physical adjustment in children with cancer (n = 1230). Coping strategies were operationalized in accordance with two coping taxonomies; the first is based on the general orientation of the child's coping attempts (approach or avoidance), and the second is based upon coping efforts to regulate the stressor and/or feelings of distress attributed to it (problem-focused and emotion-focused). Approach, avoidance, and emotion-focused coping were unrelated to overall adjustment. A small-to-medium but negative association was found between problem-focused coping and adjustment, indicating more use of the strategies that compose this dimension are associated with poorer adjustment. However, homogeneity analyses also indicated significant variation for all of these effect sizes. Follow-up moderator analyses found coping-adjustment relations were both dependent upon time since diagnosis and the particular stressor the child was dealing with during treatment.     

Coping with pain and surgery: Children’s and parents’ perspectives

This article examines relations between coping with general and postoperative pain. Children's and parent's coping ratings, and the contribution of temperament and coping to postoperative adjustment. Before and after day surgery, 7-to 12-year-olds (n = 124) rated their coping with pain. Parents rated their child's coping and temperament pain and distress were rated on the day of and 2 days following surgery. Coping with general and postoperative pain were moderately correlated (median r = .48). Except for distraction, all types of coping strategies were used more frequently for general than postoperative pain. Correlations between child and parent coping ratings were moderate (median r = .36). After controlling for emotionality and medications, lower levels of emotion-focused avoidance and higher levels of distraction were related to lower pain and distress. After controlling for a priori surgical group (no-low pain; moderate-high pain), emotionality, and medications, lower levels of emotion-focused avoidance were related to lower pain and distress but distraction was no longer significant in a number of the regressions. Coping with pain has trait-like qualities but differences in the nature and context of pain create differences in strategy use. Level of pain appears to influence the type of coping strategies used. Interventions should target children's use of distraction and minimize us of emotion-focused avoidance.     

Cancer Patients and their Spouses: Gender and its Effect on Psychological and Social Adjustment

The aim of this research was to examine the effects of gender on the social adjustment and psychological distress experienced by cancer patients and their spouses. A total of 87 patients and spouses participated in the study, with the patients undergoing active medical treatment (chemotherapy, radiation or both) and three months post-diagnosis. Three questionnaires were used to collect data: a personal information one; the Brief Symptom Inventory (BSI), in which stress was examined; and the PAIS-SR, in which psychosocial adjustment to physical illness was examined. Both cancer patients and their spouses reported the same level of psychological distress and difficulties in social adjustment in most areas studied. Patients reported more difficulties in relationships with extended family and in sexual relations than their spouses did. In the area of social environment, spouses reported higher levels of difficulties than patients. Both men and women reported difficulties with social adjustment in most areas studied. Women reported more difficulties with social environment. As for psychological stress, generally men as patients and as spouses reported higher levels of anxiety. As patients, men reported higher levels of paranoia.     

Communication avoidance,coping and psychological distress of women with breast cancer

This study examined the relationship between communication avoidance of cancer-related topics with psychological distress, and the mediating role of coping strategies, in women with breast cancer. Women diagnosed with breast cancer (N = 338) completed an online survey including measures of self- and perceived-partner communication avoidance, psychological distress (depression, anxiety and stress), and coping strategies. Linear regression analyses indicated that women’s and perceived-partner’s communication avoidance was associated with anxiety, depression, and stress in the cancer-affected women. Bootstrapping analyses showed significant mediation effects of self- and perceived-partner communication avoidance on all distress outcomes through greater disengagement coping, and on anxiety through lower engagement coping. Emotionally valenced topics (i.e., disease progression and sexuality) were most avoided and practical issues were least avoided. Enhancing couple communication about cancer and women’s adaptive coping skills (i.e., discourage use of disengagement coping strategies and promote use of engagement coping strategies) may be important targets for psychosocial intervention.     

The Role of Illness, Resources, Appraisal, and Coping Strategies in Adjustment to HIV/AIDS: The Direct and Buffering Effects

This study examined the utility of a stress and coping model of adjustment to HIV/AIDS. A total of 114 HIV-infected gay or bisexual men were interviewed and they completed self-administered scales. Predictors included illness variables (disease stage and number of symptoms), coping resources (optimism and social support), appraisal (threat, challenge, and controllability), and coping strategies (problem- and emotion-focused). Adjustment outcomes were depression, global distress, social adjustment, and subjective health status. Results from hierarchical regression analyses indicated that better adjustment was related to an asymptomatic illness stage, fewer HIV-related symptoms, greater social support, challenge and controllability appraisals, problem-focused coping, and lower threat appraisals and reliance on emotion-focused coping. There was limited support for the stress-buffering effects of optimism. Findings support the utility of a stress and coping model of adjustment to HIV/AIDS.     

Psychosocial Functioning of Carcinoid Cancer Patients: Test of a Stress and Coping Mediated Model1

This study examined a mediated‐effects stress and coping model among cancer patients with carcinoid tumors to identify specific pathways with a view toward determining (a) which coping strategies predict more positive adjustment, (b) which strategies predict less positive adjustment, and (c) whether coping would mediate the effect of optimism on psychosocial outcomes. Coping strategies partially mediated the effects of optimism on the psychological adjustment in cancer patients with carcinoid tumors. Specifically, self‐blame and active coping significantly predicted outcomes of distress. Thirty‐seven percent of the respondents met criteria for elevated depressive symptoms warranting intervention. Generalizability of the mediated‐effects stress and coping model and findings unique to the carcinoid population are discussed.     

Breast cancer patients' topic avoidance and psychological distress: the mediating role of coping

Avoiding communication about cancer is common and is likely to have negative psychological health consequences for patients, yet the connection between topic avoidance and psychological well-being is not well understood. This study of women with breast cancer examined coping behaviors as mediating mechanisms through which their cancer-related topic avoidance might affect their psychological distress. Consistent with predictions, greater levels of patient topic avoidance were associated with higher levels of depression and anxiety. Results indicated that topic avoidance may decrease patients' use of emotional support and increase patients' self-blame, each of which may lead to higher levels of psychological distress.     

Cross-sectional relationships between dyadic coping and anxiety,depression, and relationship satisfaction for patients with prostate cancer and their spouses

Objective

Dyadic coping has an impact on couples’ adjustment to breast cancer; however, there is limited evidence regarding whether dyadic coping influences couples’ adjustment to other types of cancer. The objective of this analysis was to further our knowledge of the relationships between dyadic coping, anxiety, depression, and relationship satisfaction among couples facing prostate cancer.

Methods

Forty-two men recently diagnosed with prostate cancer recruited from urology clinics and their spouses completed measures of dyadic coping, anxiety, depression, and relationship satisfaction. The Actor-Partner Interdependence Model was used to examine the relationships among these concepts.

Results

Relationship satisfaction was significantly associated with patients’ and wives’ use of positive and negative dyadic coping, and their partners’ use of these strategies. Although patients’ and wives’ use of supportive dyadic coping was not associated with their anxiety and depression, their partner's use of this strategy was associated with anxiety and depression. Only husbands’ and wives’ perceptions of their partner's negative dyadic coping was associated with anxiety and depression.

Conclusions/Practice implications

Couples respond to a prostate cancer diagnosis as an interactional system. Future research should focus on tailoring couple-based interventions such that patients and spouses are equipped to provide the specific support their partners need.     

Psychological adjustment in caregivers of school-age children infected with HIV: stress, coping, and family factors

OBJECTIVE: To assess for significant differences in psychological functioning between caregivers of HIV-infected children and caregivers of healthy children, and to examine the utility of applying a stress and coping model to caregivers of children with HIV disease. METHODS: Participants included caregivers of HIV-infected children (n = 36) and caregivers of a demographically matched control group of healthy children (n = 32). During their child's pediatric clinic visits, caregivers completed measures of psychological adjustment, stress, coping style, and family resources and support. They also completed a measure of their child's psychological adjustment. RESULTS: Caregiver psychological distress scores did not significantly differ between the HIV and control groups, and clinically significant rates of psychological distress were reported by more than a third of caregivers in both groups. Hierarchical multiple regression analyses revealed that independent of their child's illness status, stress and coping style were significant predictors of caregiver's psychological adjustment. In addition, caregiver psychological distress was a significant predictor of children's maladjustment. CONCLUSIONS: High rates of psychological distress were observed in caregivers of children with HIV disease; however, similarly high rates of psychological adjustment problems were found in caregivers of healthy children. Caregivers who reported high levels of daily stress and emotion-focused coping styles tended to report more psychological distress. Further, caregivers who reported more psychological distress also reported more internalizing and more externalizing behavior problems in their children, regardless of the child's illness status. These findings reflect the impact of poverty and environmental stress on caregivers' adjustment.     

Early Stage Breast Cancer: Explaining Level of Psychosocial Adjustment Using Structural Equation Modeling

In many women, the diagnosis of breast cancer leads to psychosocial adjustment problems. Biodemographic variables, coping, and social support are factors that influence psychosocial adjustment. The main objective of the present study was to identify and estimate the associations between psychosocial adjustment and biodemographic variables, coping, and social support by using Structural Equation Modeling (SEM). Eighty-seven women with newly diagnosed early stage breast cancer completed several questionnaires covering these areas. It appeared that in the period shortly after surgery, coping style, especially illness-specific coping, is of high relevance for psychosocial adjustment. In our study, we could not confirm the positive role of social support found in other studies on psychosocial adjustment. Biodemographic variables had both direct and indirect associations with psychosocial adjustment: older women and women who had had breast-conserving treatment used a more optimistic coping style; the latter group also reported higher body image; and finally, women with a more advanced stage of disease reported a reduction in recreational activities.     

Psychosocial intervention for women with primary, non-metastatic breast cancer: a comparison between participants and non-participants

BACKGROUND: Despite improvements in the medical treatment of breast cancer, resulting in better prognoses, women diagnosed with the illness often experience psychosocial problems. As a result, many psychosocial intervention programs have been developed, usually with positive results. The aim of this study was to examine the effects of two 12-week psychosocial intervention programs for women with a primary, non-metastatic breast cancer diagnosis in comparison to women who were on a waiting list for these interventions for 3 months. METHODS: Sixty-nine women with primary, non-metastatic breast cancer, but otherwise without psychosocial problems, were randomized to a group of patients treated with the intervention program (group psychotherapy or social support group) or a control group (on a waiting list). Differences between both groups in psychosocial adjustment, social support and coping at the short-term follow-up were described in this study. RESULTS: Women who participated in the group intervention programs did not differ from women in the control group regarding psychosocial adjustment at the end of the study. Women who participated in the social support groups reported to receive more social support from others not very close to them. They also used more palliative coping than women from the psychotherapy group. CONCLUSIONS: Apparently, women who are being diagnosed with breast cancer, but otherwise have no psychosocial adjustment problems following the diagnosis, do not especially benefit from a short-term intervention program compared to women in the control group.     

Coping strategies of women with breast cancer: a comparison of patients with healthy and benign controls

BACKGROUND: Cancer has an enormous impact on the patient, triggering fears of suffering, disability and death. Still, little research has been published which investigates the coping strategies adopted by cancer patients, when attempting to deal with their serious health threat. Moreover, it is often not clarified whether the selected coping strategies are used exclusively by cancer patients, or whether other groups of women facing benign breast diseases or having health worries regarding their breasts share similar coping strategies. This study attempts to identify those coping strategies that distinguish breast cancer patients from non-malignant controls. METHODS: A sample of 180 breast cancer patients was assessed on how it coped with health threats. The control group was composed of 268 women who were diagnosed as having either a benign disease or were disease free. The Ways of Coping Questionnaire was administered in order to record the frequency of the coping strategies used under the health conditions. Univariate analyses were conducted to compare mean scores in coping strategies among the diagnostic groups. Multivariate analyses were performed to identify those variables that distinguish one group from the other. RESULTS: Compared with women with benign breast disease and those who were disease free, breast cancer patients significantly infrequently exhibited attributions of blame to self, whereas they did not differ from controls in other ways of coping such as self-isolation, passive acceptance, seeking social support, problem-focused coping, positive reappraisal, distancing, and wishful thinking. CONCLUSION: Our results may suggest that under the conditions of a cancer diagnosis, patients do not tend to assign responsibility on themselves and their character, since they possibly need to avoid guilt, low self-esteem, and social distance, and to maintain a potential to invest in the adjustment process.     

Coping with infertility: distress and changes in sperm quality.

Infertility represents a serious stressor for some patients as well as a risk factor for a decrease in sperm quality. The purpose of the present study was to identify coping strategies that went along with both better emotional and physical adjustment to infertility. The sample consisted of 63 patients who contacted an andrological clinic more than one time. Prior to clinical examination, patients filled out a questionnaire referring to the way in which they coped with their wives' previous menstruation. Participants also completed a scale assessing perceived distress due to infertility. Change in sperm concentration since baseline semen analysis and the level of distress were used to evaluate patient's adjustment. The better-adjusted patients showed less prominent overall coping efforts, and a higher proportion of distancing coping strategies. An improvement in sperm quality also was associated with a low cognitive involvement in infertility. Situational uncontrollability of infertility could be a moderator of the effectiveness of coping employed by the better-adjusted patients. In addition, the coping behaviour related to better adjustment could be due to a dispositional stress resistance factor. For clinical implementation of the findings, the attitudes of a patient and the expectations of his wife have to be taken into consideration.     

Psychological and neuropsychological predictors of coping patterns by patients with multiple sclerosis

To determine the relative contribution of psychological and neuropsychological (NP) variables to the prediction of patterns of coping with disease-related stressors and satisfaction with their coping efforts, 56 patients with multiple sclerosis (MS) were administered the Ways of Coping Checklist, the Symptom Checklist-90-Revised, and a battery of NP tests chosen for their sensitivity to MS. Higher levels of psychological distress were associated with greater use of emotion-focused coping strategies and reduced perceived effectiveness of the coping strategies employed. Psychological distress was not related to the use of problem-focused strategies and NP variables did not predict coping style or effectiveness. MS patients who display heightened psychological distress may be good candidates for psychotherapeutic interventions aimed at improving perceived coping effectiveness.     

The closer ‘We’ are,the stronger ‘I’ am: the impact of couple identity on cancer coping self-efficacy

The present study tested the supposition that greater levels of couple identity (or we-ness) increase a woman’s coping self-efficacy in relation to breast cancer, which, in turn, predicts better psychosocial adjustment. Women (N = 112) in committed relationships completed surveys assessing their levels of couple identity, cancer coping self-efficacy, and aspects of their psychosocial adjustment (specifically, depression, anxiety and functional well-being) during one of their outpatient visits to the cancer centre. As predicted, the more women identified with their relationships, the lower their levels of depression and anxiety were and the greater their functional well-being was. This relationship was mediated by coping self-efficacy: greater identification with one’s relationship predicted greater confidence in one’s ability to cope, which, in turn, predicted better adjustment. The role intimate relationships play in women’s adjustment to breast cancer, as well as directions for further research, are discussed.     

Positive and Negative Religious Coping in German Breast Cancer Patients

A growing interest has been focusing on the relationship between religious coping and psychosocial adjustment among cancer patients. However, previous research mostly has not differentiated between positive and negative components of religious coping. The current cross-sectional study investigated the role of both positive religious coping, i.e., a confident and constructive turning to religion, and negative religious coping, i.e., religious struggle and doubt, in a sample of 156 German breast cancer patients. Participants were assessed upon admission to an inpatient rehabilitation program. In addition to religious coping, two basic nonreligious coping styles (depressive coping and active problem-focused coping) and psychosocial adjustment (anxiety and depression) were measured. Major research questions concerning the mediating role of nonreligious coping and the relative predictive power of positive and negative religious coping were primarily addressed using structural equation modeling. Results indicated that the relationship between religious coping and psychosocial outcomes was completely mediated by nonreligious coping, whereby only depressive coping and not active problem-focused coping proved to be a mediating variable. Positive and negative religious coping were somewhat positively related to each other; their (indirect) predictive power on psychosocial adjustment was identical though in an opposite direction. All in all, the results correspond to previous Anglo-American research. There are, however, some discrepancies which may be due to the specific religious-cultural background in Germany.     

Patient-centered care and breast cancer survivors' satisfaction with information

Satisfaction with information is an important patient outcome and may be related to the physician's ability to elicit the patients' concerns, to consider the patients' psychosocial needs, and to involve patients in treatment decision making; these communication techniques have been described under the umbrella of "patient-centered." The aim of this study was to examine the relationship between patient-centered care and satisfaction with information among women with a history of breast cancer. We administered a questionnaire to 182 women who had completed treatment for breast cancer. Our findings suggest that, while breast cancer survivors are highly satisfied with information related to treatment, they are less satisfied with information related to the long-term physical, psychological, and social sequelae of the disease and its treatments. In multivariate analysis, patients' perception of patient-centered behaviors was strongly associated with patients' satisfaction with information. These results provide support for the theory that patient satisfaction is improved when physicians incorporate patient-centered behaviors into their care.     

Hiding Worries from One's Spouse: Associations Between Coping via Protective Buffering and Distress in Male Post-Myocardial Infarction Patients and Their Wives

The relationship between protective buffering, a style of coping in which the individual hides his/her concerns from spouse, and level of distress was studied among post-myocardial infarction (MI) patients and their spouses. Forty-three male married MI survivors and their wives completed measures of psychological distress and protective buffering at 4 weeks and 6 months post-hospital discharge. At both time periods, a greater propensity for protective buffering by the patient was related to higher levels of patient distress. Protective buffering by wife was also associated with higher levels of wife distress. In addition, patient buffering at 4 weeks predicted increased patient distress at 6 months. The results suggest that male MI patients who conceal their worries from their spouses adjust more poorly over time.     

Cognitive,interpersonal, and behavioral predictors of patients' and spouses' depression

BACKGROUND: This study examined the relationship between five theory-based variables and the severity of depression. The variables were self-concept, self and spouse ascribed hostility, spouses' level of depression, and involvement in home activities. METHODS: Based on DSM-IV criteria and Beck Depression Inventory (BDI) scores, 75 wife-depressed couples and 59 husband-depressed couples were included in the study. In addition to the BDI, both spouses completed questionnaires relating to self-concept, self- and spouse ascribed hostility, and involvement in home activities. RESULTS: Multiple regression analyses for male and female patients and spouses revealed that in the four groups self-concept was significantly related to the severity of depression. Irrespective of clinical status, involvement in home activities was significantly associated with the severity of depression of women. The relationship between spouse ascribed hostility and the level of depression of both spouses in husband-depressed couples approached significance so did the relationship between patient's and spouse's level of depression in wife-depressed couples. In husband-depressed couples the association between spouses' level of depression reached significance. CONCLUSIONS: The shared and gender-related predictors of severity of depression support an integrative theoretical approach to depression and offer practical implications.