Depression and family interaction among low-income, predominantly hispanic cancer patients: a longitudinal analysis

Purpose

Among cancer patients, family interaction has been associated with depression. According to the stress generation theory, depression among cancer patients triggers stressful interpersonal events that contribute to poor family interactions and additional depression. This conflict may occur with a spouse/partner or other family member, including extended family. This study evaluated the longitudinal association between depression and marital and family conflict among low-income, predominantly Hispanic cancer patients.

Methods

Data were collected during a randomized controlled clinical trial of depression treatment among 472 low-income cancer patients with baseline depression scores of 10 or more on the Patient Health Questionnaire-9 and whose depression symptoms and negative family interactions were assessed at baseline and at 6, 12, 18, and 24 months. Considering that not all participants were in an intimate relationship, only 237 participants were included in the analysis of marital conflict. Mixed linear modeling with and without decomposition of between- and within-person variability was conducted to examine the longitudinal association between family interaction and depression.

Results

Overall, family conflict was significantly associated with changes in depression over time, and marital conflict was significantly associated with mean depression levels over 2 years. In addition, within-subject change in both marital and family conflict was significantly associated with within-patient deviation from average depression levels.

Conclusions

Findings provide evidence of an association between depression and negative family interaction among depressed cancer patients. Cancer patients with clinically significant depressive symptoms may benefit from clinical assessment and psychotherapy relevant to family interaction.     

Anger dysregulation, depressive symptoms, and health in married women and men

BACKGROUND: Anger problems (anger dysregulation) and depressive symptoms have been linked to risk for all causes of mortality, but less is known about the association between anger dysregulation and depressive symptoms within the context of gender differences and health outcomes. OBJECTIVES: The association between anger dysregulation, depressive symptoms, and self-reports of health in married adults was evaluated using an emotion-regulation model. METHODS: Fifty-two married couples completed a series of procedures that included an interview assessing their ability to regulate anger, a questionnaire reporting depressive symptoms (Beck Depression Inventory) and self-reports indicating health. RESULTS: Results provided support for hypothesized links between the variables, but they varied by gender: (a) greater anger dysregulation in the wives, but not the husbands, was predictive of depressive symptoms; (b) anger dysregulation was predictive of the husbands' self-reports of health but was not predictive of the wives' self-reports of health; (c) depressive symptoms were not significantly associated with self-reports of health for either married women or men. DISCUSSION: These results suggest that anger dysregulation may play different roles in the depressive symptoms and self-reports of health for married women and men.     

Appraisals of Spouse Affiliation and Control during Marital Conflict: Common and Specific Cognitive Correlates Among Facets of Negative Affectivity

The present study examined associations between individual differences in trait negative affect and appraisal biases during a marital conflict discussion in a sample of 300 middle-aged and older couples. We used the interpersonal circumplex (IPC) to quantify specific appraisal biases, defined as discrepancies between participant ratings of their spouses’ levels of hostility, friendliness, and control during a marital disagreement relative to independent behavioral coding of these behavioral dimensions. Further, we examined the specific component affective traits (i.e., anxiety, depression, and anger) individually, as well as their independent effects in simultaneous analyses. Composite negative affectivity was associated with appraisals of the spouse as displaying more control, less friendliness, and more hostility than was evident in independent ratings. For the specific negative affects, depressive tendencies—and perhaps the closely related trait of anxiety—were associated with viewing the spouse as both more hostile and less warm or friendly than did independent observers. In contrast, individuals prone to anger perceived more control in their spouse’s behavior than was rated by observers. The results support interpersonal and cognitive models of the role of appraisals in general negative affectivity and its specific components.     

Marital adjustment following spinal cord injury

The present study examined marital characteristics of couples who are coping successfully with spinal cord injury (SCI) versus those who are not and the relationship of positive marital adjustment in SCI couples as compared with positive adjustment among able-bodied (AB) couples. In a 2 X 2 factorial design the marital relations of 10 nondistressed and 10 distressed SCI couples and 14 nondistressed and 10 distressed AB couples were examined. Assessments were conducted in the couples' homes and included self-report measures of recreational-social activities and sexual relations, and observations of marital communication skills. Multivariate analyses revealed significant interaction effect with posthoc comparisons, indicating that spouses in distressed SCI marriages engaged in significantly fewer activities alone and with their spouse and requested the greatest degree of change in the marital relationship in comparison with the other groups. There was a significant main effect for marital satisfaction, with distressed couples expressing more dissatisfaction in sexual relations and more negative communications during conflict resolution tasks. Although the results do not indicate that substantive differences exist in quantitative and qualitative aspects of marital relations between SCI and AB couples, several trends were observed which suggest the need for further research.     

Interactive grief and coping in the marital dyad

Experiencing the death of one's child has been described as one of the most traumatic events that can occur in adult life. This qualitative study examined the grief resolution process of 27 marital couples after the fetal or infant death of their child. Interactive dynamics in the couples' relationship and ways in which they coped with the effects of the death on themselves individually and as a part of a dyadic system were of central importance. The central focus of this article is on the dyadic context, in which marital partners attempt to meet relational responsibilities as well as their own needs. The pressures of being in a system in which both partners are coping with strong and frequently unfamiliar thoughts and emotions are described. Those factors that lead to conflict and stress during this time are discussed as well as other factors that minimize conflict and reduce stress. Finally, implications of these findings for those working with bereaved parents are presented.     

Parenting stress, marital quality, and child behavior problems at age 7 years

The study examined the relationship of early family environment and infant characteristics with childhood behavior problems at age 7 years. Sixty-two mothers and 56 fathers of preterm (30-36 weeks gestation and greater than 1500 g) and full-term boys and girls completed the Parenting Stress Index, Dyadic Adjustment Scale, and a measure of socioeconomic status during the child's first year. When their child was age 7 years, parents completed the Eyberg Child Behavior Inventory Intensity (frequency of behavior) and Problem (impact of behavior) scales. Hierarchical regression analyses showed that parenting stress because of their child's distractibility during infancy predicted the frequency of childhood behavior problems at age 7 years for mothers and of the impact of behaviors on the mother and the father. The quality of the marital relationship during infancy predicted the frequency of behavior problems reported by fathers. Public health nurses are well positioned to assess parenting stress and marital quality and to provide support to families during the early stages of parenthood.     

Altered Psychophysiological Responses to the View of Others' Pain and Anger Faces in Fibromyalgia Patients

Facial expression provides information for an accurate estimation of others' pain. Nevertheless, little is known about psychophysiological responses to pain faces in chronic pain. Event-related potentials and brain oscillations, corrugator activity, and heart rate were recorded in 20 fibromyalgia patients and 20 pain-free controls when viewing pain, anger, happy, and neutral faces. Pain and anger faces elicited greater unpleasantness and arousal than happy and neutral faces, and pain faces evoked greater corrugator response than the rest of faces in all participants. Fibromyalgia patients displayed greater cardiac deceleration to all facial expressions than pain-free controls, and enhanced N100 amplitudes to pain and anger faces in comparison with neutral faces. Pain-free controls were characterized by enhanced N100 amplitudes to happy faces as compared to patients, and by more positive event-related potential amplitudes to happy than to other faces in the time window of 200 to 300 ms. Fibromyalgia patients showed greater theta power in response to pain and anger faces, as well as more reduced alpha power than pain-free controls to all faces. These findings suggest that information processing in fibromyalgia might be characterized by enhanced defensive reactions and increased mobilization of attention resources to pain and anger faces, and by reduced allocation of attention to happy faces.PerspectiveOur findings suggest that brain and cardiac activity elicited by viewing facial expressions of pain and anger in others is altered in fibromyalgia patients. This cognitive bias toward negative emotions could be used in clinical settings as a psychobiological marker during the assessment and treatment of fibromyalgia.     

Type D personality and vulnerability to adverse outcomes in heart disease

General distress, shared across depression, anxiety and anger, partly accounts for the link between mind and heart. The type D (distressed) personality profile identifies individuals who are particularly vulnerable to the adverse effect of general distress. Type D individuals frequently experience negative emotions and are socially inhibited. This profile is more stable than that associated with episodes of clinical depression and describes the chronic nature of distress in some patients. Type D may also partly account for the effect of emotional distress on cardiac prognosis. Type D is associated with a threefold increased risk of adverse cardiovascular outcomes, even after adjustment for depression. This relationship is less obvious in patients with heart failure. Plausible pathways linking type D to cardiovascular complications include hypothalamic-pituitary-adrenal-axis hyperreactivity, autonomic and inflammatory dysregulation, and increased oxidative stress. Research needs to further clarify these pathways and investigate whether type D patients may benefit from closer monitoring of risk factors and a personalized approach to behavioral intervention. The DS14 is a brief, well-validated measure of type D that could be incorporated into clinical research and practice to identify high-risk patients.     

女性精神分裂症患者及其配偶的婚姻质量调查

目的 :讨论女性精神分裂症患者及其配偶的婚姻质量。方法 :采用Olson婚姻质量表 (ENRICH) ,对 30例女性精神分裂症患者及配偶进行评定。结果 :女性精神分裂症及配偶的婚姻质量明显低于正常水平 ,其配偶得分低于患者。结论 :女性精神分裂症患者及其配偶的婚姻质量明显降低。夫妻双方在性格相容性、夫妻交流及解决冲突方式、业余活动、性生活、与亲友的关系等方面存在不和谐 ,易出现矛盾和冲突     

A preliminary investigation of affective interaction in chronic pain couples

The objective of this preliminary study was to examine the extent to which affective marital interaction related to depressive symptoms in persons with chronic pain and their spouses and to pain severity in persons with pain. Couples from the community completed self-report surveys and engaged in a videotaped conversation on a topic of mutual disagreement that was coded for three affect types (i.e., anger/contempt, sadness, humor). Humor was positively related to marital satisfaction in both partners. Spouse anger/contempt and sadness were positively related to depressive symptoms in spouses. Several significant interaction effects between couple pain status (i.e., whether one or both partners reported pain) and affect also emerged. Specifically, sadness in the participant designated as the person with pain was associated with greater depressive symptoms and pain severity when only he or she reported pain whereas sadness was related to fewer depressive symptoms and less pain severity when both partners reported pain. The relationships between spouse anger and spouse depressive symptoms and between spouse humor and pain severity in the person with pain were also moderated by couple pain status. These exploratory findings can be interpreted in light of emotion regulation and pain empathy theories. For example, partners who have not experienced pain themselves may fail to empathize with persons in pain, thus preventing effective emotion regulation. When both spouses report chronic pain, expressions of negative affect may instead promote emotion regulation because the affect is experienced with a spouse who may be more empathetic.     

Competency Lies in the Eye of the Beholder? Comparing the Interpersonal Skills of Currently, Formerly and Never Depressed Females Using Self and Partner Reports

Research examining the social skills of currently and remitted depressed individuals has yielded inconsistent results. The current study aimed to clarify some of this research by comparing the responses of 58 female partners (10 currently depressed, 23 formerly depressed, and 25 never depressed) to hypothetical marital conflict vignettes. Male partners were also asked to report on how their partners would respond in each of the conflict situations. As anticipated, results indicated that currently and formerly depressed females reported behaviors suggestive of lower competency than did never depressed females. The analysis controlled for female relationship quality. However, the reports of the male partner indicated that men’s relationship quality, rather than female depression status, affected men’s reports of their partner’s competency, such that men who were happier in their relationship reported higher levels of competent behavior in their partners. Our findings provide converging evidence for interpersonal models of depression using standardized measures of social competence and also highlight the importance of taking the quality of the interpersonal relationship into account when testing interpersonal models of depression.     

Managing common marital stresses

Marital conflict and divorce are problems of great magnitude in our society, and nurse practitioners are frequently asked by patients to address marital problems in clinical practice. "Family life cycle theory" provides a framework for understanding the common stresses of marital life and for developing nursing strategies to improve marital satisfaction. If unaddressed, marital difficulties have serious adverse consequences for a couple's health, leading to greater dysfunction and a decline in overall wellness. This article focuses on identifying couples in crisis, assisting them to achieve pre-crisis equilibrium or an even higher level of functioning, and providing appropriate referral if complex relationship problems exist.     

Religiosity, spirituality, and marital relationships of parents raising a typically developing child or a child with a disability

In order to discover if differences or relationships exist between religiosity, spirituality, and marital relationships, 111 parents raising a child with a disability (CWD) and 34 parents raising typically developing children independently completed self-report questionnaires assessing religiosity, spirituality, and marital relationships. Parents raising typically developing children scored higher on private and public religiosity and marital satisfaction than parents raising a CWD; mothers scored higher on religiosity variables than fathers. Mothers' ratings of spirituality and family type (disability or typically developing child) predicted their ratings of marital conflict. Higher spirituality and raising typically developing children were associated with higher ratings of marital satisfaction for both mothers and fathers. However, spirituality also moderated the relationship between private/public religiosity and marital satisfaction only for fathers. This information helps improve interventions for families raising CWD and adds to the literature on the interplay of religiosity/spirituality/marital relationship.     

Conflict about expressing emotions and chronic low back pain: associations with pain and anger.

There has been growing interest among researchers and clinicians in the role of ambivalence over emotional expression (AEE) in adjustment to chronic illness. Because of the salience of anger in chronic low back pain, this condition provides a particularly good model in which to examine the role of AEE. This study examined the relation of AEE to pain and anger in a sample of 61 patients with chronic low back pain. Patients completed standardized measures of AEE, pain, and anger. Correlational analyses showed that patients who had higher AEE scores reported higher levels of evaluative and affective pain as well as higher levels of state and trait anger and the tendency to hold in angry thoughts and feelings. Mediational analyses revealed that most of the associations between AEE and pain, and AEE and anger, were independent of one another. These findings suggest that a potentially important relationship exists between AEE and key aspects of living with persistent pain. PERSPECTIVE: This preliminary study suggests that there is a relation between ambivalence over emotional expression and pain and anger in patients with chronic low back pain. Patients who report greater conflict with regard to expressing emotions may be experiencing higher pain and anger.     

The dorsal medial frontal cortex is sensitive to time on task, not response conflict or error likelihood

The dorsal medial frontal cortex (dMFC) is highly active during choice behavior. Though many models have been proposed to explain dMFC function, the conflict monitoring model is the most influential. It posits that dMFC is primarily involved in detecting interference between competing responses thus signaling the need for control. It accurately predicts increased neural activity and response time (RT) for incompatible (high-interference) vs. compatible (low-interference) decisions. However, it has been shown that neural activity can increase with time on task, even when no decisions are made. Thus, the greater dMFC activity on incompatible trials may stem from longer RTs rather than response conflict. This study shows that (1) the conflict monitoring model fails to predict the relationship between error likelihood and RT, and (2) the dMFC activity is not sensitive to congruency, error likelihood, or response conflict, but is monotonically related to time on task.     

Interactive grief and coping in the marital dyad

Abstract

Experiencing the death of one's child has been described as one of the most traumatic events that can occur in adult life. This qualitative study examined the grief resolution process of 27 marital couples after the fetal or infant death of their child. Interactive dynamics in the couples' relationship and ways in which they coped with the effects of the death on themselves individually and as a part of a dyadic system were of central importance. The central focus of this article is on the dyadic context, in which marital partners attempt to meet relational responsibilities as well as their own needs. The pressures of being in a system in which both partners are coping with strong and frequently unfamiliar thoughts and emotions are described. Those factors that lead to conflict and stress during this time are discussed as well as other factors that minimize conflict and reduce stress. Finally, implications of these findings for those working with bereaved parents are presented.