Sexuality and quality of life

The purpose of this research was to explore the relationships between sexual activity and intimacy and quality of life (QOL) of older adults. The authors' research question was "To what extent do age, gender, marital status, health status, education, satisfaction with personal relationships, sexual activity, and satisfaction with intimacy explain older adults' ratings of QOL?" A secondary analysis was conducted using results from a cross-sectional survey. Data were available from a convenience sample of 426 individuals living in British Columbia, Canada, who volunteered to complete the questionnaire. Instruments included the WHOQOL-100, WHOQOL-OLD, and a demographic data sheet. It was found that the strongest contributors to the variance of overall QOL were satisfaction with personal relationships, followed by health status andsexual activity. Age, gender, marital status, and education were not significant. The implications for gerontological nurses include the need to support personal relationships for older adults, to encourage health promotion, and to ensure sexuality is discussed with older adults.     

The marital relationship and psychosocial adaptation and glycemic control of individuals with diabetes

OBJECTIVE: To explore the relationship between marital relationship domains (i.e., intimacy and adjustment) and glycemic control and psychosocial adaptation to diabetes. RESEARCH DESIGN AND METHODS: A total of 78 insulin-treated adults with both type 1 and type 2 diabetes were assessed on a single occasion. They completed two marital quality measures (Spanier Dyadic Adjustment Scale and Personal Assessment of Intimacy in Relationships Scale) and four quality-of-life measures (Diabetes Quality of Life Scale, Medical Outcomes Study Health Survey, Problem Areas in Diabetes Scale, and Positive and Negative Affect Scale). Glycemic control was assessed by HbA(1c). Demographic data (age, sex, type and duration of diabetes, years married, other medical conditions, family history, disability, and years of education) were gathered from the chart and questionnaires. RESULTS: Concerning psychosocial adaptation, both of the marital quality measures were predictors of aspects of adaptation. Better marital satisfaction was related to higher levels of diabetes-related satisfaction and less impact, as well as less diabetes-related distress and better general quality of life. Higher levels of marital intimacy were related to better diabetes-specific and general quality of life. Concerning glycemic control, there was a nonsignificant trend for marital adjustment scores to relate to HbA(1c) (P = 0.0568). CONCLUSIONS: For insulin-treated adults with diabetes, quality of marriage is associated with adaptation to diabetes and other aspects of health-related quality of life. The suggestive finding that marital adjustment may relate to glycemic control warrants further study. Future work should also explore the impact of couples-focused interventions on adaptation, adherence, and glycemic control.     

A prospective analysis of marital relationship factors and quality of life in diabetes

OBJECTIVE: To prospectively assess the relation between marital relationship domains (i.e., intimacy and adjustment) and health-related quality of life (HRQoL) and glycemic control of individuals with diabetes. RESEARCH DESIGN AND METHODS: A previous cross-sectional study assessed the relationship between marital quality and adaptation to diabetes for 78 insulin-treated adults. Each participant completed two marital quality measures (Spanier Dyadic Adjustment Scale and Personal Assessment of Intimacy in Relationships Scale) at time 1 (T1). A total of 61 subjects were contacted two years later (time 2 [T2]) and re-administered four HRQoL measures (Diabetes Quality of Life Scale, Medical Outcomes Study Health Survey-SF36, Problem Areas in Diabetes Scale, and Positive and Negative Affect Schedule). Glycemic control was assessed by HbA(1c). Demographic data (age, sex, type and duration of diabetes, years married, other medical problems, family history, and years of education) were gathered from charts and questionnaires. Linear regression analyses were used to assess the ability of the two marital measures at T1 to predict HRQoL at T2, controlling for confounding HRQoL and baseline subject variables. RESULTS: Both of the marital quality measures at T1 were prospective predictors of aspects of HRQoL at T2. Less diabetes-related distress at T2 was predicted by better marital adjustment at T1. Greater satisfaction with aspects of the diabetes care regimen at T2 was predicted by better marital adjustment and greater perceived marital intimacy at T1. Neither marital measure predicted general HRQoL or glycemic control. CONCLUSIONS: For insulin-treated adults with diabetes, quality of marriage prospectively predicts diabetes-related quality of life. This study highlights the sensitivity of diabetes-specific measures. Future work should explore the value of interventions that target the spouse and/or couple.     

Post-migration changes in gender relations among Ethiopian couples living in Canada.

The Ethiopian community ofToronto, Canada, has identified the prevention of marital conflict and partner abuse as a priority issue. Previous research and community discussions suggested that changes in gender relations following migration contribute to both marital conflict and partner abuse. The objective of this community-based pilot study was to explore post-migration changes in gender relations among Ethiopian couples in order to inform the development of violence-prevention strategies. Qualitative research methods and analyses were used. In-depth interviews and focus-group discussions were conducted with 8 couples who had been married in Ethiopia and migrated to Toronto. The findings indicate changes in gender relations following migration as well as concordant and discordant patterns of change. Change was found to be associated with factors such as age, number of years married, experience in a third country, and gender-role socialization. Implications for future research and nursing practice are discussed.     

The Exercising Together project: design and recruitment for a randomized, controlled trial to determine the benefits of partnered strength training for couples coping with prostate cancer

Prostate cancer can threaten quality of life for the patient and his spouse and the quality of his marital relationship. The purpose of our study is to evaluate the effects of "Exercising Together" - a partnered strength training program for married couples coping with prostate cancer - on the physical and emotional health of prostate cancer survivors (PCS) and their spouses and on marital quality. We are conducting a 6-month randomized controlled trial with two groups: 1) Exercising Together - a progressive, supervised strength training program and 2) a usual care control condition. The primary aims of this exploratory study are to: 1) Determine the effect of partnered strength training on physical and emotional health (muscle strength, physical function, body composition and self-report physical and mental health) in PCS, 2) Determine the effect of partnered strength training on physical and emotional health in spouses and 3) Explore the effect of partnered strength training on marital quality (incongruence, communication, relationship quality, intimacy) of the PCS and spouse. Target accrual has been met in this study with 64 couples enrolled and randomized to exercise (n=32) or usual care (n=32) groups. This study is the first to examine the feasibility of this exercise format in both the chronically ill patient and spouse and explore benefits at the individual and couple level.     

Quality of life issues in patients with implantable cardioverter defibrillators: driving, occupation, and recreation

In the United States over 350,000 individuals die annually from sudden cardiac arrest due to ventricular tachyarrhythmias. Numerous large-scale clinical trials have consistently demonstrated that implantable cardioverter defibrillators (ICDs) reduce mortality among appropriately selected patients who have survived an episode of potentially life-threatening ventricular arrhythmia (secondary prevention) or are at risk for ventricular arrhythmia (primary prevention). Despite the demonstrated success of the ICD, many patients often experience unique physical, emotional, and psychosocial needs that can directly impact their overall quality of life (QOL). The most common psychological disturbances following ICD implantation include stress, anxiety, depression, or fear, typical of any chronic illness. Additionally, ICDs impose unique emotional pressures relating to altered body image, painful shocks, and the possibility of hardware failure. The random nature of shocks commonly induces feelings of isolation and powerlessness and the experience of shocks is directly linked to poor QOL outcomes. Lifestyle changes, such as restrictions on driving, eligibility for employment, marital and social relationships, sexual intimacy, or participation in recreational activities can significantly affect the ICD patient's psychological and emotional well-being. The purpose of this article is to review the QOL data from several large-scale clinical trials of ICD patients as well as to examine specific QOL issues such as driving restrictions, occupational, and recreational concerns.     

婚姻质量及夫妻关系与抑郁情绪的相关性研究

目的探讨夫妻关系及婚姻质量与抑郁情绪的相关性。方法对深圳市4550名中学生家长采用一般情况问卷、Olson婚姻质量问卷、夫妻冲突量表、领悟社会支持量表（夫妻之间）和贝克抑郁量表进行调查,将结果进行相关分析、多元逐步回归分析和路径分析。结果Olson婚姻质量问卷总分及各因子分均与夫妻支持总分呈显著正相关（P〈0．05或0．01）,与贝克抑郁量表总分呈显著负相关（P〈0．01）。多元逐步回归分析显示：夫妻冲突与满意度和性格相容性有关（P〈0．05或0．01）,夫妻支持与性别、过分理想化、满意度和信仰一致性有关,抑郁与性别、性格相容性、夫妻冲突和支持有关（P〈0．01）。路径分析显示：性别、性格相容性和满意度是抑郁的预测变量,对抑郁情绪产生直接影响。结论夫妻之间性格相容和满意度是影响夫妻冲突和支持的重要因素,且对情绪有着间接或直接的影响。因此,在加强心理健康宣传的同时,应强调夫妻间的接纳和宽容的重要性,增进夫妻间交流和沟通的技巧,提高婚姻质量。     

Partner-assisted emotional disclosure for patients with GI cancer: 8-week follow-up and processes associated with change

Purpose

We recently reported that a partner-assisted emotional disclosure intervention for gastrointestinal cancer led to improvements in relationship quality and intimacy for couples in which the patient initially reported higher levels of holding back from discussing cancer-related concerns. The purposes of the present study were to examine outcomes at 8-week follow-up and process variables that may influence treatment effects.

Methods

One hundred thirty couples were randomly assigned to either partner-assisted emotional disclosure or an education/support control condition. Participants completed measures of relationship quality, intimacy, and psychological distress before randomization, post-treatment, and 8?weeks later. Patients in the disclosure intervention completed measures of negative affect immediately following each treatment session, and their level of expressiveness during the sessions was rated by trained observers. Data were analyzed using multilevel modeling.

Results

Among couples in which the patient initially reported higher levels of holding back, the disclosure intervention led to improvements in relationship quality and intimacy that were maintained at 8-weeks follow-up. High levels of patient expressiveness during the disclosure sessions were associated with improvements in relationship quality and intimacy, and high levels of patient negative affect immediately following the sessions were associated with reductions in psychological distress at the post-test assessment.

Conclusions

For couples in which the patient tends to hold back from discussing concerns, partner-assisted emotional disclosure is a beneficial intervention leading to improvements in relationship functioning that maintain over time. Future research is needed to examine methods of enhancing intervention effects, including encouraging patient expressiveness and negative affect during the sessions.     

安徽省三级甲等医院肿瘤科护士死亡态度现状及其影响因素研究

[目的]调查安徽省肿瘤科护士死亡态度现状,分析其影响因素。[方法]采用便利抽样的方法,抽取安徽省17所三级甲等医院肿瘤科护士528人,应用一般情况调查表、中文版死亡态度描绘量表(Death Attitude Profile-Revised,DAP-R)进行调查。[结果]死亡态度各维度得分从高到低依次为:自然接受(3.97±0.54)分,死亡逃避(3.27±0.78)分,死亡恐惧(3.11±0.72)分,趋近接受(2.95±0.72)分,逃离接受(2.79±0.87)分。单因素分析结果显示,性别、年龄、工作年限、婚姻状况、学历、劳动关系、宗教信仰、照顾临终病人的经历、丧亲经历是影响肿瘤科护士死亡态度的因素;多元线性逐步回归分析显示,性别、年龄、婚姻状况、学历、劳动关系、宗教信仰及丧亲经历是影响肿瘤科护士死亡态度的主要因素。[结论]安徽省肿瘤科护士死亡态度较消极,年龄、性别、学历、劳动关系、宗教信仰、丧亲经历及婚姻状况是其主要影响因素。护理管理者应重视护士的死亡态度,并根据影响因素进行有针对性的干预,促进护士对死亡态度的正向转变,进而提升对肿瘤病人的照护品质。     

First-time fathers' health status during the perinatal period

BackgroundFor first-time fathers, the perinatal period is a critical period of stress and imbalance. Marital intimacy and social support may affect their stress and health status while they change their roles.AimThis study was to explore the changes of and correlations among marital intimacy, social support, and health status and predictors of first-time fathers' health status during the perinatal period.MethodsWith a repeated measures study design, a total of 217 first-time fathers whose spouses were in the third trimester of pregnancy were recruited for the study. The Chinese Health Questionnaire, Marital Intimacy Scale, and Social Support Scale were employed to collect data at a medical center in the 36th week of pregnancy and the 1st and 4th weeks after childbirth.ResultsThe levels of marital intimacy and social support of first-time fathers during the perinatal period increased significantly with time. Meanwhile, the period of the first week after childbirth was a predictor of first-time father's health status.ConclusionsThis study only tracked the first-time fathers' health status in the 36th week of pregnancy and the 1st and 4th weeks after childbirth. Future studies could track them until one year after childbirth in order to explore the impact of the perinatal period on the couples and their babies. During the perinatal period, health care providers shall assess and provide needed interventions to first-time fathers as soon as possible to facilitate the first-time fathers to get ready for the role transition and to promote their health status.     

Marital quality in the context of mild cognitive impairment

Profound behavioral changes in persons with dementia often negatively affect the quality of marital relationships. Yet, little is known about the extent to which the marital relationship may be affected when the care recipient has milder degrees of cognitive impairment. This study characterizes marital quality among 27 adults who live with a spouse with mild cognitive impairment (MCI). This study demonstrates that at mild levels of cognitive impairment, specific behaviors in the affected person are distressing and may degrade the quality of the marital relationship. These results have implications for clinical practice and the delivery of health care and social services to these families. It is important to develop interventions to address the needs of these individuals and their caregivers. Results of this study suggest the need for mental health interventions designed to preserve the quality of these marital relationships.     

Predictors of husbands' and wives' grief reactions following infant death: the role of marital intimacy

This follow-up study examined how bereaved couples' grief reactions change over time and how the quality of the marriage can predict these reactions for men and women. A group of 31 bereaved couples who 2 to 4 years earlier had lost an infant ( greater than 20 weeks gestation and less than 1 year of age) were revisited in their home 24 months after the initial home visit. With the exception of somatization, couples' grief reactions were less intense at follow-up than at the initial visit. Overall, husbands experienced less guilt, meaninglessness, yearning, and morbid fear than wives. Both husbands and wives who reported lower levels of marital intimacy soon after the loss experienced more intense grief at follow-up. Finally, couples continued to be vulnerable to a resurgence of grief even years later.     

Mental health in older spouses: the dynamic interplay of resources, depression, quality of the marital relationship, and social participation

This study demonstrates a conceptual linkage between exchange theory and psychoanalytic theory of depression. The effects of diminished resources and the dynamic relationships between depression, quality of the marital relationship, and social participation were investigated with a sample of 229 community residing, married older people (Duke Longitudinal Study) using a combined structural and measurement model with linear structural relations (LISREL) analysis. Findings are that some resources have direct effects on depression, marital quality, and social participation. However, it is through the pathway of depressive moods that ill health, retirement, and stress have their negative effects on the marital relationship. Depressive moods do affect social participation, but psychosomatic symptoms of depression do not affect the amount of social participation nor the marital relationship. Recognizing depressive moods as intervening variables is important because older people tend to deny feeling depressed. Without a conceptual linkage of exchange and depression theories, this pathway would not have been identified.     

Sequential and Base Rate Analysis of Emotional Validation and Invalidation in Chronic Pain Couples: Patient Gender Matters

The purpose of this study was to examine the extent to which communication patterns that foster or hinder intimacy and emotion regulation in couples were related to pain, marital satisfaction, and depression in 78 chronic pain couples attempting to problem-solve an area of disagreement in their marriage. Sequences and base rates of validation and invalidation communication patterns were almost uniformly unrelated to adjustment variables unless patient gender was taken into account. Male patient couples’ reciprocal invalidation was related to worse pain, but this was not found in female patient couples. In addition, spouses’ validation was related to poorer patient pain and marital satisfaction, but only in couples with a male patient. It was not only the presence or absence of invalidation and validation that mattered (base rates), but the context and timing of these events (sequences) that affected patients’ adjustment. This research demonstrates that sequences of interaction behaviors that foster and hinder emotion regulation should be attended to when assessing and treating pain patients and their spouses.

Perspective

This article presents analyses of both sequences and base rates of chronic pain couples’ communication patterns, focusing on validation and invalidation. These results may potentially improve psychosocial treatments for these couples, by addressing sequential interactions of intimacy and empathy.     

Effects of a child's death on the marital relationship: A preliminary study

This study examined the effects of a child's death on the parents' marital relationship. The participants were 20 couples who lost children in a variety of ways. The data collected through interviews were analyzed to determine common experiences among parents. Five themes were identified and discussed. They were fathers' concern and frustration about their wives' grief wives' anger over husbands' not sharing their grief, temporary halt in communication, loss of sexual intimacy, and general irritability between spouses. Implications for mental health professionals are discussed.     

Effects of psychological intervention for Korean infertile women under In Vitro Fertilization on infertility stress,depression, intimacy,sexual satisfaction and fatigue

This quasi-experimental study with a nonequivalent control group pretest-posttest design was conducted to evaluate the effects of a psychological intervention program for 50 women with infertility (experimental group: 26, control group: 24) utilizing assisted reproductive technology. The experimental group received six four-hour sessions of intervention, with outcomes measured at baseline and four weeks post-intervention. The experimental group demonstrated significant improvements in marital intimacy (z = 6.528, p < .001) and sexual satisfaction (z = 3.148, p = .003) and significant reductions in depression (z = −4.850, p < .001) and fatigue (z = −4.597, p < .001). Thus, the program can alleviate depression and fatigue. Further, psychological intervention centered on the marital and personal dimensions may improve marital intimacy and sexual satisfaction.     

Perceived enactment of autonomy and related factors among elders

This study aims to investigate the perceived enactment of autonomy (PEA) of Chinese elders as well as its relationship to other variables, such as morale, life satisfaction, need for assistance, subjective overall health status, etc. Selected demographic attributes (gender, age, living arrangements, etc.) were also examined for their relationship to PEA. A purposive sample of 324 subjects over 64 years old was recruited from homes and long-term care facilities in southern Taiwan. A Chinese version of the PEA scale (PEA-CV) and the Revised Philadelphia Geriatric Center Morale Scale (R-PGCMS) were used to measure PEA and morale. Data were analyzed using SPSS/PC software version 10.0. The results show that these elders had high perceived enactment of autonomy (mean = 2.99). Through multiple regression analysis, these results also revealed that need for daily living assistance, type of living arrangement, scores for morale and marital status significantly affected perceived enactment of autonomy among Chinese elders. The results suggest that we should help elders recognize possible choices, respect the choices they have made, advocate elders' autonomy while providing assistance, and design appropriate activities for them so that they gain a sense of freedom, individuality and independence. Directions for future studies are suggested.