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.     

The roles of marriage and anger dysregulation in biobehavioral stress responses

Physiological and behavioral correlates of anger dysregulation in adults were evaluated in the context of marital stress. Fifty-four married couples participated in a series of laboratory procedures that included electrocardiogram measures during a 15-min marital conflict interaction and an interview assessing their inability to regulate anger (anger dysregulation). Results from the multivariate regression analyses indicated that the nature of the couple's relationship, rather than individual levels of anger dysregulation, predicted lower parasympathetic cardiac activity (indexed by high-frequency heart period variability) and shorter cardiac interbeat intervals. Anger dysregulation, rather than the dyadic relationship, was predictive of greater displays of angry behavior during the marital conflict interaction. The importance of contextual factors in stress processes, such as stress due to marriage, are discussed in light of research linking poor marital quality to greater health risks for women than for men.     

Child Exposure to Marital Conflict and Child Coping Responses as Predictors of Child Adjustment

This study examined the influence of children's exposure to marital conflict and children's coping responses to marital conflict on child adjustment. Forty-three mother–child dyads and 38 of the children's teachers participated in this investigation. Preadolescent children reported the marital conflict they witnessed, their coping responses to marital conflict, and their feelings of depression and global self-worth, while mothers reported their marital conflict and children's internalizing and externalizing behavior problems and teachers reported children's internalizing and externalizing behavior problems. Hierarchical regression analyses were conducted to examine the contribution of demographic, marital conflict, and child coping variables to the prediction of child adjustment. The results indicated that aggressive marital conflict was predictive of children's feelings of low self-worth, mother's reports of child externalizing behavior problems, and teacher's reports of child internalizing behavior problems. Moreover, child coping factors contributed unique variances to the prediction of child reports of child depression and teacher reports of child externalizing behavior problems after marital conflict and demographic variables were considered.     

Marital relationship and health‐related quality of life after prostate cancer diagnosis

Prostate cancer has an impact on the health‐related quality of life (HRQoL) of patients and their spouses. However, the marital relationship at the time of prostate cancer diagnosis is not well known. The aim of the study was to describe and compare the marital relationship of patients with prostate cancer and their spouses and to identify factors associated with HRQoL at the time of diagnosis. The data of this cross‐sectional study were collected with The Marital Questionnaire and RAND‐36 Item Health Survey scales after the diagnosis of prostate cancer from 232 patients and 229 spouses at five Finnish central hospitals from October 2013 to January 2016. Patients with prostate cancer rated their dyadic satisfaction better than their spouses. Respectively, spouses reported better dyadic cohesion. The marital relationship of the patients or spouses was not associated with demographic variables of the respondents. In patients, energy, emotional well‐being and general health were associated with the marital relationship. In spouses, emotional role functioning, emotional well‐being and social functioning were explained by the marital relationship. At the time of diagnosis, the marital relationship of patients with prostate cancer and their spouses was good. However, there were differences in associations between patients' and their spouses' marital relationship and HRQoL. Based on the results of this study, it is useful to take into account the spouses and the marital relationship in the nursing of patients with prostate cancer. The follow‐up research on this subject is needed.     

Dyadic influence of hope and optimism on patient marital satisfaction among couples with advanced breast cancer

Purpose

An estimated 10–40 % of breast cancer (BC) patients report negative changes to their partnered relationships. Literature suggests that for these patients, marital satisfaction is related to depression and other quality of life factors which are associated with survivorship and treatment response. However, existing literature does not provide a clear explanation of the factors that strengthen vs. create strain in couples facing cancer. Given the benefits of a satisfying relationship to patient quality of life, it is important to better understand factors that put patients at greater risk for marital difficulties. This study examined the differential and combined roles of hope and optimism among BC patients and their partners on patient marital satisfaction.

Method

Fifty-six breast cancer patient-partner dyads completed study questionnaires as part of a larger study. Regression analyses were used to examine the main and interaction effects of patient and partner hope and optimism on patient marital satisfaction.

Results and conclusion

Higher patient and partner hope predicted greater patient marital satisfaction, whereas optimism did not. These results are divergent from the literature on optimism and well-being, which shows the importance of studying these two traits concurrently. Interaction effects suggest certain combinations of patient and partner hope and optimism are more beneficial than others for patient marital satisfaction and suggest a dyadic approach is important for investigation of well-being in breast cancer.     

Dyadic Coping of Parents After the Death of a Child

This article explores the grief process of parents following the death of a child due to a life-limiting illness, putting particular focus on dyadic coping. Participants included 46 married parents (23 couples). A mixed-methods design was used with in-depth interviews and standardized questionnaires. All parents were interviewed separately. Aspects of common dyadic coping (e.g., sharing emotions or maintaining bonds to the child) helped them work through their grief as a couple but also individually. The authors conclude that dyadic coping plays an important role in grief work and adjustment to bereavement.     

The family dynamics of childbearing and childrearing families in Finland

Within the context of an international comparative family dynamics project, this study had two chief goals to describe the family dynamics of childbearing and childrearing families in Finland, and to study changes in family dynamics after childbirth The sample consisted of families expecting ( n = 118) and rearing ( n = 94) their first or second child in Finland Two instruments were used in data collection, i e the Family Dynamics Questionnaire and the Family Dynamics Measure, both these tools have been developed in the USA According to the results, childbearing and childrearing families were thought to function quite well Pregnant mothers described their family dynamics in more positive terms than fathers, reporting greater flexibility and clearer communication Similarly, mothers reported more individuation and mutuality than their partners First-time expectant families reported more mutuality than families expecting their second child Childrearing mothers reported more individuation, but also more role conflict than did fathers Communication in families rearing their first child was clearer than in families rearing their second child The birth of a child affected family dynamics by bringing about various changes such as role conflict, isolation and distorted communication     

Key factors affecting dying children and their families

The death of a child alters the life and health of others immediately and for the rest of their lives. How a child dies influences parents' abilities to continue their role functions as well as siblings' abilities to make and maintain friendships, and may be the basis for health care providers' decisions to exit direct care roles. Thus, facilitating a "good death"-an obvious care priority for all involved with the dying child-ought also to be a priority for the health of bereaved families and affected health care providers. Making this a care priority is complicated by a serious lack of data, as details of the last hours or weeks of a dying child or adolescent's life are largely unknown. The purpose of this paper is to identify key factors that affect the course of dying children and adolescents and that of their bereaved survivors, and to link those key factors to needed research that could produce clinically relevant findings to improve the care of these patients. Key factors described here include suffering (physical, psychological, and spiritual), communication, decision making, prognostic ambiguities, ability of the seriously ill child to give assent to research participation, and educational preparation of health care providers to give competent end-of-life care.     

The effect of chronic pain on the family unit

The purpose of the study was to examine what kind of effect a relative with chronic pain had on his or her partner and the other members of the family. The methodology used was grounded theory. The sample was a convenience group of 18 chronic pain sufferers, their partners, and one adult child taken from two pain clinics. The subjects were briefed on the purpose of the study, and how their confidentiality would be protected. Informed consent was then obtained. Data were collected through audio-taped interviews, which were conducted on an individual basis in the subject's home environment. Analysis was conducted through the constant comparative method. Findings revealed that two main variables emerged, that of social relationships and coping techniques. The aspects of social relationships affected were the marital partnership, sexual activity, contact with friends and relatives, and roles. This meant that chronic pain caused social isolation, role tension, marital conflict, reduced sexual activity and feelings of anger, anxiety, resentment and despondency in other family members. However, the results also suggested that the extent to which chronic pain negatively affected the chronic pain sufferer's respective partner and other family members was dependent to some extent on how effective the family was in coping with a relative with chronic pain.     

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.     

A holistic intervention programme for families with a child with a disability

BACKGROUND: The birth of a child with a disability may cause serious stress for the parents and affect each member of the family. Parents need support to deal with such a situation; however, health care professionals themselves are not always well equipped to help them and often adopt an attitude of withdrawal. AIM: The aim of this paper is to describe a family intervention programme developed in collaboration with families who were adapting to the birth of a child with a disability. DISCUSSION: The primary purpose of the programme is to help family members adapt to the situation in which they suddenly find themselves, primarily by reducing stress. The family's autonomy and competencies in providing care for the child are promoted and called into action. The programme encompasses different aspects of family relations: the individual, marital, parental, family, extended family and non-family sub-systems. Its theoretical foundations, clinical experience with families of a child with a health problem, and our previous research have enabled a remodelled vision of the way individuals and families adapt to such a situation. CONCLUSION: The symbioses of the design of the programme, training in its application, and intervention itself have transformed families of a child with a disability as well as the nurses themselves. The key element of this transformation has been the mutual recognition of relevant skills and authority by families and health care professionals that has led to new competencies, self-determination and an individuality that may change their lives.     

Bereaved parents' outcomes 4 to 60 months after their children's deaths by accident,suicide, or homicide: a comparative study demonstrating differences

In this article, the authors revisit a controversial issue in the bereavement field: Does one violent cause of death of a child influence parents' outcomes more than another? To address this question, we observed 173 parents prospectively 4, 12, 24, and 60 months after their children's deaths by accident, suicide, or homicide. Quantitative and qualitative research methods were used to examine the influence of three types of a child's violent death and time since death upon 4 parent outcomes (mental distress, post-traumatic stress disorder [PTSD], acceptance of the child's death, and marital satisfaction). The results showed a significant interaction for the bereavement Group x Time effect for acceptance of death, a significant main effect for time for all four outcomes, and a significant main effect for group (homicide) for PTSD. Nearly 70% of the parents reported that it took either 3 or 4 years to put their children's death into perspective and continue with their own lives; however the child's cause of death did not significantly influence parents' sense of timing in this regard. Clinical and research implications of the findings are discussed.     

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.     

Perpetrators of spousal homicide: a review

It has been argued that individuals who engage in spouse abuse increase their violence toward their partners, which can culminate in the death of either the assaulter or the victim. The aim of this review is to identify risk factors that determine whether an abusive relationship will end in eventual death. An extensive search revealed 22 empirical research studies on risk factors for spousal homicide. The circumstances of spousal homicide are described and salient risk factors are highlighted. In the United Kingdom, 37% of all women were murdered by their current or former intimate partner compared to 6% of men. The most common cause of an intimate partner's death in England and Wales was being attacked with a sharp implement or being strangled. By contrast, the most common cause in the United States for spousal homicide was being shot. Nine major risk factors are found that may help predict the probability of a partner homicide and prevent future victims.     

Parenting and childhood behavior problems: mothers' and fathers' voices

Through thematic analysis of interviews, we explored parents' perceptions of their child's behaviors and their own parenting. A purposive sample of four mothers and four fathers who reported behavior problems for their 7(1/2) year-old-child was selected from a larger study. Parents appraised their child positively despite episodic behavior problems, and described parenting in the context of financial difficulties, marital conflict, chronic illness, lack of support for parenting, and abuse in the parent's family of origin. Data suggest a need for timely mental health services to assist parents with managing their child's behaviors within the context of the family's situation.     

Psychosocial adjustment of patients and spouses to severe cardiomyopathy

Severe cardiomyopathy (SCM) imposes considerable psychosocial stress on families however, little is known about the effect of SCM from the point of view of the marital couple. In this study, adjustment to SCM of 90 patients and their spouses was compared. Patients reported more vocational, domestic, and sexual problems than spouses. Spouses reported more problems in health care orientation, family relationships, and psychological distress than patients. The findings indicate that severe cardiomyopathy impacts on the psychosocial integrity of both partners. Therefore, one should plan interventions to support spouses as well as patients. Because problems of spouses and patients may differ, both partners should be assessed to appropriately target interventions.     

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.