Spouses' cardiovascular reactivity to their partners' suffering

A tale of two marital stressors: Comparing proinflammatory responses to partner distress and marital conflict

Marital quality shares ties to inflammatory conditions like cardiovascular disease and diabetes. For decades, research has focused on marital conflict as a primary mechanism given its potential to trigger inflammatory responses. However, longitudinal evidence suggests that marital conflict declines over time, and little attention has been paid to the inflammatory aftermath of other types of marital exchanges. A spouse's emotional distress is an important but overlooked marital context, as partners are exposed to each other's upsetting emotions throughout adulthood. To directly compare reactivity in proinflammatory gene expression to these two marital stressors and to examine differences by age and marital satisfaction, 203 community adults ages 25-90 (N = 102 couples) provided blood samples and rated their negative mood before and after they 1) watched their partner relive an upsetting personal memory and, in a separate visit 1-2 weeks later, 2) discussed a conflictual topic in their relationship. Controlling for age, sex, race/ethnicity, BMI, alcohol use, smoking, and comorbidities, increases in proinflammatory gene expression were significantly larger after the partner's upsetting disclosure than after marital conflict (B = 0.073, SE = 0.031, p = .018). This pattern paralleled emotional reactivity to the tasks, wherein negative mood rose more in response to the partner's disclosure than to marital conflict (B = 4.305, SE = 1.468, p = .004). In sum, proinflammatory and mood reactivity to spousal distress exceeded reactivity to marital conflict, a well-established marital stressor. Findings reveal spousal distress as a novel mechanism that may link marriage to inflammation-related diseases, and even pose risks for both happy and unhappy couples across adulthood.

Daily Rumination Among Older Men and Women: The Role of Perceived Family and Nonfamily Social Partner Life Stress

OBJECTIVES

Women tend to ruminate more than men, and are generally more hypervigilant to the emotions of others in order to maintain positive social ties. Thus, compared to men, women may ruminate more when their social partners have greater life stresses. However, the literature on stressful events typically focuses on individuals' experiences and perceptions of stressors experienced by specific social ties such as spousal partners and adult children. The purpose of this study was to examine links between perceptions of a broad array of family and nonfamily social partner stresses and daily rumination among older men and women.

METHODS

Adults aged 65 and older (N = 293, 55% women) completed baseline assessments of family and nonfamily life stressors and 5-6 consecutive nightly assessments regarding rumination, interpersonal tensions, worries, and support provision.

RESULTS

Multilevel structural equation models revealed that perceptions of greater family and nonfamily life stressors were associated with greater rumination. The links between family stress and rumination varied by gender: family stress was related to greater rumination among women and not men. Moreover, among women, family and nonfamily stress-rumination links were accounted for by greater daily worries about others, and among men, the nonfamily stress-rumination link was due to greater interpersonal tensions as well as daily worries.

DISCUSSION

These findings may be due in part to gender role socialization and women's greater kin-keeping and investment in family ties.

New Opportunities for Advancing Dyadic Health Science in Gerontology

As dyadic health science enters a golden age, important conceptual, theoretical, and technical challenges remain. This forum review brings together perspectives on the burgeoning dyadic literature from several subdisciplines within aging research. We first define key concepts and terms so that interested researchers can navigate the complex and various ways in which dyadic health research is conducted. We discuss exciting scientific advances and close by identifying crucial challenges and considerations that coincide with important future directions for the field.

Revisiting the caregiver stress process: Does family caregiving really lead to worse mental health outcomes?

While the act of caregiving is often characterized as a stressful experience detrimental to mental health, recent studies are challenging this view by reporting robust health and well-being benefits linked to family caregiving. The current study attempted to provide an explanation of this apparent paradox by focusing on the role played by family health problems in the association between being a caregiver and mental health. Framed within the life course perspective and focusing on caregiving provided to aging mothers, the current study aimed 1) to demonstrate how the linkage between caregiving and depression reported in earlier studies may be misleading and 2) to further investigate whether caregiving to an aging mother may lead to any mental health benefits. Using longitudinal data drawn from the nationally representative US Health and Retirement Study, I follow adult children 50 and older who had a living mother during the observation period (N = 4812; 18,442 person-wave observations). A series of within-between random effects models were estimated to explicate how health conditions of aging mothers (i.e., disability and dementia) and caregiving transitions of adult children were associated with changes in depressive symptoms of adult children. Findings demonstrated that caregiving transitions were unrelated to depressive symptoms among adult children once the model controlled for the confounding effects of having their mother experience disability and dementia. Further, caregiving behavior was found to buffer the direct detrimental effect of maternal disability on adult children's depressive symptoms. This study adds to the growing body of research that cautions against characterizing caregiving as a chronic stressor detrimental to mental health and further echoes earlier calls for a more balanced portrayal of caregiving in policy reports and research literature.

Moving beyond the lab: investigating empathy through the Empirical 5E approach

Empathy is a complex and multifaceted phenomenon that plays a crucial role in human social interactions. Recent developments in social neuroscience have provided valuable insights into the neural underpinnings and bodily mechanisms underlying empathy. This methodology often prioritizes precision, replicability, internal validity, and confound control. However, fully understanding the complexity of empathy seems unattainable by solely relying on artificial and controlled laboratory settings, while overlooking a comprehensive view of empathy through an ecological experimental approach. In this article, we propose articulating an integrative theoretical and methodological framework based on the 5E approach (the "E"s stand for embodied, embedded, enacted, emotional, and extended perspectives of empathy), highlighting the relevance of studying empathy as an active interaction between embodied agents, embedded in a shared real-world environment. In addition, we illustrate how a novel multimodal approach including mobile brain and body imaging (MoBi) combined with phenomenological methods, and the implementation of interactive paradigms in a natural context, are adequate procedures to study empathy from the 5E approach. In doing so, we present the Empirical 5E approach (E5E) as an integrative scientific framework to bridge brain/body and phenomenological attributes in an interbody interactive setting. Progressing toward an E5E approach can be crucial to understanding empathy in accordance with the complexity of how it is experienced in the real world.

Compassion in dementia caregiving: Psychometric properties of the Caregiving Compassion Scale in Spanish caregivers

Compassion has been suggested as a relevant variable for understanding dementia caregivers' psychological distress. The objectives were to analyse the psychometric properties of the Caregiving Compassion Scale (CCS) and to explore the association between caregivers' compassion and their emotional health. Two hundred and thirty-six dementia caregivers were evaluated for compassion, depressive symptoms, guilt, ambivalence, care-recipient's functional and cognitive status, frequency of behavioural problems and desire to institutionalise the care-recipient. Exploratory factor analyses, correlations and regression analyses were done. Two factors were obtained. The factor labelled "Distress from witnessing the care recipient suffering" was associated with higher stress linked to witness depressive problems in the care-recipient and with caregivers' ambivalence and guilt levels. The factor labelled "Motivation/disposition for helping" was associated with less desire for institutionalisation, and it showed a negative association with ambivalence and guilt feelings. The CCS seems to be a valid and reliable scale for assessing compassion in dementia caregivers.

The Differential Effects of Caregiving Intensity on Overnight Hospitalization

This study aims to examine how caregiving for a spouse affects caregivers' likelihood of overnight hospitalization. Using data from the Health and Retirement Study, we examine the odds of spousal caregivers experiencing an overnight hospitalization in the previous two years according to caregiving status, intensity, and change in caregiving intensity. Caregivers were no more likely to experience an overnight hospitalization than noncaregivers (OR = .92; CI [.84, 1.00]). Effects varied by intensity of care. Compared to noncaregivers, caregivers who reported providing no assistance with activities of daily living were less likely to experience overnight hospitalization (OR = .77; CI [.66, .89]); however, caregivers who provided care to someone living with dementia for 4 to <6 years had 2.11 times the odds of experiencing an overnight hospitalization (CI [1.16, 3.85]). Although caregivers overall experience overnight hospitalization at a similar rate as noncaregivers, there are differences between caregivers by the intensity of care.

Partner Pain and Affect in the Daily Lives of Older Couples

OBJECTIVES

The susceptibility of older adults' affect to fluctuations in their own health (within-person health sensitivity) indicates how they handle everyday health challenges. In old age, affective well-being is often increasingly influenced by close others, yet it is unknown whether older adults' affect is additionally susceptible to fluctuations in their spouse's health (within-partnership health sensitivity) and the extent to which age and relationship satisfaction moderate such associations.

METHODS

Parallel sets of multi-level actor-partner interdependence models are applied to self-reported health (feelings of pain/discomfort) and positive and negative affect, obtained 6 times a day over 7 consecutive days from two independent samples, the Berlin Couple Dynamics Study (N= 87 couples; Mage= 75 years; M relationship length= 46 years) and the Socio-Economic Panel Couple Dynamics Study (N= 151 couples; Mage= 72 years; M relationship length= 47 years).

RESULTS

Husbands and wives had lower positive affect and higher negative affect in moments when they reported more pain (within-person health sensitivity) and when their respective spouse reported more pain (within-partnership health sensitivity). Tests for moderation suggest that within-person, but not within-partnership, health sensitivity is lower at older ages and higher with more satisfying relationships.

DISCUSSION

These findings empirically illustrate lifespan notions that close relationships shape time-varying health-affect links and thus underscore the theoretical and practical utility of examining social contextual antecedents of older adults' everyday affective well-being.

The relationship between perceived support and depression in spousal care partners: a dyadic approach

OBJECTIVES

Caregiving within a spousal partnership marks a novel relationship stage for couples. Caregiving introduces new stressors and affects couples' ability to cope, and potentially alters perceptions of emotional support. Prior research on older married couples illustrates how perceived support not only affects an individual's mental health, but also that of their partner. To date, the dyadic relationship between emotional support and mental health is largely unexamined among caregiving partners, where support expectations may differ.

METHOD

Actor partner interdependence models using linear mixed modeling were applied to data from spouses where one partner received caregiving within the 2014 and 2016 waves of the Health and Retirement Study. We examined the cross-sectional and lagged associations between perceived emotional support and strain from a spouse on actor and partner depression scores, as well as whether one was the caregiver or the care recipient moderated associations.

RESULTS

More positive perceptions of support were associated with lower depression scores for oneself (b= -0.55, p < 0.001) and one's partner (b= -0.24, p < 0.001). Actor effects-how one's own perceptions of support associate with one's own depressive symptomology-were stronger for care recipients than for caregivers (b= -0.83, p < 0.001 v. b= -0.26, p < 0.05). Higher perceptions of strain were also associated with higher depression scores for oneself (b = 0.57, p < 0.001) and one's partner (b = 0.39, p < 0.001), associations that remained even in lagged models.

CONCLUSIONS

The observation of both actor and partner effects in this study suggests opportunities to improve care recipient outcomes through intervention with caregivers or both members of the care dyad.

Cortisol slopes and conflict: A spouse's perceived stress matters

BACKGROUND

Perceived stress can lead to dysregulated cortisol patterns, including blunted peaks and flatter slopes, which are associated with increased morbidity and mortality risks. Couples' interdependence provides a prime opportunity for partners' stress to disrupt a healthy cortisol pattern. This study examined how individuals' own perceived stress and their partners' perceived stress shape cortisol levels and slopes across the day, as well as how positive and negative behaviors during conflict discussions impact associations between stress and cortisol.

METHODS

Both partners of a married couple (n = 43 couples, 86 individuals) completed a full day in-person visit. Each partner completed the Perceived Stress Scale, and all couples engaged in a 20-min marital problem discussion which was recorded and later coded for positive and negative behaviors using the Rapid Marital Interaction Coding System (RMICS). Partners also provided five salivary cortisol samples across the day, two samples before the conflict and three after the conflict. The dyadic design and analyses provided a way to account for the interdependent nature of married couples' data, as well as to use the Actor-Partner Interdependence Model (APIM) to assess the mutual influence of spouses' stress on cortisol.

RESULTS

Individuals with more stressed partners had flatter cortisol slopes than individuals with less stressed partners, who showed steeper and thus healthier declines across the day. Individuals' cortisol levels at the beginning of the day were similar regardless of their partners' perceived stress, but individuals with more stressed partners had higher cortisol levels 30-min, 1 h, and 4 h after the conflict discussion than those with less stressed partners. Couples' behavior during the conflict moderated the relationship between partner perceived stress and average cortisol; when couples used more negative and less positive behaviors, individuals with more stressed partners had higher average cortisol levels than those with less stressed partners.

CONCLUSION

On a day couples experienced conflict, having a partner with higher perceived stress is associated with dysregulated cortisol patterns, including higher levels and flatter slopes, but having a partner with lower perceived stress is linked to steeper and thus healthier cortisol declines. A partner's stress was particularly consequential for one's own cortisol when couples used more negative and fewer positive behaviors during a conflict discussion. This research adds to the growing literature on pathways connecting marital interactions to important biorhythms and health.

Daily and bidirectional linkages between pain catastrophizing and spouse responses

Pain catastrophizing has been shown to predict greater pain and less physical function in daily life for chronic pain sufferers, but its effects on close social partners have received much less attention. The overall purpose of this study was to examine the extent to which pain catastrophizing is an interpersonal coping strategy that is maladaptive for patients and their spouses. A total of 144 older knee osteoarthritis patients and their spouses completed baseline interviews and a 22-day diary assessment. Multilevel lagged models indicated that, on days when patients reported greater catastrophizing in the morning, their spouses experienced more negative affect throughout the day. In addition, a higher level of punishing responses from the spouse predicted greater pain catastrophizing the next morning, independent of patient pain and negative affect. Multilevel mediation models showed that patients' morning pain catastrophizing indirectly impacted spouses' negative affect and punishing responses through patients' own greater negative affect throughout the day. There was no evidence that spouses' empathic or solicitous responses either followed or preceded patients' catastrophizing. These findings suggest that cognitive-behavioral interventions that reduce pain catastrophizing should be modified for partnered patients to address dyadic interactions and the spouse's role in pain catastrophizing.

Are Spouses' Sleep Problems a Mechanism Through Which Health is Compromised? Evidence Regarding Insomnia and Heart Disease

BACKGROUND

Symptoms of insomnia have been widely identified as risk factors for health, including heart disease. Despite the expansive and growing literature on health concordance among coupled individuals, few studies have examined insomnia as a shared risk factor for heart disease among middle-aged and older couples.

PURPOSE

This study examined the association between insomnia and incident heart disease among couples. A dyadic modeling approach was employed to investigate the relationships between one's own insomnia and partners' insomnia for the risk of incident heart disease for each partner.

METHODS

Data from the 2010, 2012, and 2014 Health and Retirement Study were utilized in a prospective research design (N = 3,221 couples). Actor-partner interdependence models were employed to estimate actor and partner effects of insomnia symptoms for incident heart disease over the 4 year observation period.

RESULTS

Insomnia symptoms measured at baseline were related to an increased risk for heart disease for husbands, whereas for wives the association was attenuated after other health measures were controlled. Wives' insomnia was related to an increased risk of incident heart disease for husbands but husbands' insomnia was not related to wives' risk of heart disease.

CONCLUSIONS

This study showed how subjective insomnia symptoms among middle-aged and older adults in intimate partnerships are associated with their heart disease risk. Further research is needed to verify the results with objective measures of sleep problems and heart disease.

Early Exposure to Cardiac Treatment and Distress Among Patients and Their Caregiving Partners

Background: The experience of an acute coronary event (ACE), including early care and evaluation, can be a distressing and traumatic experience for patients and their romantic partners, who also act as caregivers. We hypothesized that, among partners who were present during the ACE, those who were also present during (1) transportation to the hospital and (2) initial medical treatment would experience greater (a) anxiety early post-event and (b) posttraumatic stress symptoms (PSS) related to the event 4 months later. The associations between partner presence with patient anxiety and PSS were also explored.

Methods: Participants were ACE patients and their partners recruited between March 2015 and December 2016 from the Intensive Cardiac Care Unit (ICCU) of the Sheba Medical Center in Israel (N = 143; all patients were males and partners were females). Partners self-reported whether or not they were present during the cardiac event, the hospital drive, and initial care. Patients and partners self-reported anxiety in-hospital and PSS, keyed to the ACE, an average of 4 months later. Data were analyzed using General Estimating Equations (GEE) and Multilevel Modeling.

Results: Neither patient anxiety nor PSS differed according to partner presence during the drive to the hospital. In contrast, partners had higher anxiety when they were not present at all (difference = 3.65, p = 0.019) and when present during the event and during the drive (difference = 2.93, p = 0.029) as compared to when they were present for the event but not for the drive. Partners who were present during the event, but not the drive, had lower PSS than those who were present for both the event and the drive (difference = −4.64, p = 0.026).

Conclusions: Partners who accompany patients on the drive to the hospital may inadvertently put themselves at risk for greater distress following their loved one’s cardiac event. Future research should enroll couples in an acute care context to inform couple-targeted tailored interventions to reduce distress in patients and their caregiving partners.

Bereavement outcomes among spousal hospice caregivers: Relief, rumination, and perceived patient suffering

Witnessing end-of-life suffering of loved ones is an underappreciated stressor that may affect caregiver bereavement. We interviewed 61 spousal caregivers of hospice patients who died within the past 6-18 months. Higher rumination about suffering and lower feelings of relief was related to poorer well-being. Rumination by caregivers about end-of-life suffering was an important predictor of depression and complicated grief. Most caregivers viewed the death as at least in part a relief. One important focus of grief support may be to help caregivers find productive ways to avoid rumination and use other forms of coping and to acknowledge feelings of relief.

Spousal understanding and marital satisfaction in pain patients and their spouses

The current study tested the hypotheses that knee osteoarthritis (OA) patients and spouses who report more spousal understanding of patient's pain would report greater marital satisfaction. A total of 124 couples completed interviews at three time points across 18 months. Results from dyadic analyses showed that patients who felt more understood by their spouse report, and have spouses who report, higher marital satisfaction concurrently. In addition, patients who felt more understood by their spouse reported higher marital satisfaction over time. Spouses' reports of understanding also had a significant influence on the patients' and their own marital satisfaction concurrently. Results highlight the importance of spouses understanding knee OA patients' pain for both dyad members' marital satisfaction.

Capturing patients' symptom expression and spouses' cardiovascular responses continuously: The feasibility of examining a mechanism of disease risk in the home

INTRODUCTION

Spousal caregivers face increased cardiovascular risks; lab studies suggest that autonomic reactivity to patients' physical suffering may play a role. To evaluate this mechanism in daily life, our pilot study characterized the feasibility of recruiting couples for a multimethod, in-home assessment. We examined the usability of the resulting data in an effort to link spousal cardiovascular changes to patient pain expression during couples' everyday interactions.

METHOD

For two 48-hr periods, individuals with rheumatoid arthritis (RA) and their partners wore heart monitors while audio-recordings captured couples' in-home interactions. Interbeat intervals were subsetted in 1-, 2-, and 5-min windows before and after each pain expression. Pre-post difference scores in high-frequency heart rate variability (HF-HRV) and heart rate were examined.

RESULTS

Of the 17 screened RA patients, 11 were ineligible, and 3 partners declined. The 3 participating couples completed all study activities. The resulting 288 hr of recordings were coded for patients' RA symptom expression, which varied from none to an average of 11 times daily. One couple had sufficient data for physiological analysis: Contrary to prediction, spouse HF-HRV significantly increased after patient symptom expression.

CONCLUSIONS

Recruitment rates mirrored other couples studies, and enrolled couples complied with study procedures. In-home conversations were reliably coded and successfully linked to spousal ongoing cardiovascular activity. Preliminary findings highlight the importance of optimal sampling windows and suggest symptom expression as a relevant process for some spouses but not others. We offer recommendations for efficiently scaling up the method in future studies. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Recalling support provision decreases distress and anger in response to partner suffering

OBJECTIVES

Thinking about a loved one's suffering can be emotionally stressful and have negative effects on a person's psychological and physical health over time. This study examined the hypotheses that when thinking about a partner's suffering (1) recalling past support provision to the suffering partner can decrease distress and anger and increase compassion, and (2) attachment orientation moderates these effects.

METHOD

Seventy-seven older adult spouses of individuals with chronic pain were video-recorded while they disclosed: (1) an instance of partner suffering and (2) an instance of partner suffering plus their support provision. Compassion for the partner and their own distress and anger were self-reported immediately after each account. Accounts were coded for statements of support. Attachment was assessed with the Experiences with Close Relationships measure.

RESULTS

As hypothesized, distress and anger were lower in the 'suffering with support' condition versus the 'suffering only' condition. There was no evidence that attachment orientation significantly moderated the effect of support recollection on emotional responses; however, more avoidant individuals reported less compassion and anger and used more words reflecting anger across conditions. More anxiously attached individuals reported greater compassion across conditions.

CONCLUSION

When thinking about a partner's suffering, there are attachment-related differences in emotional reactions. Yet, regardless of these differences, it may be adaptive for spouses to think about their role in providing support to their partner to decrease their own negative emotions.

The role of compassion, suffering, and intrusive thoughts in dementia caregiver depression

OBJECTIVES

Exposure to suffering of a relative or friend increases the risk for psychological and physical morbidity. However, little is known about the mechanisms that account for this effect. We test a theoretical model that identifies intrusive thoughts as a mediator of the relation between perceived physical and psychological suffering of the care recipient and caregiver depression. We also assess the role of compassion as a moderator of the relation between perceived suffering and intrusive thoughts.

METHODS

Hispanic and African American caregivers (N = 108) of persons with dementia were assessed three times within a one-year period. Using multilevel modeling, we assessed the mediating role of intrusive thoughts in the relation between perceived physical and psychological suffering and CG depression, and we tested moderated mediation to assess the role of caregiver compassion in the relation between perceived suffering and intrusive thoughts.

RESULTS

The effects of perceived physical suffering on depression were completely mediated through intrusive thoughts, and compassion moderated the relation between physical suffering and intrusive thoughts. Caregivers who had greater compassion reported more intrusive thoughts even when perceived physical suffering of the CR was low. For perceived psychological suffering, the effects of suffering on depression were partially mediated through intrusive thoughts.

DISCUSSION

Understanding the role of intrusive thoughts and compassion in familial relationships provides new insights into mechanisms driving caregiver well-being and presents new opportunities for intervention.

Couples' Shared Beliefs About Aging and Implications for Future Functional Limitations

Purpose of the Study

Individual beliefs are known to be predictive of health. This study examines the co-construction of couple norms and links couples' shared beliefs about aging to future individuals' and couples' functional limitations.

Design and Methods

Data from the 2008 and 2014 waves of the Health and Retirement Study (1,231 couples; age range = 51-90) were analyzed using latent variables that estimated shared and individual variance in beliefs about aging in 2008 and functional limitations at follow-up in 2014. Spouses' individual processes of physical activity and disease burden were modeled to contribute to couples' shared beliefs about aging and subsequent functional limitations. Models progressively controlled for indicators of partner selection, couples' shared health experiences, and similarities and differences in age.

Results

Couples' beliefs about aging predicted future functional limitations. The effect magnitude decreased but remained significant in all models. Physical activity predicted couples' future functional limitations but was largely explained by shared health experiences and similarities and differences in age for wives and husbands, respectively. Disease burden contributed to couples' shared beliefs about aging. Husbands' contributions were explained by partner selection, but wives' contributions remained significant in all models. The effect of couples' shared beliefs on change in couples' functional limitations was explained by couples' shared health experiences.

Implications

Beliefs about aging and health occur within the context of close relationships and shared experiences. Knowledge of couples' beliefs and health is necessary to support their individual and collective efforts to age successfully together.

Lovesick: How Couples' Relationships Influence Health

This review highlights recent advances in research addressing intimate partner relationships and health. Consideration of the strong mutual influences that the members of a couple have on each other's mental and physical health trajectories provides a new way to view the health implications of couples' convergence or interdependence; marital closeness can have a clear downside when one partner has mental or physical health problems. Couples' interconnectedness can also be leveraged to promote better treatment outcomes. Major themes include the pivotal role of depression and the importance of gender differences in the pathways from the marital relationship to physiological functioning and health. The health risks and benefits of support are weighed. Additionally, two prominent emerging paths from marital distress to poor health are emphasized: sleep problems and metabolic alterations that promote obesity and its comorbidities.

Lovesick: How Couples' Relationships Influence Health

This review highlights recent advances in research addressing intimate partner relationships and health. Consideration of the strong mutual influences that the members of a couple have on each other's mental and physical health trajectories provides a new way to view the health implications of couples' convergence or interdependence; marital closeness can have a clear downside when one partner has mental or physical health problems. Couples' interconnectedness can also be leveraged to promote better treatment outcomes. Major themes include the pivotal role of depression and the importance of gender differences in the pathways from the marital relationship to physiological functioning and health. The health risks and benefits of support are weighed. Additionally, two prominent emerging paths from marital distress to poor health are emphasized: sleep problems and metabolic alterations that promote obesity and its comorbidities.

To Love is to Suffer: Older Adults' Daily Emotional Contagion to Perceived Spousal Suffering

Objectives

For older adults coping with a spouse's chronic condition, greater marital satisfaction may not be entirely protective for psychological health. We examined marital satisfaction and gender as moderators of the association between perceived spousal suffering and daily emotional contagion. Based on empathy-altruism and interdependent self-construal theories, we hypothesized that high marital satisfaction and being female would heighten daily emotional contagion, or within-person associations between perceived spouse suffering and distress to spouse suffering.

Method

Forty-five older adults who had a spouse with a musculoskeletal condition completed daily interviews. Participants reported their marital satisfaction once in the laboratory and then daily perceptions of their spouse's physical suffering and their own distress to spouse suffering via phone at home for 7 days.

Results

Consistent with hypotheses, there were significant within-person effects such that highly satisfied wives experienced heightened emotional contagion on days when they perceived higher than average spouse suffering. Unexpectedly, men who were high in marital satisfaction experienced heightened daily distress irrespective of their perceptions of level of spousal suffering.

Discussion

Marital satisfaction can increase daily emotional contagion to spousal suffering among older couples dealing with chronic conditions. Wives' distress may be more dependent on perceiving high levels of partner suffering compared with husbands' distress.

Caregiver's burden in pulmonary arterial hypertension: a clinical review

Caregiver’s burden is a multidimensional phenomenon affecting care-givers physically, emotionally and socially. It is critical to examine the burden of caregivers, because of the complex responsibility they have with their partners. There are relatively few studies that have examined factors linked with psychological burden amongst caregivers of pulmonary arterial hypertension (PAH) patients. Hence, it is pertinent to develop a good understanding of these factors and develop appropriate management strategies, modified to assist PAH caregivers.

Dyadic Associations Between Physical Activity and Depressive Symptoms in Older Adults with Musculoskeletal Conditions and Their Spouses

This study examined the association between physical activity of older individuals with musculoskeletal conditions (IMCs) and their spouses' physical activity, how physical activity related to one's own and one's partner's depressive symptoms, and whether the similarity of partners' physical activity related to each partner's depressive symptoms using the actor-partner interdependence model. Seventy-seven dyads completed self-report measures of physical activity, depressive symptoms and potential covariates (socio-demographics, physical health conditions and marital satisfaction; IMCs' functional impairment and pain; and spouses' support-related stress). As hypothesized, we found a positive association between the IMC's and the spouse's physical activity. Also, spouses had more depressive symptoms when IMCs engaged in less physical activity. However, for both partners, one's own physical activity was not significantly associated with one's own depressive symptoms. The spouse's physical activity was also not significantly associated with the IMC's depressive symptoms, and the similarity between partners' physical activity did not significantly relate to either partner's depressive symptoms. Our findings suggest that interventions that help increase the physical activity of both partners, but particularly IMCs, may benefit spouses' well-being. Copyright © 2014 John Wiley & Sons, Ltd.

Reactivity to a Spouse's Interpersonal Suffering in Late Life Marriage: A Mixed-Methods Approach

OBJECTIVE

To determine how older adult spouses react to their partners' interpersonal suffering.

METHOD

Spouses of individuals with musculoskeletal pain were recorded describing their partners' suffering while their blood pressure (BP) was monitored. After the account, spouses described their distress. Speeches were transcribed and analyzed with Linguistic Inquiry and Word Count software and coded for interpersonal content. Multivariate regression analyses were conducted with interpersonal content variables predicting BP and distress. Exploratory qualitative analysis was conducted using ATLAS.ti to explore mechanisms behind quantitative results.

RESULTS

Describing partners' suffering as interpersonal and using social (family) words were associated with higher systolic BP reactivity. Husbands were more likely to describe partners' suffering as interpersonal. Qualitative results suggested shared stressors and bereavement-related distress as potential mechanisms for heightened reactivity to interpersonal suffering.

DISCUSSION

Spouses' interpersonal suffering may negatively affect both men and women's cardiovascular health, and older husbands may be particularly affected.

Stress and Negative Relationship Quality among Older Couples: Implications for Blood Pressure

OBJECTIVES

The cardiovascular system may represent a significant pathway by which marriage and stress influence health, but research has focused on married individuals cross-sectionally. This study examined associations among chronic stress, negative spousal relationship quality, and systolic blood pressure over time among middle-aged and older husbands and wives.

METHOD

Participants were from the nationally representative longitudinal Health and Retirement Study. A total of 1,356 (N = 2,712) married and cohabitating couples completed psychosocial and biomeasure assessments in waves 2006 and 2010. Analyses examined whether Wave 1 (2006) relationship quality and stress were associated with changes in blood pressure over time.

RESULTS

The effects of stress and negative relationship quality were dyadic and varied by gender. Husbands had increased blood pressure when wives reported greater stress, and this link was exacerbated by negative spousal relationship quality. Negative relationship quality predicted increased blood pressure when both members of the couple reported negative quality relations.

DISCUSSION

Findings support the dyadic biopsychosocial model of marriage and health indicating: (a) stress and relationship quality directly effect the cardiovascular system, (b) relationship quality moderates the effect of stress, and (c) the dyad rather than only the individual should be considered when examining marriage and health.

EEVEE: the Empathy-Enhancing Virtual Evolving Environment

Empathy is a multifaceted emotional and mental faculty that is often found to be affected in a great number of psychopathologies, such as schizophrenia, yet it remains very difficult to measure in an ecological context. The challenge stems partly from the complexity and fluidity of this social process, but also from its covert nature. One powerful tool to enhance experimental control over such dynamic social interactions has been the use of avatars in virtual reality (VR); information about an individual in such an interaction can be collected through the analysis of his or her neurophysiological and behavioral responses. We have developed a unique platform, the Empathy-Enhancing Virtual Evolving Environment (EEVEE), which is built around three main components: (1) different avatars capable of expressing feelings and emotions at various levels based on the Facial Action Coding System (FACS); (2) systems for measuring the physiological responses of the observer (heart and respiration rate, skin conductance, gaze and eye movements, facial expression); and (3) a multimodal interface linking the avatar's behavior to the observer's neurophysiological response. In this article, we provide a detailed description of the components of this innovative platform and validation data from the first phases of development. Our data show that healthy adults can discriminate different negative emotions, including pain, expressed by avatars at varying intensities. We also provide evidence that masking part of an avatar's face (top or bottom half) does not prevent the detection of different levels of pain. This innovative and flexible platform provides a unique tool to study and even modulate empathy in a comprehensive and ecological manner in various populations, notably individuals suffering from neurological or psychiatric disorders.

Predictors of depression among caregivers of older adults with severe mental illness

Caregivers of older persons with severe mental illness (SMI) contend with the double challenge of providing assistance related to both the psychiatric condition and older age of their family member. Study explored factors influencing negative psychological outcomes experienced by caregivers (n = 96) of older adults with SMI. One-quarter of caregivers scored at or above the clinical point for depression. Low income, care recipient gender, poor health, problems dealing with care recipient's symptoms and the interaction of health and problems dealing with symptoms were associated with higher rates of depression. Implications for service provision and future research are discussed.

Choosing treatment for depression in older adults and evaluating response

An update is provided on the current information regarding late life depression with regard to assessment, clinical implications, and treatment recommendations. Several treatments are considered evidence-based, but when deployed into field trials, the efficacy of these treatments falls short. It is thought that the lower impact in community trials is due in large part to patient, clinical, environmental, socio-economic, and cognitive correlates that influence treatment response. The aim is to assist providers in making decisions about what type of treatment to recommend based on a sound assessment of these clinical correlates.

The impact of daily arthritis pain on spouse sleep

Although chronic pain has been linked to poorer psychosocial well-being in the spouse, the extent to which patient pain affects spouse sleep is unknown. The aim of the present study was to test the hypothesis that greater daily knee pain would be associated with poorer sleep for the spouse that evening. We also tested the hypothesis that this pain contagion is exacerbated in couples who have a close relationship. A total of 138 knee osteoarthritis (OA) patients and their spouses completed baseline interviews and a 22-day diary assessment. Multilevel lagged models indicated that greater knee OA pain at the end of the day was associated with spouses' poorer overall sleep quality that night and feeling less refreshed after sleep. In contrast, there was no evidence that spouse sleep was related to greater patient pain the next day. The effects of patient pain on spouse sleep were not due to disturbances in patient sleep and were also independent of spouse sex, depressive symptoms, and physical comorbidities; both partners' negative affect; and the quality of marital interactions throughout the day. As predicted, we also found that patient pain was more strongly related to less refreshing sleep for spouses who were in a close relationship. Findings illustrate that chronic pain may place the spouse's health at risk and suggest an important target for couple-oriented interventions.

Attachment and Psychological Health in Older Couples Coping with Pain

Attachment theory is useful for understanding how couples cope with stress across the lifespan. This study used the the Actor Partner Interdependence Model to examine the extent to which attachment related to one's own (actor effect) and one's partner's (partner effect) depressive symptoms and marital satisfaction among older, married couples with a musculoskeletal condition. Pain and support were also examined as mediators. A group of 77 couples completed self-report measures as part of a larger study in which support was manipulated. Results revealed that, when one or both partners were insecurely attached, both partners reported greater depressive symptoms and lower satisfaction; however, pain and support were not significant mediators. Findings have implications for targeted, dyadic interventions to improve psychological health of couples coping with pain.

Cardiovascular response to psychosocial repeated stress in caregivers of offspring with schizophrenia

Taking care of offspring suffering a long-term illness such as schizophrenia is one of the more stressful life experiences. Care conditions may act as a protective factor in the health of the caregiver. The present study assesses heart rate (HR), blood pressure (BP), and mood responses to psychosocial stress in 16 mothers receiving specialised support for the care of their offspring (CARE+) and in 11 mothers caring for their offspring without support (CARE-). The CARE- group take care of less functional and more symptomatic offspring; and display higher basal, but lower HR, responses after stress than the CARE+ group. No significant group effects were found for BP. For mood states, there were significant decreases in the anger subscale in the CARE- group that were not found in the CARE+ group. HR was related to active and passive coping styles, trait anxiety, and years spent providing care. In the total sample, other significant relationships between cardiovascular responses and life events and personality traits have been found. In sum, the data suggests that specialised support for patients may modulate cardiovascular responses to repeated stress in caregivers.

Informal caregiving and the risk for coronary heart disease: the Whitehall II study

BACKGROUND

The stress associated with informal caregiving has been shown to be associated with poor health, including coronary heart disease (CHD). However, it is unclear if the risk of CHD is attributable to caregiving or prior poor health of the caregiver.

METHODS

We used data from the Whitehall II cohort study. Caregiving and caregiver's health (using 3 measures: self-rated health, mental health using the General Health Questionnaire, and physical component score of the SF-36) were assessed in 1991-1993 among 5,468 men and 2,457 women aged 39-63 years. CHD (fatal CHD, clinically verified nonfatal myocardial infarction, and definite angina) incidence was recorded for a mean 17 years; sociodemographic variables, health behaviors, and cardiovascular risk factors were included as covariates.

RESULTS

Cox regression showed the risk of CHD in caregivers not to be higher (hazard ratio = 1.18; 95% CI: 0.96, 1.45) compared with noncaregivers. Analyses stratified by health status showed that compared with noncaregivers in good health, caregivers with poor self-rated (hazard ratio = 2.00; 95% CI: 1.44, 2.78), mental (hazard ratio = 1.63; 95% CI: 1.16, 2.30), or physical (hazard ratio =1.87; 95% CI: 1.34, 2.62) health had greater risk of CHD. A similar elevated risk was observed in noncaregivers with poor health; no excess risk was observed among caregivers reporting good health, and the combined effect of poor health and caregiving did not exceed their independent effects.

CONCLUSIONS

Caregiving in midlife is not in itself associated with greater risk of CHD, but it is associated with increased risk for CHD among caregivers who report being in poor health.

Helping patients and their family caregivers cope with cancer

Family caregivers face multiple demands as they care for their loved ones with cancer, and these demands have increased dramatically in recent years. Patients with cancer now receive toxic treatments in outpatient settings and return home to the care of their family members. Some patients receive in-home infusions, which were unheard of a few years ago. Family caregivers provide tasks that were previously provided by nurses; however, caregivers lack the educational preparation that nurses receive.

Linguistic markers of emotion regulation and cardiovascular reactivity among older caregiving spouses

This study examined linguistic markers of emotion regulation and cardiovascular stress reactivity in spousal caregivers. Fifty-three individuals were audiotaped while they privately disclosed an instance of partner suffering and a typical partner interaction (i.e., a meal together). Systolic blood pressure, diastolic blood pressure, and heart rate (HR) were measured. Linguistic analysis determined emotion and cognitive processing word use. Results revealed that using more positive emotion words was associated with lower HR reactivity in each verbal account. Caregivers who used fewer cognitive processing words (e.g., think, realize, because) overall had the highest HR reactivity to talking about the partner's suffering. These findings have implications for interventions for all caregivers as well as distinguishing more resilient caregivers from those who may be at a higher risk for caregiver burden.

Compassion fatigue: an application of the concept to informal caregivers of family members with dementia

Introduction. Compassion fatigue is a concept used with increasing frequency in the nursing literature. The objective of this paper is to identify common themes across the literature and to apply these themes, and an existing model of compassion fatigue, to informal caregivers for family members with dementia. Findings. Caregivers for family members with dementia may be at risk for developing compassion fatigue. The model of compassion fatigue provides an informative framework for understanding compassion fatigue in the informal caregiver population. Limitations of the model when applied to this population were identified as traumatic memories and the emotional relationship between parent and child, suggesting areas for future research. Conclusions. Research is needed to better understand the impact of compassion fatigue on informal caregivers through qualitative interviews, to identify informal caregivers at risk for compassion fatigue, and to provide an empirical basis for developing nursing interventions for caregivers experiencing compassion fatigue.

Perception of pain in others: implication for caregivers

SUMMARY The subjective nature of pain renders its perception in others a challenge for clinicians and informal caregivers responsible for its assessment and relief. Adequate perception of others’ pain relies on different behavioral and neurophysiological mechanisms. Several individual, relational and contextual factors can influence the way the brain reacts to others’ pain and the perception and assessment of this pain. This article focuses on recent neurophysiological and psychological evidence that characterizes these factors, and discusses their potential impact on the perception of others’ pain in a caregiving context. Factors influencing the perception of pain in others are divided into factors related to the self (caregiver), factors related to the other (patient), and factors related to the relationship between those individuals and the context in which the pain is perceived. We propose that the perception of others’ pain plays a crucial role in the treatment provided by clinicians and informal caregivers, and that further research could lead to improving decision-making regarding pain management.

A new program in pain medicine for medical students: integrating core curriculum knowledge with emotional and reflective development

OBJECTIVE

Improvements in clinical pain care have not matched advances in scientific knowledge, and innovations in medical education are needed. Several streams of evidence indicate that pain education needs to address both the affective and cognitive dimensions of pain. Our aim was to design and deliver a new course in pain establishing foundation-level knowledge while comprehensively addressing the emotional development needs in this area.

SETTING

One hundred eighteen first-year medical students at Johns Hopkins School of Medicine.

OUTCOME MEASURES

Performance was measured by multiple-choice tests of pain knowledge, attendance, reflective pain portfolios, and satisfaction measures.

RESULTS

Domains of competence in pain knowledge included central and peripheral pain signalling, pharmacological management of pain with standard analgesic medications, neuromodulating agents, and opioids; cancer pain, musculoskeletal pain, nociceptive, inflammatory, neuropathic, geriatric, and pediatric pain. Socio-emotional development (portfolio) work focused on increasing awareness of pain affect in self and others, and on enhancing the commitment to excellence in pain care. Reflections included observations on a brief pain experience (cold pressor test), the multidimensionality of pain, the role of empathy and compassion in medical care, the positive characteristics of pain-care role models, the complex feelings engendered by pain and addiction including frustration and disappointment, and aspirations and commitments in clinical medicine. The students completing feedback expressed high levels of interest in pain medicine as a result of the course.

DISCUSSION

We conclude that a 4-day pain course incorporating sessions with pain specialists, pain medicine knowledge, and design-built elements to strengthen emotional skills is an effective educational approach.

SUMMARY

Innovations in medical education about pain are needed. Our aim was to design and deliver a new course for medical students addressing both the affective and cognitive dimensions of pain. Combining small-group sessions with pain specialists, active-learning approaches to pain knowledge, and design-built elements to strengthen emotional skills was highly effective.

The Effects of Suffering in Chronically Ill Older Adults on the Health and Well-Being of Family Members Involved in Their Care: The Role of Emotion-Related Processes

A large literature shows that caregivers of chronically ill older adults have a higher risk for impaired health and decreased longevity. In this paper we review research that addresses pathways through which family members experience negative health consequences from exposure to a partner's suffering. We first provide a conceptualization of suffering and describe how it can be measured, then review empirical evidence that exposure to suffering uniquely influences caregivers' health, and discuss individual differences in caregivers' emotional reactions to partners' suffering using three emotion theories (Gross' process model of emotion regulation, attachment theory, and a functionalist perspective on emotion). Finally, we discuss implications of the effects of suffering for the health and well-being of family caregivers.

Measuring the experience and perception of suffering

PURPOSE

assess psychometric properties of scales developed to assess experience and perception of physical, psychological, and existential suffering in older individuals.

DESIGN AND METHODS

scales were administered to 3 populations of older persons and/or their family caregivers: individuals with Alzheimer's disease (AD) and their family caregivers (N = 105 dyads), married couples in whom 1 partner had osteoarthritis (N = 53 dyads), and African American and Hispanic caregivers of care recipients with AD (N = 121). Care recipients rated their own suffering, whereas caregivers provided ratings of perceived suffering of their respective care recipients. In addition, quality of life, health, and functional status data were collected from all respondents via structured in-person interviews.

RESULTS

three scales showed high levels of internal consistency, test-retest reliability, and convergent and discriminant validity. The scales were able to discriminate differences in suffering as a function of type of disease, demonstrated high intra-person correlations and moderately high inter-person correlations and exhibited predicted patterns of association between each type of suffering and indicators of quality of life, health status, and caregiver outcomes of depression and burden.

IMPLICATIONS

suffering is an important but understudied domain. This article provides valuable tools for assessing the experience and perception of suffering in humans.

Attachment Insecurity and Perceived Partner Suffering as Predictors of Personal Distress

This study examined the extent to which perceptions of partner suffering mediate the association between attachment insecurity (anxiety and avoidance) and personal distress among spouses of older adults with osteoarthritis. Fifty-three spouses watched two videos of targets (their partner and an opposite sex stranger) perform a pain-eliciting household task, and spouses were asked to rate their own distress and perceptions of the targets' pain. Spouses also completed self-report measures of trait attachment. Results revealed that attachment anxiety was associated with greater personal distress in reaction to the partner's suffering, and heightened perceptions of partner pain mediated this association. Avoidant attachment was associated with less distress in reaction to the partner's suffering, but not with less perceived pain. The results of this study identify an important mechanism linking attachment insecurity and heightened distress responses when observing the suffering of a significant other.