Dyadic coping mediates the effects of attachment on quality of life among couples facing ovarian cancer

Cancer is an interpersonal stressor affecting both patient and spouse. To examine the pathways that insecure adult attachment can impact health outcomes by way of dyadic processes, this cross-sectional study used the actor-partner interdependence mediation model to examine whether common dyadic coping (CDC) mediated the associations between attachment and quality of life (QOL). Couples (N = 106) facing ovarian cancer were recruited from a comprehensive cancer center and completed self-report questionnaires. Results indicated that worse social and functional QOL were associated with both one's own and one's partner's greater insecure attachment, by way of one's own use of less CDC. Unexpectedly, greater CDC reported by one's partner was associated with one's own lower functional QOL. Although CDC has beneficial effects on QOL, CDC may also be experienced as draining. Effects of adult attachment on dyadic coping are a significant contributor to subjective health outcomes among couples facing ovarian cancer.

Insomnia Symptoms, Subjective Appraisals, and Fatigue: A Multiple Mediation Model

OBJECTIVE AND BACKGROUND

Fatigue and insomnia are common debilitating symptoms associated with multiple sclerosis (MS). Negative subjective appraisals of symptoms may influence both insomnia and fatigue severity, but this relationship has not been examined among those with MS. The relationship between insomnia symptoms and both physical and cognitive fatigue were examined. Health-related self-efficacy, fatigue catastrophization, and rumination were examined as potential mediators of the relationship between insomnia symptoms and fatigue.

PARTICIPANTS

Participants diagnosed with MS (N = 115) were recruited from hospital and community settings in a large metropolitan city.

METHODS

Participants completed self-report questionnaires, including: Modified Fatigue Impact, Insomnia Severity Index, MS Quality of Life Questionnaire-54, Fatigue Catastrophizing Scale, Multidimensional Health Locus of Control Scale, and the Rumination-Reflection Questionnaire. Two multiple mediation analyses were performed using bootstrapping techniques, examining the cognitive and physical domains of fatigue as separate outcomes.

RESULTS AND CONCLUSIONS

Mediation analyses revealed a significant association between insomnia symptom severity and the cognitive and physical domains of fatigue. Fatigue catastrophizing was the only significant mediator, accounting for 25% of the variance in the relationship between insomnia symptoms and the cognitive fatigue. However, fatigue catastrophizing did not significantly mediate the relationship between insomnia symptoms and physical fatigue, indicating physical and cognitive fatigue may reflect distinct processes in fatigue expression in those with MS.

Adult attachment, hostile conflict, and relationship adjustment among couples facing multiple sclerosis

OBJECTIVE

Couples facing multiple sclerosis (MS) report significantly elevated rates of relationship distress, yet the effects of attachment have never been examined in this population. We examined whether hostile conflict mediated the dyadic effects of attachment on relationship adjustment in couples facing MS and whether these associations were moderated by gender or role. We also explored whether dyadic adjustment mediated the relationship between attachment and hostile conflict.

DESIGN

The study was cross-sectional and included 103 couples in which one partner had been diagnosed with MS.

METHODS

Participants completed the Experiences in Close Relationships-Revised, Dyadic Adjustment Scale, and Aversive Interactions Scale, as well as demographic variables. We used the actor-partner interdependence model for data analysis.

RESULTS

There were significant actor and partner effects of greater anxious attachment and worse dyadic adjustment. Actor and partner effects of anxious attachment were significantly mediated by greater hostile conflict. Gender significantly moderated the effects between avoidant attachment and dyadic adjustment. The actor effect was significant for males and females; the partner effect was only significant for females. The actor effect for females but not males was significantly mediated by greater hostile conflict. Role was not a significant moderator. Exploratory analyses also showed that dyadic adjustment mediated the relationship between anxious and avoidant attachment and hostile conflict.

CONCLUSIONS

Findings highlight the important effects of attachment on relationship adjustment in MS couples. Both hostile conflict and dyadic adjustment appear to be mechanisms through which insecure attachment has a detrimental effect. Statement of contribution What is already known on this subject? Despite higher-than-normal rates of marital distress and separation/divorce, the effects of attachment on relationship adjustment among couples facing multiple sclerosis have never been examined. Prior studies within healthy populations have supported within-person and cross-dyadic associations between attachment and relationship adjustment; however, they have failed to use dyadic analyses. Hostile conflict has been associated with both insecure attachment and relationship adjustment and therefore may be an important mediator to help understand these relationships. What does this study add? Women were more negatively affected by their partner's avoidant attachment then men. Hostile conflict mediated the effects of anxious attachment on dyadic adjustment for individuals and across dyads. Hostile conflict accounted for the individual effect of avoidant attachment on dyadic adjustment for women.

The effects of attachment and outness on illness adjustment among gay men with prostate cancer

OBJECTIVE

Previous research has suggested that gay men facing prostate cancer may be particularly vulnerable to poor illness adjustment. Moreover, although attachment and greater disclosure of sexual orientation have been associated with health outcomes, their associations in this population have been largely unexamined. The purpose of the present study was to investigate whether greater outness about one's sexual orientation significantly mediated the associations between anxious and avoidant attachment and illness intrusiveness among gay men with prostate cancer.

METHODS

Ninety-two gay and bisexual men who had received a diagnosis of prostate cancer in the past 4 years were recruited for the present study. Self-report questionnaires assessed demographic and medical variables, attachment, outness level and comfort, and illness intrusiveness. Bootstrapping procedures were used to assess for mediation.

RESULTS

Results suggested significant associations between anxious attachment, outness comfort, and illness intrusiveness. Less comfort with outness significantly mediated the association between greater anxious attachment and more illness intrusiveness. Avoidant attachment was not significantly associated with illness intrusiveness.

CONCLUSIONS

Findings support the mediating role of the subjective experience of being an out gay man in the association between anxious attachment and illness intrusiveness. These results suggest that facilitating greater comfort with outness would be beneficial for illness adjustment among gay men with prostate cancer whom have more anxious attachment styles. Copyright © 2015 John Wiley & Sons, Ltd.

Fear of recurrence: the importance of self-efficacy and satisfaction with care in gay men with prostate cancer

OBJECTIVE

Limited research has investigated the psychosocial processes that underpin the effect of physical symptoms on fear of cancer recurrence. Additionally, despite evidence of increased vulnerability of marginalized populations to negative outcomes, few studies have examined the unique experience of gay men coping with the cancer process. The goals of this study were to determine whether disease-related self-efficacy and satisfaction with medical care mediated the relationship between greater physical symptoms and worse fear of recurrence among gay or bisexual prostate cancer survivors.

METHODS

Participants were composed of 92 self-identified gay or bisexual men, who had received a diagnosis of prostate cancer in the past 4 years. Participants provided demographic information and completed self-report questionnaires that assessed symptom function, self-efficacy for prostate cancer symptoms, satisfaction with healthcare, and fear of recurrence. Bootstrapping procedures were used to assess for significant mediation.

RESULTS

Results suggested significant mediation of the relationship between each of bowel, hormonal, and sexual function with fear of recurrence by self-efficacy and satisfaction with healthcare. Mediation was not significantly supported for the association between urinary function and fear of recurrence.

CONCLUSIONS

Findings support the explanatory effects of self-efficacy for symptom management and satisfaction with healthcare on the relationship between symptom function and fear of recurrence. These results indicate that psychological processes, specifically psychological factors that hold particular relevance to gay or bisexual men, reflect a potential avenue for intervention to decrease fear of cancer recurrence.

Development and assessment of the constipation-related disability scale

BACKGROUND

Chronic constipation is associated with impaired quality of life and physical discomfort. Although inability to engage in day-to-day activities has been significantly associated with psychological distress, limited research has examined this relationship in constipated samples.

AIM

To develop and validate the Constipation-Related Disability Scale (CRDS), which assesses the extent of disability caused by constipation.

METHODS

A total of 240 constipated participants and 103 healthy controls completed the CRDS. Reliability was measured with Cronbach's coefficient alpha and test-retest reliability was assessed with intraclass correlation coefficients. Convergent, divergent and predictive validity were assessed.

RESULTS

Component and factor analyses were used to derive two factors: Work/Leisure Activities and Activities of Daily Living, as well as a total CRDS score. Good reliability was found, with alphas ≥ 0.87 and intraclass correlation coefficients ≥ 0.85. All scales were negatively correlated with the physical health subscales of the SF-36 (P < 0.001) and were not significantly correlated with the Epworth Sleepiness Scale and Social Desirability Scale, providing support for convergent and divergent validity, respectively. Evidence of predictive validity was supported by associations between the total CRDS with number of physician visits per year (P < 0.01), missed work in the last year (odds ratio [OR = 1.11, 95% confidence interval [CI] = 1.06-1.19, P < 0.001) and ER visits in the last year (OR = 1.08, 95% CI = 1.00-1.16, P < 0.05).

CONCLUSIONS

The Constipation-Related Disability Scale is the first instrument that assesses the impact of constipation on daily activities. There is evidence of strong reliability and validity of the instrument.

Moderators of cancer-related distress and worry after a pancreatic cancer genetic counseling and screening intervention

OBJECTIVES

Although the hereditary breast and ovarian cancer literature has demonstrated short-term gains in psychological adjustment following genetic counseling, there has been limited research examining long-term outcomes and moderators. Moreover, there has been minimal research into the psychological effects of this intervention in populations at high risk for pancreatic cancer. This study examines the long-term effects of pancreatic cancer screening and genetic counseling on cancer-related distress and cancer worry in a high-risk population at 1-year follow-up. Additionally, this study explores potential moderators of the effectiveness of this intervention.

METHODS

One hundred twenty-nine participants with familial pancreatic cancer or with the BRCA2 gene mutation completed a baseline questionnaire prior to their first pancreatic cancer screening and genetic counseling session. Participants also completed questionnaires at 3- and 12-month follow-up.

RESULTS

Cancer-related intrusive thoughts decreased significantly over time, whereas cancer-related worry decreased at 3 months and showed a small but significant increase at 1 year. Age and baseline distress exhibited moderator effects. Younger individuals showed a significant decrease in cancer-related intrusive thoughts, cancer-related avoidant thoughts, and cancer worry. Additionally, individuals with greater baseline distress showed a significant decrease in cancer-related intrusive thoughts over time.

CONCLUSIONS

Analysis of the long-term effects of pancreatic cancer screening and genetic testing reveal psychological gains that are maintained at 1-year follow-up. This intervention is particularly effective for younger participants and individuals with greater baseline distress.