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PubMed2005

Gender differences among spouses of surgeons.

BACKGROUND: The goal of this study was to identify whether gender differences exist regarding the degree of spousal support for, satisfaction with, and perception of surgeons' careers. METHODS: A survey was performed of spouses of academic surgeons in the United States and Canada. RESULTS: Female respondents were significantly less likely to work outside of the home and were significantly more likely to be the major decision-makers at home. They were less likely to credit their surgeon spouses with contributing to household duties and childcare. If both spouses worked outside of the home, the female spouse was still more likely to be the major decision maker. Overall, male and female respondents rated their role in and their satisfaction with their spouses' career choices similarly. CONCLUSIONS: Male and female spouses contribute equally to the career choices of their surgeon spouses. However, female spouses, both surgeon and nonsurgeon, are more likely to make the majority of the decisions at home and contributions to household care.

Adult↗

PubMed1997

Spouses of spinal cord injury survivors: the added impact of caregiving.

OBJECTIVE: To better understand the needs of spouses who provide care to spinal cord injury (SCI) survivors, by comparing their self-perceptions and complaints with those of their partners with disabilities and with those of spouses who do not provide care. DESIGN: Survey, including demographics, health concerns questionnaire, and administration of the Center for Epidemiologic Studies Depression Scale (CES-D), the Perceived Stress Scale (PSS), the Life Satisfaction Index (LSI-Z), and the Quality of Life and Individual Needs Questionnaire. SETTING: Two British SCI treatment centers, serving a defined population-based catchment area. PARTICIPANTS: One hundred twenty-four spouses of a longitudinally followed sample of SCI survivors, all of whom had been injured 23 or more years when the study was conducted in 1993. OUTCOME MEASURES: Scores on the above standardized tests, and responses to survey questions. RESULTS: Spouses had more depressive affect (p < .001) than their partners with disabilities, as measured by the CES-D. On the PSS, they exhibited no significant differences. Compared with spouses who were not caregivers, the caregiving spouses reported more physical stress (p = .005), emotional stress (p = .011), burnout (p = .007), fatigue (p = .002), and anger and resentment (p = .029). On the CES-D, they had more symptoms of depressive affect (p = .004) and somatic depression (p = .005). CONCLUSIONS: Spouses of long-term SCI survivors who fulfill a caregiving role report more symptoms of stress and depression than their partners with disabilities and other spouses who are not caregivers.

Adult↗

PubMed1998

Spouse similarity for lifetime psychiatric history in the general population.

BACKGROUND: Most studies of spouse similarity for psychiatric disorders have focused on clinical samples and are thus limited by selection bias. This study is, to our knowledge, the first comprehensive investigation of spouse similarity for lifetime psychiatric history in a general population sample using standardized diagnostic criteria. METHODS: We studied 519 pairs of spouses residing in Edmonton, Canada who completed the Diagnostic Interview Schedule psychiatric interview. In each pair, one spouse belonged to a random subsample of persons who had participated in a large population survey and was re-interviewed. Association between spouses for lifetime DSM-III psychiatric disorders was analysed with bivariate and multivariate logistic regression analyses. RESULTS: We observed significant spousal association for lifetime presence of affective disorders and for the spectrum of antisocial personality and addiction disorders. Antisocial personality in one spouse was also associated with anxiety disorders in the other spouse, namely post-traumatic stress disorder in wives and phobia in husbands; similarly, drug abuse/dependence in wives was associated with generalized anxiety in husbands and male drug abuse/dependence was associated with female post-traumatic stress disorder. Dysthymia in wives was associated with generalized anxiety and post-traumatic stress disorder in husbands. CONCLUSIONS: The existence of associations between spouses for the presence of psychiatric disorders, either similar or different, has significant implications for both clinicians and researchers. Future research should aim at exploring the aetiological mechanisms of these associations.

Adult↗

PubMedDate not supplied

The role of spouse responses to disability and family environment in multiple sclerosis.

Research in the area of family issues and multiple sclerosis has mainly focused on the impact of multiple sclerosis on the spouse. The aim of the current study was to examine the relationship between patients' ratings of their spouses' responses to multiple sclerosis patient disability behaviors and the impact on patient psychological and physical functioning. Multiple sclerosis patients were interviewed over the telephone using standardized questionnaires to assess patient physical and psychological functioning, spouse responses to patient disability and well behaviors (i.e., how does the spouse respond when you're having difficulties related to multiple sclerosis?), and family environment factors. The study was set in a large university-based Multiple Sclerosis Clinical Center. Forty-four of 64 patients approached with definite multiple sclerosis participated in the study. Physical functioning was assessed by the Kurtzke-EDSS, SIP, SF-36, and psychological functioning was assessed by the CES-D and SF-36. Scores on the SF-36 were generally lower compared with a normative sample of individuals with major medical problems; however, mean Kurtzke scores of 5.60 reflected moderate to severe impairment. Exploring spouse responses to disability, correlation analyses revealed that solicitous spouse responses to patient disability behaviors were significantly associated with greater multiple sclerosis-related physical disability. This relationship was stronger for patients who were more depressed. Spouse negative responses to patient disability behaviors were associated with poorer mental health, whereas spouses' encouragement of patient well behaviors was associated with lower emotional distress. Poorer psychological functioning was found in patients with families who were reported to have higher conflict and/or who were more controlling. Higher levels of independence in families were associated with better psychological and physical functioning in the patients. These preliminary findings suggest that patients' perceptions of their families' responses to disability and family environment factors may be important areas for further research. The findings may also provide potential targets for clinical intervention in the future.

Activities of Daily Living↗

PubMedDate not supplied

Substantial changes in life: perceptions in patients with newly diagnosed advanced cancer and their spouses.

There are few studies on patients' perceptions of their situation after being recently diagnosed with an advanced gastrointestinal cancer and those of their spouses. Fourteen patients and their spouses were interviewed separately. The interviews were analyzed using a phenomenographic approach. The analysis indicated that the response categories for patients and spouses were roughly the same, but the number of patients and spouses who made statements differed between categories. All informants perceived substantial changes in life. This included negative physical, mental, and practical changes as well as positive changes. Mental changes included 3 categories: despair, why, and uncertainty. The informants described several ways of handling these changes in life. The most frequently reported by patients were that "one shouldn't complain" and by spouses to "hope," and by all informants to "make the best of it." Other ways of handling the situation were reconciliation, avoidance, preparation for death, seeking support, and isolation. In conclusion, more patients than spouses seemed to accept their situation because fewer patients complained and instead prepared for death, whereas more spouses felt despair, used hope and avoidance, and were preoccupied with practical matters. These findings suggest that spouses are a vulnerable group and healthcare staff should be just as aware of their situation as that of the patients.

Adaptation, Psychological↗

PubMedDate not supplied

Predictors of patient treatment preferences and spouse substituted judgments: the case of dialysis continuation.

OBJECTIVES: To examine the factors predicting preferences for continued hemodialysis treatment among patients with endstage renal disease (ESRD) and to compare these factors to those predicting their spouses' predictions of patients' preferences (substituted judgments). DESIGN: Descriptive, cross-sectional. PARTICIPANTS: Total of 291 hemodialysis patients, aged 55 years and older, and their spouses. MEASUREMENT: Hypothetical scenarios were designed to elicit preferences for dialysis continuation under various health conditions. Other measures included the Philadelphia Geriatric Center Negative Affect Scale, Kidney Disease Symptoms Scale, Brief Multidimensional Measure of Religiousness, single-item global subjective health and quality-of-life measures, 2-item fear of end-of-life suffering measure, and selected demographics. RESULTS: Patients' preferences and spouses' judgments were only moderately correlated (r = 0.33). Multiple regression analyses revealed that patients' preferences to continue dialysis were positively related to education, subjective quality of life, and religious participation and negatively related to months of ESRD treatment and fear of end-of-life suffering (R(2) = 0.15). Spouses' substituted judgments regarding patients' dialysis continuation preferences were positively related to African American race and spouses' perceptions of patients' quality of life and negatively related to months of ESRD treatment, spouses' perception of patients' negative affect, and spouses' own fear of end-of-life suffering. CONCLUSION: Patients and surrogates used different criteria in formulating judgments about continuation of life-sustaining treatment and had different perceptions about the patients' condition. Furthermore, the substituted judgments of spouses were influenced by their own characteristics. These processes may explain inaccurate substituted judgments.

Boston↗

PubMed2006

Relationship between coping and depression in heart transplant candidates and their spouses.

CONTEXT: Survival rates for heart transplantation are encouraging, but the pretransplant period can be extremely stressful for patients and their spouses. Although a relationship between patients' depression levels and the coping strategies employed by their spouses has been demonstrated, this association has not been examined in heart transplant candidates and their spouses. Depression in this group of patients is important because heart transplant patients with preoperative depression have been found to have a higher mortality rate after transplantation. OBJECTIVE: To determine if a relationship exists between spousal coping strategies and heart transplant candidates' depression. METHODS: A descriptive, exploratory pilot study. PARTICIPANTS: Twenty-two individuals with end-stage heart disease who were undergoing an inpatient evaluation for heart transplantation, plus their spouses. Design-Heart transplant candidates were assessed via the Structured Interview Guide for the Hamilton Depression Scale. Spouses completed the COPE Inventory and the Center for Epidemiological Studies Depression Scale. RESULTS: Spousal behavioral disengagement was positively associated with heart transplant candidates' depression. CONCLUSIONS: Heart transplant candidate depression may follow spousal disengagement, or, conversely, a spouse may disengage in response to the patient becoming depressed. Identification during the pretransplant evaluation of those spouses who cope using behavioral disengagement might be a first step in the process of assessment and intervention. Clinical interventions may need to focus on the spouse as well as on the transplant candidate.

Adaptation, Psychological↗

PubMed2004

Clinical and laboratory assessment of distal peripheral nerves in Gulf War veterans and spouses.

BACKGROUND: The prevalence of symptoms suggesting distal symmetric polyneuropathy (DSP) was reported to be higher among deployed veterans (DV) to the Persian Gulf in 1990-1991 than to control non-deployed veterans (NDV). The authors therefore compared the prevalence of DSP by direct examination of DV and their spouses to control NDV and spouses. METHODS: The authors performed standardized neurologic examinations on 1,061 DV and 1,128 NDV selected from a cohort of veterans who previously participated in a national mail and telephone survey. Presence of DSP was evaluated by history, physical examination, and standardized electrophysiologic assessment of motor and sensory nerves. Similar examinations were performed without electrophysiologic tests in 484 DV spouses and 533 NDV spouses. Statistical analyses were performed with appropriate adjustments for the stratified sampling scheme. RESULTS: No differences between adjusted population prevalence of DSP in DV and NDV were found by electrophysiology (3.7% vs 6.3%, p = 0.07), by neurologic examination (3.1% vs 2.6%, p = 0.60), or by the methods combined (6.3% vs 7.3%, p = 0.47). Excluding veterans with non-military service related diseases that may cause DSP did not alter outcomes. DV potentially exposed to neurotoxins from the Khamisiyah ammunition depot explosion did not significantly differ in DSP prevalence compared to non-exposed DV. The prevalence of DSP in DV spouses did not differ from NDV spouses (2.7% vs 3.2%, p = 0.64). CONCLUSIONS: Neither veterans deployed during the Gulf War era nor their spouses had a higher prevalence of DSP compared to NDV and spouses.

Adult↗

PubMed1995

Stressors, social support, and adjustment in kidney transplant patients and their spouses.

Kidney transplant patients and their spouses (n = 121 couples) rated their overall stress, social support, and adjustment following transplantation. Patients experienced significantly more overall stress than did spouses, although spouses were equally or more stressed than patients on some issues. Patients and spouses did not differ in marital satisfaction, although patients reported significantly more depression than did spouses. Overall stress was related to lower marital satisfaction and increased depression for both patients and spouses. Patients who were experiencing higher stress benefitted more from the support they received from their spouses. Spouses who were less stressed offered more helpful and less unhelpful support to patients. Implications for social work practice are discussed.

Adaptation, Psychological↗

PubMed2000

Breast and cervical cancer screening: associations with personal, spouse's, and combined smoking status.

The objective of this study was to examine the association of women's cancer screenings with both personal and spouses' smoking status, as well as with the broader context of household smoking, in a United States national-level sample of women aged 42-75 years. Data were from the 1994 National Health Interview Survey Health Promotion Supplement. The sample included 1586 women who reported they were married and living with a spouse in a two-person household. Three measures of smoking status were used: personal smoking status, smoking status of spouse, and household smoking status (self and spouse smoked, spouse only smoked, self only smoked, and both nonsmokers). Using logistic regression modeling, associations were examined between the smoking status measures and three cancer screening indicators: mammogram < or =2 years, clinical breast exam < or =2 years, and Pap test < or =3 years. The both nonsmokers group consistently had the highest screening rates for all three exams. The spouse only smoking group was 10-12% less likely to obtain all three cancer screening tests compared to the both nonsmokers group. The self and spouse group was less likely to report a recent mammogram and clinical breast exam. The self only group did not differ significantly from the both nonsmokers group on any of the cancer screening measures. Results suggest that smoking status of a spouse may be an important correlate of women's cancer screenings.

Adult↗

PubMed2000

[Indirect traumatization of spouses of Dutch war victims].

OBJECTIVE: To determine the specific problems experienced by spouses of Dutch war victims. DESIGN: Cross-sectional written questionnaire investigation. METHOD: A written questionnaire was sent to 382 supporters of a foundation for spouses of war victims (Stichting Partners van Oorlogsgetroffenen (SPO)). This organization facilitates contact between fellow sufferers. The questionnaire incorporated elements from the 'Symptom checklist'-90, the 'Impact of event scale', and the 'Maudsley marital questionnaire'. The data obtained were compared to those from previous investigations. The first of these was among 346 spouses of veterans, members of a veteran organization (Bond van Nederlandse Militaire Oorlogs- en Dienstslachtoffers), who were subdivided into two groups, married to veterans with post-traumatic stress disorder (PTSS) (n = 76) and married to veterans without PTSS (n = 264). The second was with 555 women who had participated in a study, carried out in 1992, concerning the long-term effects of severe war experiences among elderly Dutch people. RESULTS: The response rate was 161/382 (42%). The spouses experienced a high burden of care. All of their symptoms were significantly more severe than in the two comparison groups, but equalled those in the partners of veterans with PTSS, with the exception of the quality of the partner relation. This was significantly less than in the partners of veterans with PTSS. In particular, the spouses reported having problems with the war victim being uncommunicative, emotionally numb, sad, and irritable. Spouses themselves also reported posttraumatic reactions such as re-experiencing and avoidance that could not be explained by their own exposure to war and violence. CONCLUSION: The results confirm the theory that by their close contact with the war victim spouses are indirectly traumatized. It is recommended that the physician who has traumatized patients in his or her practice actively inquiries as to whether the spouse can cope with the situation and to what extent.

Adaptation, Psychological↗

PubMed2003

My love is hurting: the meaning spouses attribute to their loved ones' pain during palliative care.

The purpose of this qualitative study was to develop our knowledge of the pain experiences of family members by addressing the meaning of cancer pain to the spouse of a patient receiving palliative care. In particular, this study explored factors associated with the meanings the spouses ascribe to the experience of pain during palliative care and whether the meanings the patients attributed to pain were similar to the meanings held by the spouse. Two different states emerged, the "in-pain state" and the "out of pain state". The spouses described feelings of helplessness, fear, and unfairness when witnessing their loved one in pain. Once the pain had been controlled, spouses described feelings of peace and relaxation, and felt this meant that the couple could return to their old routines because their spouse was still alive. It was discovered that the meanings placed on the cancer pain differed for the spouse and the patient, with the spouse focusing on future consequences. Implications and suggestions for nursing practice and future research are proposed.

Aged↗

PubMedDate not supplied

Depressive distress among the spouses of terminally ill cancer patients.

Bereaved spouses comprise a population at risk for psychological distress. Evidence suggests that spouses 55 years of age and younger are at increased risk of morbid outcomes, including major depressive episodes. Although the emotional impact of the sudden loss of a spouse has been well studied, less attention has been paid to the psychological impact of loss that is foreseeable, as in the case of a serious illness. In this study, data were obtained from pre-death interviews with 103 well spouses of terminally ill cancer patients. Subjects were white, 55 years of age or younger, and living with the patient and their child(ren) aged 7 to 16 years old. Depressive distress was assessed using the Brief Symptom Inventory. Fifty eight percent of males and 42% of females had scores for depressive distress in a clinically significant range. Regression analyses revealed gender was the most important predictor of the level of depressive distress reported, followed by patient's functional status and whether the well spouse quit work as a result of the patient's illness. The number of children 18 years or younger living in the household was inversely related to the level of depressive distress. The results of this analysis suggest that a large proportion of well spouses of patients with cancer who are also the parents of school-aged children may experience significant depressive distress during the terminal phase of their spouse's illness. These findings are important for planning future programs and improving existing ones for the spouses of terminal cancer patients.

Activities of Daily Living↗

PubMed1997

Reciprocal support in the context of cancer: perspectives of the patient and spouse.

PURPOSE/OBJECTIVES: To examine the relationship between mutual spousal support and psychological health status of patients and their spouses. DESIGN: Cross-sectional, descriptive. SETTING: Outpatient oncology clinics (physician, hospital, state cancer center) in the southwestern United States. SAMPLE: A convenience sample of 73 predominantly Caucasian couples with one dyad member receiving treatment for cancer. The mean age of the husbands and wives was 60.7 years and 57.1 years, respectively. METHODS: Questionnaires (Interpersonal Relationships Inventory; Disease Course Graphic Scale; Rosenberg Self-Esteem Scale; Centre for Epidemiological Studies-Depression Instrument; demographic form) completed by patients and spouses. MAIN RESEARCH VARIABLES: Marital reciprocal support, interpersonal support, severity of illness, interpersonal conflict, self-esteem, and depression as perceived by the patients and spouses; performance status as assessed by the patients. FINDINGS: The patients perceived more interpersonal support than the spouses. Both experienced more self-esteem when marital reciprocal support was balanced and high rather than unbalanced or balanced but low. A similar pattern was found for the spouses for self-esteem and depression regarding interpersonal support. Marital and interpersonal support decreased and depression increased as interpersonal conflict increased. CONCLUSIONS: Mutual spouse support is significantly related to patient and spouse self-esteem and depression. Marital reciprocal support is negatively related to interpersonal conflict. More attention must be given to family-oriented oncology nursing care. IMPLICATIONS FOR NURSING PRACTICE: Include the patients' and spouses perceptions of balance in the exchange of marital support in family assessments. Intervene directly or through referral to enable couples to understand the benefit and obligation to support each other when faced with a life-threatening illness.

Adaptation, Psychological↗

PubMed1981

Spouse similarity in newlyweds with respect to specific cognitive abilities, socioeconomic status, and education.

Newlywed spouses (N = 215 couples) were tested on 21 tests of specific cognitive abilities and responded to a questionnaire on their educational and socioeconomic (SES) background. A comparison of the present spouse correlations with those of long-standing marriages suggests that spouses resemble each other in abilities from the start and that the degree of resemblance changes little over time. The low spouse correlations for SES of origin (their parents) suggests that education is the chief SES variable by which spouse selection takes place. Spouse resemblance in education and parental SES could explain almost all of the spouse correlations in perceptual speed and spatial ability. However, a small but significant degree of spouse similarity in verbal and reasoning abilities was independent of education and SES.

Adolescent↗

PubMed1989

Spouse adjustment to stroke: aphasic versus nonaphasic partners.

A survey of spouses of stroke patients examined the impact of stroke with and without aphasia on spouse role change, emotional problems, social adjustment, and the partner's perceived communication abilities. The results of this study support earlier findings that stroke with aphasia has a greater negative impact on the patient's spouse than does stroke without aphasia. For the spouses of aphasic patients sampled in this study, role changes represented the major adjustment made to a partner's stroke. These adjustments were greater than those experienced by the spouses of nonaphasic patients. The inability of aphasic patients to communicate well with their spouses served to make necessary role adjustments more difficult. Both spouse groups were affected to some degree by the communication problems associated with stroke, with the spouses of aphasic partners being affected the most.

Aphasia↗

PubMed1984

The spouse's adjustment to chronic pain: cognitive and emotional factors.

Recent research has demonstrated that the pain behaviors displayed by patients who have chronic pain complaints can be rewarded and maintained by the solicitous and attentive responses of spouses. The present study examines cognitive and emotional factors which may underly such solicitous responding by the spouses. In this study spouses completed a questionnaire (The Spouses' Perception of Disease--SPOD) which was designed to determine their perceptions of the patients' chronic pain syndromes. Additionally spouses completed a measure of emotional and psychological functioning (SCL-90) and a measure of marital satisfaction (Locke-Wallace Scale). The results of this study show that spouse's cognitive interpretation of the patient's chronic pain syndrome is closely associated with the spouse's emotional adjustment and marital satisfaction. Optimism, perception that the patient has a positive attitude along with few psychological problems and the perception that the patient is severely disabled all are associated with more positive emotional status in spouses. The results are discussed in terms of their implications for the rehabilitation of chronic pain patients.

Adaptation, Psychological↗

PubMed1991

Depression in spouses of chronic pain patients: the role of patient pain and anger, and marital satisfaction.

Although several studies have shown that spouses of chronic pain patients may experience clinically significant depressive symptoms few studies have comprehensively examined the role of both patient and spouse-related factors in the development and maintenance of this emotional distress. Twenty-nine married male chronic benign low back pain patients and their spouses were recruited in order to examine the role of patient, spouse, and marital factors in spouse depressive symptomatology. The results indicated that 28% percent of the spouses in the sample reported significantly depressed mood. A 2-stage regression analysis was employed that revealed 3 significant predictors of spouse's depressed mood, namely patient's average pain; patient's reported levels of anger and hostility, and the spouse's level of marital satisfaction. These findings are discussed in terms of their implications for clinical interventions for pain patients and their families.

Adult↗