The psychological well-being of couples experiencing a chronic illness: A matter of personal and partner illness cognitions and the role of marital quality

Abstract

This study aimed to examine the effects of 75 cardiac patients’ and their spouses’ illness cognitions of acceptance and helplessness on their own and their partner’s psychological symptoms, as well as the impact of marital quality. Dyadic responses were examined with the Actor–Partner Interdependence Model, while PROCESS was used to examine possible conditional indirect effects. Patients’ and spouses’ cognitions were related to their partners’ symptoms through the partners’ cognitions. These relationships were not statistically significant at the higher levels of marital quality. Thus, there seems to be a flow of information between partners, while marital quality may impact self-regulation processes.

Keywords

cardiovascular disease dyadic adaptation to illness illness perception marital quality

Introduction

Despite the fact that adaptation to chronic illness has mostly been examined at the individual level (mainly the patient), it is a process that deeply involves family members and especially partners. In fact, the interaction between patients and their partners seems to be fundamental for adaptation to illness and the well-being of both. For example, there is evidence that partners can affect patients’ illness perceptions and coping (e.g. Bodenmann, 2005; Hajdarevic et al., 2013) or even act as a ‘yardstick’ for their health concerns (e.g. Markey and Markey, 2011). On the contrary, illness impacts the well-being of patients’ partners, who often report problems such as depression and are at increased risk of developing physical health problems (e.g. August et al., 2011; Christakis and Allison, 2006; Franks et al., 2010). Yet, the interaction between patients and their partners is not a straightforward process. For instance, although spouses typically act in a beneficial way as far as patients’ illness management is concerned, Henry et al. (2013) found that spouses may sometimes undermine patients’ efforts to adhere to medical advice. Such findings underline the need to closely examine the complex issue of the patient–partner relationship in order to better understand adaptation to illness.

A crucial aspect of patients’ adaptation to illness is their perceptions of illness, which are based on three major sources of information: bodily symptoms, previous experience with illness and information from the social environment such as family members and health professionals (Leventhal et al., 1980, 1992). Patients’ partners also develop their own illness perceptions (Weinman et al., 2003), probably based on patients’ reactions and personal understanding of illness, knowledge and experience. However, patients’ and their partners’ illness perceptions are not developed in isolation but are connected (Bodenmann, 2005), provided that couples often engage in discussions about their illness experience (e.g. Whitford et al., 2009) and develop a shared appraisal of illness and common ways of coping (e.g. Berg and Upchurch, 2007; Bodenmann, 2005). It is possible that patients and their partners use the illness perceptions and beliefs of each other as an important source of information (Leventhal et al., 1980) in order to form or adjust their own perceptions and behaviour and better adapt to illness. Thus, the perception of illness of each member of the couple may affect his or her partner’s well-being in two ways: directly and indirectly by affecting the partner’s illness perception.

Despite the importance of these relations, very few studies have examined the issue. Benyamini et al. (2009) found that both partners’ perceptions of infertility were related to their psychological adjustment. Mellon et al. (2007) found that cancer survivors’ and their partners’ meaning of illness was related to the fear of recurrence of both. Karademas and Giannousi (2013) found that recently diagnosed cancer patients’ symptoms of anxiety and depression were associated with both patients’ and their spouses’ representations of illness control. Finally, Searle et al. (2007) found that partners’ illness representations partially mediated the relationships between diabetes patients’ representations and their prospective self-management behaviours.

Patients’ and their partners’ perceptions and their relations to well-being are also likely to be affected by several broader factors, as adaptation to illness does not occur in a vacuum (Leventhal et al., 1980). The patient’s and partner’s personal experience and characteristics as well as the broader context (e.g. within-family relationships) may affect the entire process. One such important factor reflecting the within-couple climate is marital quality. Higher levels of marital quality have been related to more adaptive illness perceptions and illness management behaviour, as well as to better health and quality of life for both patients and their partners (e.g. Bodenmann, 2005; Fisher et al., 2004; Randall et al., 2009; Schokker et al., 2010; Zhou et al., 2011). Furthermore, marital quality seems to affect how partners understand and react to the behaviour of each other. For example, Hagedoorn et al. (2000) found that at low levels of marital satisfaction, cancer patients tended to perceive their partners’ supportive efforts as unhelpful, although partners might have good intentions.

In this study, which is part of a broader research effort concerning the dyadic relations of patient and spouse personality, the perception of illness, social support, marital quality and psychological symptoms, we examined the direct and indirect relations of cardiac patients’ and their spouses’ illness cognitions of acceptance and helplessness to their own and their partners’ psychological symptoms, as well as the possible impact of marital quality. To our knowledge, this is the first study that examined these relationships. Illness acceptance reflects the recognition of the need to adapt to illness while perceiving self as able to handle its aversive nature (Evers et al., 2001) and has been related to better physical and psychological well-being (e.g. Bossema et al., 2011; Evers et al., 2001; Karademas et al., 2009; McCracken and Eccleston, 2005). Illness-related helplessness reflects the evaluation of illness as a negative, burdensome and uncontrollable condition (Evers et al., 2001) and has been associated with worse health and treatment outcomes (e.g. Andreu et al., 2012; Bossema et al., 2011; Evers et al., 2001; Voth and Sirois, 2009).

Provided that both partners’ perceptions of illness are closely connected to the well-being of each other (e.g. Benyamini et al., 2009; Karademas and Giannousi, 2013), our first hypothesis (hypothesis 1) was that patients’ and spouses’ illness cognitions of acceptance and helplessness are directly related to their partners’ psychological well-being (i.e. at a dyadic level), independently of the partner’s illness cognitions. Acceptance was expected to be positively related to psychological well-being, whereas helplessness was expected to be negatively related to well-being. Our second hypothesis (hypothesis 2) was that there is an indirect (in addition to a direct) relation of each partner’s illness cognitions to the other partner’s well-being through the corresponding cognitions of the latter. In other words, we hypothesized that patients’ and spouses’ illness cognitions are related to their partners’ corresponding cognitions, which in turn are related to the partners’ well-being. These analyses were performed after controlling for marital quality, in order to exclude the possibility that the effects reflect just the quality of the relationship between partners. Finally, given the protective role of marital quality, our third hypothesis (hypothesis 3) was that at the individual level and for both partners, higher levels of marital quality would buffer the impact of helplessness on psychological well-being as well as strengthen the positive relation of illness acceptance to well-being. We also expected that higher levels of marital quality would ‘immunize’ against the feelings of helplessness coming from the partner. That is, we expected the relation between patients’ and spouses’ feelings of helplessness to be weaker at higher levels of marital quality. On the contrary, we expected the relation between patients’ and spouses’ illness acceptance to be stronger at higher levels of marital quality.

Method

Participants and procedure

Consecutive patients with a chronic cardiovascular disease visiting the outpatient cardiology departments of a public hospital and their partners were invited to participate in the study. Inclusion criteria for the patients were a chronic cardiovascular disease, a first agreement to participate in the two phases of the study, age over 18 years, being able to understand the study protocol and provide informed consent and consenting to have their partner be involved in the study. The patients who met the inclusion criteria and their spouses were invited to participate in the study. Patients and spouses who agreed to participate were invited for another appointment (about 45 days later) in order to take part in the second phase of the study. Both partners’ illness cognitions of acceptance and helplessness as well as their evaluations of marital quality were assessed in the initial phase, while their psychological well-being was assessed in the second phase. The study was approved by the Ethics Committee of the Department of Psychology, University of Crete.

A total of 88 patients were initially approached. However, 9 patients or their spouses refused to participate (4 of them in the second phase of the study). In addition, in 4 of the remaining couples, both or only one of the partners did not return all questionnaires completed. There were no significant differences concerning gender, age and education level between those who participated in the study and those who did not. The final sample consisted of 150 individuals nested in 75 couples (all couples were of the opposite sex and married). The patients’ mean age was 60.03 years (standard deviation (SD) = 9.44 years); 69 of them were males and 6 females. The mean duration of illness was 10.64 years (SD = 9.97 years). In all, 30 patients had suffered a myocardial infarction in the past, 31 were dealing with coronary artery disease and/or angina pectoris, 8 were suffering from arrhythmias and 6 from a valvular disease. Of the total participants, 43 had undergone a cardiac surgery in the past. Regarding the education level, 25.30 per cent of the patients had finished the 9-year mandatory education or less, 46.70 per cent had finished high school and 28 per cent were holders of a higher education degree. The spouses’ mean age was 56 years (SD = 8.92 years); 37.3 per cent had finished the 9-year mandatory education or less, 42.7 per cent had finished high school and 20 per cent were holders of a higher education degree.

Measures

Illness acceptance and helplessness

Illness acceptance and helplessness were measured with the corresponding scales from the Illness Cognition Questionnaire (Evers et al., 2001). A slightly reworded version was used to assess spouses’ cognitions about the illness. Acceptance was assessed with 6 items (e.g. I have learnt to live with my illness (spouses’ version: I have learnt to live with my spouse’s illness)). Helplessness was also assessed with 6 items (e.g. My illness frequently makes me feel helpless (spouses’ version: My spouse’s illness frequently makes me feel helpless)). Respondents used a Likert-type scale ranging from 1 (strongly agree) to 5 (strongly disagree) to answer the items. Both scales have excellent psychometric properties (Evers et al., 2001). The internal consistency coefficients (Cronbach’s α) for all scales used in the study are presented in Table 1.

Table 1.

Descriptive statistics and intercorrelations of patients’ and their spouses’ illness cognitions, psychological symptoms and marital quality (N = 75 couples).

		1	2	3	4	5	6	7	8
1	P helplessness	1.00
2	P acceptance	−.01	1.00
3	S helplessness	.41^***	.14	1.00
4	S acceptance	.12	.42^***	−.06	1.00
5	P symptoms	.41^***	−.34^**	.33^**	−.13	1.00
6	S symptoms	.29*	−.12	.41^***	−.12	.60^***	1.00
7	P marital quality	−.13	.22	−.03	.03	.14	−.18	1.00
8	S marital quality	−.14	.09	−.11	.03	−.35^**	−.32^*	.54^***	1.00
	Mean	1.88	3.05	1.66	3.08	.90	.99	9.05	8.23
	SD	.87	.72	.70	.58	.57	.47	2.59	4.62
	Cronbach’s α	.91	.86	.78	.72	.90	.85	.89	.86

P: patient; S: spouse; SD: standard deviation.

p < .05; **p < .01; ***p < .001.

Psychological symptoms

Psychological symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS; Mystakidou et al., 2004; Zigmond and Snaith, 1983, for the Greek adaptation). Anxiety and depression symptoms are measured with 7 items each (e.g. I feel tense or ‘wound up’, I still enjoy the things I used to enjoy). To answer the questionnaire, respondents used a 4-point frequency Likert-type scale with higher scores indicating more intense symptoms. Responses to all items were added up to create an overall psychological symptoms score. The Greek adaptation of the HADS has good internal consistency and test–retest reliability (Mystakidou et al., 2004).

Marital quality

Marital quality was measured with the Marital Quality Index (QMI; Norton, 1983). It consists of 6 items (e.g. We have a good marriage). To answer, respondents used a 7-point Likert-type scale (from ‘very strong disagreement’ to ‘very strong agreement’) for the first 5 items and a 10-point scale (from ‘very unhappy’ to ‘perfectly happy’) for the last item. The QMI score was calculated in the following way (Norton, 1983): each item was standardized, the standardized items were summed and the summed score was log-transformed. Higher scores indicate higher levels of marital quality (for the psychometric properties of the QMI, see Norton, 1983). Both partners completed the QMI.

Statistical analysis

The dyadic effects of patients’ and their spouses’ illness cognitions on their own and their partners’ psychological well-being (hypothesis 1) were examined with the Actor–Partner Interdependence Model (APIM; Kenny et al., 2006). According to APIM, the relation of a person’s characteristics to own outcomes is referred to as the actor effect, while the relation of a person’s characteristics to his or her partner’s outcomes is referred to as the partner effect. Actor effects are estimated after controlling for partner effects, and vice versa. Following Kenny et al. (2006), we applied structural equation modelling (SEM) using LISREL 8.54 (Joreskog and Sorbom, 1996) to run the APIM analyses. Illness acceptance and helplessness were used as the independent variables, while psychological symptoms were used as the dependent variables.

To examine the indirect effects (hypothesis 2) of patients’ and spouses’ illness cognitions (independent variables) on their partners’ psychological well-being (dependent variable) through the partners’ cognitions (mediators), we used PROCESS, a freely available computational tool for SPSS and SAS developed by Hayes (2012). In this study, we performed the analyses corresponding to PROCESS Model 4, in order to examine for indirect effects. Two sets of possible indirect effects were tested: the indirect effects of spouses’ cognitions on patients’ psychological symptoms through patients’ cognitions (set 1), as well as the indirect effects of patients’ cognitions on spouses’ symptoms through spouses’ cognitions (set 2).

The analyses corresponding to PROCESS Model 60 were also performed in order to examine conditional indirect (i.e. moderated mediation) effects, that is, whether the strength of the above-mentioned indirect effects depend on (are moderated by) the level of marital quality (hypothesis 3). According to this model, an indirect effect is assumed to be conditional on the values of two possible moderators. The first moderator is assumed to affect the path from the independent variable to the mediator, as well as the path from the mediator to the dependent variable. The second moderator is assumed to affect only the path from the independent variable to the mediator. With regard to this study, provided that the relation between patients’ and spouses’ illness cognitions involves both of them (one as the ‘sender’ and the other as the ‘receiver’), we examined the possible moderation effects of both partners’ evaluations of marital quality on this relation. On the contrary, provided that the relation of each person’s cognitions to own psychological symptoms refers to a rather within-person process (e.g. Leventhal et al., 1980), only the personal evaluation of marital quality was considered as relevant and examined as a potential moderator of this relation. Patients’ evaluation of marital quality served as the first moderator (affecting both paths) and spouses’ corresponding evaluation as the second moderator (affecting only the first path) when the conditional indirect effects of set 1 were examined. Spouses’ evaluation of marital quality served as the first moderator and patients’ corresponding evaluation as the second when the conditional indirect effects of set 2 were examined. PROCESS determines whether indirect effects vary at different levels of the moderator (by default indirect effects are reported at M and ±1 SD of the moderator). Patients’ and spouses’ illness cognitions and evaluations of marital quality were mean-centred prior to analyses. All analyses were performed after controlling for the specific type and duration of illness. A post hoc examination revealed a statistical power equal to .95 at an alpha level equal to 5 per cent and a medium effect size for the analyses performed in this study.

Results

Preliminary results

A one-way analysis of variance (ANOVA) of patients’ and their spouses’ psychological symptoms across gender was performed. No significant differences were observed (for the patients, F(1, 73) = 2.25, p > .10, η² = .03; for the spouses, F(1, 73) = 2.08, p > .10, η² = .03). In addition, no significant differences in psychological symptoms across educational level were observed (for the patients, F(2, 72) = .26, p > .10, η² = .01; for the spouses, F(2, 72) = .30, p > .10, η² = .01). The correlations between patients’ and spouses’ illness cognitions, psychological symptoms and evaluations of marital quality are presented in Table 1. Patients’ illness acceptance was negatively related to own, but not to spouses’ symptoms, while spouses’ acceptance was not related to either own or patients’ symptoms. On the contrary, patients’ and spouses’ helplessness was positively related to own as well as their partners’ symptoms.

Direct and indirect effects of illness cognitions and the role of marital quality

Figure 1 presents the results of the path analyses employed to test for the APIM effects of illness cognitions on psychological symptoms. Only actor effects were detected for both patients’ and spouses’ symptoms. In other words, each partner’s illness cognitions were associated only with own symptoms.

Figure 1.

Beta-coefficients from the SEM analysis testing for actor and partner effects of illness cognitions on psychological symptoms (N = 75 couples).

Regarding the indirect impact of each partner’s illness cognitions, after controlling for patients’ and spouses’ marital quality, type and duration of illness, results indicated that spouses’ illness acceptance and helplessness were related to patients’ psychological symptoms through patients’ corresponding cognitions (mean indirect effects = −.16 and .11, respectively; standard errors (SEs) = .09 and .06, respectively; 95% bias-corrected and accelerated (5000 bootstrap samples) confidence intervals (CIs): −.38 to −.04 and .03 to .29, respectively). In addition, patients’ helplessness was related to spouses’ psychological symptoms through spouses’ helplessness (mean indirect effect = .07; SE = .04; 95% CI: .01 to .17). The indirect effect of patients’ acceptance on spouses’ psychological symptoms was not statistically significant (mean indirect effect = −.001; SE = .04; 95% CI: −.07 to .08).

Conditional indirect effects (i.e. whether marital quality moderates the indirect effects found in the previous analyses) were examined in those relations in which a statistically significant indirect (mediation) effect was identified, after controlling for the type and duration of illness. Regarding the relation of spouses’ acceptance to patients’ acceptance and symptoms, only patients’ marital quality affected the path from their own acceptance to symptoms (B = .09, SE = .04; t = 2.18, p < .05; 95% CI: .01 to .17). In addition, regarding the relation of spouses’ helplessness to patients’ helplessness and symptoms, only patients’ marital quality affected the same path (B = −.06, SE = .02; t = −2.19, p < .05; 95% CI: −.11 to −.01). Finally, in the relation of patients’ helplessness to spouses’ helplessness and symptoms, only spouses’ marital quality affected the path from their own helplessness to symptoms (B = −.04, SE = .02; t = −2.50, p < .05; 95% CI: −.07 to −.01). All other effects of marital quality, as evaluated by either the patients or the spouses, on the first path of the indirect relations were not statistically significant (B = −.11 to .01, SE = .06 to .04; t = |1.79| to |.24|, p > .07; 95% CI: −.24 to .16).

For those interactions that were statistically significant, conditional indirect effects at different values of marital quality (at M and ±1 SD) were estimated (see Table 2). In all cases, the indirect effects were not significant at higher levels of marital quality (+1 SD). That is, patients’ and spouses’ cognitions were related to their own psychological symptoms at the lower and medium levels of marital quality as evaluated by themselves (i.e. at −1 SD and M), but were not related to psychological symptoms at the higher levels of marital quality (+1 SD).

Table 2.

Mean indirect effects (SE in parentheses) of patients’ and their spouses’ illness cognitions on their partner’s psychological symptoms at specific values of marital quality.

Independent variable	Levels of marital quality
	−1 SD (95% CI^a)	Mean (95% CI^a)	+1 SD (95% CI^a)
	Mediator: P same cognition	Outcome: P symptoms	Moderator: P marital quality
S illness acceptance	−.25 (.11) (−.53 to −.09)	−.14 (.06) (−.30 to −.05)	−.03 (.07) (−.17 to .10)
S helplessness	.16 (.07) (.05 to .35)	.09 (.05) (.01 to .22)	.02 (.06) (−.10 to .14)
	Mediator: S same cognition	Outcome: S symptoms	Moderator: S marital quality
P helplessness	.13 (.04) (.07 to .24)	.08 (.04) (.02 to .19)	.03 (.06) (−.05 to .19)

SE: standard error; SD: standard deviation; CI: confidence interval; P: patient; S: spouse.

Bias-corrected and accelerated (5000 bootstrap samples).

Discussion

Overall, the findings of this study indicated that patients’ and their spouses’ illness cognitions can predict their partners’ psychological well-being, while the quality of their relationship can affect these relations. Contrary to our hypotheses, patients’ and spouses’ illness cognitions were not directly, but only indirectly, related to their partners’ psychological symptoms. In addition, the personal but not the partner’s evaluation of marital quality moderated only the relation of patients’ and spouses’ cognitions to their own symptoms.

At the individual level, illness acceptance was related, as expected, to fewer psychological symptoms of anxiety and depression, whereas helplessness was related to more symptoms. This is in accordance with the results of several previous studies (e.g. Bossema et al., 2011; Evers et al., 2001; Voth and Sirois, 2009). Only spouses’ acceptance was unrelated to their symptoms. It seems that illness acceptance was not important as far as spouses’ well-being is concerned, probably because they tend to focus on other aspects of the illness experience (such as the disease burden and its effects on patients and family members). However, this is a tentative explanation that should be examined in future studies.

At the dyadic level, a major finding of this study was that even after controlling for marital quality, patients’ and spouses’ illness cognitions were related to their partner’s corresponding cognitions that in turn were associated with the partner’s psychological symptoms. In other words, our findings suggest that there is a flow of information between partners regarding their illness experience, which can affect their well-being. This is in line with the Common Sense Model, which suggests that information from the social environment shapes the perception of illness, which in turn affects health-related behaviour and outcomes (Leventhal et al., 1980; Weinman et al., 2003). It is also in line with research in cognitive science, which indicates that it is through the more typical ways of communication (such as facial expressions, speech intonation and content) that important information is exchanged (e.g. Regenbogen et al., 2012) and, moreover, reactions are generated (e.g. Burris and Rempel, 2012).

Each partner’s understanding of illness probably conveys information about illness and its impact on self and others that may help the other partner develop or reform own illness perception and related behaviour. However, this is a bidirectional process provided that patients and spouses are at the same time both senders and receivers of information regarding illness. It is possible that this exchange of information results in the development of common (at least to a certain extent) ways of understanding and dealing with illness, as well as in the accommodation of each partner’s perceptions and behaviour to the other partner’s responses (as reflected, for example, in the frequently observed similarity in illness perceptions between patients and their partners; e.g. Figueiras and Weinman, 2003; Sterba et al., 2008). An additional possible outcome of the active interaction between patients and their partners might be the development of an intra-family system of responding to illness. That is, a dyadic or multiple regulation system responsible for the shared processing of illness information, planning and implementing courses of action and evaluating outcomes in order to protect, restore and promote the welfare of family members.

At this point, we should underline that the APIM analysis revealed only actor effects. This is in contrast to the results of previous studies according to which patients’ and spouses’ perceptions are directly related to both partners’ (e.g. Benyamini et al., 2009) or at least to patients’ well-being (e.g. Karademas and Giannousi, 2013). A possible explanation for this difference might be that the dyadic regulation process is dissimilar at different illness stages or different medical conditions. In previous studies, participants were dealing with infertility (Benyamini et al., 2009) or a recently diagnosed cancer (Karademas and Giannousi, 2013), whereas in this study, patients and spouses were dealing with a chronic medical condition for several years. Thus, they were probably habituated to this condition as well as to their partners’ reactions that could not affect them, as suggested by our findings, in other ways but as a source of information. In any case, far more research is needed to understand the complex interactions between patients’ and their partners’ perceptions and their adaptation to illness.

A further crucial finding was that all of the statistically significant indirect relations of patients’ and spouses’ cognitions to their partner’s psychological symptoms were conditional on the values of marital quality. Marital quality moderated the relation of each person’s illness cognitions to his or her own psychological symptoms. Of course, several previous studies have demonstrated the significance of marital quality and its protective role in adaptation to illness (e.g. Berg and Upchurch, 2007; Randall et al., 2009). However, our findings showed that marital quality does not just buffer the detrimental effects of negative illness perception (i.e. helplessness) on psychological symptoms. The relation between illness acceptance and symptoms was surprisingly interrupted at higher levels of marital quality (+1 SD) as well. In this respect, marital quality did not simply act as a protective variable for well-being, but as a major factor that can alter (i.e. inhibit) the overall relation of the perception of illness to well-being. A possible reason might be that high marital quality reflects the perception of a supportive and comforting family environment that helps persons deal with adversities and thus feel better irrespective of the illness impact (as reflected in the personal illness cognitions). Still, it should not escape our attention that as already underlined, the participants were dealing with illness for several years. There is a strong possibility that personal illness perceptions regain their ‘strength’ when couples are faced with new or exacerbating symptoms and relapses. In any case, such findings indicate that adaptation to illness is not a ‘close’ process. It interacts with the broader personal and social context in interesting and, sometimes, unexpected ways that deserve systematic examination.

Finally, it is worth noting that contrary to our hypotheses, marital quality did not moderate the relation between patients’ and their spouses’ illness cognitions. In other words, it did not impact the flow of information between partners despite that marital quality affected the intra-personal processes (i.e. the relation of personal cognitions to own psychological well-being). It seems that each partner can express his or her experience with illness in such ways that are noticed by the other partner, even when their relationship is damaged and their overall communication not satisfactory.

This study has certain limitations. It is a cross-sectional study with all the limitations this implies in testing causal effects. Only illness acceptance and helplessness were examined, while other illness perceptions that may also be important (e.g. about treatment) were not assessed. In addition, coping procedures and illness-related behaviours, which are important for adaptation to illness and well-being, were not included in this study. It should also be noted that participants were confronted with a cardiovascular disease for several years. Finally, we did not examine whether patients had been diagnosed with other diseases as well, although this could impact their responses and well-being.

Nevertheless, our findings are important as they emphasize the interdependence between partners and indicate that adaptation to chronic illness is not simply an issue of personal beliefs. They suggest that the form, function and outcomes of patients’ and spouses’ adaptation to illness mechanism are also a matter of their partners’ illness perceptions as well as of the quality of their relationship. In this regard, our findings add to the understanding of the complex ways in which dyadic adaptation to illness takes place. Moreover, the findings of this study suggest that in order to improve adaptation to illness, a possible strategy would be to address the illness perceptions of both patients and their partners while addressing issues related to the quality of their relationship, such as communication skills and the ways of providing support and comfort. This could probably take place through the involvement of patients and their partners in joint intervention programmes that will aim in promoting illness-related cognition and behaviour changes, as well as in enhancing communication and support-providing skills for both partners (e.g. Martire et al., 2004).

Footnotes

Funding

This work was partly supported by the Special Account for Research, University of Crete (grant number 3526).

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