The effects of health-related spousal influence on couples coping with chronic heart failure: an application of the actor-partner interdependence model

2013-07-21Coping with chronic illness is increasingly being viewed as a relational process rather than an individual-based phenomenon. Although spouses serve as each others' primary source of support and assistance, relatively little is known about how spousal involvement in illness management affects outcomes for patients and spouses. The aims of this project were to (1) identify the distinct effects of two types of health-related spousal influence attempts (positive and negative) on patient compliance and subsequent chronic heart failure (CHF) symptoms, (2) examine the potential broader consequences of these influence attempts for patients' and spouses' general physical and mental health, (3) investigate how the marital context (specifically marital quality and variability in closeness) influences the above associations, and (4) explore the day-to-day effects of providing and receiving influence attempts on feelings of marital closeness using a daily diary methodology. Analyses for Aims 1 through 3 were conducted using an actor-partner-interdependence model (APIM) with a short-term longitudinal dataset (n = 60 couples). Data revealed that negative spousal influence attempts at baseline were associated with lower treatment compliance for patients six months later and in turn greater CHF symptom levels, whereas positive influence attempts had the opposite effect when feelings of marital closeness were stable. Spouses exhibited a negative association between positive influence attempts and physical health, but no association between influence attempts and physical health was found for patients. Negative influence attempts were negatively associated with patients' mental health six months later; however, no association was found for spouses' mental health. Lastly, in the daily diary study (n = 26 couples) using lagged-time analyses in a repeated measures APIM (Aim 4), I found that receiving influence from one's spouse served to increase patients' feelings of marital closeness, particularly when the influence was more positive than negative. However, providing influence had no effect on spouses’ feelings of marital closeness. These findings demonstrate that spouses' involvement in illness management is indeed consequential for patients with CHF, with distinct consequences of positive and negative influence attempts. Benefits of positive influence attempts were dependent on the marital context, whereas costs of negative influence remained regardless of the marital context. Efforts to influence compliance also have effects on feelings of marital closeness. Findings suggest future directions for research and reveal potential areas for intervention