Exploring Collaboration Enjoyment and Decisional Uncertainty: Actor-Partner Effects in Advanced Care Planning

Caregivers are often engaged in decision making with and for patients. However, the role of patient-caregiver interpersonal processes on decisions about advance care planning (ACP) are not well known. This secondary data analysis examined the effects of patient-caregiver enjoyment about collaboration regarding choices for life-sustaining treatment on patients’ and caregivers’ decisional uncertainty following a dyadic ACP intervention. A purposive sample of 18 adult home health patients and their informal caregivers (N=36) participated in a one-group pretest posttest study. The Interpersonal Enjoyment subscale of the Perceptions of Collaboration Questionnaire and the Decisional Uncertainty subscale of the Decisional Conflict Scale were administered using parallel questionnaires. The Actor-Partner Interdependence Model (APIM) was used to examine actor and partner effects of patients and caregivers’ interpersonal enjoyment on their uncertainty in decisions about ACP before and after the intervention. The mean age was 68.2±9.6 years for patients and 61.3±13.6 years for caregivers. The majority of patients (61.1%) and caregivers (72.2%) were female and married (55.6% and 66.7%, respectively). Almost all were non-Hispanic White (97.0%). Patients’ and caregivers’ interpersonal enjoyment and uncertainty scores were similar before the intervention. A significant partner effect between greater interpersonal enjoyment among caregivers at pretest and greater patient uncertainty at posttest (β=0.44, p=.037) was found. Previous analyses found that overall patients improved in decisional uncertainty at posttest. However, these findings suggest that for some dyads, interpersonal factors can negatively affect patients’ decisional certainty. Future research is needed to verify this finding with a larger sample.

Effects of Late-Life Health Transitions on Spouses’ Psychological Well-Being

Declining physical health likely affects not only older adults’ own well-being, but also that of their spouse. Using two waves of data from 610 couples in the National Social Life, Health and Aging Project, we examined effects of health declines over five years on change in self and spousal psychological well-being. Actor-Partner Interdependence Model findings showed that declines in spouses’ physical health (i.e., increased pain and decreased physical and cognitive function) predicted increases in older adults’ anxiety. Given the increasing importance of later-life social ties outside of marriage, we further considered the role of non-spousal health confidants. Preliminary findings suggest that effects of health declines on both partners’ well-being depend on the availability of these confidants. When older adults have people in addition to their spouse with whom they can talk about their health, detrimental effects of spouses’ declining health on older adults’ well-being are weakened for some health outcomes

Interpersonal Associations Between Affect and Depressive Symptoms in Persons With Early Dementia and Their Spouses

Positive and negative affect have independent effects on health and occur frequently in close relationships. No research to our knowledge has examined self-reported affective experiences of persons with dementia (PWD) and their spouses and interpersonal associations with their psychological health. Secondary analysis of baseline interviews from a randomized clinical trial testing a stress reduction intervention in 45 couples (n=90) examined whether individuals’ positive and negative affect were associated with their own depressive symptoms (actor effects) as well as their partner’s depressive symptoms (partner effects) and whether these associations differed for PWD and spouses. Actor partner interdependence model results showed that for PWDs and spouses, one’s own positive affect was related to one’s own lower depressive symptoms (B=-3.10, SE=.59, df=58.70, p<.001), and one’s own negative affect was associated with one’s own greater depressive symptoms (B=6.62, SE=.60, df=65.67, p<.001). These effects were independent from each other. Partner effects were not significant.

The Mediating Role of Self-esteem between Spousal Support and Infertility-related Stress among Infertile Couples: Actor Effects and Partner Effects

The purpose of this study was to examine actor and partner effects among infertile couples in determining whether self-esteem affects the degree of infertility-related stress via perceived spousal support. The sample comprised 219 couples who experienced infertility, each of whom completed an online survey. To analyze the data, descriptive statistics, t-test, correlation analysis and APIM (Actor-Partner Interdependence Model) were performed using SPSS 25.0 and Mplus 7.3 program. The main results were as follows. First, the actor effect of spousal support on self-esteem was significant in both husbands and wives. Second, the actor effects of spousal support on infertility-related stress and self-esteem on infertility stress were significant only in husbands. Third, in the association between husbands’ and wives’ spousal support and infertility-related stress, three mediating pathways via husband’s self-esteem were found to be significant. Based on these results, the necessity for a couple-level analysis in infertility research, psycho-emotional interventions for infertile couples, and implications for follow-up studies were discussed.

Exploring Insecure Romantic Attachment and Justifications for the Use of Intimate Partner Psychological Aggression in Couples

The attachment theory has commonly been used to examine intimate partner psychological aggression (IPPA), but few studies have examined its association with self-reported justifications for one’s own use of IPPA. Behaviors, including the use of IPPA, are influenced, maintained, and function within the context of their justifications, highlighting the importance of investigating these justifications to obtain a clearer picture of IPPA. This study examined whether insecure romantic attachment (i.e., attachment anxiety and attachment avoidance) in both partners of a couple was associated with their justifications for their own use of IPPA. A community sample of 81 mixed-sex couples who reported using IPPA in the last year completed self-reported questionnaires on adult romantic attachment and their justifications for their use of IPPA. Results of a path analysis based on the actor-partner interdependence model revealed moderate positive associations between attachment anxiety and one’s use of internal and external justifications for their IPPA perpetration in men and women. An unexpected dyadic positive association is discussed. These results suggest that the use of justifications for one’s use of IPPA may reflect a strategy of hyperactivation that could contribute to the cycle of psychological aggression. Uncovering the function of these justifications could provide important therapeutic benefits, which are discussed in the study’s implications.