Predictors of partnership and sexual satisfaction and dyadic effects in couples affected by endometriosis and infertility.

PURPOSE: Endometriosis and infertility are associated with impaired partnership and sexuality of the patients, but also of their male partners. Also, endometriosis is one of the most common causes of infertility, resulting in a large overlap of both pathologies. The aim of this study was to determine the association of different predictors of partnership and sexual satisfaction and dyadic effects in couples with endometriosis and infertility. METHODS: A cross-sectional study was conducted with n = 62 women with endometriosis and n = 46 partners, including a total of n = 44 couples, some of whom were affected by infertility. The questionnaire included items on partnership, sexuality, depression, social support, and desire for a child. Multiple linear regression and the actor-partner-interdependence-model were used for analysis. RESULTS: Significant dyadic effects only occurred in couples with both endometriosis and infertility. Depression showed a significant negative actor effect in men for partnership satisfaction and a negative actor and partner effect in women for sexuality satisfaction (p < .05). For women, social support showed a significant positive actor effect for partnership satisfaction (p < .05), age showed a significant actor and partner effect for sexuality satisfaction (p < .05). CONCLUSION: The results show a significant association of endometriosis and infertility with partnership and sexuality satisfaction. Infertility could be a decisive factor. However, the large overlapping of both endometriosis und infertility in many couples support the importance of further studies to differentiate between the both effects. TRIAL REGISTRATION: German Clinical Trials Register DRKS00014362 on the 29.03.2018.

German and Italian validation of the Dyadic Coping Inventory-Sexual Minority Stress (DCI-SMS) scale.

Lesbian, gay, bisexual, and transgender individuals (hereafter people with minoritized sexual orientation and/or gender identities) have limited legal rights and access to resources because of their marginalized status in society. These limitations are associated with notable health disparities and increase experiences of minority stress. For those in a romantic relationship, being able to communicate and cope with one's partner-dyadic coping-can help buffer stress' deleterious effects on well-being. Given the promise of understanding how dyadic coping can mitigate experiences of sexual minority stress, the Dyadic Coping Inventory-Sexual Minority Stress (DCI-SMS) was recently created and validated with those living in the United States to assess how partners cope with sexual minority stress. Answering a global call to expand psychological science beyond a U.S. centric perspective, the purpose of this study was to validate the DCI-SMS in German and Italian using samples from Austria, Germany, Switzerland, and Italy, respectively. Confirmatory factor analysis results, along with tests of convergent and discriminant validity, and measurement invariance, suggest that the DCI-SMS is a valid measure of stress communication and dyadic coping behaviors for those in a same-gender relationship in the countries sampled. Important future directions include examining its efficacy in other countries, such as those with more adverse sociopolitical climates for people with minoritized sexual orientation and/or gender identities in a same-gender relationship. Limitations and future directions for research and clinical practice are presented. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Relationship satisfaction and metabolic health parameters: a cross-sectional study in Burkinabe population of older adults.

BACKGROUND: Over- and undernutrition coexist in many African countries and pose a threat to metabolic health. This study assessed the associations between relationship satisfaction and Body Mass Index (BMI), waist circumference (WC), and glycated hemoglobin (HbA1c), in a rural population of older adults in Burkina Faso. It also explored potential gender differences and the mediating role of depressive symptoms. METHODS: Data from the "Centre de Recherche en Santé de Nouna (CRSN) Heidelberg Aging Study (CHAS)," a cross-sectional population-based study conducted in 2018 in Burkina Faso, were used in our study. Hierarchical linear regression models were applied for each of the three outcome variables. Among 2291 participants aged 40 years or older who provided data on relationship satisfaction, 2221, 2223, and 2145 participants had BMI, waist circumference (WC), and HbA1c values respectively. RESULTS: Higher relationship satisfaction (CSI-4 score) was associated with increased BMI (ß = 0.05, p = 0.031) and WC (ß = 0.12, p = 0.039). However, the association of CSI-4 and BMI became non-significant after controlling for depressive symptoms (PHQ-9 score) and physical inactivity (BMI: ß = 0.04, p = 0.073). Depressive symptoms fully mediated the relationship between relationship satisfaction and BMI (ß = -0.07, p = 0.005). There was no significant association between relationship satisfaction and HbA1c. These results were consistent across genders and age groups. CONCLUSION: Higher relationship satisfaction may lead to increased body weight among Burkinabe adults aged 40 years and older, and depressive symptoms may be a mediator in this association.

EFFects of Exposure and Cognitive behavioral Therapy for chronic BACK pain ("EFFECT-BACK"): study protocol for a randomized controlled trial.

INTRODUCTION: Chronic back pain is a widespread medical condition associated with high socioeconomic costs and increasing prevalence. Despite the advanced implementation of multidisciplinary approaches, providing a satisfactory treatment offer for those affected is often not possible. Exposure therapy (EXP) promises to be an effective and economical form of treatment and in a previous pilot study showed to be superior to cognitive behavioral therapy (CBT) in reducing perceived limitations of movement. The current study aims to further compare the efficacy of both treatment methods and identify those patient groups that particularly benefit from EXP. METHODS: The general objective of this randomized multicenter clinical trial (targeted N = 380) is to improve and expand the range of treatments available to patients with chronic back pain. As the primary objective of the study, two different psychological treatments (EXP and CBT) will be compared. The primary outcome measure is a clinically significant improvement in pain-related impairment, measured by the QPBDS, from baseline to 6-month follow-up. Secondary outcome measures are absolute changes and clinically significant improvements in variables coping, psychological flexibility, depressiveness, catastrophizing, exercise avoidance and fear of exercise, and intensity of pain. Participants are recruited in five psychological and medical centers in Germany and receive ten sessions of manualized therapy by trained licensed CBT therapists or clinical psychologists, who are currently in their post-gradual CBT training. Potential predictors of each treatment's efficacy will be explored with a focus on avoidance and coping behavior. CONCLUSION: This study will be the first RCT to compare CBT and EXP in chronic back pain in a large sample, including patients from different care structures due to psychological and medical recruitment centers. By identifying and exploring potential predictors of symptom improvement in each treatment group, this study will contribute to enable a more individualized assignment to treatment modalities and thus improves the care situation for chronic back pain and helps to create a customized treatment program for subgroups of pain patients. If our findings confirm EXP to be an efficacious and efficient treatment concept, it should gain more attention and be further disseminated. TRIAL REGISTRATION: ClinicalTrials.gov NCT05294081. Registered on 02 March 2022.

Endometriosis: patient-doctor communication and psychological counselling.

The fact that endometriosis is one of the most frequent gynaecological disorders in women and girls is gradually attracting greater public and political attention. There is also substantial awareness of the disorder among German gynaecologists, albeit without sufficient "equipment" for discussing the condition with patients and providing psychological counselling. This article offers hands-on proposals for medical counselling and the discussion of relevant issues, as well as other practical tips and suggested verbalisations for use by women suffering from endometriosis (and their partners). These practical recommendations will certainly help to improve the doctor-patient relationship in the case of endometriosis. The resources mentioned below (guidebooks, websites) focus on German-language offerings only.

A compassion-based treatment for couples with the female partner suffering from current depressive disorder: A randomized-controlled trial.

BACKGROUND: Studies have shown that depression and interpersonal relationships are interdependently connected and that including the intimate partner in treatment for depression has beneficial effects. Given evidence that compassion is both an interpersonal quality and a promising treatment target, the goal of this study was to examine the effects of a compassion-based, contemplative treatment for couples employing a multi-method approach for evaluation. METHODS: In a pre-post-follow-up design, n = 53 different-sex couples including women with current depression were randomly assigned to a 10-week-long CBCT®-fC (Cognitively-Based Compassion Training/intervention for couples) or treatment-as-usual (TAU) condition. Multi-level linear regression models and post-hoc contrasts were calculated to determine changes in depressive symptoms, mindfulness and self-compassion, interpersonal functioning and neuroendocrine markers collected during a partnership appreciation task (PAT) in the laboratory before and after CBCT-fC treatment. RESULTS: While CBCT-fC led to a comparable decrease of depressive symptoms as TAU, the training specifically increased self-compassion and mindfulness versus TAU. Interestingly, interpersonal functioning did not improve, which was also reflected in participants' preferred self-focus in-between-session practices, instead of practices with interpersonal focus. There were no group-specific changes in psychobiological stress-marker reactivity. CONCLUSIONS: CBCT-fC was effective in decreasing current depressive symptomatology and increasing mindfulness, and self-compassion. Especially the motivation to participate, such as improving interpersonal functioning, should be addressed and intrinsic motives of the partners to be involved. In highly burdened individuals, self-regulation may need to be improved before co-regulation can be addressed, which would requiring longer treatments. Facilitating factors for engaging in the practice between-sessions seem meaningful.

Understanding Psychological Symptoms of Endometriosis from a Research Domain Criteria Perspective.

Endometriosis is currently the second most common gynecological disease and is associated with severe pain, vegetative impairment, and infertility. In association, there are considerable psychological symptoms that limit the quality of life of those affected. In this narrative review, the Research Domain Criteria (RDoC) framework was utilized to display the different transdiagnostic processes involved in disease progression and maintenance in regard to psychosocial functioning. Using the RDoC framework, it becomes clear that immune/endocrinological dysregulation is interlocked with (pelvic) pain chronification processes and psychological symptoms such as depressive mood, loss of control, higher vigilance toward the onset or worsening of symptoms, social isolation, and catastrophizing. This paper will discuss and identify promising treatment approaches, in addition to medical care, as well as further research implications. Endometriosis can come with substantial psychosomatic and social burden, requiring more research to understand the interdependence of different factors involved in its chronic development pathway. However, it is already clear that standard care should be extended with multifaceted treatments addressing pain, as well as the psychological and social burden, in order to halt the cycle of aggravation of symptoms and to improve quality of life for patients.

Analysing medical predictors for the outcome of infertility treatment: a 5-year follow-up survey.

PURPOSE: For many couples, bearing children is a common life goal; however it cannot always be fulfilled. Undergoing infertility treatment does not always guarantee pregnancies and live births. Couples experience miscarriages and even discontinue infertility treatment. Significant medical predictors for the outcome of infertility treatment have yet to be fully identified. METHODS: To further our understanding, a cross-sectional 5-year follow-up survey was undertaken, in which 95 women and 82 men that have been treated at the Women's Hospital of Heidelberg University participated. Binary logistic regressions, parametric and non-parametric methods were used for our sample to determine the relevance of biological (infertility diagnoses, maternal and paternal age) and lifestyle factors (smoking, drinking, over- and underweight) on the outcome of infertility treatment (clinical pregnancy, live birth, miscarriage, dropout rate). In addition, chi-square tests were used to examine differences in the outcome depending on the number of risk factors being present. RESULTS: In the binary logistic regression models for clinical pregnancies, live births and drop outs were statistically significant only for the maternal age, whereas the maternal and paternal BMI, smoking, infertility diagnoses and infections showed no significant predicting effect on any of the outcome variables. A correlation between the number of risk factors and the outcome of infertility treatment could not be excluded. CONCLUSION: The results confirm that maternal age has an effect on infertility treatment, whereas the relevance of other possible medical predictors remains unclear. Further large-scale studies should be considered to increase our knowledge on their predictive power.

Associations of SLC6A4 methylation with salivary cortisol, salivary alpha-amylase, and subjective stress in everyday life.

Dysregulations of the hypothalamic-pituitary-adrenal (HPA) and sympatho-adrenal medullary (SAM) axis are associated with mental and somatic illness. However, there is lack of knowledge regarding the molecular mechanisms underlying these effects. Epigenetic states in the serotonin transporter gene (SLC6A4) were shown to be associated with stress in various forms. We hypothesized that levels of DNA methylation (DNAm) of SLC6A4 would be associated with altered SAM- and HPA regulation in daily life. N = 74 healthy persons participated in the study. An ecological momentary assessment (EMA) approach was used to assess indicators of stress in daily life. Each day included six concurrent assessments of saliva, to quantify cortisol (sCort; HPA axis) and alpha-amylase (sAA; SAM axis), and to assess self-reports on subjective stress. To assess SLC6A4 DNAm, peripheral blood was drawn and analyzed via bisulfite pyrosequencing. All data were assessed in two waves three months apart, each including two days of EMA and the assessment of SLC6A4 DNAm. Data were analyzed using multilevel models. On the between-person level, higher average levels of SLC6A4 DNAm were associated with higher average levels of sAA, but not with average levels of sCort. On the within-person level, higher levels of SLC6A4 DNAm were associated with lower levels of sAA and sCort. There were no associations of subjective stress with SLC6A4 DNAm. The results help to clarify the association between environmental stress and stress axes regulation, pointing towards an important role of differential within- and between-person effects of SLC6A4 DNAm, which might shape this association.

Affectionate touch and diurnal oxytocin levels: An ecological momentary assessment study.

Background: Affectionate touch, which is vital for mental and physical health, was restricted during the Covid-19 pandemic. This study investigated the association between momentary affectionate touch and subjective well-being, as well as salivary oxytocin and cortisol in everyday life during the pandemic. Methods: In the first step, we measured anxiety and depression symptoms, loneliness and attitudes toward social touch in a large cross-sectional online survey (N = 1050). From this sample, N = 247 participants completed ecological momentary assessments over 2 days with six daily assessments by answering smartphone-based questions on affectionate touch and momentary mental state, and providing concomitant saliva samples for cortisol and oxytocin assessment. Results: Multilevel models showed that on a within-person level, affectionate touch was associated with decreased self-reported anxiety, general burden, stress, and increased oxytocin levels. On a between-person level, affectionate touch was associated with decreased cortisol levels and higher happiness. Moreover, individuals with a positive attitude toward social touch experiencing loneliness reported more mental health problems. Conclusions: Our results suggest that affectionate touch is linked to higher endogenous oxytocin in times of pandemic and lockdown and might buffer stress on a subjective and hormonal level. These findings might have implications for preventing mental burden during social contact restrictions. Funding: The study was funded by the German Research Foundation, the German Psychological Society, and German Academic Exchange Service.

Stress during the COVID-19 Pandemic Moderates Pain Perception and Momentary Oxytocin Levels.

Self-reported pain levels have been associated with increased stress levels during the COVID-19 pandemic. Less is known about the long-term effects of stress on individuals' physical and emotional pain levels and their associations with the neuropeptide hormone oxytocin. We aimed to predict momentary pain through individual stress levels and momentary oxytocin levels at genuinely high-stress phases, namely during COVID-related lockdowns. In a cross-sectional (n = 254) and a longitudinal (n = 196) assessment during lockdowns in Germany, participants completed a 2-day ecological momentary assessment (EMA) protocol (collecting six saliva samples on two consecutive days each and simultaneously reporting on stress, physical, and emotional pain levels) in 2020, as well as one year later, in 2021. Hierarchical linear modeling revealed significant positive associations between individuals' stress levels and physical pain, both cross-sectionally (b = 0.017; t(103) = 3.345; p = 0.001) and longitudinally (b = 0.009; t(110) = 2.025; p = 0.045). Similarly, subjective stress ratings showed significant positive associations with emotional pain on a within-person (b = 0.014; t(63) = 3.594; p < 0.001) as well as on a between-person (b = 0.026; t(122) = 5.191; p < 0.001) level. Participants further displayed significantly lower salivary oxytocin when experiencing higher levels of emotional pain (b = -0.120; t(163) = -2.493; p = 0.014). In addition, high-stress levels significantly moderated the association between physical pain and salivary oxytocin (b = -0.012; t(32) = -2.150; p = 0.039). Based on mechanistic and experimental research, oxytocinergic mechanisms have long been suggested to modulate pain experiences, however, this has not yet been investigated in everyday life. Our data, which was collected from a large sample experiencing continued stress, in this case, during the COVID-19 pandemic, suggests that individuals experience more intense physical pain and elevated stress levels, as shown by particularly low salivary oxytocin concentrations.

Effects of mental contrasting on sleep and associations with stress: A randomized controlled trial.

Mental contrasting with implementation intentions (MCII) has been successfully applied to improve health-related behaviors (e.g. exercise). We explored its effectiveness to improve sleep outcomes beyond effects of sleep hygiene (SH) information, and investigated associations with stress. Eighty university employees (mean age: 29.6, SD = 4.5) were randomized to either a MCII + SH or a SH-only condition. During a baseline-week and a post-intervention week, sleep duration (Fitbit Alta and self-report), sleep quality, and stress were assessed daily and saliva was collected to assess the cortisol awakening response (CAR). In total, self-reported sleep quality and duration increased, but there was no meaningful condition*week interaction for sleep parameters or CAR. Higher average stress was associated with shorter sleep duration and lower sleep quality. Within-person, days with higher stress were followed by nights with lower sleep quality. Despite overall improvements, effects of MCII were not confirmed. MCII might be less effective to improve behaviors which are less controllable.

[Psychotherapeutic Work with Relatives and Couples in Selected Mental and Physical Illnesses]. / Psychotherapeutische Arbeit mit Angehörigen und Paaren bei psychischen und körperlichen Erkrankungen.

A physical or mental illness affects not only patients but also their family environment. The immediate (caring) relatives are of particular importance in coping with the illness. However, they are often overlooked as invisible patients in the second row. Using selected diseases such as cancer, dementia and pain as examples, the following article will illustrate the special importance of working with relatives and couples. The focus in this article is on adult relatives. The group of children as relatives requires separate consideration.

Effectiveness of psychosocial interventions for infertile women: A systematic review and meta-analysis with a focus on a method-critical evaluation.

BACKGROUND: Approximately seven to nine percent of couples of reproductive age do not get pregnant despite regular and unprotected sexual intercourse. Various psychosocial interventions for women and men with fertility disorders are repeatedly found in the literature. The effects of these interventions on outcomes such as anxiety and depression, as well as on the probability of pregnancy, do not currently allow for reliable generalisable statements. This review includes studies published since 2015 performing a method-critical evaluation of the studies. Furthermore, we suggest how interventions could be implemented in the future to improve anxiety, depression, and pregnancy rates. METHOD: The project was registered with Prospero (CRD42021242683 13 April 2021). The literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six databases were searched and 479 potential studies were discovered. After reviewing the full texts, ten studies were included for the synthesis. Not all studies reported the three outcomes: four studies each for depression, three for anxiety and nine studies for pregnancy rates were included in the meta-analysis, which was conducted using the Comprehensive meta-analysis (CMA) software. RESULTS: Psychosocial interventions do not significantly change women's anxiety (Hedges' g -0,006; CI: -0,667 to 0,655; p = 0,985), but they have a significant impact on depression in infertile women (Hedges' g -0,893; CI: -1,644 to -0,145; p = 0,026). Implementations of psychosocial interventions during assisted reproductive technology (ART) treatment do not increase pregnancy rates (odds ratio 1,337; 95% CI 0,983 to 1,820; p = 0,064). The methodological critical evaluation indicates heterogeneous study design and samples. The results of the studies were determined with different methods and make comparability difficult. All these factors do not allow for a uniform conclusion. METHODOLOGICAL CRITICAL EVALUATION: Study design (duration and timing of intervention, type of intervention, type of data collection) and samples (age of women, reason for infertility, duration of infertility) are very heterogeneous. The results of the studies were determined with different methods and make comparability difficult. All these factors do not allow for a uniform conclusion. CONCLUSION: In order to be able to better compare psychosocial interventions and their influence on ART treatment and thus also to achieve valid results, a standardised procedure to the mentioned factors is necessary.

Neural responses to instructed positive couple interaction: an fMRI study on compliment sharing.

Love is probably the most fascinating feeling that a person ever experiences. However, little is known about what is happening in the brains of a romantic couple-the central and most salient relationship during adult age-while they are particularly tender and exchanging loving words with one another. To gain insight into nearly natural couple interaction, we collected data from N = 84 individuals (including N = 43 heterosexual couples) simultaneously in two functional magnetic resonance imaging scanners, while they sent and received compliments, i.e. short messages about what they liked about each other and their relationship. Activation patterns during compliment sharing in the individuals revealed a broad pattern of activated brain areas known to be involved in empathy and reward processing. Notably, the ventral striatum, including parts of the putamen, was activated particularly when selecting messages for the partner. This provides initial evidence that giving a verbal treat to a romantic partner seems to involve neural reward circuitry in the basal ganglia. These results can have important implications for the neurobiological mechanisms protecting and stabilizing romantic relationships, which build a highly relevant aspect of human life and health.

An analgesic pathway from parvocellular oxytocin neurons to the periaqueductal gray in rats.

The hypothalamic neuropeptide oxytocin (OT) exerts prominent analgesic effects via central and peripheral action. However, the precise analgesic pathways recruited by OT are largely elusive. Here we discovered a subset of OT neurons whose projections preferentially terminate on OT receptor (OTR)-expressing neurons in the ventrolateral periaqueductal gray (vlPAG). Using a newly generated line of transgenic rats (OTR-IRES-Cre), we determined that most of the vlPAG OTR expressing cells targeted by OT projections are GABAergic. Ex vivo stimulation of parvocellular OT axons in the vlPAG induced local OT release, as measured with OT sensor GRAB. In vivo, optogenetically-evoked axonal OT release in the vlPAG of as well as chemogenetic activation of OTR vlPAG neurons resulted in a long-lasting increase of vlPAG neuronal activity. This lead to an indirect suppression of sensory neuron activity in the spinal cord and strong analgesia in both female and male rats. Altogether, we describe an OT-vlPAG-spinal cord circuit that is critical for analgesia in both inflammatory and neuropathic pain models.

The Posttraumatic Impact of Recurrent Pregnancy Loss in Both Women and Men.

Introduction Recurrent pregnancy loss is usually associated with significant psychological distress for both partners of the couple. It may act as a traumatic experience resulting in a posttraumatic stress disorder. The object of this study is to examine the posttraumatic impact of recurrent pregnancy loss on men and women and their interdependencies. Methods Cross-sectional study. All couples referred to the special unit for recurrent pregnancy loss between March 2019 and October 2020 were asked to participate with a sample size of 105 couples and 17 women. They were invited to complete a questionnaire package estimating the prevalence of posttraumatic stress, with anxiety, depression, lack of social support and dysfunctional coping strategies as contributing risk factors. Couple data were analysed with the Actor Partner Interdependence Model, taking the couple as a dyad. Results The response rate was 82.3 percent, with posttraumatic stress being measured in 13.7% of the women versus 3.9% of the men (p = 0.017). For women, number of curettages, controlled for the number of losses, correlated with the severity of posttraumatic stress (p < 0.05). Higher levels of anxiety, depression and lack of social support in women correlated positively with posttraumatic stress in their partners. The men's coping strategy "trivialization and wishful thinking" as well as "avoidance" correlated with more severe posttraumatic stress in the female partners (both p < 0.05). Conclusion The posttraumatic risks within a couple with recurrent pregnancy loss are interdependent. Recurrent pregnancy loss clinics should assess posttraumatic risks of both partners in their routine diagnostic process.

Effects of intranasal oxytocin and positive couple interaction on immune factors in skin wounds.

BACKGROUND: Intimate social relationships improve individual health and longevity, an effect which is supposed to be mediated through stress-sensitive endocrine and immune mechanisms in response to positive interaction behavior. On a neuroendocrine level, oxytocin (OT) buffers stress responses, modulates social attachment behavior and has been associated with cytokine expression. Consequently, the aim of the present study was to investigate instructed positive couple interaction, observed behavior, and OT in their effect on immune function. METHODS: In a 4-group design, 80 healthy couples (N = 160 individuals) received four standard dermal suction blister wounds and were randomized to instructed positive interaction/control and intranasal OT/placebo. Unstimulated cytokines (IL-1ß, IL-6, TNF-α) were assessed from wound liquid at 40 min, 105 min and 24 hrs after wounding. RESULTS: Overall, group assignment did not affect friendly or dominant behavior during the interaction sequence. IL-1ß and IL-6 levels, however, were moderated by group assignment with lowest levels in women in the positive interaction and OT condition in IL-1 and highest levels in IL-6. TNF-α responses to wounding were not affected from group assignment, however observed friendliness in women was associated with lower TNF-α levels. DISCUSSION: These findings support the immune-regulating role of friendly behavior in romantic couples. Above this, the data provide the first empirical evidence that an intervention that simultaneously targets neuroendocrine mediators and behavior could affect immune function in a sex specific manner and with potential long-term health relevance.

Characteristics of salivary cortisol and alpha-amylase as psychobiological study outcomes in palliative care research.

BACKGROUND: Psychosocial interventions are rapidly emerging in palliative care. However, randomized trials often fail to provide evidence for their effectiveness with regard to patient-reported outcomes. Stress biomarkers could complement self-report data, but little is known about their feasibility, acceptance, and interpretability. METHODS: Therefore, we designed a randomized crossover trial in which 42 patients in a palliative care unit participated in both a brief mindfulness intervention (MI) and a resting state control condition (CC) on two consecutive afternoons. On each day, we collected four saliva samples in 20-min intervals using Salivettes© to determine salivary cortisol (sCort) and alpha-amylase (sAA) concentration levels. At all measurement points, self-rated well-being and stress as well as cardiovascular markers were assessed. Baseline measurements further included self-rated quality of life and clinician-rated functional status. RESULTS: 78.6% of the patients provided the maximum number of 8 saliva samples and 62.2% reported no subjective difficulties with the sampling procedures. 66.6% (sCort) and 69.6% (sAA) of all possible samples were finally included in the analysis. Xerostomia and nausea were the main reasons for missing data. Higher sCort levels were associated with higher heart rate and lower quality of life, functional status, and heart rate variability. Corticosteroid and sedative medication as well as time since last meal were identified as potential confounders. Regarding reactivity to the MI, we found an overall decrease in sCort levels over time (b = -.03, p = .01), but this effect did not differ significantly between the study conditions (b = .03, p = .21). sAA levels were higher in men than in women. Trajectories over time did not significantly differ between the two conditions (b = -.02, p = .80) and associations with other stress and health-related constructs were weak. CONCLUSIONS: Findings indicate that sCort might serve as a psychobiological outcome in future palliative care trials. However, future research should refine the exact measurement and conceptualization strategies for sCort in palliative care research. High attrition rates should be expected in patients with xerostomia or nausea. TRIAL REGISTRATION: Registered at the German Clinical Trials Registry (DRKS00013135) at 04/12/2017.

Feeling low and unhappy together? An actor-partner-interdependence model uncovering the linkage between different operationalizations of relationship quality and depression in different-sex couples.

Some studies suggest a bi-directional association between low relationship quality and depression. However, the social impact of depression and the potential preventative effects of healthy relationships are not yet sufficiently understood, as studies have shown heterogenous results for effects in both directions. Therefore, the main aim of this study was to differentiate the actor and partner effects of this association more comprehensively using two measures to capture characteristics of relationship quality-firstly regarding general aspects of social system quality and secondly considering specific aspects of the romantic relationship. 110 different-sex couples were included, being separated in partners with highly pronounced depressive symptoms in women (Cw/DW) versus partners with low depressive symptoms (LDCs). We investigated effects cross-sectionally using multi-group analyses to predict relationship (couple specific questionnaire: PFB) versus system quality (general system quality questionnaire: EVOS) in a step-by-step approach, modelling actor and partner effects with variation within and across both groups and then comparing the results to models with equal actor and partner effects. Depression was measured with the PHQ-9. With regard to the relationship between depressive symptoms and system quality, the model that constrained actor and partner effects to be equal across both groups was preferred and showed negative significant actor effects across gender and groups. Concerning the association between depressive symptoms and relationship quality, the model constraining actor and partner effects to be equal within groups had the best fit to the data and revealed a negative partner effect in LDCs. Conclusions Controlling for the moderating variable of clinically relevant depressive symptoms, we found evidence for actor and partner effects, which differed between the two relationship measures. This underlines the importance to reflect how relationship quality is operationalized. The negative partner effect on relationship quality in LDCs emphasizes that even in a non-clinical context, depressive symptoms negatively impact the perceived relationship quality of both women and men. This suggests that addressing the relationship is important in non-clinical preventive contexts and calls for integrating the partner into counselling or trainings.