Examining Contextual Influences Affecting health-related Quality of life Among under-resourced Appalachian Patients Attending pop-up Medical Clinics.

Appalachian residents face substantial barriers to accessing health care and these barriers have negative ramifications for this community's health-related quality of life (HRQoL) [1, 2]. Pop-up medical clinics address some of these barriers by offering a range of free health care services throughout Appalachia. Although these services are undoubtedly helpful, information on how these clinics may be linked to HRQoL changes among under-resourced communities is limited. The present study is among the first to examine how (1) individuals attending pop-up medical clinics present on HRQoL indicators, (2) how HRQoL changes 3-months post-clinic, and (3) how individual, social, and community factors interact with HRQoL at presentation and change in HRQoL 3-months post-clinic. Data were collected from 243 individuals attending one of seven pop-up medical clinics across Central, South Central, and Southern Appalachia. During the week of the clinic, participants completed a survey assessing individual, social, and community factors as well as HRQoL variables (i.e., overall health, depressive symptoms, pain, sleep quality, and several physical symptoms). Participants completed the same survey 3-months post-clinic. Results revealed that baseline individual, social, and community factors were predictive of HRQoL indicators at baseline; individual and social factors also uniquely predicted change in HRQoL at 3-months post-clinic. Within the Social Ecological Framework, these data emphasize the significance of individual and social level factors on an individual's HRQoL. Clinical implications and directions for future research are discussed.

Depressed mood and environmental mastery as potential pathways linking family relationship quality and disease self-management for African Americans with hypertension.

African Americans are at significantly greater risk of hypertension and worse cardiovascular outcomes than other racialized groups, yet hypertension intervention effects remain limited. Thus, it is necessary to understand the potential mechanisms whereby interventions may be more effectively targeted to improve health. Supported by prior research evidence and guided by the Biobehavioral Family Model, this study examined associations between family relationship quality, psychological wellbeing, and self-management behaviors for African Americans with hypertension. Data were pooled from three Midlife Development in the U.S. projects, resulting in a sample of 317 African Americans (63.4% female, Mage  = 53.32) with self-reported high blood pressure in the past 12 months. We tested four cross-sectional multiple mediator models, with depressed mood and environmental mastery mediating associations between family strain and exercise, smoking, problematic alcohol use, and stress-eating. Environmental mastery mediated the association between greater family strain and decreased odds of achieving recommended exercise levels; greater odds of reporting problematic alcohol use; and greater stress-eating. Though family strain was associated with depressed mood in each model, this variable did not serve as an indirect pathway to self-management behaviors. Family strain, and the potential pathway identified via environmental mastery, may be a meaningful predictor of disease self-management for African Americans with hypertension. Longitudinal studies are needed to examine directionality and to support intervention trials for improving self-management and hypertension outcomes.

"A cuff is not enough": A community-based participatory research approach to soliciting perspectives of African Americans with hypertension and their family members on self-management intervention features.

We aimed to solicit the perspectives of African Americans with hypertension and their family members on the desired features of a behavioral hypertension self-management intervention. Using a community-based participatory approach to intervention design, we conducted four dyadic focus groups, including African American community members with hypertension (n = 23) and their family members (n = 23), recruited from African American-serving Christian churches in a large, southern metropolitan area. We used open-ended questions to elicit participants' perspectives regarding program features they would recommend, intervention delivery, and barriers necessary to address. Our grounded theory analysis identified themes reflecting participants' recommendations for hypertension self-management interventions to enhance health literacy and provide communication training via an accessible, population-tailored, family-based approach, which they believed has the potential to create family-level impact on health across generations. Participants also recommended intervention researchers engage in advocacy (i.e., via physician education and policy change) as part of a broader impact on structural inequities driving worse hypertension and health outcomes for African Americans. The perceptions and recommendations of African Americans with a lived experience of hypertension, as well as their family members, aid in shaping acceptable and efficacious behavioral interventions aiming to promote hypertension self-management behavior while leveraging the unique power of family relationships to create sustained behavior change.

Relationship quality and psychophysiological distress for underserved breast cancer patients and their caregiver before treatment.

OBJECTIVE: Breast cancer patients and caregivers experience biobehavioral reactivity (e.g., depression, anxiety, pain, fatigue) during breast cancer treatment which predicts cancer recurrence and mortality. High quality patient-caregiver relationships can mitigate this distress during treatment, but this association is unclear pre-treatment. Identifying early interventions that target high risk Appalachian patients could impact biobehavioral reactivity. METHODS: We recruited 55 breast cancer patient-caregiver dyads to complete a self-report survey after diagnosis but before treatment. We used a series of Actor-Partner Interdependence Models to test the hypotheses that both patient and caregiver relationship quality would be linked to their own and their partners' biobehavioral reactivity. RESULTS: Caregiver reported marital quality lower caregiver anxiety, patient anxiety, caregiver depression, patient depression, caregiver pain, and caregiver fatigue. Interestingly, patient-reported marital quality was linked with higher caregiver anxiety, higher patient anxiety, lower patient depression, and lower patient pain. Patients reported family quality was linked to lower patient and caregiver pain. CONCLUSIONS: This study demonstrates that pre-treatment marital and family quality levels are directly related to psychophysiological measures in both the caregiver and the patient, though sometimes in unexpected directions. Additionally, our findings potentially reveal an opportunity to intervene at the time of diagnosis to improve relationship quality, impacting patient and caregiver psychophysiological outcomes.

Couple variables predicting retention in a brief intervention and research.

Therapy is an effective form of treatment for couple distress; yet, research shows that 20%-60% of couples terminate treatment prematurely. Predictors of couple retention in therapy and research are unclear, particularly for couples from marginalized populations, which has important implications for the quality and generalizability of research results, and the benefits derived from therapy are limited when participants are not retained. The purpose of this study (N = 1310) was to identify couple-level variables that predict (1) retention in a brief, two-session couple intervention (The Relationship Checkup) delivered as a home visitation program and (2) retention in research participation at 1- and 6-month follow-up. Hypotheses were tested using a two-level multi-level model. Couples are significantly less likely to be retained in the brief intervention if (1) at least one partner identifies as Asian, Pacific Islander, or Native American, (2) at least one partner identifies as Hispanic/Latinx, or (3) both partners report mental or emotional health as a concern in their relationship. Couples are significantly less likely to be retained in research if (1) at least one partner identifies as Asian, Pacific Islander, or Native American (1 month only), (2) at least one partner identifies as Hispanic/Latinx (1 and 6 months), (3) if either partner reports clinically significant relationship distress at baseline (1 and 6 months), or (4) if either partner reports relationship aggression at baseline (6 months only). These findings are discussed with relevance to clinicians and researchers to recruit and retain more diverse and marginalized participants in couple interventions and follow-up research.

In Our Lives and Under Our Skin: An Investigation of Specific Psychobiological Mediators Linking Family Relationships and Health Using the Biobehavioral Family Model.

The objective of this study was to use the Biobehavioral Family Model (BBFM) to delineate which psychophysiological variables link romantic and family relationship satisfaction variables to health outcomes. Data from individuals who reported being partnered from the second wave of the National Survey of Midlife Development in the United States (MIDUS II), Project 4 (n = 812) were used to test a structural equation model which explored which psychophysiological variables potentially mediated associations between positive and negative family emotional climate variables and disease activity. This model found that current and past family variables had larger associations with the psychophysiological variables than romantic partner variables; depressive symptoms, anxiety, and inflammation partially mediated associations between family relationships and health; and, contrary to the hypotheses, romantic partner and family support were linked to worse health outcomes. However, the findings should be viewed with regard to the cross-sectional design of the study. Overall, the findings support the use of the BBFM as a model that can guide clinical interventions.

El objetivo de este estudio fue usar el Modelo Bioconductual Familiar (BBFM, por sus siglas en inglés) para describir qué variables psicofisiológicas vinculan las variables de satisfacción en las relaciones amorosas y familiares con el estado de salud. Se utilizaron datos de personas que informaron estar asociadas desde el Proyecto 4 de MIDUS II (n = 812) para evaluar un modelo de ecuaciones estructurales que analizó qué variables psicofisiológicas posiblemente mediaron las asociaciones entre las variables del clima emocional familiar negativo y positivo y la actividad de la enfermedad. Este modelo descubrió que las variables familiares actuales y pasadas tuvieron mayores asociaciones con las variables psicofisiológicas que las variables de la pareja sentimental. Los síntomas depresivos, la ansiedad y la inflamación mediaron parcialmente las asociaciones entre las relaciones familiares y la salud; y contrariamente a las hipótesis, la pareja sentimental y el apoyo familiar estuvieron ligados a un peor estado de salud. Sin embargo, los resultados deberían considerarse teniendo en cuenta el diseño transversal del estudio. En general, los resultados respaldan el uso del BBFM como un modelo que puede guiar las intervenciones clínicas.

An Implementation Study of Relationship Checkups as Home Visitations for Low-Income At-Risk Couples.

Couples with the greatest need for relationship health maintenance and intervention are often least able to afford and access it; therefore, accessible, affordable, effective, and brief interventions are needed to improve relationship health for those who need it most. Consequently, this paper examined whether a brief relationship intervention could be effectively implemented with a low-income, underserved population. All enrolled participants (N = 1,312) received the Relationship Checkup, which consists of an assessment and a feedback session delivered in their homes or at a local clinic at their request. Measures assessed relationship satisfaction, communication, psychological and physical aggression, and intimacy at baseline and 1-month follow-up, and program and relationship satisfaction at 6-month follow-up. All participants reported significant improvements on all outcomes with small effect sizes. However, moderation analyses suggested that distressed couples reported significantly larger effects across the board. Overall, participants reported that they were highly satisfied with the intervention both immediately after its delivery and 6 months later. Findings provide preliminary support for the effectiveness of this brief checkup and point to the utility of offering these kinds of low-cost brief interventions in flexible formats for those who might have the most difficulty accessing them.

Las parejas más necesitadas de mantenimiento e intervención para la salud de sus relaciones son con frecuencia las menos equipadas para costear y obtenerlos; por lo tanto, las intervenciones accesibles, asequibles, efectivas y breves son necesarias para mejorar la salud de las relaciones de aquéllos que más lo necesitan. Por consiguiente, este artículo examinó si sería posible implementar una intervención breve para relaciones con una población subatendida de bajo ingreso. Todos los participantes inscritos (N = 1312) recibieron un Control de Relación, que consiste en una evaluación y una sesión de comentarios realizadas en sus hogares o en una clínica local a petición de ellos. Las medidas evaluaron la satisfacción en la relación, comunicación, agresión psicológica y física, e intimidad en la línea de base y en un seguimiento después de un mes, así como satisfacción con el programa y con la relación en un seguimiento después de seis meses. Todos los participantes informaron mejoras sustanciales en todos los resultados con tamaños de efecto pequeños. Sin embargo, análisis de moderación sugirieron que las parejas angustiadas informaron efectos considerablemente mayores en todos los renglones. En general, los participantes informaron que estaban sumamente satisfechos con la intervención tanto inmediatamente después de realizarse como seis meses después. Los hallazgos proporcionan apoyo preliminar a la efectividad de este control breve y señalan la utilidad de ofrecer estos tipos de intervenciones breves de bajo costo en formatos flexibles para aquéllos que podrían tener mayores dificultades para obtenerlos.

The Effects of a Couples-Based Health Behavior Intervention During Pregnancy on Latino Couples' Dyadic Satisfaction Postpartum.

Many couples tend to report steadily decreasing relationship quality following the birth of a child. However, little is known about the postpartum period for Latino couples, a rapidly growing ethnic group who are notably underserved by mental and physical health caregivers in the United States. Thus, this study investigated whether a brief couples' intervention focused on helping couples support each other while increasing healthy behaviors might improve dyadic functioning postpartum. This study presents secondary analyses of data regarding couple functioning from a larger randomized controlled trial with 348 Latino couples to promote smoking cessation. Portions of the intervention taught the couple communication and problem-solving skills to increase healthy behavior. Couples participated in four face-to-face assessments across 1 year starting at the end of the first trimester. Latent growth curve analyses revealed that the treatment group reported an increase in relationship satisfaction and constructive communication after the intervention, which diminished by 1-year follow-up, returning couples to their baseline levels of satisfaction. Results suggest that incorporating a brief couple intervention as part of a larger health intervention for Latinos may prevent postpartum decreases in relationship satisfaction.

Rejection sensitivity and depressive symptoms: Longitudinal actor-partner effects in adolescent romantic relationships.

The present study utilizes the actor-partner interdependence model to examine the longitudinal relationship between rejection sensitivity and one's own and one's partner's depressive symptoms. The sample included adolescent romantic couples from the U.S. (N = 198 adolescents; 50% girls; 90.2% Caucasian) whose rejection sensitivity at Time 1 and depressive symptoms approximately one year later (Time 2) were assessed. Additionally, aggressive behaviors and maintenance behaviors that commonly associated with rejection sensitivity (e.g., self-silencing) are explored as mediators. Results indicate that boyfriends' rejection sensitivity at Time 1 predicted girlfriends' depressive symptoms at Time 2. Additionally, girls' rejection sensitivity predicted their own and their boyfriends' self-silencing. Developmental and clinical implications are discussed.

Hooking up during the college years: is there a pattern?

Hook ups are sexual encounters that can include a variety of behaviours (e.g., kissing to intercourse) with no expectation of future contact or a committed relationship. Although hooking up is reported to be common on college campuses across the USA, little is known about whether the frequency of hooking up changes over the course of the college experience. Using cross-sectional data and the covariates alcohol use, gender and relationship status, we examined a synthetic cohort of undergraduate students (n = 1003) on rates of hooking up using (1) logistic regression and (2) an applied form of survival analysis. Whereas both analytic techniques produced similar results, survival analysis provided a more complete picture by showing an increase in the rate of hooking up that peaked between spring semester of the first year of college and autumn semester of the second year of college, followed by a gradual decline in hook up rates over subsequent semesters. Findings indicate that gender is significantly related to hooking up in the logistic regression analysis, with women reporting fewer hook ups; however, gender was not significantly related to hooking up in the survival analysis, indicating that there are no differences in the pattern across cohorts. Implications for promoting the sexual health of college students and future research are discussed.

The impact of rural structural and community health factors on postmastectomy complications among south central Appalachian breast cancer patients.

PURPOSE: The study examined how structural and community health factors, including primary care physicians (PCP), food insecurity, diabetes, and mortality rate per county, are linked to the number and severity of postmastectomy complications among south central Appalachian breast cancer patients depending on rural status. METHODS: Data was obtained through a retrospective review of 473 breast cancer patients that underwent a mastectomy from 2017 to 2021. Patient's ZIP Code was used to determine their rural-urban community area code and their county of residence for census data. We conducted a zero inflated Poisson regression. FINDINGS: Results demonstrated that patients in small rural/isolated areas with low (B = -4.10, SE = 1.93, OR = 0.02, p = 0.03) to average (B = -2.67, SE = 1.32, OR = 0.07, p = 0.04) food insecurity and average (B = -2.67, SE = 1.32, OR = 0.07, p = 0.04) to high (B = -10.62, SE = 4.71, OR = 0.00, p = 0.02) PCP have significantly fewer postmastectomy complications compared to their urban counterparts. Additionally, patients residing in small rural/isolated areas with high (B = 4.47, SE = 0.49, d = 0.42, p < 0.001) diabetes and low mortality (B = 5.70, SE = 0.58, d = 0.45, p < 0.001) rates have significantly more severe postmastectomy complications. CONCLUSION: These findings demonstrate that patients who reside in small/rural isolated areas may experience fewer and less severe postmastectomy when there is certain optimal structural and community health factors present compared to their urban counterparts. Oncologic care teams could utilize this information in routine consult for risk assessment and mitigation. Future research should further examine additional risks for postmastectomy complications.

Improvements in depressive symptoms following a brief relationship intervention.

In the United States, 21 million adults are diagnosed with depression. Couple therapy effectively treats depression, however, couples encounter access barriers. The Relationship Checkup is an assessment and feedback intervention delivered in participants' homes. The current study examines changes in relationship satisfaction and depressive symptoms, and moderators and mechanisms of change in a community sample (N = 85 couples). Changes in depressive symptoms and satisfaction, and the association between changes in satisfaction and depressive symptoms were examined with multilevel modeling. Depressive symptoms (Cohen's d = 0.36) and satisfaction (d = 1.43) improved from baseline to 1-month follow-up, with greater declines in depression (d = 0.44) for those with more severe symptoms. Increases in satisfaction were associated with decreases in depressive symptoms (d = 0.23), and decreases in depressive symptoms were associated with increases in satisfaction (d = 0.33). Individuals with depression and relationship distress may be well served by this intervention.

Overcoming Patient Pain Together: Breast Cancer Patients and Caregivers' Pretreatment Psychosocial Distress Linked to Patients' Pain Interference During the First Year of Treatment.

Breast cancer patients experience treatment-related pain from surgery, radiation, chemotherapy, and long-term hormonal treatment, which can lead to poorer outcomes. Patient and family caregivers' psychosocial distress exacerbates patient pain interference, but this has not been directly examined among breast cancer patients in dyadic models longitudinally. Guided by a biopsychosocial framework, the Biobehavioral Family Model, we explore how multiple reports of patient pain interference across the first year of treatment are linked to the patient (N = 55) and caregiver (N = 55) pretreatment psychosocial distress (eg, depression, anxiety, marital satisfaction, family relationship quality). Specifically, we find that breast cancer patients' pain interference increases and then decreases over the first year of treatment. Additionally, caregivers' pretreatment anxiety was associated with increased patient pain interference over time (B = .19, SE = .07, P = .008), while patients' pretreatment psychosocial distress was not associated with a change in their pain interference. Yet, looking at clinically specific times during the first year of treatment, we find that caregiver-reported higher marital satisfaction is associated with lower patient-reported pain interference later in treatment (6 months: B = -.58, SE = .24, P = .017; 12 months: B = -.82, SE = .23, P < .001). We conclude that, per the Biobehavioral Family Model, pretreatment patient and caregiver psychosocial distress is linked to patient pain interference during the first year of breast cancer treatment. Thus, caregivers' psychosocial distress (ie, anxiety and marital satisfaction) may be a particularly important target in future dyadic behavioral intervention strategies to reduce breast cancer patient pain. PERSPECTIVE: This article presents the link between breast cancer patients and family caregiver pretreatment psychosocial distress (anxiety, depression, marital satisfaction, and family quality) on patient pain interference during 1 year of breast cancer treatment. Findings suggest that caregiver anxiety and marital satisfaction may be important targets for future dyadic behavioral pain interventions.

Longitudinal Associations of Family Relationship Quality With Chronic Pain Incidence and Persistence Among Aging African Americans.

OBJECTIVES: This study examines how family relationships convey risk or resilience for pain outcomes for aging African Americans, and to replicate and extend analyses across 2 nationally representative studies of aging health. METHODS: African American participants in Midlife in the United States (MIDUS, N = 755) and the Health and Retirement Study (HRS, N = 2,585) self-reported chronic pain status at 2006 waves and then again 10 years later. Logistic regression was used to estimate the odds of pain incidence and persistence explained by family, intimate partner, and parent-child strain and support, as well as average support and average strain across relationships. RESULTS: On average, MIDUS participants were younger (M = 52.35, SD = 12.06; 62.1% female) than HRS (M = 66.65, SD = 10.92; 63.7% female). Family support and average support were linked to decreased odds of pain incidence in MIDUS, but only when tested without accounting for strain, whereas parent-child strain was a risk factor for pain incidence in HRS, as was average strain. Family support protected against pain persistence in MIDUS, whereas average support was linked to reduced odds of pain persisting in HRS. DISCUSSION: Chronic pain outcomes are worse for African Americans for a number of reasons, but parent-child strain may contribute to the risk of new pain developing over time for older adults. Conversely, family support may offer a protective benefit for pain incidence and persistence among aging African Americans. Findings implicate family relationships as a potential target of pain management interventions.

Comparative efficacy of the relationship checkup for same-gender couples.

Same-gender couples face unique sexual minority stressors that significantly impact individual and relationship health. This impact may be even greater among same-gender couples living in regions where there are pervasive social and legal biases that affect the lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, asexual, two-spirit (LGBTQIA2S+) community (e.g., south central Appalachia). Brief relationship interventions, like the relationship checkup, are effective at improving relationship health and can be widely disseminated due to the brief and flexible nature of the program. Yet, this program was developed for different-gender couples and, as a result, may lack specific intervention for the unique stressors of same-gender couples. While many skills delivered in relationship interventions, including the relationship checkup, are applicable to all couples, untailored interventions for same-gender couples may result in less impactful outcomes. The present study examined whether the relationship checkup, in its original, unadapted format, is as effective for same-gender couples as it is for different-gender couples. Using a subsample from the larger relationship checkup study (N = 656 couples), the present sample included 64 committed couples (same-gender = 32; different-gender = 32). We used propensity score matching to match different-gender participants to the same-gender participants based on racial minority status, poverty status, marital status, and parenting status. Results revealed that same-gender couples presented similarly to different-gender couples on baseline relationship functioning and changed similarly on all relationship functioning outcomes through 1-month postintervention. Same-gender couples also reported similar degrees of satisfaction with and perceived helpfulness of the relationship checkup. The relationship checkup appears to be equally effective and acceptable for same-gender and different-gender couples. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Family strain, but not family support, is linked to worse pain interference among midlife adults reporting new chronic pain.

INTRODUCTION: Although family relationship quality has been linked to later chronic pain incidence for aging adults, it is unclear whether the quality of these relationships is linked to the impact of pain. We estimated longitudinal associations between family relationship quality (i.e., family support and family strain) and pain interference for adults who develop novel chronic pain across 10 years of midlife. METHOD: We conducted a secondary analysis of data from the Midlife in the United States (MIDUS) study. Using path analysis, we tested whether family support and strain reported by participants (54% female, age M = 54.8 years) who denied having chronic pain at the study's second wave (MIDUS 2, 2004-2006) but reported chronic pain 10 years later (MIDUS 3, 2014-2016; N = 406) was associated with the interference of that pain with daily activities after accounting for key covariates, including sociodemographics, depression symptoms, global physical health, and MIDUS 3 reports of family support and strain. RESULTS: The hypothesized model demonstrated good fit to the data based on multiple model fit indices. Greater family strain at baseline, but not family support, was significantly associated with greater pain interference 10 years later. DISCUSSION: Findings build on prior studies to suggest that not only are stressful family relationships likely associated with the odds of developing chronic pain, but they are also linked to the interference of that chronic pain when it develops. We recommend biopsychosocial screening in primary care that captures family relationship quality and can inform best practices for nonpharmacological, family-based pain management. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The importance of family relationships for the health of underserved Appalachians: An application and extension of the biobehavioral family model.

INTRODUCTION: Appalachia is characterized by many contextual stressors, including geographic, economic, and cultural barriers to healthcare. Guided by the biobehavioral family model (BBFM), an understanding of the influence of interpersonal relationships (i.e., marital and nonmarital relationships) on health outcomes could be critical to mitigating the region's contextual stressors. METHOD: Data were collected from 2018 to 2019 among 243 participants across seven pop-up medical clinics in central and southern Appalachia 59% from rural Appalachian counties (rural Mage = 41, 66% women, 90% White; urban Mage = 36, 74% women, 82% White). A series of multivariate regression models were conducted for outcome measures (i.e., depression, pain, physical symptoms, number of conditions, and perceived health). RESULTS: The results suggest that family quality was significantly related to all outcome measures except for perceived health, whereas marital satisfaction was only significantly linked to physical symptoms. Rurality was not significantly associated with any outcome measures and only moderated the association between family quality and a number of conditions. DISCUSSION: These findings demonstrate the importance of nonmarital family relationships on health outcomes for people in Appalachia. Given the limited direct impact rurality in this sample, close relationships may be important for the health and well-being of all economically marginalized Appalachians regarding where they live. Given the cultural tendency for Appalachians to rely on family and kinship networks for healthcare support and the findings in this study, medical professionals should develop innovative programs to incorporate family into healthcare visits, and disease management interventions for people living in Appalachia. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

I am feeling stressed, are you?: Breast cancer patients and caregivers' inter-psychophysiological symptoms during the first year of breast cancer treatment.

OBJECTIVE: Breast cancer treatment can be a stressful time for both the patient and their caregiver. Both patients and caregivers can experience increases psychophysiological distress (e.g., pain interference, fatigue, anxiety, depressive symptoms, perceived health); however, it is not clear how psychophysiological distress before treatment is linked to distress during the first year of treatment both interpersonally and intrapersonally. METHODS: The present study recruited 54 patient-caregiver dyads during diagnosis before breast cancer treatment started. Both patients and caregivers complete self-reported surveys at baseline (before treatment), then 6-weeks, 6-months, and 12-months after the start of treatment. Specifically, we examine trajectories of psychophysiological change using Actor-Partner Interdependence Models (APIMs) Growth Curve Models and clinically specific times of psychophysiological influence using APIM path analyses. RESULTS: Results indicate that patient and caregiver psychophysiological distress before treatment is linked to psychophysiological distress during the first year of treatment both intrapersonally and interpersonally but somewhat differently depending on the symptom. For example, for perceived health there are no interpersonal effects and for fatigue caregivers appear to experience the majority of psychophysiological distress effects. CONCLUSION: Our findings suggest that medical practitioners could evaluate patients and their caregivers for psychophysiological distress prior to breast cancer treatment and consider referrals to therapy or psychoeducation to help with symptom management throughout the first year of treatment.