The association between communication behavior and psychological distress among couples coping with cancer: Actor-partner effects of disclosure and concealment.

OBJECTIVE: This study applies the Actor-Partner Interdependence Model (APIM) to explore the associations between disclosure and concealment with depression and anxiety among patients with cancer and their partners. METHOD: 90 patient-spouse dyads completed the Self-Disclosure Index (SDI), the Self-Concealment Scale (SCS), the Couples Illness Self-Concealment (CISC) questionnaire, and anxiety and depression via the Patient-Reported Outcomes Measurement Information System (PROMIS) and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Significant actor effects were found for most variables, showing disclosure is negatively and concealment is positively associated with depression and anxiety (ß between |0.29| to |0.65|, p ≤ .029). Partner's effect showed a negative association between patients' self-disclosure and their spouses' depression (ß = -0.35, p = .043). Patients' anxiety was negatively associated with similarity in all communication variables (ß between -0.21 to -0.22, p = .042). CONCLUSIONS: Dyadic communication is an important correlate of distress among couples coping with cancer. Specifically, concealment behaviors have a positive association with distress, whereas disclosure is related to lower levels of anxiety and depression among both partners. In addition, whereas patients are affected more strongly than their spouses by the dyadic similarity, spouses seem to be more attuned to their partners' behaviors and therefore potentially more related to patients' propensity for sharing.

Hide and "sick": Self-concealment, shame and distress in the setting of psycho-oncology.

ABSTRACTObjective:Both trait and contextual self-concealment, as well as shame- and guilt-proneness, have previously been found to be associated with psychological distress. However, findings regarding the associations between these variables among patients with cancer and among the spouses of patients with cancer are limited. The aim of the current study was therefore to investigate the relationship between shame-proneness and psychological distress (anxiety and depression) by examining the mediating role of both trait and contextual self-concealment among patients with cancer and among the spouses of patients with cancer. METHOD: The current study was part of a large-scale cross-sectional study on self-concealment among patients with cancer and spouses of patients with cancer. It was based on two independent subsamples: patients with cancer and spouses of patients with cancer, who were not dyads. A total of 80 patients with cancer and 80 spouses of (other) patients with cancer completed questionnaires assessing shame- and guilt-proneness, trait and contextual self-concealment, anxiety, and depression. RESULTS: Results indicate that spouses reported both greater shame-proneness and anxiety than did patients (main effect of role). Female participants reported greater shame-proneness, higher levels of contextual self-concealment, and greater depression and anxiety than did male participants (main effect of gender). No group differences (role/gender) were found for guilt-proneness and trait self-concealment. Trait and contextual self-concealment partially mediated the relationship between shame-proneness and distress, pointing out the need to further examine additional mediators. SIGNIFICANCE OF RESULTS: Findings suggest that contextual self-concealment and shame-proneness are important variables to consider when assessing distress in the setting of psycho-oncology. Study results may have significant clinical implications regarding the need to identify patients and spouses who are more prone to shame and self-concealment behavior in order to better tailor interventions for them.

Correlates of concealment behavior among couples coping with cancer: Actor partner model.

OBJECTIVES: Contextual self-concealment in the psychooncology literature has been found to be associated with elevated distress. The current study aimed to understand the dyadic relationships of an individual's perception of spousal support and dispositional perspective-taking with own and partner's levels of self-concealment behavior, among couples coping with cancer. METHODS: A subsample of 61 heterosexual couples coping with cancer was taken from a large-scale cross-sectional study. Patients and their spouses independently completed measures of perceived spousal support, perspective-taking, and contextual self-concealment. Dyadic data were analyzed by using the actor-partner interdependence model both for couples in which the woman was the patient and also for couples in which the man was the patient. RESULTS: Perceived spousal support negatively predicted contextual self-concealment, regardless of gender and role. Implications of perspective-taking for concealment behavior were dependent on role and gender. A female patient's perspective-taking was associated with a reduction in her own and her spouse's concealment behavior. A male spouse's perspective-taking was associated with an increase in his own and his spouse's concealment behavior. A female spouse's perspective-taking negatively predicted patient's concealment behavior, but not her own. CONCLUSIONS: Findings stress the important roles played by spousal support and perspective-taking in communication patterns between couples affected by cancer. Although the perception of support from one's spouse seems to reduce the need to conceal cancer-related issues, interventions that focus on couples' communication should address the differential implications of perspective-taking, as they can lead to either more or less self-concealment among couples, depending on role and gender.

Self-concealment among couples who cope with chronic illness: development and preliminary validation of the Couples Illness Self-Concealment (CISC) questionnaire.

PURPOSE: The aim of this study was to develop and assess the psychometric characteristics of a new brief self-report measure, which evaluates self-concealment behavior in the context of couples coping with chronic illness. METHODS: The Couples Illness Self-Concealment (CISC) scale was developed, emphasizing the active process involved in self-concealment. It was then tested among 56 cancer patients and partners of cancer patients. Correlations and multiple regression analysis were used to assess the internal consistency reliability and validity of the scale. RESULTS: Psychometric evaluation of the CISC final version, which includes 13 items, provides evidence that the scale has high internal consistency reliability. The findings support the construct validity of the scale, examined by both convergent validity and between group differences (patients vs. spouses). CONCLUSIONS: The CISC scale has acceptable psychometric qualities, internal consistency reliability and validity. The use of CISC may assist in revealing important aspects of couple's illness communication patterns, and enable examination of possible links between self-concealment behavior in the context of illness, and psychological outcome. It may also contribute to the assessment of interventions aimed at enhancing communication between partners coping with chronic illness.

The need for friendships and information: Dimensions of social support and posttraumatic growth among women with breast cancer.

OBJECTIVE: Employing a cross-sectional design, the current study examined the relationships between various agents and types of support and posttraumatic growth (PTG) among women with breast cancer. METHOD: Eighty married women who were coping with breast cancer completed social support and PTG questionnaires. RESULTS: All agents of social support (family, friends, belief-based), excluding spousal support, and all types of social support were found to be related to the various PTG dimensions and its total score. Regression analyses revealed that, among the agents of support, only support provided from friends and belief-based support uniquely contribute to prediction of total PTG score. While examining the contribution of various types of support, only cognitive support had a unique contribution to prediction of total PTG score. SIGNIFICANCE OF RESULTS: Various agents and types of support play different roles in the PTG process following breast cancer. Accordingly, friends as an agent of support and information as a type of support seem to be most important in enhancing PTG among women with breast cancer.

Rescue volunteers' posttraumatic symptoms, distress, and fear of death: attachment insecurity moderates.

This study addresses the contribution of attachment orientations of ultra-orthodox volunteer rescuers involved in terror events to their posttraumatic symptoms, distress, and fear of death. The authors compared 53 ultra-orthodox rescuers operating in a terror-stricken area in Israel to 36 ultra-orthodox men unexposed to terror. Rescuers displayed lower distress than controls but were not significantly different in fear of death or posttraumatic symptoms. Attachment anxiety was found to be a risk factor by contributing uniquely to posttraumatic symptoms, distress, and fear of death, and as a debilitating factor among rescuers.

Attachment style, social support and finding meaning among spouses of colorectal cancer patients: gender differences.

OBJECTIVES: The current study explores the relationship between attachment styles, social support, gender and finding meaning in caregiving among spousal caregivers of colorectal cancer patients. METHODS: Sixty caregivers (30 men and 30 women) were administered questionnaires assessing attachment styles, social support and finding meaning in caregiving, using a cross-sectional design. RESULTS: For male caregivers avoidance attachment is associated with their finding meaning, whereas for female caregivers social support is associated with their finding meaning. SIGNIFICANCE OF RESULTS: Psychological interventions for caregivers should take into consideration gender differences and might benefit from addressing the process of finding meaning in caregiving.