Beyond the "self" in self-efficacy: Spouse confidence predicts patient survival following heart failure.

Ratings of patient efficacy to manage illness, made by 191 congestive heart failure patients and their spouses, were examined as predictors of patients' survival over the next 4 years. When considered alone, both the patient's self-efficacy and the spouse's confidence ratings predicted survival, but only spouse confidence remained significant when both partners" efficacy ratings were included in the same Cox regression model. The overlapping prognostic significance of spouse confidence and a global, multicomponent measure of marital quality positioned the former as a proxy for the latter, reflecting a fundamentally social protective factor in patient survival. Successful adaptation to heart failure appears to involve more than the patient's personal agency, and psychosocial data from spouses can improve prediction of patient outcomes.

Couples coping with congestive heart failure: role and gender differences in psychological distress.

Psychological distress and marital quality were assessed with male (n = 128) and female (n = 49) congestive-heart-failure (CHF) patients and their spouses. Hopkins Symptom Check List--25 scores were in the distressed range for 57% of patients and 40% of spouses. This role difference was greater for men than for women, and a gender difference (more distress in women than men) was greater for spouses than for patients. The patient's distress, but not the spouse's, reflected the severity of the patient's illness, and distress for both partners correlated negatively with ratings of marital quality. Female-patient couples reported better relationship quality than male-patient couples, however, and a mediation analysis indicated that the gender difference in spouse distress could be explained by marital quality. Results highlight the contextual nature of CHF distress and suggest that role differences in distress vary by gender.