Recognizing and Appreciating the Partner's Support Protects Relationship Satisfaction during Cardiac Illness.

BACKGROUND: This study aimed to examine whether dyadic coping (DC) is associated with relationship satisfaction (RS) among couples facing cardiac diseases. Furthermore, the moderating role of both partners' anxiety and depression was tested. METHODS: One hundred cardiac patients (81.5% men) and their partners (81.5% women) completed a self-report questionnaire during hospitalization. The Actor-Partner Interdependence Model (APIM) and moderation analyses were used to assess the above associations. RESULTS: Results showed that positive DC was significantly related to higher levels of RS, and negative DC was related to lower levels of RS. Furthermore, patient and partner psychological distress significantly moderated the link between DC and RS: patient-perceived positive DC was associated with higher partner RS when partner depression was high; partner-perceived positive DC was associated with higher patient RS when patient anxiety was low; patient-perceived negative DC has associated with lower patient RS when patient anxiety and depression were high. CONCLUSION: This study showed that positive DC is associated with a more satisfying relationship and identified under what conditions of cardiac-related distress this can happen. Furthermore, this study underlined the importance of examining DC in addition to the individual coping skills as a process pertaining to personal well-being and couple's outcomes.

"The heart in a bag": The lived experience of patient-caregiver dyads with left ventricular assist device during cardiac rehabilitation.

Objective: The Left Ventricular Assist Device (LVAD) has increasingly become a primary therapeutic option for longer-waiting heart transplant lists. Although survival rates are growing, the device requires complex home care. Therefore, the presence of a caregiver trained in the LVAD management is important for the success of the therapy. The LVAD leads both patients and their caregivers to experience new challenges and adapt to new lifestyle changes and limitations - but their subjective beliefs before home management remained little explored. Design: This study identified, using a phenomenological hermeneutic approach, the main components of the LVAD experience of six patient-caregiver dyads interviewed during cardiac rehabilitation. Results: We identified 4 master themes: Being between life and death, Being human with a heart of steel, Sharing is caring (and a burden), and Being small and passive. Conclusion: The knowledge from this study can be used as a guide for healthcare providers in counseling LVAD recipients and their caregivers.

Love and affectionate touch toward romantic partners all over the world.

Touch is the primary way people communicate intimacy in romantic relationships, and affectionate touch behaviors such as stroking, hugging and kissing are universally observed in partnerships all over the world. Here, we explored the association of love and affectionate touch behaviors in romantic partnerships in two studies comprising 7880 participants. In the first study, we used a cross-cultural survey conducted in 37 countries to test whether love was universally associated with affectionate touch behaviors. In the second study, using a more fine-tuned touch behavior scale, we tested whether the frequency of affectionate touch behaviors was related to love in romantic partnerships. As hypothesized, love was significantly and positively associated with affectionate touch behaviors in both studies and this result was replicated regardless of the inclusion of potentially relevant factors as controls. Altogether, our data strongly suggest that affectionate touch is a relatively stable characteristic of human romantic relationships that is robustly and reliably related to the degree of reported love between partners.

Taking care of who cares: Evaluation of a training program for home palliative care professionals.

OBJECTIVES: To evaluate an enrichment training program targeted at home palliative care professionals in terms of its effects and participants' satisfaction. The program had 2 main aims: give voice to professionals' emotional fatigue and promote their personal resources. METHODS: One hundred twenty-three home palliative care professionals participated in 12 parallel training courses; each course consisted of four 3-hour meetings led by 2 trainers and involved about 10-15 participants. The program adopted the method and tools typical of the enrichment approach, with the insertion of an art therapy exercise in the central meetings. The topics addressed were the following: emotional awareness in care relationship; the recognition of the needs of the patient, the family, and the professional himself; the inevitability of the death of the patient; and the challenges and resources of the multidisciplinary care team. At the first (T1) and last (T2) meetings, participants filled in a self-report questionnaire assessing work emotional fatigue, empowerment, generativity, and satisfaction with the course. RESULTS: Participants were highly satisfied with the course. They reported a higher level of work emotional fatigue and a higher perception of personal resources, in terms of empowerment (both individual-oriented and relationship-oriented) and generativity at the end of the program than before. SIGNIFICANCE OF RESULTS: Results confirm the need to provide home palliative care professionals with trainings in which they can express, share, and deal with personal and professional needs. This course gave voice to professionals' work emotional fatigue and promoted their personal resources, while enhancing collaboration in the multidisciplinary team.

Yes, I can (with you)! Dyadic coping and self-management outcomes in cardiovascular disease: The mediating role of health self-efficacy.

Cardiac patients show alarming levels of nonadherence to medications. It is important to consider also patient activation levels. Furthermore, the partner could have a supporting role in these processes. The aim of this study was to investigate the mediating role of patient health self-efficacy (HSE) in the link between dyadic coping (DC) and two self-management outcomes (i.e. medication adherence and patient activation) across the first 6 months of cardiac disease. One hundred couples completed two self-report questionnaires during the hospitalisation for cardiac disease and 6 months after discharge. A longitudinal and dyadic research design was adopted. Cross-sectional analyses at T0 revealed that patient-provided and perceived positive DC and common DC are positively associated with HSE, which in turn is positively associated with medication adherence. HSE mediated the association between patient positive and common DC styles, with the only exception of Patient-provided positive DC, and patient activation. Conversely, patient-provided and perceived negative DC are negatively associated with HSE, which in turns is positively associated with medication adherence and patient activation. Prospective analyses showed that only patient-perceived negative DC at discharge is negatively associated with HSE at T1, which in turns is positively associated with patient activation over time. These results suggest to consider patient perceived and provided DC as antecedents of self-management outcomes via patient HSE. Furthermore, our results recommend to pay particular attention to negative DC, whose negative consequences are manifested also over time, planning interventions targeting partners' awareness of their own DC style.

Perceived Changes in Family Life During COVID-19: The Role of Family Size.

OBJECTIVE: The current study was aimed at exploring Italian parents' perceived negative and positive changes in family life during the COVID-19 pandemic, taking into account the role of the stage of the family life and family size. BACKGROUND: During the emergency of the COVID-19 pandemic, millions of families drastically changed their daily life and routines. Little evidence exists on how family characteristics, such as family size or presence of children, are related to families' experience of family change. METHOD: A large sample of 1,407 Italian parents (70.1% mothers) filled in an anonymous online survey during the third week of the lockdown period (between March 30 and April 7, 2020). RESULTS: Results showed that parents reported perceiving more positive changes than negative ones, especially in terms of feeling more emotionally close to their children and spending more fun time with them. Interestingly, parents with two or more children reported more positive changes in family life compared with parents who had one child, showing a greater relational regenerative capacity in the face of COVID-19 lockdown. CONCLUSION AND IMPLICATIONS: Investing in family relationships, especially for larger families, is an effective coping strategy to deal with traumatic situations and promote positive family changes in stressful situations.

The Association Between Cardiac Illness-Related Distress and Partner Support: The Moderating Role of Dyadic Coping.

Managing cardiac illness is not easy because it dramatically disrupts people's daily life and both the patient and his/her spouse are at risk for experiencing distress, which, in turn, may affect the support provided by the partner as caregiver. The partner, in fact, is the main source of support, but his/her support may sometimes be inadequate. In addition, dyadic coping (i.e., the way partners cope together against stress and support each other in times of difficulty) could likely be a moderating factor. The main aim of the present study was to examine the role that dyadic coping (DC, in terms of positive, negative, and common dyadic coping responses) plays in moderating the link between patient and partner cardiac illness-related distress (in terms of anxiety and depression) and partner support (in terms of overprotection, hostility, and partner support for patient engagement). The study included 100 married couples faced with cardiac illness who completed a self-report questionnaire. We analyzed our data in PROCESS using multiple regressions in order to assess the moderating effects of DC responses in the relationship between the couple's cardiac illness-related distress and partner support. With regard to patient distress, results showed that higher levels of patient anxiety and depression were linked with ineffective partner support (i.e., overprotection and hostility). With regard to partner distress, higher levels of partner depression were linked with hostility; higher levels of partner depression and anxiety were associated with less partner support for patient engagement. Moreover, the association between distress and partner support was moderated by the quality of DC. In particular, low positive DC represented a risk factor for both the patient and the partner during a cardiac illness, as low positive DC exacerbated the link between patient and partner distress and less effective partner support styles. Also, higher levels of negative DC were risky for couples: The association between distress and less adequate partner supportive behaviors was stronger in the case of higher negative DC. These results imply a need for psychosocial interventions for couples in cardiac illness, especially for couples lacking relational competences, such as positive dyadic coping.

A Postcard From Italy: Challenges and Psychosocial Resources of Partners Living With and Without a Chronic Disease During COVID-19 Epidemic.

The new Coronavirus (COVID-19) has been declared a global pandemic by the World Health Organization (WHO). The sudden outbreak of this new virus and the measure of lockdown adopted to contain the epidemic have profoundly changed the lifestyles of the Italian population, with an impact on people's quality of life and on their social relationships. In particular, due to forced and prolonged cohabitation, couples may be subject to specific stressors during the epidemic. In addition, living with a chronic health condition may add specific challenges to the ones posed by the epidemic itself. The present cross-sectional study aimed to provide a picture of the challenges as well as the resources for both individual and relational well-being of Italian individuals in a couple relationship (N = 1921), with a specific attention to the comparison between individuals living with and without a chronic disease. Results showed that people with a chronic disease had lower psychological well-being and more fears and worries about the COVID-19. People with a chronic disease perceived fewer resources than healthy people. Moreover, the challenges are shown to be associated with less psychological well-being and high pessimism about the future. Instead individual, relational, and social resources play a protective role during the pandemic for both healthy and chronically ill people.

Together Against COVID-19 Concerns: The Role of the Dyadic Coping Process for Partners' Psychological Well-Being During the Pandemic.

The situation caused by the 2019 coronavirus disease (COVID-19) has been representing a great source of concern and a challenge to the psychological well-being of many individuals around the world. For couples in particular, this extraordinary rise in concern, combined with the stress posed by the virus containment measures, such as prolonged cohabitation and lack of support networks, may have increased the likelihood of couple problems. At the same time, however, COVID-19 concerns may have been a stimulus to activate couples' stress management processes. A couple's resource, which may have an important role in dealing with COVID-19 concerns and stress, is dyadic coping, i.e., the process through which partners face stress together. Drawing on a sample of 1,823 Italian individuals involved in a couple relationship, the current study tested a serial mediation model in which concerns about COVID-19 predicted psychological well-being, through both explicit stress communication and perceived partner dyadic coping responses. In addition, the study explored whether this dyadic coping process functioned the same way in satisfied and dissatisfied couples. Results showed that concerns about the situation related to COVID-19 significantly threatened individuals' psychological well-being. However, these concerns positively predicted explicit stress communication, which in turn positively predicted perceived partner's dyadic coping responses, which finally positively predicted psychological well-being. In addition, in the group of dissatisfied individuals, the association between explicit stress communication and perceived partners' dyadic coping responses was not significant. The present study adds to the research on couples' coping by testing for the first time the whole theoretical model of dyadic coping and does so during a global emergency situation. The study also suggests key components of preventive interventions for individuals in couples.

Trajectories of perceived superiority across the transition to marriage.

Perceived superiority, the tendency to regard one's own relationship as better than other people's relationships, is a key relationship maintenance mechanism. Little is known about whether and how it changes during the transition to marriage, a pivotal moment in most couples' life cycle. In a longitudinal study following 97 couples for three waves across the transition, men presented stable perceived superiority, whereas women presented a curvilinear change in superiority perceptions, with a substantial increase in perceived superiority between T1 and T2 and a significantly reduced change between T2 and T3. In addition, trajectories differed according to partners' commitment level. More committed and less committed partners both showed a curvilinear change in perceived superiority, though following different patterns. Results point to the functional value of perceived superiority, which emerges as a strategy aimed at sustaining partners through the challenges deriving from the transition to marriage.

The Combined Effect of Psychological and Relational Aspects on Cardiac Patient Activation.

The literature assumes that activating patients in the treatment is associated with positive health-related outcomes, such as clinical indicators in the normal range, high medication adherence, and low emergency department utilization. In the cardiac population, patient activation, that is the patient's knowledge, skills, confidence, and behaviors needed for managing one's own health and health care, has been less investigated. In addition, limited attention has been given to the role of the partner as an informal caregiver. However, the patient in the care process is rarely alone, and the partner may play a key role in this process. The goal of this dyadic study (N = 100 heterosexual couples with one partner suffering from an acute cardiac event) is to analyze how individual factors (patients' anxiety, depression, medication adherence, pessimistic perception of illness) and the couple's relationship functioning (e.g., different kinds of partner support and dyadic coping) are associated with patient activation. The results showed that patient activation is not a mere question of age. It is positively related to medication adherence and to the partner's support patient activation. It is negatively correlated with the patient's psychological distress, pessimistic perception of illness, and to the partner's hostility. The need for a dyadic approach to both research and intervention with this population is discussed.

If You Shared My Happiness, You Are Part of Me: Capitalization and the Experience of Couple Identity.

The way in which individuals react to a partner's disclosure of positive news (capitalization response) is associated with relational well-being. Two studies analyzed the role of couple identity in explaining the association between perceived capitalization responses and relationship quality. A daily diary study (n = 90 couples) revealed that on days people perceived their partners' responses as active-constructive, they reported higher levels of couple identity. A longitudinal two-wave study (n = 169 couples) showed that couple identity mediated the link between active-constructive (for both women and men) and passive-destructive responses (only for men) and relationship quality. Overall, our findings suggest that the experience of the partner's involvement and support in good times contribute to a sense of couple identity, which over the long turn, is associated with partners' relational well-being.

"What Makes Us Strong?": Dyadic Coping in Italian Prospective Adoptive Couples.

Becoming an adoptive parent is a particularly stressful transition, given the additional challenges couples have to face. Dyadic coping, an under-investigated dimension in the adoption literature, may play a relevant role for prospective adoptive couples' ability to better cope with the adoptive process. The general aim of the present study was to investigate the association between dyadic coping and relationship functioning, in terms of relationship satisfaction and couple generativity, among prospective adoptive couples. Participants were 103 prospective adoptive couples pursuing international adoption in Italy. Couples were asked to fill in a self-report questionnaire. Results of the Actor-Partner Interdependence Model showed that prospective adoptive partners reported high levels of positive and common dyadic coping and low levels of negative dyadic coping - suggesting partners' ability to successfully cope together with a common stressor - a high level of relationship satisfaction, and an average level of couple generativity. Moreover, analyses showed significant actor effects of one's own perception of the partner's dyadic coping (positive, negative, and common) on one's own relationship satisfaction and on couple generativity for both wives and husbands. With regard to partner effects, we found that both partners' perceptions of the other's dyadic coping responses (positive, negative, and common) were associated with the other's relationship satisfaction, with the only exception of wives' perceptions of common dyadic coping, which were not associated with their husbands' relationship satisfaction. As for couple generativity, the only significant partner effect referred to negative dyadic coping responses for both wives and husbands.

Explicit Stress Communication Facilitates Perceived Responsiveness in Dyadic Coping.

The present study was aimed at examining the role of explicit stress communication in the context of dyadic coping. The general aim of the present study was to test (a) whether explicit communication of daily stressful events predicted relationship satisfaction and (b) whether the perception of responsiveness in dyadic coping mediated the association between explicit stress communication and partners' satisfaction. We analyzed daily diary data from 55 married couples and multilevel analyses suggested that, although explicit stress communication was not associated with relationship satisfaction, it predicted both partners' responsiveness in dyadic coping behaviors. Finally, responsive dyadic coping behaviors mediated the relationship between explicit stress communication and relationship satisfaction. On the whole, our findings showed that perceived responsiveness in dyadic coping with daily stressors was facilitated by explicit stress communication and that this contributed to the effectiveness of dyadic coping behaviors in fostering partners' relationship satisfaction. We discussed how the current study contributes to the understanding of the dyadic coping process and its contribution to partners' satisfaction, underscoring the importance of communication skills.

The associations for separated parents in Italy: Their role for parents' well-being and coparenting.

After separation or divorce, people generally experience a deterioration of health, not only in terms of physical well-being but also in terms of emotional and social well-being. In addition, when separated, individuals are parents as well and they are concerned with the well-being of their children. The main task for separated parents is to maintain a parental alliance (coparenting) for the sake of their children's well-being. Social support is a critical resource, which helps parents face their new life condition, promoting their psychological well-being. In recent years in Italy, many associations targeting separated and divorced parents have been founded: They support ex-partners during and after separation and are active in defending their rights. These associations are voluntary associations/non-profit organisations and self-help groups, which are constituted by parents themselves who associate to support each other in the tasks connected with separation. The present study investigated, with an explorative aim, the role of these associations for separated parents' well-being and coparenting abilities. In particular, drawing on a sample of 318 Italian separated parents (73.30% fathers; 26.70% mothers) belonging to a formal association targeting separated parents, the study analysed whether and how the perception of being supported by the association was related to psychological and relational well-being and to coparenting. Results showed that the more parents perceived to be supported by the association the less they were depressed, the more they were satisfied with the relationship with children and friends, and the more they displayed coparenting abilities. Our findings suggest that social support from these associations is a resource for separated parents' health.

Free to love? The role of intrusive parenting for young adult children's romantic relationship quality.

Intrusive parenting is a form of boundary disturbance in the parent-child relationship which has been consistently associated with children's maladjustment. The present study examines the role of intrusive parenting for young adult children's romantic relationship quality. Relying on data from a two-wave longitudinal study among young couples in transition to marriage in Italy, we investigated the link between young adults' perceived intrusive parenting and change in their romantic relationship quality from 6 months before marriage to 18 months after marriage, as well as the mediating role of change in the capacity to include the partner in the self. Data were analyzed using actor-partner interdependence modeling. Perceived intrusive parenting negatively predicted change in inclusion of the other in the self and change in romantic relationship quality for both partners. For females, change in their capacity of inclusion of the other in the self fully mediated the association between their perceived intrusive parenting and change in their own and partner's relationship quality. Limitations and implications for practice are discussed.

Religiosity, Marital Quality and Couple Generativity in Italian Couples Belonging to a Catholic Spiritual Association: A Quali-Quantitative Study.

The current studies aimed, firstly, at exploring the relationship between the level of religiosity and marital outcomes, in terms of relationship quality and couple generativity; secondly, at gaining insight into which strategies the couples use to ensure their marital quality/couple generativity, and understanding if religious practices have a positive influence on the development of such strategies. The studies focused on a specific aspect of religiosity, that is the active involvement in a Catholic association, and compared couples with a high level of religious involvement (HRI) belonging to a Catholic international association (New Families) and couples with a low level of religious involvement (LRI). Study 1 (N = 194) adopted a quantitative approach and analyzed data from questionnaires administered in two phases. Study 2 (N = 32) adopted a qualitative approach (grounded theory) and analyzed data from semi-structured interviews. Results of Study 1 showed that HRI men scored higher in relationship quality and couple generativity than LRI men, while HRI women scored higher in couple generativity than LRI women. In Study 2, no differences were found between HRI and LRI couples with respect to the factors that ensure marital quality and generativity (care of the relationship, dialogue, sharing, maintenance of the centrality of the relationship), but HRI and LRI couples used different strategies to achieve these goals.

Engaged patients, engaged partnerships: singles and partners dealing with an acute cardiac event.

A few studies examine patients' (and partners') individual and relational functioning after an acute cardiac event and no research focuses on the individual and relational factors associated with the patient's engagement in his/her disease management. The present study aimed at exploring these variables in male and female patients as well as their partners. We pursued our objectives by taking advantage of a dyadic research design that involved both partners in the data collection, when present, and by including women patients in the sample. Findings showed that patients in a couple, compared to single patients, perceive that their illness had less serious consequences for their life and they were more engaged in their health care; that patients and partners showed comparable levels of distress; and that less depressed, more confident, and better informed patients were more likely to actively engage in their treatment. Findings are discussed in light of their implications for clinical practice.