Couple and family interventions for depressive and bipolar disorders: Evidence base update (2010-2019).

This article systematically reviews the evidence base for couple and family interventions for depressive and bipolar disorders published from 2010 to 2019. Included in the review were intervention studies on depression for couples (n = 6), depression for families (n = 13), and bipolar for families (n = 5); zero studies on couple interventions for bipolar were located. Well-established interventions include cognitive and/or behavioral couple and family interventions for depression and psychoeducational family interventions for bipolar. Attachment-based couple and family interventions for depression are probably efficacious. Finally, family psychoeducation for depression is possibly efficacious, and integrative couple interventions and family play-based interventions for depression are experimental. Couple and family interventions also improved relationship dynamics, which is noteworthy since poor relationships are associated with non-remission, relapse, and recurrence of depressive and bipolar symptoms. Future research is needed on couple interventions for bipolar disorders and interventions for minoritized populations.

The Development and Validation of the FACES-IV-SF.

The Family Adaptability and Cohesion Scale IV (FACES-IV) was developed to capture the balanced and unbalanced levels of cohesion and flexibility in families. Although this measure has been shown to be valid and reliable, its length at 62 items limits utility and uptake in clinical and research settings. This paper details the development of a shorter form of the FACES-IV (the FACES-IV Short Form) using two studies. In the first study, three item-level analyses were used to identify 24 items that provided the best measurement of each of the scales of the FACES-IV. In the second study, the reliability, and convergent and divergent validity of the short form was tested. Results suggest that the FACES-IV-SF is a valid and reliable measure that adheres to the theory underlying the original FACES-IV but may be better utilized in clinical and research settings due to its brevity.

Discrimination, family emotional climate, and African American health: An application of the BBFM.

The Biobehavioral Family Model (BBFM) is a biopsychosocial model of health that has been substantiated across multiple studies. However, the findings of those studies are limited given the lack of representation of Black/African American individuals in the samples. Discrimination is a chronic and pervasive stressor for many African American families, yet little is known about connections between discrimination, family relationships, and health. Using Data from the Midlife Development in the United States (MIDUS) Milwaukee project (n = 592), this study tested the pathways of the BBFM with a sample comprised only of African American individuals Additionally, it tested how discrimination influenced the pathways of the BBFM. Results of model testing found that family support (above and beyond romantic partner relationship quality and family strain) was a key factor in respondents' mental and physical health and that family support mediated the association between discrimination and mental health. The findings suggest the importance of including discrimination when examining family health pathways for African Americans and exploring the influence of relationships beyond the romantic partnership when examining health. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Family versus intimate partners: Estimating who matters more for health in a 20-year longitudinal study.

This study tested the extent to which the emotional climate (positive and negative relationship quality) in family relationships and intimate partnerships are each uniquely linked to specific domains of aging health outcomes, over and above the impact of earlier health. Data included partnered participants who completed all three waves of the Midlife Development in the United States (MIDUS). We used measures of family and intimate partner strain and support, at MIDUS 1, 2, and 3, and estimated the effects of each on subsequent morbidity and health appraisal (i.e., 10 and 20 years later). Autoregressive cross-lagged paths were modeled using maximum likelihood estimation with robust standard errors. Family strain was associated with later health in both the morbidity, χ²(35) = 411.01, p < .001; root mean square error of approximation (RMSEA) = .062, comparative fit index (CFI) = .952; standardized root-mean-square residual (SRMR) = .034 and health appraisal, χ²(35) = 376.80, p < .001; RMSEA = .058, CFI = .956; SRMR = .032 models. Morbidity and health appraisal also predicted later family emotional climate, reciprocally. Intimate partner emotional climate-health pathways were nonsignificant at each wave, in both models. Results are novel and may be the first to indicate the quality of family relationships are a more powerful predictor of aging health than the quality of intimate partnerships. Findings implicate the health of adults should be considered in the systemic context of families. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Close relationships as a contributor to chronic pain pathogenesis: Predicting pain etiology and persistence.

RATIONALE: Chronic stress contributes to the pathogenesis of chronic pain. Yet, the role of close relationship stress in these pathways to pain is not fully understood. OBJECTIVE: To delineate specific psychosocial pathways associated with chronic pain, specifically emphasizing close relationships for midlife adults. We tested whether relationship strain, relationship support, social integration, depression, anxiety, and pain severity predict chronic pain etiology and persistence over 10 years, highlighting specific associations for acute versus chronic pain. METHOD: Using data from the National Survey of Midlife in the U.S. (MIDUS 2 and 3, collected in 2004-2006 and 2013-2014, respectively), we used logistic regression to test the etiology of new chronic pain (n = 1591) and persistence of pain for adults with acute (n = 352) and chronic pain (n = 367) conditions at baseline. RESULTS: Of participants who reported they did not have chronic pain at baseline, the development of chronic pain 10 years later was significantly associated with baseline family strain (OR = 1.38, p < .01). For participants with acute pain at baseline, the transition of this pain to chronic a decade later was significantly associated with initial reports of pain interference (OR = 1.24, p < .001), family support (OR = 0.60, p < .05), and depression (OR = 1.20, p < .05). Persistent chronic pain was solely associated with baseline pain interference (OR = 1.21, p < .01). CONCLUSIONS: Family strain is an important part of the chronic stress profile associated with chronic pain etiology, whereas family support is associated with a reduced risk of acute pain transitioning to chronic pain over time. Prioritizing family relationships in treatment approaches to pain may be an indicated, innovative approach to preventing pain development and escalation and requires systems training in healthcare.

Examining Differentiation of Self as a Mediator in the Biobehavioral Family Model.

The Biobehavioral Family Model (BBFM) is a biopsychosocial model of health. This model proposes that biobehavioral reactivity mediates the association between the family emotional climate and disease activity. To improve the clinical relevance of the BBFM, variables that mediate the association between family emotional climate and biobehavioral reactivity need to be tested. This study examined differentiation of self as a mediator. Using data from the Midlife Development in the United States study (n = 854), results suggested that differentiation of self mediated the association between the family and intimate partner emotional climate and mental health symptoms. These findings suggest that including differentiation of self into the BBFM may help interventions based on the model target factors that could improve health outcomes.

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.

Developing an Inclusive and Welcoming LGBTQ Clinic.

People who identify as lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) are underserved and face barriers to knowledgeable health care. Most health systems are ill prepared to provide care that addresses the needs of the LGBTQ community. Basic steps to developing an LGBTQ welcoming health care program are presented. It can be adapted to diverse health care models, from obstetrics and gynecology and other primary care services whether public or private and to hospitals and specialty clinics. This LGBTQ inclusive health care model was developed in collaboration with the LGBTQ community, a multidisciplinary team of health care providers, and professionals of Law and Information Technology.

Do the Constructs of the FACES IV Change Based on Definitions of "Family?" A Measurement Invariance Test.

The Family Adaptability and Cohesion Scale (FACES) IV does not provide instructions about which family members respondents should think about while answering questions. This study examined which family members respondents thought about while completing the FACES IV, and if this changed measurement invariance and population heterogeneity of the measure. Using a sample of n = 511 individuals, a latent class analysis showed three distinct classes: Nuclear Family, Family of Origin, and All of the Above. The FACES IV demonstrated measurement invariance across classes on the majority of subscales; however, population heterogeneity tests suggested that the means and variances of the subscales varied across classes. The findings suggest further examination of how the measure functions with unique family constellations is warranted.

The Biobehavioral Family Model: Close relationships and allostatic load.

RATIONALE: This study tested the inclusion of allostatic load as an expansion of the biobehavioral reactivity measurement in the Biobehavioral Family Model (BBFM). The BBFM is a biopsychosocial approach to health which proposes biobehavioral reactivity (anxiety and depression) mediates the relationship between family emotional climate and disease activity. METHODS: Data for this study included a subsample of n = 1255 single and married, English-speaking adult participants (57% female, M age = 56 years) from the National Survey of Midlife Development in the United States (MIDUS II), a nationally representative epidemiological study of health and aging in the United States. Participants completed self-reported measures of family and marital functioning, anxiety and depression (biobehavioral reactivity), number of chronic health conditions, number of prescribed medications, and a biological protocol in which the following indices were obtained: cardiovascular functioning, sympathetic and parasympathetic nervous system activity, hypothalamic pituitary adrenal axis activity, inflammation, lipid/fat metabolism, and glucose metabolism. RESULTS: Structural equation modeling indicated good fit of the data to the hypothesized family model (χ (2) = 125.13 p = .00, SRMR = .03, CFI = .96, TLI = .94, RMSEA = .04) and hypothesized couple model (χ(2) = 132.67, p = .00, SRMR = .04, CFI = .95, TLI = .93, RMSEA = .04). Negative family interactions predicted biobehavioral reactivity for anxiety and depression and allostatic load; however couple interactions predicted only depression and anxiety measures of biobehavioral reactivity. CONCLUSION: Findings suggest the importance of incorporating physiological data in measuring biobehavioral reactivity as a predicting factor in the overall BBFM model.

Predicting Improvement in Depression Across Therapies Using Indicators of Romantic Relationship Functioning: A Preliminary Investigation.

Depression is a common presenting problem, often affected by couple interactions in unique ways. However, research in the area of romantic relationship functioning and depression often replicates previous research or consists of literature reviews, limiting the clinical relevancy. The purpose of this preliminary study is to expand the research on the effects of relational processes on depression treatment outcomes. We tested whether initiator tendency, attachment anxiety, attachment avoidance, and marital satisfaction predicted improvement in depression for women with Major Depressive Disorder enrolled in a depression treatment clinical trial (n = 17). Women completed treatments of either pharmacotherapy or combined Emotionally Focused Therapy for couples and pharmacotherapy. We found that higher baseline levels of partner initiator tendency resulted in less change in depression (worse outcomes), regardless of treatment type and that higher baseline levels of attachment avoidance predicted better depression outcomes in treatment. Marital satisfaction, however, was not linked to change in depression. Initiator tendency is discussed as a critical romantic relationship factor for depression treatment outcomes.

Substance abuse treatment response in a Latino sample: the influence of family conflict.

Latino Americans report underutilization of treatment and poor treatment response for substance use and abuse compared to other racial/ethnic groups; thus, it is important to assess factors that contribute to these disparities. The current study objective was to assess the influence of family conflict on substance abuse treatment response in a sample of Latino Americans using two different yet complementary analyses. First, ordinary least squares regression was used to assess the association between overall family conflict and pre- and post-treatment substance use. Second, repeated measures latent class analysis was used to identify groups based on family member conflict and timing of conflict during treatment. Findings indicated that family conflict contributed unique variance to concurrent substance use; however pre-treatment family conflict was not related to post-treatment outcomes. Results also identified three distinct family conflict groups: no/low conflict, pre-treatment conflict, and post-treatment conflict who differed in pre- and post-treatment substance use. Post hoc investigation revealed that those who experienced pre-treatment conflict but low post-treatment conflict showed the greatest decrease in substance use. Findings highlight the importance of considering family conflict during all stages of treatment for Latino American substance users.

A Bowen Family Systems Model of Generalized Anxiety Disorder and Romantic Relationship Distress.

Many individuals with generalized anxiety disorder (GAD) do not respond well to currently available treatments. Moreover, treatments are less effective when GAD is accompanied by romantic relationship distress. In order to develop effective treatments for GAD and relationship distress, it is necessary to conduct theory-based research to identify links common to both GAD and romantic relationship distress. Drawing on Bowen's family systems theory, the roles of family abuse/violence and differentiation in GAD and romantic relationship distress were examined using existing data from the National Comorbidity Survey Replication (n = 2,312; 2005). As predicted, family abuse/violence was directly linked to both GAD and romantic relationship distress. Differentiation mediated the relationship between family abuse/violence and GAD, and partially mediated the relationship between family abuse/violence and romantic relationship distress. Findings suggest that current and past relationship processes may help maintain chronic anxiety and that Bowen's theory may be a useful framework for developing couple therapy treatment of GAD and romantic relationship distress.

The biobehavioral family model: testing social support as an additional exogenous variable.

This study tests the inclusion of social support as a distinct exogenous variable in the Biobehavioral Family Model (BBFM). The BBFM is a biopsychosocial approach to health that proposes that biobehavioral reactivity (anxiety and depression) mediates the relationship between family emotional climate and disease activity. Data for this study included married, English-speaking adult participants (n = 1,321; 55% female; M age = 45.2 years) from the National Comorbidity Survey Replication, a nationally representative epidemiological study of the frequency of mental disorders in the United States. Participants reported their demographics, marital functioning, social support from friends and relatives, anxiety and depression (biobehavioral reactivity), number of chronic health conditions, and number of prescription medications. Confirmatory factor analyses supported the items used in the measures of negative marital interactions, social support, and biobehavioral reactivity, as well as the use of negative marital interactions, friends' social support, and relatives' social support as distinct factors in the model. Structural equation modeling indicated a good fit of the data to the hypothesized model (χ(2)  = 846.04, p = .000, SRMR = .039, CFI = .924, TLI = .914, RMSEA = .043). Negative marital interactions predicted biobehavioral reactivity (ß = .38, p < .001), as did relatives' social support, inversely (ß = -.16, p < .001). Biobehavioral reactivity predicted disease activity (ß = .40, p < .001) and was demonstrated to be a significant mediator through tests of indirect effects. Findings are consistent with previous tests of the BBFM with adult samples, and suggest the important addition of family social support as a predicting factor in the model.

Relational discord in urban primary care: prevalence rates and psychiatric comorbidities.

The current study primarily assesses uninsured, low-income patients (n = 125) in a primary care practice. Despite the knowledge that family relationships affect the management and outcomes of chronic illness, the rates of relational discord among primary care patients are unknown. Findings reveal that 54% of patients met criteria for problematic family functioning, while 40% of those in a romantic relationship reported relationship distress. In addition, 67% reported depression, 32% reported clinical levels of anxiety, and 33% at-risk alcohol use. Researchers used latent class analysis to explore characteristics of the sample, which revealed four classes. Comparisons with prior research with similar populations are made and implications for behavioral health providers working within primary care are discussed.

Anxiety disorders and the quality of relationships with friends, relatives, and romantic partners.

OBJECTIVES: Though research suggests support for the association between marital quality and anxiety disorders, less is known about relationship quality with relatives and friends and anxiety disorders. METHOD: Using data from the Collaborative Psychiatric Epidemiology Surveys (n = 9912; mean age 44.8; 52.2% female), the association between relationship quality with relatives, friends, and romantic partners and anxiety disorders is examined for those who are divorced, single, or married. RESULTS: For those who are single or divorced, relationship quality with relatives and friends was associated with many anxiety disorders including agoraphobia, social phobia, and generalized anxiety disorder. For those who are married, relationship quality with relatives and partners was associated with generalized anxiety disorder and posttraumatic stress disorder. CONCLUSION: Given that those with anxiety disorders have higher rates of divorce and are more likely to be single, examining the relationship quality with relatives and friends, in addition to romantic partners, may be important for understanding the onset and course of anxiety disorders.