Faculty Bibliography

Purpose/Objectives: To describe advanced cancer patient-spouse caregiver couples' cancer-related concerns, determine dyadic concordance of concerns, and predict concordance based on demographic characteristics. Design/Research Approach: Secondary analysis of cross-sectional self-report data. Sample/Participants: 88 advanced cancer patients and spouse self-identified caregivers. Methods/Methodological Approach: Participants individually completed questionnaires, including demographics and the Cancer Inventory of Problem Situations. Data are described and concordances were calculated using Kappa scores. Generalized Linear Modeling was used to predict concordances using demographic characteristics. Findings: The top patient concern was lack of energy, while the top spouse caregiver concern was worry about cancer. Couples generally had low concordance about concerns. Demographic characteristics did not significantly predict concordance. Conclusions/Interpretation: Low inter- and intra-dyadic congruence may suggest little communication within couples regarding cancer-related concerns. Implications for Psychosocial Providers or Policy: Healthcare providers should reinforce the importance of communication among patients and spouse caregivers to improve concordance and potentially reduce conflict.

Effective, accessible prevention programs are needed for adults at heightened risk for intimate partner violence (IPV). This parallel group randomized controlled trial examines whether such couples receiving the American version of Couple CARE for Parents of Newborns (CCP; Halford et al. 2009) following the birth of a child, compared with controls, report fewer first occurrences of clinically significant IPV, less frequent physical and psychological IPV, and improved relationship functioning. Further, we test whether intervention effects are moderated by level of risk for IPV. Couples at elevated risk for IPV (N = 368) recruited from maternity units were randomized to CCP (n = 188) or a 24-month waitlist (n = 180) and completed measures of IPV and relationship functioning at baseline, post-program (when child was 8 months old), and two follow-ups (at 15 and 24 months). Intervention effects were tested using intent to treat (ITT) as well as complier average causal effect (CACE; Jo and Muthén 2001) structural equation models. CCP did not significantly prevent clinically significant IPV nor were there significant main effects of CCP on clinically significant IPV, frequency of IPV, or most relationship outcomes in the CACE or ITT analyses. Risk moderated the effect of CCP on male-to-female physical IPV at post-program, with couples with a planned pregnancy declining, but those with unplanned pregnancies increasing. This study adds to previous findings that prevention programs for at-risk couples are not often effective and may even be iatrogenic for some couples.

OBJECTIVE:Describe communication between patients with advanced cancer and their spouse/partner caregivers. DESIGN:Prospective observational study. SAMPLE:83 advanced cancer patient-spouse caregiver couples. METHODS:Couples completed surveys and recorded naturalistic communication for one day. Descriptive analysis was performed on self-report and observational communication data. FINDINGS:Both patients and caregivers self-reported high likelihood of engaging in positive interactions. The majority of observed communication was logistical or social small-talk. Cancer and relationship talk was highly skewed; many couples had no talk in these domains. CONCLUSION:This study is one of the first to assess continuous naturalistic observation of communication in the homes of couples coping with advanced cancer. We found that routine aspects of daily life continue even when couples are facing important challenges. Implications for Psychosocial Providers: There appear to be few naturalistic cues encouraging couples to discuss potentially difficult topics. More work is needed to determine appropriate levels of communication.

BACKGROUND:Intimate partner violence (IPV) during pregnancy can have serious health consequences for mothers and the unborn child. Nevertheless, IPV is seldom addressed in the context of parent preparation. AIM/OBJECTIVE:This study aimed to map the prevalence, direction, and severity of IPV in a sample of expectant couples signing up for universally-offered parent preparation. METHOD/METHODS:A total of 1726 Danish couples expecting their first child provided data on physical and psychological IPV by completing the Family Maltreatment measure during the second trimester of pregnancy. RESULTS:In 18.5% of the couples, at least one partner reported psychological or physical IPV acts during the past year. In more than 8% of couples, one or both partners reported acts and impacts above the ICD-11 threshold for clinically-significant IPV (CS-IPV) during the past year (3.6% physical CS-IPV, 5.3% psychological CS-IPV, and 0.8% both physical and psychological CS-IPV). Among couples with physical IPV below the clinical threshold, pregnant-woman-to-partner (50%) and bidirectional (38.2%) IPV were more common than partner-to-pregnant-woman IPV (11.8%). Among couples with physical CS-IPV, pregnant-woman-to-partner (36.1%), partner-to-pregnant-women (29.1%) and bidirectional (34.4%) forms were equally common. Among couples with psychological IPV, pregnant-woman-to-partner (54.9%) and partner-to-pregnant-woman (39.6%) IPV were more common than bidirectional IPV (5.5%). DISCUSSION/CONCLUSIONS:The prevalence of violence was markedly higher in this study compared with previous reports from the Nordic region and highlights a previous oversight of a substantial and clinically significant level of pregnant-woman-to-partner IPV-as well as the reverse. Data from this study call for IPV to be addressed in universally offered parent preparation programs.

OBJECTIVES/OBJECTIVE:We sought to identify subgroups of individuals based on patterns of psychological health problems (PH; e.g., depressive symptoms, hazardous drinking) and family maltreatment (FM; e.g., child and partner abuse). METHOD/METHODS:We analyzed data from very large surveys of United States Air Force active duty members with romantic partners and children. RESULTS:Latent class analyses indicated six replicable patterns of PH problems and FM. Five of these classes, representing ∼98% of survey participants, were arrayed ordinally, with increasing risk of multiple PH problems and FM. A sixth group defied this ordinal pattern, with pronounced rates of FM and externalizing PH problems, but without correspondingly high rates/levels of internalizing PH problems. CONCLUSIONS:Ramifications of these results for intervention are discussed.

Background/Objective: Intimate partner relationship problems and intimate partner abuse and neglect - referred to in this paper as "relational problems and maltreatment" - have substantial and well-documented impact on both physical and mental health. However, classification guidelines, such as those found in the International Classification of Diseases (ICD-10), are vague and unlikely to support consistent application. Revised guidelines proposed for ICD-11 are much more operationalized. We used standardized clinical vignette conditions with an international panel of clinicians to test if ICD-11 changes resulted in improved classification accuracy. Method: English-speaking mental health professionals (N = 738) from 65 nations applied ICD-10 or ICD-11 (proposed) guidelines with experimentally manipulated case presentations of presence or absence of (a) individual mental health diagnoses and (b) relational problems or maltreatment. Results: ICD-11, compared with ICD-10, guidelines resulted in significantly better classification accuracy, although only in the presence of co-morbid mental health problems. Clinician factors (e. g., gender, language, world region) largely did not impact classification performance. Conclusions: Despite being considerably more explicated, raters' performance with ICD-11 guidelines reveals training issues that should be addressed prior to the release of ICD-11 in 2018 (e. g., overriding the guidelines with pre-existing archetypes for relationship problems and physical and psychological abuse).

Dysfunctional conflict resolution behaviors in couples have been long recognized as markers of relationship maladjustment and are, consequently, frequent targets of couple therapy. The process of flooding may play a role. Flooding is the subjective sense of being overwhelmed by the partner's negative affect, which is perceived as unexpected and intense, and feeling as though one's information processing is impaired. It has been theorized that flooding is so aversive as to lead to maladaptive conflict behaviors (e.g., conflict escalation or withdrawal) as attempts to terminate the offending input (i.e., partner anger). Despite strong theory describing the construct, there has been a lack of valid measures to assess it. In the present study, we evaluated the psychometric properties of a 15-item measure in a sample of 453 couples. Reasonable unifactoriality, excellent internal consistency, and high test-retest reliability were demonstrated. Furthermore, using a dyadic latent variable model, the IPFS showed strong structural validity and concurrent validity with measures of relationship satisfaction, intimate partner violence, anger, depressive symptoms, and observed negative conflict behaviors. The IPFS appears to be a promising, economical instrument to assess flooding, a process relevant for understanding dysfunctional couple conflict behaviors.

Relationship behaviors contribute to compromised health or resilience. Everyday communication between intimate partners represents the vast majority of their interactions. When intimate partners take on new roles as patients and caregivers, everyday communication takes on a new and important role in managing both the transition and the adaptation to the change in health status. However, everyday communication and its relation to health has been little studied, likely due to barriers in collecting and processing this kind of data. The goal of this paper is to describe deterrents to capturing naturalistic, day-in-the-life communication data and share how technological advances have helped surmount them. We provide examples from a current study and describe how we anticipate technology will further change research capabilities.