Faculty Bibliography

OBJECTIVE:Short sleep duration is a common problem for both advanced cancer patients and their spouse caregivers. Sleep and distress have been shown to be interdependent in patient-caregiver and spouse dyads, yet virtually, no work has explored the dyadic effects of psychological distress on sleep in advanced cancer patients and spouse caregivers. The goal of the present study was to examine the dyadic impact of anxiety and depression on sleep duration in a sample of advanced cancer patients and their spouse caregivers. It was hypothesized that, for both patients and caregivers, anxiety and depression in individuals would be associated with sleep duration in both themselves (actor effects) and in their spouses (partner effects). METHOD/METHODS:Advanced cancer patients and their spouse caregivers (N = 87 dyads) completed cross-sectional questionnaires assessing demographic variables, subjective health, subjective sleep duration, and anxiety and depression symptoms. RESULTS:Controlling for sex, age, and subjective health, individuals' anxiety was negatively associated with their own and their partner's sleep duration. No significant actor or partner effects were found for depression. CONCLUSIONS:Results provided partial support for hypotheses. Although past work has demonstrated links between subjective sleep disturbance and anxiety/psychological distress, this is one of the first studies to examine partner effects of distress on sleep disturbance in advanced cancer patients and spouse caregivers.

OBJECTIVE:Differentiating suicide attempters from suicide ideators has been named a critical suicidology frontier (Klonsky & May, 2013). Per Bronfenbrenner's (1977, 1994) ecological systems theory, risk/protective factors from four ecological levels (individual, family, workplace, and community) were used to predict last year suicide attempt status among active duty service members expressing suicide ideation. METHOD/METHODS:Active duty U.S. Air Force members (N = 52,780, 79.3% male, 79.2% non-Hispanic White, M age = 31.8 years) anonymously completed an online community assessment administered biennially at 82 bases worldwide. Last year suicide ideation and attempts were concurrently measured, as were an array of co-occurring risk and protective factors. RESULTS:Among the 1,927 (approximately 4%) service members self-reporting suicidal ideation, 152 also reported a last year suicide attempt (7.9% of the ideators, 8.7% of men vs. 6.1% of women). However, in multivariate models, military member sex was not a significant moderator. In bivariate models, numerous individual, family/spouse/parent, and community factors were associated with suicide attempt status. In the final multivariate model for the whole sample, risk for a last year attempt was associated with years in the military, social support, and alcohol use problems, but not depression. Among active duty military in relationships, attempt status risk was associated with years in the military, social support, and intimate partner violence victimization. However, the effect sizes for these models were small. CONCLUSIONS:Beyond a focus on depression, addressing alcohol misuse, facilitating resilient and nonviolent couple/family relationships, and increasing social support may enhance suicide attempt prevention efforts among military members. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Noxious family environments are associated with a wide range of adverse child outcomes. In order to prevent couple and parent-child relationship problems, a number of programs have been developed for couples with newborns. The current paper describes a program of research evaluating the American version of couple CARE for parents of newborns. This version of CCP was administered to low-income, unmarried couples with a new baby in an uncontrolled demonstration project (Study 1), compared with a waitlist control condition in a randomized controlled trial (Study 2), and evaluated with low-income parents recruited from urban hospitals in two major metropolitan areas of the United States (Study 3 and Study 4). Despite participant satisfaction with CCP, preventive effects of the program were limited and there was one potential iatrogenic effect. Results were likely impacted by major challenges with recruiting participants and maintaining their engagement in CCP for the duration of the program. We discuss methodological differences between this series of studies and previous trials of prevention programs and make recommendations for improving service delivery to at-risk new parents. These results have implications for public policies that aim to benefit children and families.

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.