Review and meta-analysis of couple-oriented interventions for chronic illness

Abstract

Background: Evidence continues to build for the impact of the marital relationship on health as well as the negative impact of illness on the partner. Targeting both patient and partner may enhance the efficacy of psychosocial or behavioral interventions for chronic illness.

Purpose: The purpose of this report is to present a cross-disease review of the characteristics and findings of studies evaluating couple-oriented interventions for chronic physical illness.

Methods: We conducted a qualitative review of 33 studies and meta-analyses for a subset of 25 studies.

Results: Identified studies focused on cancer, arthritis, cardiovascular disease, chronic pain, HIV, and Type 2 diabetes. Couple interventions had significant effects on patient depressive symptoms (d = 0.18, p < 0.01, k = 20), marital functioning (d = 0.17, p < 0.01, k = 18), and pain (d = 0.19, p < 0.01, k = 14) and were more efficacious than either patient psychosocial intervention or usual care.

Conclusions: Couple-oriented interventions have small effects that may be strengthened by targeting partners' influence on patient health behaviors and focusing on couples with high illness-related conflict, low partner support, or low overall marital quality. Directions for future research include assessment of outcomes for both patient and partner, comparison of couple interventions to evidence-based patient interventions, and evaluation of mechanisms of change.

Figure 1

This heuristic model illustrates the potential added benefit to patient health of couple-oriented intervention as compared to patient-oriented intervention, due to its effects on an additional domain of functioning (i.e., marital/partner). Examples of specific constructs are provided for each domain of functioning. Adapted from Martire and Schulz [23]