A longitudinal analysis of intimacy processes and psychological distress among couples coping with head and neck or lung cancers

Abstract

Individuals diagnosed with lung and head and neck (HN) cancers and their spouses are at increased risk for distress. This study assessed whether the way couples communicate about cancer and their perceptions of relationship intimacy influenced both partners' adjustment. One-hundred thirty-nine patients and their spouses [For purposes of clarity, we refer to the patients' intimate partner as the spouse, regardless of actual marital status and we reserve the term partner to refer to the other person in the couple (i.e., the patient's partner is the spouse and the spouse's partner is the patient)] completed measures of spousal communication, intimacy, and distress at three time points over 6 months. Using multilevel modeling, an over-time actor-partner interdependence model was specified that examined whether intimacy mediated associations between one's own and one's partner's reports of communication at baseline and later distress. Patients and spouses who reported greater baseline distress reported more negative baseline communication as well as lower levels of intimacy and greater distress over time. Mediation analyses showed patients' and spouses' reports of positive spousal communication were associated with less subsequent distress largely through their effects on intimacy. Clinicians working with head and neck or lung cancer patients should assess communication and intimacy because both impact couples' distress.

Fig. 1

Actor-Partner Model depicting the direct effects of positive and negative communication measured in the previous wave (i.e., time t – 1, where t = 1, 2) on cancer-related distress at the current wave (i.e., time t, where t = 2, 3) controlling for cancer-rated distress at the previous wave (i.e., time = t – 1 where t = 1, 2). Actor PC represents the actor effect of the person's positive communication on his/her own distress, Partner PC represents the partner effect of the person's positive communication on his/her distress (likewise for negative communication or NC)

Fig. 2

Actor-Partner Model mediational model depicting both the direct and indirect effects of previous positive and negative communication on current cancer-related distress in which the effects of communication are mediated by current intimacy. Note: For simplification purposes, in the figure, positive and negative communication are depicted together, but in the actual analysis each of the two types of communication were treated as separate predictors, each with its own actor and partner effects (as depicted in Fig. 1). Actor distress indicates the actor effect for communication on distress and Actor intimacy indicates the actor effect for communication on distress (likewise for the two partner effects)

Fig. 3

Summary of results from the mediational model in which the effects of the person's own past positive communication and his or her partner's past negative communication on current distress are mediated by the person's current intimacy. Coefficients in parentheses indicate direct effects when current intimacy is not included in the model. *p < .05; **p < .01