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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Mental Health".

Deadline for manuscript submissions: closed (31 January 2023) | Viewed by 23896

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Special Issue Editors

Dr. Wendy C. Birmingham

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Guest Editor

Department of Psychology, Brigham Young University, 1054 KMBL, Provo, UT 84602, USA
Interests: relationship quality; health behaviors; blood pressure; cardiovascular disease risk

Dr. Maija Reblin

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Guest Editor

College of Medicine, University of Vermont, Burlington, VT 05405, USA
Interests: caregiving; social relationships; social support; oncology; interpersonal communication; behavioral interventions

Special Issue Information

Dear Colleagues,

Relationships can be beneficial or detrimental to both our psychological and physiological health, depending on the quality and/or quantity of the relationships and the extent to which they influence health behaviors. An individual’s romantic partner is often considered one of the most important relationships they have, yet relationships with children, siblings, parents, caregivers, or close friends can be of equal importance in terms of overall health. Poor-quality relationships have been linked to increased morbidity, and lack of social relationships is associated with increased morbidity and increased risk for premature mortality. We are now living in unprecedented times in which physical access to those important others is often not available. Additionally, we are facing a pandemic whose future health outcomes are unclear. In such times it is even more important to further our knowledge of the importance of close relationships in order to more fully understand the impact of COVID-19. Associations between relationships and health have been examined by advanced research methods such as prospective longitudinal designs, random controlled trials, meta-analyses, and innovative technologies such as fMRI, eye-tracking, and ecological momentary assessments. This Special Issue welcomes articles that specifically advance our understanding of the importance of social relationships, which may include, but are not limited to, those using innovative approaches, theories, or methods.

Dr. Wendy C. Birmingham
Dr. Maija Reblin
Guest Editors

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Keywords

disease risk
disease processes
health behaviors
loneliness
morbidity
mortality
psychological processes relationship quality
social networks

Published Papers (13 papers)

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Research

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17 pages, 1852 KiB

Open AccessArticle

Relationship Functioning and Gut Microbiota Composition among Older Adult Couples

by Qiwen Cheng, Rosa Krajmalnik-Brown, John K. DiBaise, Juan Maldonado, M. Aaron Guest, Michael Todd and Shelby L. Langer

Int. J. Environ. Res. Public Health 2023, 20(8), 5435; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20085435 - 07 Apr 2023

Viewed by 1725

Abstract

An emerging area of research extends work on couple functioning and physical health to gut health, a critical marker of general health and known to diminish with age. As a foray into this area, we conducted a pilot study to (1) determine the feasibility of remote data collection, including a fecal sample, from older adult couples, (2) examine within-couple concordance in gut microbiota composition, and (3) examine associations between relationship functioning and gut microbiota composition. Couples (N = 30) were recruited from the community. The participants’ demographic characteristics were as follows: M (SD) age = 66.6 (4.8), 53% female, 92% White, and 2% Hispanic. Two of the couples were same-sex. All 60 participants completed self-report measures and supplied a fecal sample for microbiome analysis. Microbial DNA was extracted from the samples, and the 16S rRNA gene V4 region was amplified and sequenced. The results indicated that individuals shared more similar gut microbial composition with their partners than with others in the sample, p < 0.0001. In addition, individuals with better relationship quality (greater relationship satisfaction and intimacy and less avoidant communication) had greater microbial diversity, p < 0.05, a sign of healthier gut microbiota. Further research with a larger and more diverse sample is warranted to elucidate mechanisms. Full article

(This article belongs to the Special Issue Close Relationships and Health)

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12 pages, 342 KiB

Open AccessArticle

Hugs and Cortisol Awakening Response the Next Day: An Ecological Momentary Assessment Study

by Chelsea E. Romney, Amber Carmen Arroyo, Theodore F. Robles and Matthew J. Zawadzki

Int. J. Environ. Res. Public Health 2023, 20(7), 5340; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20075340 - 30 Mar 2023

Viewed by 2289

Abstract

Previous research suggests that affectionate touch such as hugs might downregulate stress systems such as the hypothalamic pituitary adrenal (HPA) axis. However, the current literature lacks in generalizability beyond the laboratory setting and outside the context of romantic relationships. The cortisol awakening response (CAR) is a measure of the HPA axis and is responsive to daily fluctuations in stress and social information. However, associations between affectionate touch and the CAR have never been assessed. This study used ecological momentary assessment (EMA) to measure daily hugging behaviors in 104 first-year college students and salivary cortisol to assess the CAR. Participants who reported more daily hugs in their social interactions had significantly smaller CARs the next morning compared to days they reported fewer hugs. This study contributes to the literature on social interactions and stress responsive systems and emphasizes the importance of assessing affectionate touch behaviors such as hugs that can be exchanged outside the context of romantic relationships. Full article

(This article belongs to the Special Issue Close Relationships and Health)

17 pages, 366 KiB

Open AccessArticle

Attachment in Couples Coping with Cancer: Associations with Observed Communication and Long-Term Health

by Katherine Ramos, Karena Leo, Laura S. Porter, Joan M. Romano, Brian R. W. Baucom and Shelby L. Langer

Int. J. Environ. Res. Public Health 2023, 20(7), 5249; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20075249 - 24 Mar 2023

Cited by 1 | Viewed by 1968

Abstract

Cancer poses a threat to well-being that may activate the attachment system and influence interpersonal dynamics, such as communication. Research indicates that avoidant and anxious attachment, as well as communication, are independently associated with poorer psychosocial well-being, yet studies examining links between attachment, communication, and long-term physical well-being are lacking. We examined (a) associations between patient and partner attachment (measured with the adult attachment scale [AAS-Revised]) and observed communication (across affect [the Relational Affective Topography System (RATS) coding system] and behavior [the Asymmetric Behavior Coding System (ABCS) coding system]) and (b) the extent to which attachment and communication independently predicted long-term physical well-being (measured by the Functional Assessment of Cancer Therapy-General Population [FACT-GP]). Participants were 134 couples [mean age 53.9 (SD = 13.4), 86.2% Caucasian, 66% of patients, 36% of partners female]. Patient participants had either breast, colorectal, or lung cancer. Couples individually completed self-report measures of attachment (baseline) and physical well-being (baseline and 4, 8, and 12 months later). At baseline, couples engaged in a 15 min videorecorded cancer-related conversation coded for communication behavior and affective expression. Patients and partners with higher anxious and avoidant attachment exhibited more negative affect and negative approach behaviors. A greater avoidant attachment was associated with less positive affective expression. Attachment insecurity and affective expression were prospectively linked with physical well-being. Findings indicate that attachment is associated with overt communication behaviors and that insecure attachment and affective expression may be risk factors for poorer health outcomes. Full article

(This article belongs to the Special Issue Close Relationships and Health)

13 pages, 362 KiB

Open AccessArticle

Social Support: The Effect on Nocturnal Blood Pressure Dipping

by Wendy C. Birmingham, Anna Jorgensen, Sinclaire Hancock, Lori L. Wadsworth and Man Hung

Int. J. Environ. Res. Public Health 2023, 20(5), 4579; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20054579 - 04 Mar 2023

Viewed by 1181

Abstract

Social support has long been associated with cardiovascular disease risk assessed with blood pressure (BP). BP exhibits a circadian rhythm in which BP should dip between 10 and 15% overnight. Blunted nocturnal dipping (non-dipping) is a predictor of cardiovascular morbidity and mortality independent of clinical BP and is a better predictor of cardiovascular disease risk than either daytime or nighttime BP. However, it is often examined in hypertensive individuals and less often in normotensive individuals. Those under age 50 are at increased risk for having lower social support. This study examined social support and nocturnal dipping in normotensive individuals under age 50 using ambulatory blood pressure monitoring (ABP). ABP was collected in 179 participants throughout a 24-h period. Participants completed the Interpersonal Support Evaluation List, which assesses perceived levels of social support in one’s network. Participants with low levels of social support demonstrated blunted dipping. This effect was moderated by sex, with women showing greater benefit from their social support. These findings demonstrate the impact social support can have on cardiovascular health, exhibited through blunted dipping, and are particularly important as the study was conducted in normotensive individuals who are less likely to have high levels of social support. Full article

(This article belongs to the Special Issue Close Relationships and Health)

12 pages, 1625 KiB

Open AccessArticle

A Cross-Sectional Analysis of Paternal Intimacy Problems, Stress Levels, and Satisfaction from Families with Children Born with Mucoviscidosis

by Zoran Laurentiu Popa, Madalin-Marius Margan, Elena Bernad, Lavinia Stelea, Marius Craina, Ioana Mihaela Ciuca and Anca Mihaela Bina

Int. J. Environ. Res. Public Health 2022, 19(22), 15055; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192215055 - 16 Nov 2022

Viewed by 1118

Abstract

There is an increasing interest in father–child interactions and their effects. Due to the rising number of working mothers, marital interruptions, divorces, and child custody arrangements, paternal duties and the relevance of fathering continue to be re-evaluated. As there are rising expectations for men to undertake more childcare and household responsibilities, it was hypothesized that the presence of a disabled or chronically ill child would have a significant impact on the couple’s future family situation, marital conduct due to paternal dissatisfaction, and increased stress levels. Therefore, the purpose of this study was to examine paternal intimacy problems, stress levels, and couple satisfaction inside families that have children with cystic fibrosis. The study followed a cross-sectional design with five questionnaires that were answered by a total of 107 fathers of children with cystic fibrosis from the “cases” group as the reference group, and 124 fathers of healthy children from the “control” group. The statistically significant findings of the current study show that men who were taking care of their child with mucoviscidosis engaged less frequently in sexual activity. A significantly higher number of these respondents were smokers. A higher proportion of them reported marital distress (OR = 2.54) and inhibited sexual desire (OR = 2.02), all in association with a higher number of men taking psychiatric medication (7.5% vs. 1.6%). More than 40% of all respondents declared high levels of general stress and parenting distress, while the most frequently used coping mechanism for stress was avoidance-oriented (45.8% vs. 25.8%). Other important findings were the high levels of dissatisfaction and lower levels of marital quality on the SII scale, equivalent to the intimacy problems on the MIQ scale. It is likely that paternal stress is higher when parenting children with cystic fibrosis, and the lack of intervention in this vulnerable group seem to be associated with intimacy problems, couple dissatisfaction, and maladaptive coping mechanisms. It is recommended that these concerns should not only be raised for the mothers of children with mucoviscidosis, but also for the child’s father or the male caretaker partner since they might experience the same problems as the opposite gender. Full article

(This article belongs to the Special Issue Close Relationships and Health)

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15 pages, 2793 KiB

Open AccessArticle

Risky Early Family Environment and Genetic Associations with Adult Metabolic Dysregulation

by Yazmine P. Huizar, Jenny M. Cundiff, Adam T. Schmidt and Matthew R. Cribbet

Int. J. Environ. Res. Public Health 2022, 19(21), 14032; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192114032 - 28 Oct 2022

Cited by 1 | Viewed by 980

Abstract

Growing up in a family environment characterized by neglectful parenting, overt conflict, and unsupportive relationships is associated with poor health in adulthood. A risky early family environment may also be associated with obesity in adulthood, likely through the activation of the HPA axis. Likewise, the GABAergic (gamma-aminobutyric acid) T>C single nucleotide polymorphism in the 1519 nucleotide position of the GABAAα6 receptor subunit gene has been associated with a predisposition to a higher body mass index and a larger waist circumference. Participants (n = 213, M_age = 30.13 years, SD = 10.85; 57.7% men) from the Pittsburgh Cold Study 3 completed a demographic questionnaire, the Risky Families Questionnaire (RFQ) and had their height, weight, and waist circumference measured during a physical exam. Participant DNA was recovered from buccal swabs and genotyped for the various allelic types of the SNP according to published protocols. In secondary data analyses, we tested the hypothesis that early family environment and GABRA6 would be positively associated with body mass index and waist circumference. We also examined diurnal cortisol as a mechanism linking both early risky family environment and GABRA6 to metabolic outcomes. The findings provide evidence that a risky early family environment may exert more influence than genetic predisposition when determining the indices of metabolic health in adulthood. Full article

(This article belongs to the Special Issue Close Relationships and Health)

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13 pages, 621 KiB

Open AccessArticle

The Effects of Strain-Based Work–Parenting Conflict on Dual Income Couples’ Energy

by Jensine Paoletti, Jaye L. Derrick, Christopher P. Fagundes and Kenneth E. Leonard

Int. J. Environ. Res. Public Health 2022, 19(15), 9125; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19159125 - 26 Jul 2022

Cited by 1 | Viewed by 1455

Abstract

(1) Background: Gender differences between men’s and women’s parenting roles are well-documented as the “second shift”. We examined the main effects and interaction of work distress and parenting distress with energy (i.e., vigor) in a sample of 310 dual-income, different-sex couples with kids married for approximately nine years. (2) Methods: We used actor–partner interdependence modeling (APIM) to examine how spouses’ distress was associated with their energy. (3) Results: For both wives and husbands, there were negative associations between the actor’s parenting distress and their energy level and between the actor’s work distress and their energy level. However, only wives experienced a significant interaction of work and parenting distress such that high levels of both forms of distress were associated with low levels of energy, indicating that only wives experience this form of work–family conflict. (4) Conclusions: When women experience more strain at home than men, they may need more time to recover from their work and family duties. If they cannot do so, they will have less energy to carry out their responsibilities and may be at a higher risk of future adverse health outcomes. Full article

(This article belongs to the Special Issue Close Relationships and Health)

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15 pages, 1043 KiB

Open AccessArticle

Early Adversity and Changes in Cortisol and Negative Affect in Response to Interpersonal Threats in the Laboratory

by Christopher J. Wendel, Jenny M. Cundiff and Matthew R. Cribbet

Int. J. Environ. Res. Public Health 2022, 19(10), 5934; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19105934 - 13 May 2022

Viewed by 1482

Abstract

Adverse childhood experiences, such as abuse and neglect, are associated with poor health outcomes. This association may be partially explained by differences in stress physiology. Though most early adverse experiences occur within the context of interpersonal relationships, stress exposures manipulated in the laboratory rarely involve interpersonal interactions beyond the mere presence of others. This study examines whether adverse childhood experiences are associated with differences in affective and cortisol reactivity to two stressors which may more closely resemble the powerlessness and the lack of control characteristic of many adverse childhood experiences: a dominant (vs. submissive) interaction partner and lower (vs. higher) social status. We also manipulate social-evaluative threat as a test of whether these interpersonal stressors are more germane to stress reactivity associated with early adversity than the performance anxiety evoked by more traditional laboratory stressors, such as the Trier Social Stress Test. The results partially support the hypothesis that participants with greater early adversity may be more reactive to interpersonal stressors reminiscent of early adverse experience. Given the interpersonal nature of most adverse childhood experiences, conceptualizing and measuring associations with stress physiology in an interpersonal context may more closely capture the psychological and biological embedding of these early experiences. Full article

(This article belongs to the Special Issue Close Relationships and Health)

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12 pages, 1026 KiB

Open AccessArticle

Intimate Relationships and Stroke: Piloting a Dyadic Intervention to Improve Depression

by Alexandra L. Terrill, Maija Reblin, Justin J. MacKenzie, Brian R. W. Baucom, Jackie Einerson, Beth Cardell, Lorie G. Richards and Jennifer J. Majersik

Int. J. Environ. Res. Public Health 2022, 19(3), 1804; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19031804 - 05 Feb 2022

Cited by 6 | Viewed by 2412

Abstract

Stroke affects not only the survivor but also their romantic partner. Post-stroke depression is common in both partners and can have significant negative consequences, yet few effective interventions are available. The purpose of this study was to pilot test a novel 8-week remotely administered dyadic intervention (ReStoreD) designed to help couples better cope with stroke-related changes and reduce depressive symptoms. Thirty-four cohabitating survivor–partner dyads at least 3 months post-stroke and reporting some changes in mood were enrolled. Depressive symptoms were assessed pre- and post-intervention and at 3-month follow-up. Repeated measures analysis of variance was used to assess the effects of ReStoreD over time on depressive symptoms in stroke survivors and their partners. Twenty-six dyads completed the study. Although statistical significance was not reached, there was a large effect size for improvements in depressive symptoms for stroke survivors. There was no significant improvement for partners, and the effect size was minimal. Those with more significant depressive symptoms at baseline were more likely to benefit from the intervention. This pilot study established proof-of-concept by demonstrating that depressive symptoms can be lessened in stroke survivors and partners with more severe depressive symptoms. Future research will establish the efficacy of the intervention in a fully powered study. Full article

(This article belongs to the Special Issue Close Relationships and Health)

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9 pages, 323 KiB

Open AccessFeature PaperArticle

Partner’s Perceived Social Support Influences Their Spouse’s Inflammation: An Actor–Partner Analysis

by Joshua D. Landvatter, Bert N. Uchino, Timothy W. Smith and Jos A. Bosch

Int. J. Environ. Res. Public Health 2022, 19(2), 799; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19020799 - 12 Jan 2022

Cited by 2 | Viewed by 1513

Abstract

Social support has been linked to lower cardiovascular morbidity and mortality. However, most studies have examined perceived support as an intrapersonal construct. A dyadic approach to social support highlights how interdependence between individuals within relationships, including partner perceptions and interactions, can influence one’s health. This study’s overall purpose was to test actor–partner models linking perceived social support to inflammation. Ninety-four cisgender married couples completed perceived support measures and had their blood drawn for CRP and IL-6 to produce an overall inflammatory index. The primary results indicate that only a partner’s level of perceived support was related to lower inflammation in their spouse. Our sample size, although moderate for inflammatory studies, was probably not large enough to detect actor influences. These data highlight the importance of taking a dyadic perspective on modeling perceived support and its potential mechanism. Full article

(This article belongs to the Special Issue Close Relationships and Health)

Review

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25 pages, 593 KiB

Open AccessReview

Social Isolation and Social Support Influence Health Service Utilisation and Survival after a Cardiovascular Disease Event: A Systematic Review

by Rosanne Freak-Poli, Jessie Hu, Aung Zaw Zaw Phyo and S. Fiona Barker

Int. J. Environ. Res. Public Health 2023, 20(6), 4853; https://doi.org/10.3390/ijerph20064853 - 09 Mar 2023

Cited by 2 | Viewed by 1809

Abstract

Both cardiovascular disease (CVD) and social health carry high health and economic burdens. We undertook a systematic review to investigate the association between social isolation, low social support, and loneliness with health service utilisation and survival after a CVD event among people living in Australia and New Zealand. Four electronic databases were systematically searched for the period before June 2020. Two reviewers undertook the title/abstract screen. One reviewer undertook a full-text screen and data extraction. A second author checked data extraction. Of 756 records, 25 papers met our inclusion criteria. Included studies recruited 10–12,821 participants, aged 18–98 years, and the majority were males. Greater social support was consistently associated with better outcomes on four of the five themes (discharge destination, outpatient rehabilitation attendance, rehospitalisation and survival outcomes; no papers assessed the length of inpatient stay). Positive social health was consistently associated with better discharge designation to higher independent living. As partner status and living status did not align with social isolation and social support findings in this review, we recommend they not be used as social health proxies. Our systematic review demonstrates that social health is considered in cardiac care decisions and plays a role in how healthcare is being delivered (i.e., outpatient, rehabilitation, or nursing home). This likely contributes to our finding that lower social support is associated with high-intensity healthcare services, lower outpatient rehabilitation attendance, greater rehospitalisation and poorer survival. Given our evidence, the first step to improve cardiac outcomes is acknowledging that social health is part of the decision-making process. Incorporating a formal assessment of social support into healthcare management plans will likely improve cardiac outcomes and survival. Further research is required to assess if support person/s need to engage in the risk reduction behaviours themselves for outpatient rehabilitation to be effective. Further synthesis of the impact of social isolation and loneliness on health service utilisation and survival after a CVD event is required. Full article

(This article belongs to the Special Issue Close Relationships and Health)

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29 pages, 844 KiB

Open AccessReview

Positive Psychology Approaches to Interventions for Cancer Dyads: A Scoping Review

by Amy K. Otto, Dana Ketcher, Maija Reblin and Alexandra L. Terrill

Int. J. Environ. Res. Public Health 2022, 19(20), 13561; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192013561 - 19 Oct 2022

Cited by 3 | Viewed by 2754

Abstract

Objective: Positive psychology approaches (PPAs) to interventions focus on developing positive cognitions, emotions, and behavior. Benefits of these interventions may be compounded when delivered to interdependent dyads. However, dyadic interventions involving PPAs are relatively new in the cancer context. This scoping review aimed to provide an overview of the available research evidence for use of dyadic PPA-based interventions in cancer and identify gaps in this literature. Methods: Following PRISMA guidelines, we conducted a scoping review of intervention studies that included PPAs delivered to both members of an adult dyad including a cancer patient and support person (e.g., family caregiver, intimate partner). Results: Forty-eight studies, including 39 primary analyses and 28 unique interventions, were included. Most often (53.8%), the support person in the dyad was broadly defined as a “caregiver”; the most frequent specifically-defined role was spouse (41.0%). PPAs (e.g., meaning making) were often paired with other intervention components (e.g., education). Outcomes were mostly individual well-being or dyadic coping/adjustment. Conclusions: Wide variability exists in PPA type/function and their targeted outcomes. More work is needed to refine the definition/terminology and understand specific mechanisms of positive psychology approaches. Full article

(This article belongs to the Special Issue Close Relationships and Health)

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Other

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9 pages, 335 KiB

Open AccessBrief Report

Hospice Caregivers’ Perception of Family and Non-Family Social Support and Stress over Time: Associations with Reports of General Support

by Maija Reblin, Djin L. Tay, Eli Iacob, Kristin G. Cloyes, Megan C. Thomas Hebdon and Lee Ellington

Int. J. Environ. Res. Public Health 2023, 20(6), 5009; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20065009 - 12 Mar 2023

Viewed by 1604

Abstract

Social support has been identified as a key factor to protect wellbeing for home hospice cancer caregivers. However, few studies have assessed social support over time in this context, and measures of support are often limited to general assessments of perceived support. Our goal was to (1) describe change in cancer home hospice caregivers’ social support over time during care and into bereavement and (2) explore the impact of perceived stress and support from family and non-family members on caregivers’ perceived general social support. We conducted a secondary analysis of longitudinal prospective questionnaire data. Forty caregivers completed measures of general perceived support, family and non-family support and stress during hospice enrollment and 2 and 6 months post the patient’s death. Linear mixed models were used to determine change in support over time and the contribution of specific support/stress ratings to general support assessments. Caregivers overall had moderate and stable levels of social support over time, though there was significant variation between and within individuals. Family and non-family support and stress from family predicted general perceptions of social support, while no effects were found for non-family stress. This work suggests a need for more specific measures of support and stress, and the need for research to focus on improving baseline levels of caregiver perceived support. Full article

(This article belongs to the Special Issue Close Relationships and Health)

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