Tag: Mental Health

Hypothesis 4. Wives’ Anxiety Will Be Associated With Higher Levels of Husbands’ Distress (i.e., Anxiety, Anger, Depression)

We again used multilevel modeling to investigate these associations. However, we were only interested in husbands’ distress as our outcome, as follows:

HAnxik = b0i + b1Daysik + b2Weeekendik + b3WAnxik + eijk.
(4)

As indicated previously, we specified the variance-covariance matrix as autoregressive. Each distress measure (anxiety, anger, and depression) was modeled separately, with all Level 1 coefficients specified as random.

As hypothesized, wives’ anxiety was associated with greater husbands’ distress on the same day, Anxiety: b3 = 0.11, t(32) = 3.04, p < .01; Anger/Hostility: b3 = 0.14, t(32) = 2.84, p < .01; Depression: b3 = 0.15, t(32) = 3.95, p < .01. There were no significant variations around the effects of wives’ anxiety on husbands’ distress (Anxiety: τ = 0.01, LR test = 0.60; Anger/Hostility: τ = 0.02, LR test = 0.20; Depression: τ = 0.01, LR test = 0.30). The LR test here represents the difference between the −2 log likelihood of a model that treats the effect of a particular coping strategy as random and a model that does not.

Read More

Hypothesis 3. On Days in Which the Wives Reported Elevations in Anxious Mood, Husbands Will Be Perceived as Having at Least Some Involvement in the Experience of Anxiety

We identified all days on which wives reported at least moderate anxiety (2 or 3 on a 0–3 scale). We then examined the frequency, across all these days, of moderate to high (2 or 3 on a 0–3 scale) ratings on follow-up questions concerning the husbands’ influence on the wives’ anxiety that day. Wives reported at least moderate anxiety on an average of 10 of 14 days (range = 6–14). On 60.5% of these occasions, wives perceived their husbands as having at least some (ratings of 2 or 3 on a 0–3 scale) influence on their anxiety that day. On 44.4% of these days, husbands were perceived as improving the wife’s anxiety; on 17.4% of days, husbands were perceived as making the wife’s anxiety worse; and on 38.4% of days, husbands were perceived as neither making the anxiety better nor worse. A one-way chi-square test revealed significant differences in the proportions of each type of rating (i.e., anxiety made better, worse or neither) represented across all high-anxiety days, χ2(2, N = 66) = 36.69, p < .05.

Read More

Hypothesis 2. The Associations Between Wives’ Anxiety and Perceptions of RQ Will Be Moderated by Wives’ Anxiety-Specific Relationship Adjustment (CIQ), but Not Global Relationship Functioning (DAS)

We tested the moderation hypothesis in two separate multilevel analyses. The same model described in Equation 1 was used for each analysis. However, Level 2 equations included the following additional predictors as moderators: CIQ and DAS. Because we were interested in the effects of wives’ anxiety on wives’ and husbands’ relationship quality (denoted as b3w and b3h in Equation 1, respectively), b3w, and b3h were modeled as a function of these moderators, as such:

b3w = γ30w + γ31w(CIQwi) + γ32w(DASwi);
(2)

 

b3h = γ30h + γ31h(CIQwi) + γ32h(DASwi).
(3)

CIQwi reflects wives’ report of anxiety-specific relationship adjustment for dyad i, and DASwi reflects wives’ report of global relationship functioning. We did not alter the specifications of the random effects for the moderation tests.

CIQ scores moderated the within-person association between wives’ anxiety and their own ratings of positive relationship quality that same day, γ31w = 0.017, t(32) = 2.57, p < .05, such that for wives who reported low CIQ scores, their anxiety was negatively associated with their positive RQ. For wives who reported high CIQ scores, their anxiety was not associated with their positive RQ. Figure 1 is the visual representation of this interaction, for CIQ scores one standard deviation above and below the mean. CIQ scores did not moderate any other hypothesized within-dyad associations, Positive RQ: γ31h = 0.001, t(32) = 0.17, ns; Negative RQ: γ31w = −0.006, t(32) = −0.89, ns; γ31h = 0.005, t(32) = 0.79, ns. As hypothesized, DAS did not moderate the association between anxiety and negative or positive RQ, Positive RQ: γ32w = 0.005, t(32) = 0.60, ns; γ32h = 0.004, t(32) = 0.52, ns; Negative RQ: γ32w = −0.011, t(32) = −1.20, ns; γ32h = −0.010, t(32) = −1.24, ns.

Figure 1 Prediction of wives’ relationship quality (RQ) with wives’ anxiety as a function of high and low Couples Interaction Questionnaire (CIQ; Craske et al., 1989) scores.

Read More

Hypothesis 1. Wives’ Daily Anxiety Will Be Associated With Perceptions of RQ for Both Husband and Wife

We used a multilevel statistical model to investigate these associations separately for positive and negative RQ. Multilevel modeling accounts for the bias in standard errors and statistical tests that result from nonindependent data and effectively handles “unbalanced” or missing data at the level of repeated observations by using all available data for participants. Inferences are valid assuming missing data are missing at random (see ). The models had two levels: within-dyad (over time) and between-dyad. Using the dyadic longitudinal approach described by , we included wives’ and husbands’ RQ in a single multilevel analysis to account for the fact that wives’ and husbands’ data were clustered within dyad. All analyses were conducted using the MIXED procedure in SAS (Version 9.1.3, 1997).

The within-dyad level of the analysis allowed each dyad’s RQ to be modeled as a function of husbands’ and wives’ anxiety. We predicted a given day’s husbands’ and wives’ RQ for a particular dyad and adjusted for number of days in the study and weekend effects. Because husbands’ anxiety may be highly associated with husbands’ evaluations of RQ, husbands’ anxiety was included to adjust for this effect. The model specified was as follows:

Yijk = (Wifeijk) × (b0w + b1wDaysik + b2wWeekendik + b3wWAnxik + b4wHAnxik + eijk) + (Husbijk) × (b0h + b1hDaysik + b2hWeekendik + b3hWAnxik + b4hHAnxik + eijk),
(1)

where Yijk is the RQ for dyad i for person j (j = 1 is wife’s report; j = 2 is husband’s report) on day k. When the outcome is the wife’s report (Wifeijk = 1 and Husbijk = 0), the first part of the model is selected and all of the b coefficients have the subscript w. Similarly, when the outcome is the husband’s report, Wifeijk = 0, Husbijk = 1, and the second part of the model is selected. Daysik is the number of days in the study; Weekendik indicates whether it is a weekend day or not; WAnxik is the wife’s report of anxiety; HAnxik is the husband’s report of anxiety; the residual components are represented by eijk. All predictor variables were within-person centered (). Finally, the approach discussed by  allowed us not only to account for dependency within individuals across time (i.e., autoregressive) but also to account for dependency within dyads (pp. 292–295).

The between-dyad level of this analysis modeled individual differences in the coefficients specified in Equation 1. We fit a model that considered intercepts for both wives’ and husbands’ reports of RQ to be random (i.e., varying across persons). In addition, slope of day on wives’ RQ (b1w), slope of wives’ anxiety on wives’ RQ (b3w), and slope of husbands’ anxiety on husbands’ RQ (b4h) were modeled to be random for the positive RQ analysis; slope of husbands’ anxiety on husbands’ RQ (64h) was modeled to be random for the negative RQ analysis.1 Random effects were tested using the nested comparison of likelihood ratio (, p. 119).

Table 3 presents results for both wives’ and husbands’ reports of positive RQ.2 Only variables of interest are reported here. Wives’ anxiety was not associated with their own positive RQ, b3w = −0.03, t(32) = −0.89, ns, but was significantly associated with husbands’ positive RQ, b3h = −0.14, t(32) = −3.05, p < .01. Specifically, on days when wives experienced higher anxiety, husbands reported less positive relationship quality. There was no significant variation around these effects.

Read More

Results

Description of Sample

Wives featured the following primary anxiety disorders: panic disorder with agoraphobia (PDA; n = 2; 6%), GAD (n = 9; 27.2%), SAD (n = 15; 45.5%), OCD (n = 5; 15.1%), and PTSD (n = 2; 6%). The majority were receiving treatment for their anxiety (84.8% in psychotherapy, 24.2% receiving psychotropic medication), although most were enrolled in this study during the first 3 weeks of their current treatment (n = 24; 85.7%). Ten (30.3%) met criteria for comorbid dysthymic disorder, and 19 (57.6%) met criteria for at least one additional anxiety disorder, including GAD (n = 4), SAD (n = 11), PDA (n = 1), PTSD (n = 2), and anxiety disorder not otherwise specified (n = 1). Husbands’ mean scores on the STAI–A (M — 12.90, SD = 3.02) and the STAI–D (M = 24.67, SD = 6.57) subscales were comparable to those reported by  for their control sample (STAI–A M = 10.20, SD = 2.45; STAI–D M = 23.18, SD = 4.58). Husbands’ mean raw score on the SCL-90 GSI subscale (M = 0.55, SD = 0.12) was below the clinical threshold suggested by , with the majority of husbands (73.5%) scoring below the cut-off. Although husbands’ diagnostic status was not formally assessed, they did not demonstrate generally elevated levels of psychological distress.

Wives and husbands reported nearly identical levels of global relationship satisfaction on the DAS (see Table 1). Total DAS scores were comparable to those reported for a sample of agoraphobic married and cohabiting women (M = 103.2, SD = 17.2; ). Based on empirically established cutoffs (i.e., 98; ), 29.5% of couples in the current sample had at least one partner who scored within the distressed range of marital functioning. Mean levels of daily negative mood aggregated across the study period were significantly higher for wives than for husbands, as would be expected given wives’ clinical status. ICCs, representing the proportion of variance between-persons indicated that significant variability existed between and within persons on affect measures for wives (anxiety ICC = .44; anger ICC = .34; depression ICC = .40) and husbands (anxiety ICC = .42; anger ICC = .33; depression ICC = .31).

Read More

Baseline Measure for Both Spouses

Dyadic Adjustment Scale (DAS; )

The DAS is a widely used 32-item measure of global relationship quality. The summed total score, which ranges from 0 to 151 (higher scores reflect better functioning), was used to characterize global relationship functioning. Alpha was .90 for the total sample (.91 wives, .89 husbands).

Daily Measures

All standard deviations reported below and in Table 1 for the diary measures represent within-subject variation, not a combination of variation over days and participants. The reliability of these scales represents within-person consistency (reliability of change; ). See Table 1 for means, standard deviations, and reliabilities and Table 2 for intercorrelations between daily measures.

Read More

Baseline Measures for Husbands

Family Accommodation Questionnaire—Modified (FAQ–M)

The FAQ–M is a modified version of the Family Accommodation Questionnaire (FAQ; ), a 13-item self-report measure originally developed to assess the frequency of accommodating behavior in response to a family member with OCD. To make the FAQ applicable to the broader class of anxiety disorders, the wording of items was changed to refer to “anxiety symptoms” rather than “obsessive-compulsive disorder,” and OCD-specific items (e.g., “How often did you provide objects for your partner’s compulsions?”) were removed. The FAQ–M assessed husbands’ participation in symptom-related behavior, changes in routine due to wives’ anxiety symptoms, and distress caused by symptom accommodation. The original FAQ correlated highly with relevant subscales of the Questionnaire on Resources and Stress for Families with Chronically Ill or Handicapped Members (). Alpha in our sample was .82.

Patient Rejection Scale (PRS; )

The PRS is an 11-item questionnaire assessing family hostility, a central component of expressed emotion and a demonstrated predictor of relapse (). Items are statements concerning the husband’s perceptions of the wife (e.g., “I get more irritated with her as time goes on”). Husbands were asked to rate the frequency with which these statements apply to them on a scale from 0 (never) to 2 (often). Items were summed to calculate a total score. Alpha in our sample was .60.

Husbands completed two additional questionnaires assessing levels of anxiety, depression and general psychological distress:

The State-Trait Anxiety Inventory: Trait version (STAI–T; )

A 20-item scale used to assess the degree to which husbands feature a stable tendency to experience anxiety and depression. The trait scale of the STAI has been shown to have high convergent validity and test–retest reliability ().  identified two sub-scales of the STAI–T: (a) STAI–D (13 items), which loaded highly on a depression-content trait factor, and (b) STAI–A (seven items), which loaded highly on an anxiety-content trait factor. In the present sample, alphas for the STAI–D and STAI–A were .90 and .71, respectively.

The Symptom Checklist–90–Revised (SCL–90–R; )

A 90-item measure of psychological symptom distress in the past week, with each item rated on a 5-point Likert scale from 0 (not at all) to 4 (extremely). We used the Global Severity Index (GSI), a mean score of all responses, to reflect levels of general symptom distress among husbands. Raw GSI scores of 0.57 or above have been shown to reflect clinically significant symptom distress (). Alpha was .88.

Read More

Baseline Measures for Wives

Anxiety Disorders Interview Schedule for DSM–IV (ADIS–IV; )

The ADIS–IV is a semistructured clinical interview used to assess the presence of current DSM–IV anxiety, mood and substance-use disorders among adults. In this study, anxiety, mood and substance-use modules were administered to determine diagnostic status as well as the presence of comorbid disorders.  reported good to excellent reliability for the diagnosis of a principal anxiety disorder (K = .67–.86). Interviewers were advanced doctoral students trained to the exacting standards specified by . Interviews were audiotaped to avoid observer drift and half of the interviews were randomly selected for rerating by the investigator. Excellent interrater reliability was demonstrated for the Clinician’s Severity Rating associated with the primary diagnosis of an anxiety disorder (intraclass correlation coefficient [ICC] = .87).

 

Couples Interaction Questionnaire (CIQ; )

The CIQ, a measure of anxiety-specific relationship adjustment, inquires about the degree of communication, understanding, and support perceived by wives when they experience anxiety. Total scores range from 0 (poorest relationship adjustment) to 30 (highest relationship adjustment).  reported weak correlations between the CIQ and patient-reported marital happiness, suggesting that this measure captures aspects of relationship adjustment that are distinct from global measures of marital satisfaction. Cronbach’s alpha was .82 in this sample.

Read More

Procedure

Married or cohabiting adults seeking psychotherapy at the clinics listed above were contacted by a research assistant about a study on “relationships and stress.” Students were contacted if they endorsed being married or living with a significant other. All prospective participants were administered a telephone screening interview by a master’s-level clinician to inquire about the presence of anxiety disorder symptoms and to evaluate exclusion criteria. Those who endorsed clinically significant anxiety disorder symptoms in this phone interview were invited to complete a face-to-face diagnostic interview with a master’s-level clinician.

Couples who met study criteria and provided informed consent were given baseline questionnaires and 14 diary reports. Partners were instructed to complete diary reports separately at the end of each day, to refrain from discussing their responses, and to return each report in a prestamped envelope after completion. Compliance was monitored in two ways: (a) Couples were phoned once at the end of each study week to remind them to complete questionnaires separately, give them an opportunity to ask questions, and encourage consistent mailing of reports; (b) on each diary, participants were asked to indicate whether they completed the report on a day other than the one designated on the form. At study completion, couples were debriefed and given $100.00 remuneration.

Of 34 couples (i.e., 68 participants) enrolled, 91.2% (n = 31) of wives and 91.2% (n = 31) of husbands provided 14 daily reports. The mean number of data points provided was 13.8 (range = 12–14; SD = 0.41) for wives and 13.76 (range = 10–14; SD = 0.81) for husbands. Baseline questionnaires were completed by all participants. One couple was eliminated because more than half of their reports were noncompliant (completed on an incorrect day). Eight additional couples had noncompliant reports (M = 2, range = 1–3). Rather than eliminate their data, we omitted from our analyses their noncompliant days (19 total). Our final sample was therefore 33 couples.

Read More

Participants

Our sample consisted of 33 married and/or cohabiting (≥6 months) heterosexual couples in which the female partner met Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM–IV; ) criteria for a principal anxiety disorder. Exclusion criteria included evidence of psychosis, risk of self-harm, partner abuse, alcohol or substance abuse in the last 6 months, an organic mental disorder, or a history of bipolar disorder. Couples were excluded if the diagnosed partner met criteria for a current major depressive episode to minimize the potentially confounding effects of comorbid depression.

Participants were recruited from four sites in the Philadelphia area: (a) the Adult Anxiety Clinic of Temple University (n = 16 couples; 47.1%), (b) the Psychological Services Center of Temple University (n = 7; 20.6%), (c) the Anxiety and Agoraphobia Treatment Center (n = 4; 11.8%), and (d) the Temple University student body (n = 7; 20.6%) during 2004–2005.

The majority of couples (n = 21; 62%) were married (M = 7.6 years, SD = 8.7) or cohabiting for a mean duration of 3.04 years (SD = 2.0). The average age was 33.8 years (SD = 10.3). Participants were predominantly Caucasian (61.8%), with 17.6% identified as African American, 2.9% Hispanic, 8.8% Asian/Asian American, and 8.8% Other. Analysis of variance for age and chi-square analyses for categorical variables revealed site differences in the age of the diagnosed partner, Welch F(3, 10) = 7.30, p < .05, and the frequency of married versus cohabitating and unmarried couples, χ2(3, N = 66) = 19.89, p < .05. None of these variables were significantly related to mean aggregated scores on daily measures of mood or relationship quality or baseline measures of relationship adjustment.

Read More