Influencing Factors Of Dyadic Coping,and The Role Of Dyadic Coping On The Marriage Quality Of Young And Middle-aged Lymphoma Patients And Their Spouses

ObjectiveThe aim of this study is to investigate the status of dyadic coping and marital quality of young and middle-aged lymphoma patients and their spouses,explore the influencing factors of dyadic coping,and employed the Actor-Partner Interdependence Model(APIM)to analyze the role of dyadic coping in marital quality.In order to discover the positive factors that promote the adaptation of couples,interviews with young lymphoma patients and their spouses are carried out,so as to provide a basis for relevant interventions.MethodsThis study consists of two parts.In the first part,a quantitative study was conducted to investigate the influencing factors of dyadic coping,and understand the role of dyadic coping in the marriage quality of young and middle-aged lymphoma patients and their spouses.243 couples were included in our study from March 2019 to October 2019.The patients were investigated by general information questionnaire,Dyadic Coping Inventory,Strategies Used by People Promote Health,Fear of Progression Questionnaire-Short Form and Locke-Wallace Marital Adjustment Scale.The spouses of patients were investigated by general information questionnaire,Dyadic Coping Inventory,General Self-Efficacy Scale,Hospital Anxiety and Depression Scale and Locke-Wallace Marital Adjustment Scale.Spearman correlation analysis,one-way ANOVA,multiple linear regression analysis were performed by IBM SPSS Statistics 21.0.AMOS 23.0 was used to construct the Actor-Partner Interdependence Model(APIM)to analyze the actor and partner effect among variables.The Process program was used to analyze the mediating effects of dyadic coping among young and middle-aged lymphoma patients and their spouses on the quality of marriage.In the second part,qualitative research was conducted to understand the dyadic coping experience of young and middle-aged lymphoma patients and their spouses.We interviewed 12 couples to have an in-depth understanding of the couple's coping experience and explore the positive factors promoting the couple's disease adaptation.ResultsResults of the first part.(1)The total scores of dyadic coping in young and middle-aged lymphoma patients and spouses were(123.72±12.215)and(120.52±13.431)respectively,total score of marriage quality were(110.08±18.707)and(107.85±19.951)respectively.(2)Actor-partner interdependence model showed that the model fit indice?2=17.106,P=0.194,GFI=0.992,RMSEA=0.036.For both patients and caregivers,self-efficacy were associated with dyadic coping in themselves(actor effects)and in their spouses(partner effects).Fear of disease progression in patients were associated with dyadic coping in themselves(actor effects),but no significant partner efects were found for dyadic coping in spouses.Anxiety in spouses were associated with dyadic coping in themselves(actor effects),but no significant partner effects were found for dyadic coping in patients.For both patients and caregivers,dyadic coping in individuals were associated with marriage quality in themselves(actor effects)as well as their spouses(partner effects).(3)Mediation effect analysis by Process showed that for both patients and caregivers,dyadic coping mediated impact of self-efficacy on marriage quality in both themselves(actor effects)and in their spouses(partner effects).Dyadic coping of patients mediated impact of Fear of disease progression on marriage quality in themselves(actor effects),but no significant mediated effects were found in spouses.Dyadic coping of spouses mediated impact of anxiety on marriage quality in themselves(actor effects),but no significant mediated effects were found in patients.(4)Multiple regression showed that the patient' self-management effectiveness(B=0.245,P<0.001),fear of disease progression(B=0.245,P<0.001),family monthly income(B=2.430,P<0.001)and duration of disease(B=1.635,P=0.003)are influencing factors of patients' dyadic coping;the spouse' self-efficacy(B=0.540,P<0.001),anxiety(B=-0.902,P<0.001)and gender(B=-3.116,P=0.040)are the factors that influencing the dyadic coping of spouse.Results of the second part:the qualitative research found that the young and middle-aged patients with lymphoma and their spouses faced many challenges during the disease:traumatic stress response,disorder of role adjustment,family financial stress,demands of disease information and so on.Couples may make cognitive behavioral adjustment by the ways such as positive mental quality,social comparison,mutual support and understanding,rethinking couple relationship,seek social support and change communication mode.Conclusion(1)The dyadic coping and marital quality of young and middle-aged lymphoma patients and their spouses are at a medium level,which needs to be further improved.The improvement of individual dyadic coping may help improve the marital quality of themselves(actor effect)and their spouses(partner effect).(2)For both patients and spouses,dyadic coping mediated impact of self-efficacy and negative emotion on marriage quality in both themselves(actor effects)and in their spouses(partner effects)in varying degrees.(3)Patient' self-management effectiveness,fear of disease progression,family monthly income and duration of disease are the factors that influencing the dyadic coping of patients;the spouse' self-efficacy,anxiety and gender are the factors that influencing the dyadic coping of spouse.Therefore,attention should be paid to dyadic strategies such as communication,support and so on.And develop intervention from the improvement of self-efficacy and negative emotion of both patients and spouses.(4)The young and middle-aged patients with lymphoma and their spouses faced many challenges during the course of disease.Dyadic coping adjustment approaches such as positive mental quality social comparison,mutual support and understanding,rethinking couple relationship,and change communication mode may promote couples' disease adaptation.