Couples dealing with multiple sclerosis : a diary study examining the effects of spousal interactions on well-being

Abstract

Living with a chronic progressive disorder such as multiple sclerosis (MS) presents a challenge for both patients and their intimate partners. In addition to addressing the physical disability caused by MS, both patients and their partners must find ways to deal with the uncertainty of the disease's progression, changing role responsibilities and the psychosocial consequences. Being involved in a supportive relationship is believed to play a key role in adjustment to stressful life events such as chronic illness. Ample research has shown that the global perception that support is available when it is needed is related to greater psychological and physical well-being. However, results are less consistent when the effects of actual support or enacted support are studied. Some studies have documented positive effects, whereas others have shown neutral effects, or negative effects. These inconsistent results suggest that the effects of spousal interactions are not the same for each person, or that they depend on other factors that may interact with spousal interactions to determine its effect. This thesis considers daily supportive interactions with the partner among couples dealing with MS. The study is centred around two main issues: (1) The amount of support received and provided by both patients and partners. Interactions with the partners may change when one partner has a chronic illness. Partners are likely to provide more support and help to their partner, and receive less support in return. (2) The costs and benefits of received and provided support for patient's and partner's well-being. Both partners of 61 couples dealing with MS completed diaries for fourteen days and filled out questionnaires prior to completing the diaries and at seven months follow-up. Besides the diary method, other important features of the study were that both patients and partners were examined as receivers and providers of support and that we distinguished between emotional, instrumental and negative interactions. Further, specific attention was given to differences between patients and partners, both in the amount of support that was given and received as well as the relation between supportive interactions and well-being. Additionally, it was examined whether patients and partners perceived their relationship as imbalanced and whether this effected their well-being. It was shown that instrumental interactions between patients and partners were imbalanced; patients reported providing less instrumental support than partners. However, patients and partners provided equal amounts of emotional support. Overall not much support was found for the costs of receiving or providing emotional or instrumental support. In contrast, the results underscribe the importance of emotional support for both patient's and partner's well-being. Additionally, both patients and partners benefited from providing instrumental support. Negative responses received from the partner were negatively related to patient's and partner's end-of-day well-being, however, this effect was not as potent as we expected based on previous studies and this effect was moderated by the receipt of emotional support. Finally, the results showed that when patients were more disabled, patients and partners may perceive their relationship as imbalanced, which has negative consequences for the level of depression of both.