Dyadic Relationship Conflict, Gender, and Mortality in Urban Hemodialysis Patients

Abstract

Abstract. The effects of dyadic satisfaction and conflict have not been well defined in the hemodialysis (HD) population. The aim of this study was to determine whether the perception of decreased dyadic satisfaction was associated with mortality in patients treated with HD, and if so, whether there were different relationships between risk factors, and differential outcomes in men and women. A total of 174 HD patients, primarily African-Americans, involved in dyadic relationships for more than 6 mo had indices of dyadic satisfaction, depression, perception of illness effects, social support, behavioral compliance with the dialysis prescription, and plasma interleukin-1 (IL-1) and β-endorphin levels measured. Cox proportional hazards models assessed relative mortality risks. Patients' dyadic satisfaction scores correlated with β-endorphin levels. There was no correlation of IL-1 or β-endorphin with any psychosocial or behavioral compliance measure in the group as a whole. Correlations between psychosocial, medical, and neuroimmunologic variables were different in men and women. For women, dyadic satisfaction correlated with β-endorphin levels, depression, and perception of illness. Women with higher dyadic satisfaction and decreased dyadic conflict were at decreased mortality risk, but dyadic adjustment indices were unassociated with differential survival in the larger group of men. Correlations between neuroendocrine and immune markers are different in African-American male and female HD patients. Greater dyadic satisfaction and lower dyadic conflict are independently associated with decreased mortality in female African-American HD patients, of the same order of magnitude as medical risk factors. Such effects may be attributable to a relationship between dyadic satisfaction and conflict and health-related behaviors, or through an effect on neuroendocrine or immunologic status.

The relationship among couple relationship quality, physical functioning, and depression in multiple sclerosis patients and partners.

“…Researchers in both cross-sectional and longitudinal studies found higher levels of marital quality to be associated with significantly higher levels of personal well-being, with said association persisting over time (Proulx et al, 2007). In addition, marital quality was shown to be related to survival rates after congestive heart failure and kidney disease (Coyne et al, 2001; Kimmel et al, 2000), and higher marital quality was related to lower biopsychosocial risk factors for cardiovascular disease (Gallo, Troxel, Matthews, & Kuller, 2003). Overall, men and women who report better marital quality also report better health, fewer illness symptoms, and better sleep patterns (Gallo et al, 2003; Prigerson, Maciejewski, & Rosenheck, 1999; Ross, Mirowsky, & Goldsteen, 1990; Thomas, 1995).…”

“…High marital functioning has been shown to improve physical functioning, including survival rates after heart failure (Coyne et al, 2001) and kidney disease (Kimmell et al, 2000), and to enhance cardiovascular, endocrine, and immune system functioning (Kiecolt-Glaser, 2001; Uchino, Cacciopo, & Kiecolt-Glasser, 1996). Research has also shown that wound healing and cytokine production was lower at wound sites and wounds healed more slowly after marital conflicts than during supportive marital interactions (Kiecolt-Glaser et al, 2005).…”

Marital satisfaction and mortality in the United States adult population.

“…However, three of these studies focused on samples with severe, preexisting health conditions. Within these health-compromised samples: (a) marital adjustment predicted odds of survival in congestive heart failure patients (Coyne et al, 2001); (b) marital satisfaction predicted 15-year survival for coronary artery bypass grafting patients (King & Reis, 2012); and (c) greater dyadic satisfaction and lower dyadic conflict were associated with decreased mortality in female (but not male) end-stage renal disease patients (Kimmel et al, 2000). In comparison, two studies of community samples found that marital adjustment was unrelated to mortality (Eaker, Sullivan, Kelly-Hayes, D’Agostino, & Benjamin, 2007; Hibbard & Pope, 1993).…”

Medical family therapy: Reflecting on the necessity of collaborative healthcare research.

“…Several researchers have demonstrated recently that marital quality affects morbidity and mortality rates from varied chronic illnesses (Coyne et al, 2001; Kimmel et al, 2000; Orth-Gomer et al, 2000). Kiecolt et al (1987) examined how spouses' perceptions of marital quality, marital disruption, and immune function were correlated.…”