Relationship Distress in Couples With and Without Reported Existing Cardiovascular Risk Factors: Making a Case for Relationship Education (RE)

Abstract

Cardiovascular disease (CVD) is the leading cause of death in the United States, costing billions of dollars per year in direct and indirect costs, and its prevalence is projected to increase exponentially over the next 15 years. Additionally, low-income and ethnic minority populations are especially at risk for CVD and CVD-related adverse health outcomes. This study aimed to examine the influence of a 12-hr, evidence-based relationship education (RE) program, Within Our Reach (WOR), on relational distress and satisfaction in participants with and without CVD risk factors. Findings indicated that participants significantly improved in their relationship satisfaction following the RE intervention with the female group improving in their relationship satisfaction at an amount significantly greater than the male group. However, no differences were found between CVD risk factor group and non-CVD risk factor group on their relationship satisfaction either before or after the RE intervention. Clinical implications and future directions for research in this area are also discussed.

Keywords

relationship education cardiovascular risk distress

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References

Angeles

Somers

S. A.

(2007). From policy to action: Addressing racial and ethnic disparities at the ground-level. Center for Health Care Strategies.

Black

P. H.

Garbutt

L. D.

(2002). Stress, inflammation and cardiovascular disease. Journal of Psychosomatic Research, 52, 1–23. https://doi.org/10.1016/S0022-3999(01)00302-6

Blanchard

V. L.

Hawkins

A. J.

Baldwin

S. A.

Fawcett

E. B.

(2009). Investigating the effects of marriage and relationship education on couples’ communication skills: A meta-analytic study. Journal of Family Psychology, 23, 203–214. https://doi.org/10.1037/a0015211

Carlson

R. G.

Barden

S. M.

Daire

A. P.

Greene

(2014). Influence of relationship education on relationship satisfaction for low-income couples. Journal of Counseling & Development, 92, 418–427. https://doi.org/10.1002/j.1556-6676.2014.00168.x

Carlson

R. G.

Daire

A. P.

Bai

(2014). Examining relationship satisfaction and individual distress for low-to-moderate income couples in relationship education. The Family Journal: Counseling and Therapy for Couples and Families, 22, 282–291. https://doi.org/10.1177/1066480714529741

Carlson

R. G.

Fripp

Munyon

M. D.

Daire

Johnson

J. M.

DeLorenzi

(2014). Examining passive and active recruitment methods for low-income couples in relationship education. Marriage & Family Review, 50, 76–91. https://doi.org/10.1080/01494929.2013.851055

Charles

Orthner

D. K.

Jones

Mancini

(2006). Poverty and couple relationships. Marriage & Family Review, 39, 27–52. https://doi.org/10.1300/J002v39n01_03

Chida

Steptoe

(2009). The association of anger and hostility with future coronary heart disease. Journal of the American College of Cardiology, 53, 936–946. https://doi.org/10.1016/j.jacc.2008.11.044

Cohen

B. E.

Edmondson

Kronish

I. M.

(2015). State of the art review: Depression, stress, anxiety, and cardiovascular disease. American Journal of Hypertension, 28, 1295–1302. https://doi.org/10.1093/ajh/hpv047

10.

Cook

R. D.

Weisberg

(1982). Residuals and influence in regression. Chapman and Hall. University of Minnesota Digital Conservancy. http://hdl.hanle.net/11299/37076

11.

Coulter

S. A.

(2011). Epidemiology of cardiovascular disease in women: Risk, advances, and alarms. Texas Heart Institute Journal, 38, 145.

12.

Crimmins

E. M.

Hayward

M. D.

Seeman

T. E.

(2004). Race/ethnicity, socioeconomic status, and health. In Anderson

N. B.

Bulatao

R. A.

Cohen

(Eds.), Critical perspectives on racial and ethnic differences in health in late life (pp. 310–352). The National Academies Press.

13.

Curtis

B. M.

O’Keefe

J. H.

(2002, January). Autonomic tone as a cardiovascular risk factor: The dangers of chronic fight or flight. In Mayo Clinic Proceedings (Vol. 77, pp. 45–54). Elsevier. https://doi.org/10.4065/77.1.45

14.

Fincham

F. D.

Stanley

S. M.

Beach

S. R.

(2007). Transformative processes in marriage: An analysis of emerging trends. Journal of Marriage and Family, 69, 275–292. https://doi.org/10.1111/j.1741-3737.2007.00362.x

15.

Ford

Anderson

Gillespie

Giurgescu

Nolan

Nowak

Williams

K. P.

(2019). Social integration and quality of social relationships as protective factors for inflammation in a nationally representative sample of black women. Journal of Urban Health, 96, 35–43. https://doi.org/10.1007/s11524-018-00337-x

16.

Graham

J. W.

Hofer

S. M.

Donaldson

S. I.

MacKinnon

D. P.

Schafer

J. L.

(1997). Analysis with missing data in prevention research. In Bryant

Windle

West

(Eds.), The science of prevention: Methodological advances from alcohol and substance abuse research (pp. 325–366). American Psychological Association.

17.

Graham

J. W.

Schafer

J. L.

(1999). On the performance of multiple imputation for multivariate data with small sample size. In Hoyle

(Ed.), Statistical strategies for small sample research (pp. 1–29). Sage.

18.

Hawkins

A. J.

Blanchard

V. L.

Baldwin

S. A.

Fawcett

E. B.

(2008). Does marriage and relationship education work? A meta-analytic study. Journal of Consulting and Clinical Psychology, 76, 723–734. https://doi.org/10.1037/a0012584

19.

Hawkins

A. J.

Erickson

S. E.

(2015). Is couple and relationship education effective for lower income participants? A meta-analytic study. Journal of Family Psychology, 29, 59–68. https://doi.org/10.1037/fam0000114

20.

Heidenreich

P. A.

Trogdon

J. G.

Khavjou

O. A.

Butler

Dracup

Ezekowitz

M. D.

Finkelstein

E. A.

Hong

Johnston

S. C.

Khera

Lloyd-Jones

D. M.

Nelson

S. A.

Nichol

Orenstein

Wilson

P. W.

Woo

Y. J

. (2011). Forecasting the future of cardiovascular disease in the United States a policy statement from the American heart association. Circulation, 123, 933–944. https://doi.org/10.1161/CIR.0b013e31820a55f5

21.

Hendrick

S. S.

(1988). A generic measure of relationship satisfaction. Journal of Marriage and the Family, 50, 93–98. https://doi.org/10.2307/352430

22.

Hendrick

S. S.

Dicke

Hendrick

(1998). The relationship assessment scale. Journal of Social and Personal Relationships, 15, 137–142. https://doi.org/10.1177/0265407598151009

23.

Hill

M. A.

(1997). SPSS missing value analysis 7.5. SPSS.

24.

Humphries

K. H.

Izadnegadar

Sedlak

Saw

Johnston

Schenck-Gustafsson

Shah

R. U.

Regitz-Zagrosek

Grewal

Vaccarino

Wei

& Bairey Merz

C. N.

(2017). Sex differences in cardiovascular disease—Impact on care and outcomes. Frontiers in Neuroendocrinology, 46, 46–70. https://doi.org/10.1016/j.yfrne.2017.04.001

25.

Jemal

Ward

Anderson

R. N.

Murray

Thun

M. J.

(2008). Widening of socioeconomic inequalities in U.S. death rates, 1993-2001. PLoS One, 3, 1–8. https://doi.org/10.1371/journal.pone.0002181

26.

Jolly

Vittinghoff

Chattopadhyay

Bibbins-Domingo

(2010). Higher cardiovascular disease prevalence and mortality among younger blacks compared to whites. American Journal of Medicine, 123, 811–818. https://doi.org/10.1016/j.amjmed.2010.04.020

27.

Kenny

D. A.

Kashy

D. A.

Cook

W. L.

(2006). Dyadic data analyses. Guilford Press.

28.

Kiecolt-Glaser

J. K.

Newton

T. L.

(2001). Marriage and health: His and hers. Psychological Bulletin, 127, 472. https://doi.org/10.1037/0033-2909.127.4.472

29.

Kivimäki

Steptoe

(2017). Effects of stress on the development and progression of cardiovascular disease. Nature Reviews Cardiology, 15, 215–229. https://doi.org/10.1038/nrcardio.2017.189

30.

Mayou

R. A.

Gill

Thompson

D. R.

Day

Hicks

Volmink

Neil

(2000). Depression and anxiety as predictors of outcome after myocardial infarction. Psychosomatic Medicine, 62, 212–219.

31.

Mensah

G. A.

Mokdad

A. H.

Ford

E. S.

Greenlund

K. J.

Croft

J. B.

(2005). State of disparities in cardiovascular health in the United States. Circulation, 111, 1233–1241. https://doi.org/10.1161/01.CIR.0000158136.76824.04

32.

Moore

K. A.

Kinghorn

Bandy

(2011). Parental relationship quality and child outcomes across subgroups. Child Trends Research Brief, publication 2011-13. https://www.childtrends.org/wp-content/uploads/2011/04/Child_Trends-2011_04_04_RB_MaritalHappiness.pdf

33.

Orth-Gomér

(2009). Are social relations less health protective in women than in men? Social relations, gender, and cardiovascular health. Journal of Social and Personal Relationships, 26, 63–71. https://doi.org/10.1177/0265407509105522

34.

Orth-Gomér

Wamala

S. P.

Horsten

Schenck-Gustafsson

Schneiderman

Mittleman

M. A.

(2000). Marital stress worsens prognosis in women with coronary heart disease: The Stockholm Female Coronary Risk Study. Journal of the American Medical Association, 284, 3008–3014. https://doi.org/10.1001/jama.284.23.3008

35.

Pearson

Stanley

S. M.

Rhoades

G. K.

(2008). Within my reach. PREP for Individual.

36.

Robles

T. F.

Kiecolt-Glaser

J. K.

(2003). The physiology of marriage: Pathways to health. Physiology & Behavior, 79, 409–416. https://doi.org/10.1016/S0031-9384(03)00160-4

37.

Schafer

J. L.

Graham

J. W.

(2002). Missing data: Our view of the state of the art. Psychological Methods, 7, 147–177. https://doi.org/10.1037/1082-989X.7.2.147

38.

Spanier

G. B.

(1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and the Family, 38, 15–28. https://doi.org/10.2307/350547

39.

Stanley

Blumberg

Markman

(1999). Helping couples fight for their marriages: The PREP approach. In Berger

Hannah

(Eds.), Handbook of preventative approaches in couple therapy (pp. 279–303). Brunner/Mazel.

40.

Stanley

S. M.

Markman

H. J.

Jenkins

N. H.

Rhoades

G. K.

Noll

Ramos

L. D.

(2008). Within our reach instructor manual. PREP Educational Products.

41.

Tabachnick

B. G.

Fidell

L. S.

(2013). Using multivariate statistics (6th ed.). Pearson.

42.

Wayman

J. C.

(2003). Multiple imputation for missing data: What is it and how can I use it. Annual Meeting of the American Educational Research Association, Chicago, IL. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.519.4667&rep=rep1&type=pdf