Indiana University Simon Cancer Center.
J Fam Psychol. 2013 Oct;27(5):702-11. doi: 10.1037/a0033871. Epub 2013 Aug 19.
General systems theory and Bodenmann's theory of dyadic coping (Bodenmann, 1997) provided the framework for exploring the impact of life-threatening illness on the dyadic relationship. The sample included 193 dyads experiencing the stress of treatment by bone-marrow transplantation (BMT) for cancer which had not responded to first-line therapies. A prospective design over 12 months included four measurements at designated periods in the treatment process. Except for the symptom checklist, which was completed only by the recipient, data were obtained on each measure from both partners at each time point. The primary outcome was dyadic adjustment measured by the Dyadic Adjustment Scale (DAS; Spanier, 1976). A general linear mixed model indicated that dyadic adjustment was stable over time for BMT recipients and family caregivers; however, caregivers had lower mean values on dyadic adjustment than recipients, and higher mean values on negative affect. Bayesian path analysis was used to test actor-partner interdependence models reflecting the theory of dyadic coping. Models exhibited adequate fit to the data and indicated that apart from baseline dyadic adjustment, partner-related coping had the greatest positive impact on dyadic adjustment over the trajectory for both recipients and their caregivers. Limitations in resources for health care occurring on a national level have increased the extent of in-home care for acutely ill family members, including BMT recipients. This has serious implications for the mental health of the caregiver and for the integrity of the family system. Mental health assessment and integration of supportive interventions would be important in the prevention of secondary psychosocial morbidity.
一般系统理论和 Bodenmann 的对偶应对理论（Bodenmann，1997）为探索威胁生命的疾病对对偶关系的影响提供了框架。样本包括 193 对夫妇，他们在经历癌症骨髓移植（BMT）治疗的压力时，这些夫妇对一线治疗没有反应。一个为期 12 个月的前瞻性设计包括在治疗过程中指定的四个时间点进行四次测量。除了仅由接受者完成的症状清单外，在每个时间点都从每个伴侣那里获得了每个测量的信息。主要结果是由对偶调整量表（DAS；Spanier，1976）测量的对偶调整。一般线性混合模型表明，BMT 接受者和家庭照顾者的对偶调整随时间稳定；然而，照顾者的对偶调整平均值低于接受者，而消极影响的平均值较高。贝叶斯路径分析用于测试反映对偶应对理论的演员-伙伴相互依存模型。模型表现出对数据的良好拟合，并表明除了基线对偶调整外，伴侣相关应对对接受者及其照顾者的对偶调整轨迹具有最大的积极影响。国家一级医疗资源的限制增加了对急性病家庭成员（包括 BMT 接受者）的家庭护理程度。这对照顾者的心理健康和家庭系统的完整性有严重影响。心理健康评估和支持性干预的整合对于预防继发性心理社会发病率很重要。
