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Abstract
Guided by the theory of dyadic illness management, this study examined the association between the within-couple incongruence regarding perceptions of pain experienced by adults with fibromyalgia (AwFM) and symptoms of depression and anxiety in AwFM and their partners. Participants included 204 couples. Three second-order dyadic variables were created from the couples' perceptions of pain interference experienced by AwFM: (1) absolute magnitude of incongruence in perception of pain, (2) average perception of pain, and (3) direction of incongruence (i.e., who perceives pain to be higher). Structural equational modeling was used to examine the association between the three dyadic variables and AwFM and partner symptoms of depression and anxiety, adjusting for covariates. These steps were repeated for pain severity. Higher average perception of pain interference within the couple was associated with greater symptoms of depression and anxiety in AwFM and partners. AwFM exhibited greater symptoms of depression when their perception of their pain interference was higher than their partner's. Incongruence variables were not significantly associated with AwFM or partners' anxiety symptoms. Near identical results were found for pain severity. A dyadic approach to mental health treatment, which includes enhanced communication skills, should be adopted to optimize the mental health of couples living with fibromyalgia.

Over the past two decades, there has been movement toward a dyadic perspective of the illness experience. Although multilevel models have led to great insights into how dyads are affected by illness as family units, these models are still underutilized for understanding incongruent illness appraisals. Such incongruent appraisals can have implications for how the dyad collaborates to manage illness, the health of the dyad, and clinical outcomes. The focus of this article is to describe and promote the application of multilevel models to longitudinal dyadic data to understand incongruent illness appraisals over time. In particular, we present a data exemplar so researchers can apply these models to their own data and clinical questions to understand the ways care dyads converge and diverge in their appraisals and determine factors associated with such variability. We comment on the implications and extensions of these models for family nursing research and practice.

The study examined the association between changes in dyadic symptom appraisal with changes in physical and mental health of 109 family care dyads living with lung cancer over 12 months. Multilevel modeling was used to analyze both aggregate and time-varying associations of dyadic symptom appraisal with dyadic health. Patients had significantly worse physical health compared with their care partner; care partners had significantly worse mental health compared with patients. In general, greater incongruent symptom appraisals were significantly associated with worse physical health for both patients and care partners. Importantly, increases in magnitude of incongruence regarding the patient's pain interference were significantly associated with declines in patient physical health over time. Direction of the incongruence was associated with mental health. Findings highlight the need for both a longitudinal and dyadic perspective of symptom appraisal to move toward theoretically driven interventions that will optimize the health of both patients and their care partners.

Given the high symptom burden and low survivability of lung cancer, patients and their spouses have been found to experience poor mental health. The current study examined the roles of dyadic appraisal and dyadic coping on the mental health of 78 couples living with non-small cell lung cancer. Multilevel modeling revealed that spouses, on average, reported significantly worse mental health than patients. Dyadic appraisal and dyadic coping played important roles in predicting mental health, controlling for known developmental and contextual covariates. Dyadic appraisal of the patient's pain and fatigue was significantly associated with spouse mental health, albeit in opposite directions. Dyadic coping significantly predicted patient mental health. The study underlines the need to incorporate routine screening of both patient and spouse mental health, and highlights the complex role of appraisal within the couple in a life-threatening context. Viewing the couple as a unit, rather than separate individuals, raises important awareness about the role of disparate illness appraisals and coping strategies within the dyad on the health of both members. Nurses are particularly well situated to engage in a collaborative family-focused approach to the couple with cancer that promotes communication and health.

More than 60 million Americans provide care to a family member; roughly two thirds are women providing care to aging mothers. Despite the protective nature of relationship quality, little attention has been given to its role in mother–daughter care dyads, particularly in mothers without cognitive impairment. A systematic appraisal of peer-reviewed, English language research was conducted. Nineteen articles met criteria. When relationship quality is positive, mother–daughter dyads enjoy rewards and mutuality, even when conflict occurs. Daughters grow more emotionally committed to mothers' over the care trajectory, despite increasing demands. Daughters' commitment deepens as mothers physically decline, and mothers remain engaged, emotional partners. When relationship quality is ambivalent or negative, burden, conflict, and blame conspire, creating a destructive cycle. Avenues for continuing study, including utilizing the dyad as the unit of analysis, troubled dyads, longitudinal assessment, and end of life context, are needed before interventions to improve mother–daughter relationship quality may be successfully implemented.

Purpose: A strong interpersonal relationship after stroke is important for the prevention of depression in survivors and family caregivers. This study aimed to test the feasibility of quality of relationship intervention for stroke dyads called Hand in Hand (HiH). Methods: Sixteen dyads were randomized into either the HiH group ( n = 8) or information, support, and referral (ISR) control group ( n = 8). HiH dyads received up to eight sessions, with topics prioritized according to a 17-item screening tool. ISR dyads received up to eight sessions that included information, active listening, and referrals. Feasibility, acceptability, and outcomes data were collected for both groups. Results: The HiH and ISR groups were feasible and acceptable. Caregivers in both groups, as well as survivors in the ISR group, experienced improvements in depressive symptoms and other select outcomes. Conclusions: Findings suggest that HiH is feasible to implement with stroke dyads and that it merits further refinement and testing.