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A review of the literature searched the various disciplines of nursing, sociology, psychology as well as medicine. The search yielded some conflicting findings. Some findings on couples’ research suggest chronic illness can strengthen a marriage, and a second group found a weakening of marital quality with illness, and a third group found no change in marital quality. Most of the researchers agree that there are a multitude of factors that contribute to adaptation in these marriages with chronic illness present.
One factor that resonated in the couples’ research literature regarding chronic illness was partner support. It appears from numerous studies that partner support and marital quality are positively related. Partner support may enhance the quality of the marital relationship and decrease daily stress when living with chronic illness (Holmes, 2002, Revenson, 2004). Interestingly, there is a growing body of evidence that recognizes partner support as a multidimensional concept, which includes helpful as well as unhelpful support. When partner support is perceived by one’s partner as unhelpful conflict may result which decreases marital quality (Coyne, Thompson & Palmer, 2002; Trief et al, 2003). One less studied dimension of partner support is reciprocity. Although there is surprisingly little research on reciprocity in a marital relationship, this concept has meaning to all of those that live with chronic illness, and experience the ‘give- and -take’ to be one-sided in the relationship.
The Purpose
The purpose of my research study was to better understand how couples adapt to the women’s diabetes by examining the central role of the marital relationship. Sixty- seven couples enrolled in the study from sites in the Philadelphia Metropolitan area. The majority of the couples (55%) were married for over 20 years, with an average age of 56 for the women and 60 years for the men. The couples were predominately African American (45 %) and Caucasian (43%). All couples completed paper and pencil questionnaires measuring marital quality (Dyadic Adjustment Scale, Spanier, 1976) and partner support, conflict and reciprocity (Interpersonal Relationship Inventory Scale (Tilden, Nelson & May, 1990).
Findings:
 Several notable findings emerged from this research. In answer to the question: “Are women and men’s perception of partner support related to marital quality?” the answer is ‘yes’. Partner support was highly correlated with marital quality among the women (r = .84, p<.01) and their male partners (r =.89, p<.01) using Pearson correlations analysis. Indeed this strong correlation means women and men who perceived more partner support had higher levels of marital quality. Partner support has a positive influence on well- being in the lives of married women with diabetes and their male spouses. This significant correlation suggests that partner support lessens the daily stress surrounding issues related to chronic illness or partner support increases marital satisfaction enabling the partners to cope better with the changes incurred by the diabetes (Revenson, 2003). The study significantly found a strong positive correlation between reciprocity and marital quality among the women and men (women, r = .77, p=.01; men r = .73, p = .01), suggesting reciprocity increases marital quality when couples live with diabetes. Reciprocity or “give and take” among these couples maintains marital quality. Not surprising, interpersonal conflict in these marriages arising from ‘unhelpful support’ resulted in a negative association to marital quality. A significant negative relationship between conflict and marital quality among the women with diabetes (r = -.71, p = .01) as well as their male partners (r = -.70, p = .01) was found. The more conflict in the marriage the poorer the marital quality.
The last question asked in this study, “Did the marital quality scores differ among the women and men?”- The answer was ‘no’. Interestingly, previous research studies indicated there may be differences in marital quality among women and men living with chronic illness. However, in this study paired t-test analysis found no statistical difference between the women’s and men’s total scores on marital quality.
An interesting ancillary finding from this study showed the scores on marital quality, measured by the Dyadic Adjustment Scale, were equivalent to scores among couples who had ‘acceptable’ quality of marriage, as published by Spanier (1976) using this instrument.
In conclusion, a major finding in this study is the strong positive relationship among both the women and the men, regarding partner support and marital quality as well as the strong positive relationship of reciprocity to marital quality and the significant negative consequences of conflict to marital quality. However, more research is needed before assuredly concluding whether less or more marital conflict occurs in marriages where women have diabetes. The women with diabetes and their partners’ scores were not statistically different suggesting that these couples agree on their perceptions about marital quality. Clearly, this acceptable level of marital quality result suggests couples living with diabetes can be reasonably satisfied with marriages. However, other variables such as severity of the diabetes as well as knowledge of diabetes must be studied to better understand marital quality while living with diabetes.
Themes emerging from this research can be clinically important. I encourage health providers, including nurses, physicians, social workers, psychologist and psychiatrist to take the time to include both spouses in their office visits when diabetes occurs, and ask about partner support. Practitioners should encourage dialogue between women and men living with diabetes, and consider partner support an important aspect of marital quality when living with diabetes to decrease stress. The challenge is to continue the needed research in this area to uncover the specific types of support that are most helpful in couples’ lives in order to maintain marital quality.
references:
Coyne, J.C., Thompson, R., & Palmer, S.C. (2002). Marital quality, coping with conflict, marital complaints and affection in couples with a depressed wife. Journal of Family Psychology, 8(1): 43-54.
Lazarus, R.S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer Publishing Company.
Homes, J.G. (2002). Interpersonal expectations as the building blocks of social cognition: an interdependence theory perspective. Personal Relationships, 9, 1-26.
Revenson, T.A. (2004). Social support and marital coping with chronic illness. Annals of Behavioral Medicine, 16, 1122-1130.
Roy, C. (1976). An introduction to nursing: An adaptation model. Englewood Cliffs, NJ: Prentice Hall.
Spanier, B. (1989). Manual for the dyadic adjustment scale. North Tonawanda, NY: Multi-Health Systems.
Tilden, V., Nelson, C.A., & May, A.(1990). The interpersonal relationship inventory: Development and psychometric characteristics. Nursing Research, 39, 339-343.
Trief, P.M., Sandberg ,J., Greenberg, R.P., Graff, K., Castronova, N., Yoon, M., et al. (2003). Describing support: A qualitative study of couples living with diabetes. Families, Systems & Health, 21, 57-67.
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