Behavioural Science Section / Dyadic Interrelations in Lifespan
Development and Aging: How Does 1 + 1 Make a Couple?
Published online: July 8, 2010
Gerontology 2011;57:167–172
DOI: 10.1159/000318642
Affect Covariation in Marital Couples
Dealing with Stressors Surrounding
Prostate Cancer
Cynthia A. Berg a Deborah J. Wiebe b Jonathan Butner a a
Department of Psychology, University of Utah, Salt Lake City, Utah, and b Division of Psychology, Department of
Psychiatry, University of Texas Southwestern Medical Center, Dallas, Tex., USA
Key Words
Marital couples ⴢ Dyadic coping ⴢ Affect covariation ⴢ
Diary methods ⴢ Older couples ⴢ Prostate cancer
Abstract
Background: Consistent with a dyadic perspective to coping with chronic illness, couples may experience covariation
in their daily affective experiences, particularly as they deal
with stressful events surrounding chronic illness, such as
prostate cancer. Objective: Our purpose was to examine the
daily covariation of negative and positive affect among husbands and wives and whether this covariation was enhanced
when couples mentioned the same stressful event and reported frequently collaborating. Methods: Fifty-nine husbands diagnosed as having prostate cancer and their wives
participated in a daily diary where they reported on the most
stressful event of the day, positive and negative affect, coping strategies and whether their spouse was involved in a
collaborative manner. Coders independently made judgments as to whether the stressful event mentioned by husbands and wives was the same. Results: Multivariate hierarchical linear models revealed that on days when wives experienced greater negative affect, husbands did so as well.
However, negative affect covariation was only found when
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spouses mentioned the same daily stressful event. The mean
levels of collaborative coping across the 14 days moderated
this negative covariation effect for wives, such that negative
affect covariation was enhanced when wives reported collaborating more frequently. Positive affect covariation was
not found. Conclusion: The results reveal that negative affect covariation may be most likely when spouses experience similar stressors and wives perceive frequently collaborating. Partners within close relationships experience similar
negative affect as their spouse, pointing to the shared nature
of illness in late life.
Copyright © 2010 S. Karger AG, Basel
Older adulthood is marked by the increased incidence of chronic illnesses [1] that have consequences for
affective well-being [2]. Chronic illnesses may not only
influence the affective experience of those with illness,
but within the marriage also their spouses, who may
share the illness experience [3, 4]. Evidence for covariation in negative affect can be found in the literature. For
example, the depressive symptoms of elders experiencing illness such as vision loss, end-stage renal disease
and arthritis are associated with the spouse’s depressive
symptoms measured at one point in time [5], across
Cynthia A. Berg
Department of Psychology, University of Utah
380 S. 1530 E.
Salt Lake City, UT 84112 (USA)
Tel. +1 801 581 5380, Fax +1 801 581 5841, E-Mail cynthia.berg @ psych.utah.edu
multiple points in time and also change at similar rates
over time [6, 7]. However, the meta-analysis by Hagedoorn et al. [8] suggests that negative affect covariation
among spouses with cancer is modest, with large heterogeneity, indicating that there may be moderators of affect covariation.
The affective experience of spouses may also covary
on a more daily basis as individuals cope with stressors
surrounding illness. That is, spouses may covary in their
day-to-day increases or decreases in negative and positive
affect [9]. Such covariation may be indicative of emotional contagion or emotional transmission as one spouse’s
affective experience spills over to the other spouse’s experience by virtue of their close proximity [10, 11]. In couples experiencing an illness like prostate cancer, affective
covariation may reflect their shared experience of daily
stressful events and their engagement in coping with
those events. Prostate cancer and its treatment involves
numerous stressful events (e.g. incontinence and impotence) that affect not only the patient but the spouse as
well [12]. Daily affective covariation may be especially salient as spouses report similar stressful events on a daily
basis and engage in collaborative attempts to cope with
the stressful event.
We examined whether affect covariation might be enhanced when couples work closely together surrounding
daily stressful events. On a daily basis, spouses may experience similar stressful events and these events may
create a context whereby spouses work collaboratively in
coping with the event. Within the dyadic coping literature, collaborative coping entails active discussions about
both problem solving and emotions and anxieties relevant to stressful events [3, 13], and as such may be associated with greater negative affect covariation. Couples
who collaborate frequently may experience more affective covariation in both positive and negative affect as
they have more opportunities for transmission or contagion to occur.
The present study had 2 aims: (1) to examine the daily
affect covariation in negative and positive affect in couples as they dealt with daily stressors surrounding prostate cancer and (2) to examine whether affect covariation
was enhanced when couples mentioned the same daily
stressor and reported collaborating on a frequent basis.
We predicted that affect covariation would occur for both
negative and positive affect and that negative affect covariation would be higher in couples who report the same
daily stressor and who collaborate frequently to deal with
stressful events.
168
Gerontology 2011;57:167–172
Methods
Participants
Fifty-nine men diagnosed as having localized prostate cancer
(stage I) and their spouses participated in the study. The men were
40–84 years of age [M = 67.56, standard deviation (SD) = 9.16] and
were largely in long-term marriages (M = 38.4, SD = 13.7, range =
1–59 years). The participants were mostly Caucasian (94.7%), retired (67.8% men, 78% women) and had some education beyond
high school (82.8% men; 64.4% women). The wives were 38–80
years of age (M = 64.8, SD = 9.2). Out of 102 eligible men approached, 73 (72% of the eligible pool) initially agreed to participate, but 59 completed all components of the study. Nine couples
withdrew before any data collection, and another 5 withdrew after completing the baseline questionnaires. The participants most
frequently mentioned an illness in the family as a reason for not
completing the study.
Men and their wives were recruited from oncology, radiation
therapy and surgical clinics (93%), and through prostate cancer
support group publications (7%). Couples were eligible if the husband had been diagnosed as having localized prostate cancer (i.e.
cancer had not spread beyond the prostate gland) and was in the
process of making a decision about 1 or more phases of treatment;
89% of the participants were recruited during treatment consultations. The average number of days since diagnosis of prostate cancer was 83.4 (range = 1–498, SD = 106), with 90% recruited within 6 months of diagnosis. (See [13] regarding additional details
concerning sample characteristics.) Individuals were excluded if
they had a history of cancer other than skin cancer, did not speak
English and did not have a significant other.
Procedure
The study consisted of 3 components. First, husbands and
wives were asked to complete take-home packets separately. Second, approximately 1–2 weeks after initial recruitment, a 1.5hour in-home session occurred where take-home packets were
collected and reviewed and other measures not relevant to the
present paper were completed. Third, the couples completed paper diaries individually for 14 consecutive days, implementing
the following procedures that limit the shortcomings of paper
diaries [14]. The couples were called on days 1, 3, 5, 7, 9, 11 and
13 during the daily diary component of the study as a reminder
to complete their diaries and ask if they had any questions or
concerns. The participants returned each individual diary separately in self-addressed stamped envelopes, which were reviewed
by research assistants for postmarked dates and missing data.
The couples received USD 38 for completing the questionnaires
and home interview, and USD 112 for completing the entire diary.
Measures
Background Information. The participants separately provided background information (73% of the men and 78% of the women reported 2 or more medical conditions).
Diary. The daily paper diary assessed aspects of dyadic coping (see [13] for more details). At the end of each day the husbands and wives first described the most bothersome event of the
day dealing with prostate cancer. If the participants did not have
a bothersome event dealing with prostate cancer, they reported
the most bothersome event of the day. The participants then rat-
Berg /Wiebe /Butner
ed the extent to which the stressful event was due to prostate cancer on a scale of 1 = not at all to 7 = completely (M = 3.81, SD =
1.89 for husbands, M = 2.97, SD = 1.53 for wives). Fifty-six percent of husbands’ stressors and 47.1% of wives’ stressors dealt
with prostate cancer to some degree (rated 2 or above on whether the event was due to prostate cancer [13]). All stressors were
used in the present analyses to maximize the available number
of days for analysis. The participants were also asked to rate on
a 7-point scale (1 = minor annoyance to 7 = stress you would feel
upon the death of a friend or family member) how stressful the
event was (M = 3.65, SD = 1.42 for husbands, M = 3.76, SD = 1.45
for wives).
To assess whether the couples were congruent in mentioning
the same stressful events, 2 coders independently made judgments as to whether the stressful event mentioned by husbands
and wives was the same (0 = not congruent, 1 = congruent). On
average the couples were coded as mentioning the same stressful
event on 27% of the days (SD = 22). Reliability was established on
20% of the couples and the coders achieved 83% agreement.
To assess daily collaborative coping strategies, the participants
were asked to list 3 things that they thought, did or felt to deal with
the event and indicated whether their spouse was ‘not involved’,
‘supportive’ (gave advice, listened, changed his/her plans on account of me), ‘worked together’ (worked as a team, negotiated) or
‘took charge’ (told me what to do, controlled my actions) for each
coping strategy. Collaborative coping was indexed by computing
the proportion of strategies categorized as ‘worked together’
(number of coping responses categorized as collaborative out of
3) each day and then averaging across all days of the diary (for
husbands M = 0.22, SD = 0.19; for wives M = 0.30, SD = 0.21). To
assess daily positive and negative affect, individuals completed
the 20-item Positive and Negative Affect Scale [15], rating emotions on a scale of 1 = not at all to 5 = extremely. The sum across
positive affect items reported on a daily basis (M = 28.9, SD = 7.03
for husbands and M = 27.66, SD = 6.46 for wives) was greater than
total negative affect (M = 16.4, SD = 5.48 for husbands and M =
19.5, SD = 5.98 for wives).
Two couples had an unacceptably low number of consecutive
days (2 and 0) on which both husbands and wives reported diary
data and were removed from the analyses. Twenty-nine couples
completed all 14 diary entries on the same consecutive days. Fiftyseven couples had data for 4 or more days with the analyses reported based on an average of 10.5 days for both husbands and
wives. We utilized a hierarchical linear model, which interpolates
the missing data under the assumption that it is missing at random [16] (see [13] for details).
Statistical Analysis
The diary design provided up to 14 daily reports of positive
and negative affect separately from the husband and wife. To assess the relation between husbands’ and wives’ affect and whether daily congruence in stressful events and overall perceived collaboration moderated these dependencies, hierarchical linear
models with application to matched pairs were used ([17, 18],
HMLM2 [19]). These analyses simultaneously estimated models
for husbands and wives (see [3]).
The level 1 equation generates a pair of simultaneous analyses
for the husband and wife, predicting their own affect from their
partner’s daily affect (group centered), congruence between husband and wife in mention of stressful event and the interaction
Affect Covariation in Marital Couples
Dealing with Prostate Cancer
of affect and congruence. The level 2 equation then utilized the
person’s perceived collaboration across the 14 days of the diary as
a predictor of the covariation effect for both husbands and wives.
Lastly, we allowed for different residuals for husbands and wives.
Initial analyses were conducted to examine whether affect covariation was moderated by participant age, no significant effects
were found for either husband age or wife age in negative or positive affect covariation (all p values 1 0.10) and thus age was not
included in additional models. In addition to these concurrent
same-day analyses, we also tested for lagged effects (i.e. whether
affect of spouse A on day t predicted the affect of spouse B on day
t + 1 controlling for spouse B’s affect on day t). However, no
lagged associations were found (p 1 0.30) and thus are not reported.
Results
Negative Affect Covariation, Congruence in Stressful
Events and Collaborative Coping
In the primary analyses, we examined whether daily
affect covariation existed for all stressful events or only
for those that husbands and wives mentioned in common, by examining the interaction of negative affect and
congruence in the stressful event of the day. As can be
seen from table 1, for both husbands and wives the main
effect of affect covariation (when congruence is centered
at 0 reflecting that husbands and wives did not mention
the same stressful event) was not significant. The interaction between negative affect covariation and congruence,
however, was significant for both husbands (pseudo-R 2 =
0.002) and wives (pseudo-R 2 = 0.002). This effect indicated that affect covariation did occur when husbands
and wives mentioned the same stressful event on a given
day. For wives, there was significant variation in the affect covariation effect, allowing for additional level 2
modeling.
To clarify whether collaboration was a potential moderator of affect covariation for wives, we examined
whether wives who perceived greater collaboration
might experience a stronger negative affect covariation
effect. In the level 2 model, wives who reported higher
collaborative coping (i.e. wives who on average across the
14 days reported greater versus lesser amounts of collaborative coping) moderated the affect covariation effect.
Predicted values were computed from the regression
equation reported in table 1 by substituting scores 1 SD
above and below the mean for collaborative coping and
wives’ negative affect (see fig. 1). The significance of the
slope of the 2 lines was tested by first centering the level
2 effect of mean levels of collaboration across days and
rerunning the model for 1 SD above and below the grand
Gerontology 2011;57:167–172
169
Table 1. Unstandardized coefficients, standard error and variance components of multilevel models examining affect covariation
Coefficients
Variance
Husband
Negative affect
Day1
Intercept
Affect covariation
Level 2 collaboration
Congruence1
Affect covariation ! congruence
Positive affect
Day1
Intercept
Affect covariation
Level 2 collaboration
Congruence1
Affect covariation ! congruence
Wife
Husband
19.45 (0.90)**
0.00 (0.07)
0.93 (0.25)**
24.60**
0.02
0.42 (0.14)**
0.17*
28.25 (0.92)**
0.02 (0.06)
0.39 (0.26)
46.73
0.06**
Wife
–0.04 (0.04)
0.03
16.45 (0.74)**
0.03 (0.04)
38.42**
0.10*
1.58
0.77 (0.37)*
0.33 (0.10)**
0.29*
–0.07 (0.06)
29.16 (0.99)**
0.05 (0.05)
–0.07 (0.16)
0.11**
38.89
0.08**
0.35 (0.41)
–0.06 (0.10)
1.41
–0.07 (0.20)
0.20
0.14
Figures in parentheses represent standard error. * p ! 0.05; ** p ! 0.01.
1
This effect was not entered differentially for husbands and wives as the variable was the same for husbands and wives.
Wife’s negative affect
24
22
20
18
16
14
12
Low collaboration
High collaboration
Low
High
Husband’s negative affect
Fig. 1. Predicted means for wife’s negative affect from interaction
of husband’s negative affect ! wife’s perceptions of collaboration.
mean. The slope of the line for high collaboration was
significant [b = 0.33, SE = 0.07, t(55) = 4.90, p ! 0.01],
whereas the slope of the line for low collaboration was
not significant [b = –0.00, SE = 0.08, t(55) = –0.05, p 1
0.80]. This effect indicated that negative affect covariation from husbands to wives occurred in couples where
wives perceived high amounts of collaborative coping
across the 14 days.
170
Gerontology 2011;57:167–172
Additional analyses were conducted to rule out alternative explanations of the negative affect covariation effect when husbands and wives mentioned the same event.
First, to the analyses conducted above we added 2 variables, the extent to which the stressful event was due to
prostate cancer for wives and for husbands. These analyses indicated that affect covariation for events that were
mentioned by husband and wife remained (p values !
0.01 for both husbands and wives) and thus the extent to
which the stressor was due to prostate cancer was not an
explanation of the covariation effect. Second, analyses
were conducted to determine whether negative affect covariation was a manifestation of stress spillover from one
spouse to the other. An interaction term was calculated,
group centering husbands’ ratings of the stressfulness of
the event and wives’ ratings of the stressfulness of the
event. After controlling for the stressfulness covariation,
the effect of affect covariation for events that both husbands and wives mentioned remained for husbands (p !
0.01) and wives (p ! 0.01).
Positive Affect Covariation
The model predicting husbands’ and wives’ positive
affect did not reveal significant positive affect covariation
for either husbands’ or wives’ positive affect, when couples were either congruent or not congruent regarding
Berg /Wiebe /Butner
the most stressful event. For both husbands and wives,
the variance component in the unconditional model was
significant. However, collaborative coping did not predict
variation in positive affect covariation.
Discussion
Consistent with previous research examining the contagion or transmission of negative affect [10, 11], husbands’ and wives’ negative affect was associated with
their spouse’s negative affect. The daily diary approach
used here is consistent with research examining spousal
similarity in distress both cross-sectionally and longitudinally [7, 8, 20, 21]. However, negative affect covariation
only existed when spouses reported the same stressful
event of the day. These results extend the research on the
transmission or contagion of negative affect [10, 11] by
linking negative affect covariation to specific shared
stressful events that the couple experiences. In addition,
the results seem to suggest that covariation in positive affect is less likely to occur than covariation in negative affect, especially in couples who are experiencing stressful
events surrounding prostate cancer. Positive affect covariation has been found in younger couples who are
dealing with more routine daily events [9].
Negative affect covariation occurred only when spouses mentioned the same stressful event of the day and, for
wives, when they perceived greater collaboration with
their husbands across the 14-day diary. Collaborative
coping, where couples engage in discussions regarding
problem-solving approaches to dealing with daily stressors, may exacerbate this negative affect covariation for
wives. We interpret these results to suggest that one of the
potential downsides to collaborative coping for women is
that one may bear the brunt of the distress that the spouse
is experiencing. Collaborative coping involves active discussion and engagement with one’s partner and may include discussing the spouse’s feelings of distress. These
short-term costs of collaboration, however, may be associated with more long-term gains as the active engagement nature of collaborative coping may be associated
with long-term relational benefits [22]. Although these
results could be interpreted to mean that wives in the
caregiving role may be more affected by collaborative
coping, the meta-analysis by Hagedoorn et al. [18] suggests that women may experience more negative affect in
general surrounding cancer whether they are in the patient or caregiver role.
Affect Covariation in Marital Couples
Dealing with Prostate Cancer
The results should be interpreted in the context of
some limitations. The sample of prostate cancer patients
and their wives was small and largely Caucasian, with a
need to replicate the results in a larger sample. Second,
we examined collaborative coping as a between-subjects
variable, although we know from other work with this
sample that individuals differ in their use of collaborative coping on a daily basis [13]. Additional analyses examining how affect covariation was moderated by daily
collaborative coping were not significant when congruence in daily stressors was controlled, although low power to detect these daily associations may have influenced
the findings. Third, our analyses revealed concurrent associations between husband and wife affect covariation
[23] but not prospective associations (lead-lag associations). The absence of lead-lag associations may suggest
a more complex timing of affect coupling relationships
that could occur through modeling coupled relationships in rates of change over time [9]. In addition, the
timing of such lead-lag relationships may occur across a
single day, requiring more time-intensive multiday assessments (although the subject burden of such measures
may be prohibitive given participants’ overall levels of
distress in dealing with a diagnosis of prostate cancer).
Fourth, several aspects of the diary implementation may
have affected the results. For instance, concerns with paper diaries and whether they are completed on the day
that they are assigned and our inability to assess whether couples adhered to the instructions to complete them
individually may have affected the results. Further, refinements in the measurement of daily affect (beyond
the Positive and Negative Affect Scale [24]) will be important to apply in measuring daily affect surrounding
chronic illness. In addition, further methodological
work is needed into the measurement of dyadic coping
(beyond categorical assessment) and determining appropriate stems to solicit different forms of dyadic coping
(e.g. is giving advice viewed as supportive or controlling). Finally, although we conceptualized the husband
as the patient in this study, women were actually reporting a greater number of chronic health conditions than
men. Future work is needed to examine the affect regulation process of spouses where both are experiencing
symptoms and concerns of their respective chronic illnesses, a likely situation for couples during late adulthood [25].
The results add to the growing literature on the
shared or dyadic nature of illness across the life span [3].
Individuals coping with chronic illness deal with daily
stressful events within a relational context where they
Gerontology 2011;57:167–172
171
are both affected by and affect those with whom they are
in close relationships. Further research is needed to understand how the daily experience of illness (its symptoms, stressful events, see [25]) of both the patient and
the spouse contribute to the coupled affective experience.
Acknowledgments
This study was supported by a University of Utah Research
Foundation Grant awarded to C. A. B. and D. J. W. We thank the
following people for assistance in collecting the data and recruiting participants: Lindsey Bloor, Chet Bradstreet, Heather Phippen, John Hayes, Robert Stephenson, Lillian Nail and Gregory
Patton. In addition we wish to thank Malinda Freitag and Monica
Forsman for their coding of the stressful events.
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