The Relationship And Its Gender Differences Between Dyadic Coping And Anxiety And Depressive Symptoms In Young And Middle-aged Couples Dealing With Cancer

Objectives:To investigate the status and related factors of anxiety and depressive symptoms among young and middle-aged patients with cancer and their spouses;to investigate the status of dyadic coping of young and middle-aged patients with cancer and their spouses and explore its gender differences;based on the Systemic-Transactional Model,this study aimed to explore the relationship between dyadic coping and anxiety and depressive symptoms among young and middle-aged patients with cancer and their spouses and the moderating role of patient sex.Methods:This cross-sectional study comprised 275 couples(aged 20-59)in which one partner had a cancer diagnosis.Participants were conveniently selected from the cancer center of a grade A tertiary hospital in Jinan,Shandong Province from December 2021 to August 2022.Couples completed the general information questionnaire,the Hospital Anxiety and Depression Scale,and the Dyadic Coping Inventory.IBM SPSS was used for data entry and Rstudio(version 4.2.1)was used for data analysis.The statistical analysis included descriptive analysis,independent sample t-test,one-way analysis of variance,paired sample t-test,Chi-square test,Pearson correlation analysis,nonindependence test,and distinguishable test.The Structure Equation Modeling was used for path analysis,and then the actor-partner interdependence model and the actor-partner interdependence moderation model were tested respectively.Results:1.The mean score for anxiety symptoms of young and middle-aged patients with cancer was 7.76(SD=4.21),and 51.64%of patients had significant anxiety symptoms.The mean score for depressive symptoms of patients was 6.44(SD=4.39),and 41.82%of patients had significant depressive symptoms.The mean score for anxiety symptoms of spouses was 9.24(SD=4.15),and 66.55%of spouses had significant anxiety symptoms.The mean score for depressive symptoms of spouses was 7.78(SD=4.26),and 49.82%of spouses had significant depressive symptoms.The results of paired sample t-test and Chi-square test showed that the scores and incidence of anxiety and depressive symptoms of spouses were significantly higher than those of patients(all P<0.001).2.The mean total score for dyadic coping of young and middle-aged patients with cancer was 130.09(SD=17.01),and the mean scores for positive dyadic coping and negative dyadic coping were 58.04(SD=9.06)and 7.68(SD=2.87),respectively.The mean total score for dyadic coping of spouses was 126.22(SD=16.83),and the mean scores for positive dyadic coping and negative dyadic coping were 57.18(SD=8.52)and 7.93(SD=3.25),respectively.The mean total score of dyadic coping of patients were significantly higher than those of spouses(P<0.05).The majority of patients(72.00%)and spouses(73.82%)were in the normal level of dyadic coping(111-145),and 16.36%of patients and 9.82%of spouses were in the high level of dyadic coping(>145).3.The results of the independent sample t-test showed that male patients and female patients had significant differences in stress communication(t=2.590,P=0.010),and the level of stress communication of female patients was significantly higher than that of male patients.4.The results of correlation analysis showed that positive dyadic coping was negatively correlated with anxiety and depressive symptoms among young and middle-aged patients with cancer(r=-0.310/-0.346,P<0.05).The positive dyadic coping of spouses was negatively correlated with their own anxiety and depressive symptoms,as well as with patients’ anxiety and depressive symptoms(r=-0.155～-0.297,P<0.05).The negative dyadic coping of patients was positively correlated with their own anxiety and depressive symptoms,as well as with their spouses’anxiety and depressive symptoms(r=0.149～0.228,P<0.05).The negative dyadic coping of spouses was positively correlated with their own anxiety and depressive symptoms,as well as with patients’ anxiety and depressive symptoms(r=0.153～0.21 1,P<0.05).5.The results of the actor-partner interdependence model showed that there was a significant actor effect of positive dyadic coping on anxiety symptoms among young and middle-aged patients with cancer(β=-0.224,P=0.001),and significant actor effects of negative dyadic coping on anxiety symptoms among both patients and spouses(βpatients=0.200,P=0.001;βspouses=0.150,P=0.013).No significant partner effects of positive or negative dyadic coping on anxiety symptoms were found.The actor effects of positive dyadic coping on depressive symptoms were significant among both patients and spouses(βpatients=0.203,P=0.003;βspouse=0.214,P=0.002),and the partner effect of spouses’positive dyadic coping on paβtients’depressive symptoms was significant(β=-0.167,P=0.014).Both the actor effect(β=0.184,P=0.003)and the partner effect(β=0.126,P=0.044)of spouses’ negative dyadic coping on depressive symptoms were significant.6.The results of the actor-partner interdependence moderation model showed that there were no moderating effects of patient sex on the relationship between positive dyadic coping and anxiety or depressive symptoms among both patients and spouses.For negative dyadic coping,the results showed that:(1)Patient sex moderated the actor effect of patients’ negative dyadic coping on their own anxiety symptoms(β=0.264,P=0.002).The simple slope test showed that the slope of negative dyadic coping was significant only when the patient was female(β=0.259,P<0.001),and the slope was not significant in male patients(β=-0.005,P=0.954);(2)Patient sex moderated the actor effect of spouses’ negative dyadic coping on their anxiety symptoms(β=-0.235,P=0.005).The simple slope test showed that the slope of spouses’negative dyadic coping was significant only in female spouses(β=0.329,P<0.001),and the slope of male spouses was not significant(β=0.094,P=0.946);(3)Patient sex moderated the partner effect of spouses’ negative dyadic coping on patients’ anxiety symptoms(β=-0.196,P=0.023),and only female spouses’ negative dyadic coping positively predicted male patients’anxiety symptoms(β=0222,P=0.014).The slope of male spouses’ negative dyadic coping on female patients’ anxiety symptoms was not significant(β=0.026,P=0.491).(4)Patient sex moderated the actor effect of spouses’ negative dyadic coping on their own depressive symptoms,and only the slope of female spouses’ negative dyadic coping was significant(β=0.312,P<0.001).The slope of male spouses was not significant(β=-0.142,P=0.402).Conclusion:1.The prevalence of anxiety and depressive symptoms in both young and middle-aged patients with cancer and their spouses is higher,especially the spouses.2.The dyadic coping of young and middle-aged patients with cancer and their spouses is generally at a medium level,while the patients’ is higher.3.There is a gender difference in stress communication among patients.The level of stress communication among female patients is higher than that of male patients.4.Positive dyadic coping is beneficial to reducing anxiety and depressive symptoms of patients and their spouses,while negative dyadic coping aggravates their anxiety and depressive symptoms.Positive dyadic coping from spouses is also associated with lower levels of depressive symptoms in patients,while negative dyadic coping from spouses is associated with higher levels of depressive symptoms in patients.5.The correlations between negative dyadic coping and anxiety or depressive symptoms are stronger among female patients and female spouses.Compared with female patients,male patients are more affected by their spouses’ negative dyadic coping.Relevant interventions should focus on reducing negative dyadic coping behaviors of patients and spouses,especially for female patients and spouses.