The Dyadic Association Between Psychological Resources And Negative Emotions Among Dyads Of Gynaecological Cancer Patients And Spouses And The Effect Of The Intervention Based On Acceptance And Commitment Therapy

Objectives1.To describe the level of psychological resources(including mindfulness and psychological flexibility)and negative emotions(including depressionand anxiety)among gynaecological cancer patients and their spouses;2.To explore the dyadic effect of mindfulness and psychological flexibility on depression and anxiety among gynaecological cancer patientsand spouses,respectively;3.To assess the effect of the intervention based on the acceptance and commitment therapy(ACT)on negative emotions,including depression and anxiety among gynaecological cancer patients and spouses.MethodsThis study included two parts:cross-sectional study and randomized controlled trial(RCT)study.One hundreddyads of gynaecological cancer patients and spouses in four GradeⅢA hospitals in Jinan,Shandong Province,participated in this cross-sectional study.They reported demographics and measures of psychological resources(mindfulness[Five Facet Mindfulness Questionnaire-Short Form,FFMQ-SF]and psychological flexibility[The Acceptance and Action Questionnaire Ⅱ,AAQ-Ⅱ])and negative emotions(depression[Patient Health Questionnaire-9,PHQ-9]andanxiety[Generalized Anxiety Disorder-7,GAD-7]).Descriptive analysis,pairedt-test,Pearson correlation analysis,and structural equation model based on the actor-partner interdependence model(APIM)were used to analyze the data by IBM SPSS 22.0 and IBM AMOS 20.0software.In the RCT study,68 couples from the cross-sectional studywho met the inclusion and exclusion criteria were randomly divided into the ACT intervention group(n=34 couples)and thewait-list control group(n=34 couples).A 4-week psychological intervention and routinecare were provided to participants in the intervention group.Participants in the wait-list control group received routine care only.Outcome measures included self-reported depression,anxiety,fatigue,sleep quality,mindfulness,and psychological flexibility,which were assessed using the PHQ-9,theGAD-7,theBrief Fatigue Inventory,thePittsburgh Sleep Quality Index,theFFMQ-SF,and theAAQ-11.Data were collected at pre(TO),mid(T1),and post-intervention(T2)and at 8-week follow-up(T3).Main outcomes included depression and anxiety,secondary outcomes included fatigue and sleep quality,and process variables included mindfulness and psychological flexibility.Descriptive analysis,independent sample t test,chi-square test,and multilevel mixed-effects linear regressionwere used for statistical analysis by SPSS 22.0 and Stata/SE 11.0 software.Results1.The positive rates of depression and anxiety in gynaecological cancer patients and spouses were determined based on cut-off(≥10)of the PHQ-9 and the GAD-7,The positive rates of depression and anxiety in patients were 21.0%and 22.0%,respectively.The positive rates of depression and anxiety in spouses were 21.0%and 19.0%,respectively.2.There was no differencebetween patients’and spouses’levels of depression,anxiety,and mindfulness(P>0.05).Patients reported poorer psychological flexibility relative to their spouses(P=0.047).3.The dyadic effects of psychological resources on negative emotions in gynaecological cancer patients andspouses(1)The dyadic effect of the mindfulness on depression and anxiety in patients and spousesBased on the APIM,the positive effect of the patients’observe scores on the spouses’depression tended to be statistically significant(B=0.29,P=0.05),that is,the higher the patients’observe level was,the more severe the spouses’depression was.Patients’ own act with awarenessscores werenegatively associated with their own depression(B=-0.65)and anxiety(B=-0.55),that is,the higher the patient’s act with awareness level was,the lesstheir own depressionand anxiety was(P<0.001).Spouses’ own act with awarenessscores werenegatively associated with their own depression(B=-0.31,P=0.036),that is,the higher the spouses’ act with awareness level was,the less the depression was.Patients’ own act with awareness scores werenegatively associated with their spouses.depression(B=-0.46,P=0.001)and anxiety(B=-0.34,P=0.022),that is,the higher the patients" act with awareness level was,the less their spouses’depressionand anxiety was.(2)The dyadic effect of the psychological flexibility on depression and anxiety in patients and spousesPatients’ or spouses’ own psychological flexibility scores werepositively associated with their own depression(B=0.37,0.24)and anxiety(B=0.34,0.27),that is,the poorer the patients’ or spouses’ psychological flexibility level were,the more severe their depression and anxiety were(P<0.001).Patients’ own psychological flexibility scores were positively associated with their spouses’ depression(B=0.13,P=0.014)and anxiety(B=0.12,P=0.016),that is,the poorer the patients’psychological flexibility level was,the more severe the spouse’s depression and anxiety were.(3)The impact of psychological resources similarity on negative emotions in gynaecological cancer patients and spousesThe describe similarity between patients and spouseswas positively associated with patients’(B=0.34,P=0.049)and spouses’(B=0,51,P<0.001)depression,and patients’anxiety(B=0.34,P=0.029),indicating that the more the difference between patients’ and spouses’ describe level was,the more severe the patients’ and spouses’depression were,and the more severe the patients’ anxiety was.The nonjudging similarity between patients and spouseswas positively associated with patients’(B=0.67,P<0.001)and spouses’(B=0.34,P=0.059)depression,and patients’anxiety(B=0.59,P=0.002),indicating that the more the difference between patients’ and spouses’ nonjudging level was,the more severe the patients’ and spouses’depression were,and the more severe the patients’ anxiety was.4.The effect of theACT intervention on negative emotions in gynaecological cancer patients and spouses(1)The effect of theACT intervention on the main outcomes in gynaecological cancer patients and spousesAmong the patients,the results of multilevel mixed-effects linear regressionshowed thatthe interaction effect between group and time on anxiety was statistically significant.Specifically,the reduction of the anxiety scores in the ACT intervention wasmore 2.50 points than the control groupfrom pre to mid(Hedges’ g=0.046);the difference of the change scores between the two groups tended to be statistically significant from pre to post;the reduction of the anxiety scores in the ACT intervention wasmore3.59 points than the control groupfrom pre to follow-up(Hedges’g=0.222).The interaction effect between group and time on depression was not statistically significant(P>0.05).Among the spouses,the results showed that the interaction effectbetween group and time on anxiety and depression was not statistically significant(P>0.05).(2)The effect of the ACT intervention on the secondary outcomes in gynaecological cancer patients and spousesAmong the patients,the interaction effectbetween group and time onfatiguewas not statistically significant(P>0.05).The interaction effect between group and time on sleep quality tended to be statistically significant,the difference of the change scores between the two groups tended to be statistically significant from pre to post;the reduction of the sleep quality scores in the ACT intervention wasmore2.47 points than the control groupfrom pre to follow-up(Hedges’ g=0.459).Among the spouse,the interaction effectbetween group and time onfatiguewas not statistically significant(P>0.05).The interaction effect between group and time on sleep quality tended to be statistically significant,the reduction of the sleep quality scores in the ACT intervention wasmore2.39 points than the control groupfrom pre to post(Hedges’ g=0.295);the difference of the change scores between the two groups was not statistically significant from pre to follow-up(P>0.05).(3)The effect of the ACT intervention on the process variables in gynaecological cancer patients and spousesAmong the patients,the interaction effectbetween group and time onnonjudging scoreswas statistically significant,the increase of the nonjudging scores in the ’ACT intervention wasmore2.44 points than the control groupfrom pre to mid(Hedges’ g=1.161);the difference of the change scores between the two groups was not statistically significant from pre to post and from pre to follow-up(P>0.05).The interaction effectbetween group and time on psychological flexibility,mindfulness total scores,and other dimensions of mindfulness was not statistically significant(P>0.05).Among the spouses,the interaction effectbetween group and time ondescribe scoreswas statistically significant.Specifically,the reduction of the describe scores in the ACT intervention wasmorel.87 points than the control groupfrom pre to mid(Hedges’g=0.490);the difference of the change scores between the two groups was not statistically significant from pre to post(P>0.05);the increase of the describe scores in the ACT intervention wasmore1.79 points than the control groupfrom pre to follow-up(Hedges’ g=0.983).The interaction effectbetween group and time on psychological flexibility,mindfulness total scores,and other dimensions of mindfulness was not statistically significant(P>0.05).Conclusion1.Depression and anxiety in gynaecological cancer patients and their spouses is common,which deserve attention.2.Depression,anxiety,and mindfulness ingynaecological cancer patients are comparable to those of their spouses,and patients’ psychological flexibility is worse than that of their spouses.3.Higher levelof psychological resources among patients or spouses is related to their own lower negative emotions(actor effect),higher levelof psychological resources among patients is related to lower negative emotions among spouses(partner effect),and the more similar level of psychological resources among patients and spouses is related to lower negative emotions among patients and spouses.This indicates that the intevention enhancing psychological resources among both patients and spouses may attenuate negative emotions among these vulnerable populations.4.The ACT intervention can significantly improve the patients’ anxiety,sleep quality,and nonjudging level;the ACT intervention can significantly improve the spouses’ sleep quality and describe level.