Independence centrality as a moderator of the effects of spousal support on patient well-being and physical functioning.

Chronic illnesses account for more than 75% of medical care costs in the United States (National Center for Health Statistics, 2010). Close family members are a critical source of emotional support and assistance to chronically ill individuals; however, their attempts to help do not always promote adaptive functioning (Martire & Schulz, 2001). In this study we examined whether the benefits of spouse assistance for patients’ psychological well-being and physical functioning depend on the fit between amount of assistance provided and the personal importance (i.e., centrality) of completing activities independently. Support in the form of assistance with daily activities may backfire and have negative effects (Burg & Seeman, 1994). Several studies have shown that high levels of support are associated with more depressive symptoms, even after controlling for the effects of illness-related factors (Silverstein, Chen, & Heller, 1996). Miscarried support also seems to have implications for physical health. Assistance with tasks has been linked with an increased risk for new or recurrent physical disability (Seeman, Bruce, & McAvay, 1996). In addition, individuals with chronic pain exhibit more pain behaviors and become less active when their family members provide unnecessary assistance (e.g., Romano et al., 1992). An important but unanswered question is, what are the conditions under which these negative effects are most likely to occur? There is converging evidence that the personal centrality of functional independence (i.e., carrying out activities on one’s own) plays a role in negative reactions to support. Early experimental studies showed that individuals who receive assistance in a domain that is highly central to them respond with more negative emotions than those for whom the task is not highly central (e.g., DePaulo, Brittingham, & Kaiser, 1983). Research on rheumatoid arthritis indicates that patients who appraise this illness as a challenge (rather than a threat) have poorer well-being when they receive high levels of instrumental, emotional, and informational support from their husband (Schiaffino & Revenson, 1995). Our own previous arthritis research showed that female patients with low independence centrality had less negative self-evaluations in response to more assistance from their husband (Martire, Stephens, Druley, & Wojno, 2002). Research emerging from Self-Determination Theory (SDT) has addressed this issue in a somewhat different manner, by examining the effects of autonomy support on individuals who are faced with managing illness and making lifestyle changes (e.g., smoking cessation, weight loss). Autonomy support refers to behaviors that are characterized by warmth, empathy, and understanding for an individual’s situation; patient-centered communication; and the provision of choices for making health behavior changes. Individuals with Type 2 diabetes whose health care providers are more supportive of their autonomy feel that they are better able to regulate their blood glucose, and subsequently show improved glucose control over 1 year (Williams, Freedman, & Deci, 1998). In addition, nursing home residents report greater life satisfaction when they receive autonomy support from family members and nursing home staff (Kasser & Ryan, 1999). According to SDT, autonomy is a universal need that individuals have across a multitude of life domains. In contrast, the importance of being functionally independent is circumscribed to one domain and likely to vary more across individuals. That is, there are likely to be individuals for whom functional independence is not highly central and who are relatively comfortable with assistance received as a result of illness, and there are other individuals who are distressed by being dependent on others. In the current study we examined the fit between amount of spousal assistance and independence centrality among individuals who experience disability from hip or knee osteoarthritis (OA), focusing on the consequences of fit for psychological well-being and physical functioning. Our hypothesis was that higher levels of assistance from the spouse would be related to poorer well-being and functioning among those patients with high independence centrality (i.e., centrality would act as a moderator). Conversely, it was expected that more assistance would be related to better well-being and functioning among patients who ascribe less importance to being independent.