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The dyadic effects of coping and resilience on psychological distress for cancer survivor couples

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This study aimed to examine the actor and partner effects of coping and resilience characteristics on psychological distress in cancer survivors and their spouses and to examine the mediating role of resilience characteristics in the relationship between coping and psychological distress.


A total of 91 breast, colorectal, and prostate cancer survivor-spouse dyads were recruited from the University Hospital Registry in Cleveland, Ohio. Standardized questionnaires that assessed psychological distress, reframing and acquiring social support coping, and resilience characteristics were used.


The actor-partner interdependence mediation model demonstrated that the resilience of the survivors and spouses was a strong predictor of their personal psychological distress. Survivors’ and spouses’ own resilience mediated the association between their reframing coping and psychological distress. However, only the survivor model confirmed the mediating effect of resilience characteristics in the relationship between social support coping and psychological distress. In addition, spouse psychological distress was influenced by survivor resilience, indicating a spouse-partner effect in the relationship between resilience characteristics and psychological distress.


Our findings provide insight into the relationships between coping, resilience characteristics, and psychological distress at the individual and dyadic levels. Enhancing cancer survivors’ and their spouses’ positive thoughts and available external resources can improve resilience and, in turn, reduce their psychological distress of couples coping with cancer.

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The actor-partner interdependence mediation model


Brief Symptom Inventory-18


Comparative Fit Index


Family Crisis Oriented Personal Evaluation Scales


Global Severity Index


Research assistant


The root mean square error of approximation


  1. American Cancer Society (2014) Cancer facts and figures 2014. In: Editor (ed)^(eds) Book cancer facts and figures 2014. American Cancer Society, City

  2. Aries E (1996) Men and women in interaction. Reconsidering the differences. Oxford University Press, New York

    Google Scholar 

  3. Ashing-Giwa KT, Padilla G, Tejero J, Kagawa-Singer M (2003) Understanding the breast cancer experience of Asian American women. Psychooncology 12:38–58

    Article  Google Scholar 

  4. Aspinwall LG, MacNamara A (2005) Taking positive changes seriously. Cancer 104:2549–2556

    Article  PubMed  Google Scholar 

  5. Badr H, Carmack CL, Kashy DA, Cristofanilli M (2010) Dyadic coping in metastatic breast cancer. Health Psychol 29:169–180

    Article  PubMed Central  PubMed  Google Scholar 

  6. Badr H, Krebs P (2012) A systematic review and meta-analysis of psychosocial interventions for couples coping with cancer. Psychooncology 22:1688–1704

    Article  PubMed Central  PubMed  Google Scholar 

  7. Ben-Zur H (2001) Your coping strategy and my distress: inter-spouse perceptions of coping and adjustment among breast cancer patients and their spouses. Fam Syst Health 19:83–94

    Article  Google Scholar 

  8. Ben-Zur H, Gilbar O, Lev S (2001) Coping with breast cancer: patient, spouse, and dyad models. Psychosom Med 63:32–39

    Article  CAS  PubMed  Google Scholar 

  9. Bentler PM (1990) Comparative fix indexes in structural models. Psychol Bull 107:238–246

    Article  CAS  PubMed  Google Scholar 

  10. Bodenmann G (2005) Dyadic coping and its significance for marital functioning. In: Revenson TA, Kayser K, Bodenmann G (eds) Couples coping with stress: emerging perspectives on dyadic coping. APA, Washington, DC, pp 33–49

    Chapter  Google Scholar 

  11. Catalano D, Chan F, Wilson L, Chiu C-Y, Muller VR (2011) The buffering effect of resilience on depression among individuals with spinal cord injury: a structural equation model. Rehabil Psychol 56:200–211

    Article  PubMed  Google Scholar 

  12. Chambers SK, Lynch BM, Aitken J, Baade P (2009) Relationship over time between psychological distress and physical activity in colorectal cancer survivors. J Clin Oncol 27:1600–1606

    Article  PubMed  Google Scholar 

  13. David D, Montgomery GH, Bovbjerg DH (2006) Relations between coping responses and optimism-pessimism in predicting anticipatory psychological distress in surgical breast cancer patients. Pers Individ Dif 40:203–213

    Article  PubMed Central  PubMed  Google Scholar 

  14. Demos EV (1989) Resiliency in infancy. In: Dugan TF, Coles R (eds) The child in our times. Brunner/Mazel, New York, pp 3–22

    Google Scholar 

  15. Derogatis LR (2000) Brief Symptoms Inventory (BSI) 18 administration, scoring, and procedures manual. National Computer Systems Inc., Minneapolis

    Google Scholar 

  16. Diehl M, Hay EL (2013) Personality-related risk and resilience factors in coping with daily stress among adult cancer patients. Res Hum Dev 10:47–69

    Article  PubMed Central  PubMed  Google Scholar 

  17. Enders C, Bandalos D (2001) The relative performance of full information maximum likelihood estimation for missing data in structural equation models. Struct Equ Model 8:430–457

    Article  Google Scholar 

  18. Everall R, Altrows J, Paulson B (2006) Creating a future: a study of resilience in suicidal female adolescents. J Couns Dev 84:461–470

    Article  Google Scholar 

  19. Folkman S, Moskowitz JT (2004) Coping: pitfalls and promise. Annu Rev Psychol 55:745–774

    Article  PubMed  Google Scholar 

  20. Fredrickson BL, Tugade MM, Waugh CE, Larkin GR (2003) What good are positive emotions in crises? A prospective study of resilience and emotions following the terrorist attacks on the United States. J Pers Soc Psychol 84:365–376

    Article  PubMed Central  PubMed  Google Scholar 

  21. Gilbar O, Ben-Zur H (2002) Cancer and the family: distress and coping. Charles C Thomas, Springfield

    Google Scholar 

  22. Hagedoorn M, Sanderman R, Bolks HN, Tuinstra J, Coyne JC (2008) Distress in couples coping with cancer: a meta-analysis and critical review of role and gender effects. Psychol Bull 134:1–30

    Article  PubMed  Google Scholar 

  23. Hjemdal O, Vogel PA, Solem S, Hagen K, Stiles TC (2011) The relationship between resilience and levels of anxiety, depression, and obsessive-compulsive symptoms in adolescents. Clin Psychol Psychother 18:314–321

    Article  PubMed  Google Scholar 

  24. Hodgkinson K, Butow P, Hunt GE, Wyse R, Hobbs KM, Wain G (2007) Life after cancer: couples’ and partners’ psychological adjustment and supportive care needs. Support Care Cancer 15:405–415

    Article  CAS  PubMed  Google Scholar 

  25. Hou WK, Lam JHM (2014) Resilience in the year after cancer diagnosis: a cross-lagged panel analysis of the reciprocity between psychological distress. J Behav Med 37:391–401

    Article  PubMed  Google Scholar 

  26. Institute of Medicine (2007) Cancer care for the whole patient: meeting psychosocial health needs. National Academy Press, Washington D.C

    Google Scholar 

  27. Institute of Medicine (2008) Cancer care for the whole patient: meeting psychosocial health needs. National Academy Press, Washington D.C

    Google Scholar 

  28. Kumpfer K (1999) Factors and processes contributing to resilience: the resilience framework. In: Glantz MD, Johnson JL (eds) Resilience and development: positive life adaptations. Kluwer Academic/Plenum Press Publishers, New York

    Google Scholar 

  29. Kunzler A, Nussbeck FW, Moser MT, Bodenmann G, Kayser K (2014) Individual and dyadic development of personal growth in couples coping with cancer. Support Care Cancer 22:53–62

    Article  PubMed  Google Scholar 

  30. Lafaye A, Petit S, Richaud P, Houede N, Baguet F, Cousson-Gelie F (2014) Dyadic effects of coping strategies on emotional state and quality of life in prostate cancer patients and their spouses. Psychooncology (in press)

  31. Lazarus RS, Folkman S (1984) Stress, appraisal, and coping. Springer, New York

    Google Scholar 

  32. Ledermann T, Macho S, Kenny DA (2011) Assessing mediation in dyadic data using the actor-partner interdependence model. Struct Equ Model 18:595–612

    Article  Google Scholar 

  33. McCubbin HI, Larsen A, Olson DH (1987) Family crisis orientated personal evaluation scales (F COPES). In: McCubbin HI, Thompson AI (eds) Family assessment inventories for research and practice. University of Wisconsin-Madison, Madison, pp 193–207

    Google Scholar 

  34. Milbury K, Badr H, Fossella FV, Pisters KM, Carmack CL (2013) Longitudinal associations between caregiver burden and patient and spouse distress in couples coping with lung cancer. Support Care Cancer 21:2371–2379

    Article  PubMed  Google Scholar 

  35. Resenders LA, McCorkle R (2006) Spousal responses to prostate cancer: an integrative review. Cancer Invest 24:192–198

    Article  Google Scholar 

  36. Roesch SC, Adams LS, Hines A, Palmores A, Vyas P, Tran C, Pekin S, Vaughn AA (2005) Coping with prostate cancer: a meta-analytic review. J Behav Med 28:281–293

    Article  PubMed  Google Scholar 

  37. Smith BW, Dalen J, Wiggins K, Tooley E, Christopher P, Bernard J (2008) The Brief Resilience Scale: assessing the ability to bounce back. Int J Behav Med 15:194–200

    Article  PubMed  Google Scholar 

  38. Sobel ME (1982) Asymptotic confidence intervals for indirect effects in structural equation models. In: Leinhart S (ed) Sociological methodology. Jossey-Bass, San Francisco, pp 290–312

    Google Scholar 

  39. Steiger JH (1990) Structural model evaluation and modification: an interval estimation approach. Multivar Behav Res 25:173–180

    Article  Google Scholar 

  40. Stewart DE (2011) A systematic review of resilience in the physically ill. Psychosomatics 52:199–209

    Article  PubMed  Google Scholar 

  41. Todd JL, Worell J (2000) Resilience in low-income, employed, African American women. Psychol Women Q 24:119–128

    Article  Google Scholar 

  42. Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S (2001) The prevalence of psychological distress by cancer site. Psychooncology 10:19–28

    Article  CAS  PubMed  Google Scholar 

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Funding for this research was supported by a grant from the National Institute of Nursing Research (P30NR011907).

Conflict of interest

None of the sponsors played any role in the study design, the collection, analysis, or interpretation of data, the writing of the manuscript, or in the decision to submit it for publication. We have full control of all primary data and agree to allow the journal to review our data if requested.

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Correspondence to Jung-won Lim.

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Lim, Jw., Shon, Ej., Paek, M. et al. The dyadic effects of coping and resilience on psychological distress for cancer survivor couples. Support Care Cancer 22, 3209–3217 (2014).

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