Journal of Behavioral Medicine

, Volume 24, Issue 2, pp 115–136 | Cite as

Couples' Adjustment to Breast Disease During the First Year Following Diagnosis

  • Laurel Northouse
  • Tom Templin
  • Darlene Mood


The objectives were to determine (a) the extent to which psychosocial, demographic, and medical variables predict women's and husbands' adjustment to breast disease during the first year following diagnosis; (b) the degree of autocorrelation among and intercorrelation between partners' adjustment scores; (c) the extent to which baseline levels of adjustment predict adjustment 1 year later; and (d) the extent to which one partner's adjustment affects the other partner's adjustment. A stress-coping framework guided this study. The sample consisted of 131 couples, 58 couples received a cancer diagnosis and 73 received a benign diagnosis. Couples were interviewed at 1 week, 2 months, and 1 year postdiagnosis. Structural equation modeling was used to analyze the data. The strongest predictors of adjustment for women were severity of the illness and hopelessness and for husbands, their own baseline level of adjustment. Husbands' and wives' levels of adjustment at 1 year had a significant direct effect on each other's adjustment.

psychosocial adjustment breast cancer stress-coping family distress 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Baider, L., and Kaplan De-Nour, A. (1988). Adjustment to cancer: Who is the patient-the husband or the wife? Isr. J. Med. Sci. 24: 631–636.Google Scholar
  2. Baider, L., Koch, U., Esacson, R., and Kaplan De-Nour, A. (1998). Prospective study of cancer patients and their spouses: The weakness of marital strength. Psycho-Oncology 7: 49–56.Google Scholar
  3. Beck, A. T., Weissman, A., Lester, D., and Trexler, L. (1974). The measurement of pessimism: The hopelessness scale. J. Consult. Clin. Psychol. 42: 861–865.Google Scholar
  4. Bloom, J. R., Cook, M., Fotopoulis, S., Flamer, D., Gates, C., Holland, J., Muenz, L. R., Murawski, B., Penman, D., and Ross, R. D. (1987). Psychological response to mastectomy: A prospective comparison. Cancer 59: 189–196.Google Scholar
  5. Christman, N. J. (1990). Uncertainty and adjustment during radiotherapy. Nurs. Res. 39: 17–20.Google Scholar
  6. Compas, B. E., Worsham, N. L., Epping-Jordan, J., Grant, K., Mireault, G., Howell, D. C., and Malcarne, V. (1994). When mom or dad has cancer: Markers of psychological distress in cancer patients, spouses, and children. Health Psychol. 13: 507–515.Google Scholar
  7. Derogatis, L. R., and Melisaratos, N. (1983). The brief symptom inventory: An introductory report. Psychol. Med. 13: 595–605.Google Scholar
  8. Ell, K., Nishimoto, R., Mantell, J., and Hamovitch, M. (1988). Longitudinal analysis of psychological adaptation among family members of patients with cancer. J. Psychosom. Res. 32: 429–438.Google Scholar
  9. Ganz, P. A., Hirji, K., Sim, M., Schag, C. A., Fred, C., and Polinsky, M. L. (1993). Predicting psychosocial risk in patients with breast cancer. Med. Care 5: 419–431.Google Scholar
  10. Ganz, P. A., Schag, C. A., and Cheng, H. (1990). Assessing the quality of life-A study in newly diagnosed breast cancer patients. J. Clin. Epidemiol. 43: 75–86.Google Scholar
  11. Given, B., and Given, C. W. (1992). Patient and family caregiver reaction to new and recurrent breast cancer. J. Am. Med. Wom. Associ. 47: 201–206.Google Scholar
  12. Goldberg, J. A., Scott, R. N., Davidson, P. M., Murray, G. D., Stallard, S., George, W. D., and Maguire, G. P. (1992). Psychological morbidity in the first year after breast surgery. Eur. J. Surg. Oncol. 18: 327–331.Google Scholar
  13. Hilton, B. A. (1993). Issues, problems, and challenges for families coping with breast cancer. Semin. Oncol. Nurs. 9: 88–100.Google Scholar
  14. Hoskins, C. H., Baker, S., Budin, W., Ekstrom, D., Maislin, G., Sherman, D., Steelman-Bohlander, J., Bookbinder, M., and Knauer, C. (1996). Adjustment among husbands of women with breast cancer. J. Psychosoc. Oncol. 14: 41–69.Google Scholar
  15. Lazarus, R. (1966). Psychological Stress and the Coping Process, McGraw-Hill, New York.Google Scholar
  16. Lazarus, R., and Folkman, S. (1984). Stress, Appraisal, and Coping, Springer, New York.Google Scholar
  17. Lewis, F. M., and Hammond, M. A. (1996). The father's, mother's, and adolescent's functioning with breast cancer. Fam. Rel. 45: 456–465.Google Scholar
  18. Lewis, F. M., Hammond, M. A., and Woods, N. F. (1993). The family's functioning with newly diagnosed breast cancer in the mother: The development of an explanatory model. J. Behav. Med. 16: 351–370.Google Scholar
  19. Lewis, F. M., Woods, N. F., Hough, E. E., and Bensley, L. S. (1989). The family's functioning with chronic illness in the mother: The spouse's perspective. Soc. Sci. Med. 29: 1261–1269.Google Scholar
  20. Maguire, P. (1981). The repercussions of mastectomy on the family. Int. J. Fam. Psychiat. 1: 485–503.Google Scholar
  21. Maguire, G. P., Lee, E. G., Bevington, D. J., Kuchemann, C. S., Crabtree, R. J., and Cornell, C. E. (1978). Psychiatric problems in the first year after mastectomy. Br. Med. J. 1: 963–965.Google Scholar
  22. Manne, S. L., Pape, S. J., Taylor, K. L., and Dougherty, J. (1999). Spouse support, coping, and mood among individuals with cancer. Ann. Behav. Med. 21: 111–121.Google Scholar
  23. Maunsell, E., Brisson, J., and Deschenes, L. (1992). Psychological distress after initial treatment of breast cancer. Cancer 70: 120–125.Google Scholar
  24. McCubbin, H. I., and Patterson, J. M. (1983). Family stress and adaptation to crisis. In D. Olsen and B. Miller (eds.), Family Studies Yearbook, Beverly Sage, Hills, CA, pp. 87–106.Google Scholar
  25. Mishel, M. (1981). The measurement of uncertainty in illness. Nurs. Res. 30: 258–263.Google Scholar
  26. Mishel, M. (1983). Parents' perception of uncertainty concerning their hospitalized child. Nurs. Res. 32: 324–330.Google Scholar
  27. Mishel, M., Hostetter, T., King, B., and Graham, V. (1984). Predictors of psychosocial adjustment in patients newly diagnosed with gynecological cancer, Cancer Nurs. 7: 291–299.Google Scholar
  28. Mood, D. W. (1996). The diagnosis of cancer: A life transition. In R. McCorkle, M. Grant, M. Frank-Stromborg, and S. B. Baird (Eds.). Cancer Nursing, 2nd ed., W. B. Saunders, Philadelphia, pp. 298–314.Google Scholar
  29. Mood, D. W., Northouse, L. L., Risk, J. A., and Magnan, M. A. (1999). Risk for distress during radiation therapy: Gender, cultural, and socioeconomic diversity. Proceedings of the Midwest Nursing Research Society Annual Conference, Indianapolis, IN, p. 88.Google Scholar
  30. Mor, V., Allen, S., and Malin, M. (1994). The psychosocial impact of cancer on older versus younger patients and their families. Cancer 74: 2118–2127.Google Scholar
  31. Morris, T., Greer, H. S., and White, P. (1977). Psychological and social adjustment to mastectomy: A two-year follow-up study. Cancer 40: 2381–2387.Google Scholar
  32. Morrow, G. R., Chiarello, R. J., and Derogatis, L. R. (1978). A new scale for assessing patients' psychosocial adjustment to medical illness. Psychol. Med. 8: 605–610.Google Scholar
  33. Munkres, A., Oberst, M., and Hughes, S. H. (1992). Appraisal of illness, symptom distress, selfcare burden, and mood states in patients receiving chemotherapy for initial and recurrent cancer. Oncol. Nurs. Forum 19: 1201–1209.Google Scholar
  34. Northouse, L. L., Caffey, M., Deichelbohrer, L., Schmidt, L., Guziatek-Trojniak, L., West, S., Kershaw, T., and Mood, D. (1999). The quality of life of African-American women with breast cancer. Res. Nurs. Health 22: 449–460.Google Scholar
  35. Northouse, L. L., Dorris, G., and Charron-Moore, C. (1995a). Factors affecting couples' adjustment to recurrent breast cancer. Soc. Sci. Med. 41: 69–76.Google Scholar
  36. Northouse, L. L., Jeffs, M., Cracchiolo-Caraway, A., Lampman, L., and Dorris, G. (1995b). The emotional distress reported by women and husbands prior to a breast biopsy. Nurs. Res. 44: 196–201.Google Scholar
  37. Northouse, L. L., Mood, D., Templin, T., Mellon, S., and George, T. (2000). Couples' patterns of adjustment to colon cancer. Soc. Sci. Med. 50: 271–284.Google Scholar
  38. Northouse, L. L., and Swain, M. A. (1987). Adjustment of patients and husbands to the initial impact of breast cancer. Nurs. Res. 36: 221–225.Google Scholar
  39. Northouse, L. L., Templin, T., Mood, D., and Oberst, M. (1998). Couples' adjustment to breast cancer and benign breast disease: A longitudinal analysis. Psycho-Oncology 7: 37–48.Google Scholar
  40. Penman, D. T., Bloom, J. R., Fotopoulous, S. et al. (1986). The impact of mastectomy on selfconcept and social function: A combined cross-sectional and longitudinal study with comparison groups. Women Health 11: 101–130.Google Scholar
  41. Schag, C. A., Ganz, P. A., Polinsky, M. L., Fred, C., Hirji, K., and Petersen, L. (1993). Characteristics of women at risk for psychosocial distress in the year after breast cancer. J. Clin. Oncol. 11: 783–793.Google Scholar
  42. Scheier, M. F., and Bridges, M. W. (1995). Person variables and health: Personality predispositions and acute psychological states as shared determinants for disease. Psychosom. Med. 57: 255–268.Google Scholar
  43. Scott, D. W., Oberst, M. T., and Dropkin, J. M. (1980). A stress-coping model. Adv. Nurs. Sci. 3: 9–23.Google Scholar
  44. Smilkstein, G., and Zimlich, R. (1990). The stress scale validation study: An instrument for psychosocial stressor adjustment, Unpublished manuscript.Google Scholar
  45. Spanier, G. B. (1976). Measuring dyadic adjustment. New scales for assessing the quality of marriage and similar dyads. J. Marr. Fam. 38: 15–38.Google Scholar
  46. Spanier, G. B. (1989). Manual for the Dyadic Adjustment Scale, Multi-Health Systems, Toronto.Google Scholar
  47. Vinokur, A. D., Threatt, B. A., Vinokur-Kaplan, D., and Satariano, W. (1990). The process of recovery from breast cancer for younger and older patients. Cancer 65: 1242–1254.Google Scholar
  48. Watson, M., Haviland, J. S., Greer, S., Davidson, J., and Bliss, J. M. (1999). Influence of psychological response on survival in breast cancer: A population-based cohort study. Lancet 354: 1331–1336.Google Scholar
  49. Wellisch, D. K., Jamison, K. R., and Pasnau, R. O. (1978). Psychological aspects of mastectomy: II. The man's perspective. Am. J. Psychiat. 135: 543–546.Google Scholar

Copyright information

© Plenum Publishing Corporation 2001

Authors and Affiliations

  • Laurel Northouse
  • Tom Templin
  • Darlene Mood

There are no affiliations available

Personalised recommendations