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Illness, Effects on Relationships

Illness can have many effects on relationships, from contributing to their deterioration to strengthening them. The extent to which illness impacts relationships depends on the duration and severity of the illness, the characteristics of the ill persons and their partners prior to and during the illness, and the quality of the relationship and other social networks. This entry describes the differential impact of acute and chronic illness on relationships, caregiver burden and coping, the impact of illness on adults and children, and the ways in which illness may affect communication and sexuality.

Acute versus Chronic Illness

During times of acute illness, relationship members may adapt to the illness by rearranging schedules to provide care or make hospital visits. These changes are often short term, and the relationship roles usually return to the pre-illness state, especially in long-term relationships such as marriage. However, this pattern may not be the case during a severe or life-threatening condition. In these cases, the illness may have a long-term impact even after it has resolved. In the aftermath of a life-threatening illness, one's mortality becomes more salient, and there may be greater incentive to pursue activities that give meaning to life. Thus, one may have an increased motivation to pursue relationships that maximize positive affect and minimize negative affect. Relationship partners may reevaluate the importance of the relationship and other activities given life's finite timeframe. In some cases, partners will take greater appreciation in the time they spend together or may make decisions aimed at enhancing the relationship. In other cases, a life-threatening illness may cause partners to decide to end an unsatisfactory relationship and find new relationship partners that can satisfy their needs for positive affect and intimacy.

In chronic benign illnesses (e.g., chronic muscu-loskeletal pain), partners often report reduced marital satisfaction after the onset of the illness. Chronic illness may also contribute to caregiver burden experienced by those who provide informal unpaid care, including spouses, adult children, or other family members and friends. Caregiver burden can consist of physical caretaking and financial responsibilities that exceed one's ability to manage within the context of one's own life. Social burden may include limiting or eliminating social activities to care for the loved one. Emotional burden, including feelings of sadness, anger, and resentment about having to provide care, is also possible. Although not all caretakers experience burden, it can have a negative impact on mental and physical health, the quality of the relationship, and the quality of care. For instance, greater burden is related to an increased likelihood of abuse of the ill person. Although not studied as thoroughly, patients' perceived self-burden on others may also occur. This type of burden consists of guilt or resentment about receiving care from others and may relate to psychological distress and social withdrawal. Burden is reduced when coping skills appropriate to the situation are used.

Coping Skills

Coping skills are generally classified into two types. Problem-solving coping strategies are typically effective in situations amenable to change (e.g., acute illness) and include gathering information about the illness and seeking social support. Emotion-focused coping strategies such as venting distress, putting the problem into perspective, and active acceptance may be better for situations that are chronic and unchangeable. Active acceptance is characterized by a willingness to experience the illness and a realization that the illness does not have to interfere with one's activities. Contrast this type of acceptance with a passive acceptance in which one gives up pleasurable activities because of feelings of helplessness and lack of control over illness. Therefore, one way to counteract burden is to teach patients and family members coping skills directed toward facing the illness.

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