Relationship Satisfaction and Psychological Well-Being Among Greek People With Physical Disabilities Essay

Abstract

A substantial amount of existing research regarding the experience of individuals living with physical disabilities, has been done still, little is known as to how the carnal infirmity takes hold of the quality of romantic relationships. In the light of this lack of knowledge, the present study attempts to explore the degree of relationship satisfaction in connection with the way handicapped people deal with the challenges of romantic involvement, as well as the emotional outcome originating on dyadic experience. In this study, fifty physically disabled individuals between the ages of 25-35 are going to be interviewed with the purpose of assessing their level of happiness with relationship, and the impact of it on their emotional health.

Participants will be asked to complete the Relationship Assessment Scale (RAS), and the Depression, Anxiety, Stress Scale (DASS). Additionally, they will be asked to complete a demographic information form, and a disability specific information questionnaire. Interview data will be analyzed using a multiple regression analysis and an analysis of variance. Ιt is expected that physically challenged participants would demonstrate high levels of satisfaction with their relationships and as a result low levels of depression and anxiety.

Introduction

Our Inclination to form romantic relationships is an intrinsic part of human nature mulling over our need to form social bonds with other people. According to Maslow, both physical needs including sex, as well as the emotional need for affection, love, and togetherness, are essential in order to satisfy our self-esteem and by extension to develop and maintain personal welfare/comfort (Bernstein, Nash, Clarke-Stewart, Penner, & Roy, 2002). Similarly, Manfred Max-Neef (1991) described “Affection” as an important human necessity. This so called need concerns both healthy and physically disabled individuals.

Apart from the positive effects on the physical as well as mental health of those being married or in a relationship have been extensively recorded by numerous studies. Specifically, married people are mentally and physically healthier than singles or those cohabitating (Lees, 2007; Wood, Goesling & Avellar, 2007). Analogous are the results of a comparison between those in a relationship and singles. Overall, married people and those in relationships are more likely to experience lower levels of depression and anxiety as well higher levels of self-esteem. They additionally, experience higher levels of happiness, sexual and life satisfaction, and tend to live longer (Lees, 2007; Kamp Dush, & Amato, 2005; Wilson & Oswald, 2005).

The benefit of being in a loving relationship, like marriage, is so remarkable for human health that according to researchers it can be similar to this of giving up smoking (Wilson & Oswald, 2005). Respectively, loving relationships, and/or marriage are equally beneficial for disabled individuals as well. In particular, handicapped individuals who are in a relationship have higher levels of emotional and mental health, as opposed to their single counterparts; they report lower levels of depression and anxiety; they experience higher levels of self, sexual, and body esteem; and articulate better sexual and life satisfaction (Taleporos & McCabe, 2001, 2003; Kedde & Van Berlo, 2006).

Nevertheless, being married or being in a relationship by itself is not a panacea. Research evidence indicates that the most important component in a relationship that would promote emotional well-being, besides just the presence of a relationship, is the degree to which partners experience satisfaction within it. Dating and relationship happiness or unhappiness is one of the most frequently discussed topics within the context of psychotherapy which is regarded as the main cause of people’s emotional problems (Steuber, 2005). Literature indicates an association between relationship and dating dissatisfaction and feelings of depression, anxiety, frustration, low levels of self-esteem, as well as violent behavior (Steuber, 2005; Beach & O’Mahen, 2000; Burns, Saye & Moras, 1994).

A relative small number of studies on physical disability and dyadic adjustment suggest that a threatening situation such as an illness or disability may affect the quality of romantic relationships (Hwang, 2007; Hinnen, Hagedoorn, Ranchor & Sanderman, 2007). It seems that the disability related restrictions and negative physical symptoms such as lack of interpersonal skills, low socioeconomic status, high incidence of abuse within the relationship, lack of privacy, limited opportunities to participate in social activities, increased need for assistance by the non-disabled partner, sexual dysfunction, and embarrassing symptoms such as incontinence and spasms are just some of the limiting factors affecting ones romantic relationships and as an extend the quality derived from it (Hwang, 2007; Potgieter & Khan, 2005; Makoto, 2004; Vansteenwegen, Jans, & Revell, 2003; Nosec et al., 2001; Berman, et al., 1999; Kilborn, 1999; McCabe, 1999; Yoshida & Odette, 1999).

On the other hand, the majority of studies point out that disability does not affect relationship satisfaction levels. Quite the opposite, many couples where one partner is disabled experience higher levels of happiness within relationships as opposed to “healthy” couples (Hinnen, Hagedoorn, Ranchor & Sanderman, 2007). Results from 1217 married individuals, revealed that all handicapped participants demonstrated high levels of relationship satisfaction.

Moreover, husbands of disabled spouses experienced increase in dyadic adjustment whereas, wives of disabled partners did not report any decline in satisfaction levels (“Physical Disability Brings Marital Happiness”, 2009); It appears that disability acts as a uniting force promoting strong affection within the couple since the need for physical help force partners to spend much time on shared activities and experiences (“Physical Disability Brings Marital Happiness”, 2009).

Subsequently, derived from previous work, this research attempts to investigate the association between physical disability and romantic relationship satisfaction, as well as the effect of this relationship on depression and anxiety levels, among handicapped individuals. In other words this study will examine the degree to which poor dyadic adjustment associate with high or low levels of emotional health.

The study hypotheses are as follows:

1. It is expected a relationship between relationship satisfaction and disability; physically disabled participants would demonstrate high levels of relationship satisfaction. In other words we anticipate that disability would not negatively affect subjects’ degree of satisfaction (Hinnen, Hagedoorn, Ranchor & Sanderman, 2007). Moreover, it is expected that factors such as income, educational level, and need for assistance would be related to relationship satisfaction. Specifically, low educational level, increased need for physical aid, as well as financial hardship would associate with lower levels of happiness whereas, higher education, adequate compensation, and little or no need for physical help is going to correlate with higher satisfaction levels (Hwang, 2007; Potgieter & Khan, 2005; Makoto, 2004; Vansteenwegen, Jans, & Revell, 2003; Nosec et al., 2001; Berman, et al., 1999; Kilborn, 1999; McCabe, 1999; Yoshida & Odette, 1999).
2. It is expected that female participants would exhibit lower levels of relationship satisfaction as opposed to male subjects (Schumm, Webb & Bollman, 1998).
3. Relationship satisfaction will be associated with participants’ emotional health. Partakers who are going to demonstrate high levels of dyadic happiness would exhibit lower levels of depression and anxiety as opposed to those who are going to express low levels of relationship satisfaction that they are expected to demonstrate high levels of depression and anxiety (Steuber, 2005; Beach & O’Mahen, 2000; Burns, Saye & Moras, 1994).

Method

Participants

The target sample of participants is going to be composed of 50 male and female subjects between 25-35 years of age, who live in Greece, and are romantically involved in a relationship. All subjects are identified as having both a diagnosis of Spinal Cord Injury (SCI), or Multiple Sclerosis (MS) with their ability to walk affected. SCI is caused by a damage or trauma of the nerve fibres located in spinal cord. Common symptoms or signs of SCI may include loss of motor ability, loss of sensation, bowel or bladder dysfunction, difficulty in breathing ability, sexual dysfunction and infertility etc (“Spinal Cord Injury”, 2003).

MS is an autoimmune disease caused by damage of the myelin that is wrapped around neurons, located in brain and spinal cord. Patients affected by multiple sclerosis often experience symptoms of paralysis, muscle weakness, loss of balance or coordination, pain, tiredness, incontinence or constipation, sexual dysfunction etc (Breirer & Flecher, 2002). Finally, all participants will be recruited from the Pan-Hellenic Union of Paraplegic & Physically Challenged pool of subjects.

Apparatus

Participants will be asked to complete the following questionnaires and forms which are summarized below.

1. Demographic information form is going to include questions regarding partakers’ gender, age, country of origin, educational level, and financial situation (see Appendix C).
2. The Relationship Assessment Scale is a 7 item inventory that measures the degree to which one is satisfied in romantic relationships. Participants are asked to choose one out of five potential responses, however each question has slightly different answer options. It has been reported that scale’s internal consistency is.86. (Corcoran & Fischer, 2000). RAS has been translated in Greek, but not adapted (see Appendix E).
3. The Depression, Anxiety, Stress Scale (DASS) short form (Lovibond & Lovibond, 1995, as cited in Crawford, & Henry, 2003) is a 21 item questionnaire that measures the degree to which one has experienced symptoms of depression and anxiety over the past week. Partakers are presented with 21 negative statements which have to rate on a 4-point liker scale (from “Did not apply to me at all” to “Applied to me very much/most of the time”). The 3 DASS subscales consist of seven questions; seven items for depression, seven for anxiety, and seven for stress response. The reported internal consistencies for each scale are.91 for depression,.84 for anxiety, and.90 for stress (Corcoran & Fischer, 2000). The Depression, Anxiety, Stress Scale has been translated and adapted in Greek, though we do not have any information on validity and reliability estimates for Greek population (see Appendix F).
4. The disability specific information questionnaire, seeks information on the name, severity and duration of participants’ disability. Severity is going to be assessed, objectively, by asking participants to indicate whether they were able or not to perform certain physical related activities during the last week without requiring any assistance. These activities include: getting dressed, getting out of bed, bathing/showering, and brushing teeth. Moreover, severity is going to be assessed in a subjective way by asking respondents to answer on a 3-point scale (Mild, Moderate, Severe) the following question: “How severe is your disability? Duration is going to be assessed by asking participants to report on a 6-point scale (“My disability does not affect my ability to walk”; “Less than a year”; “1 – 3 years”; “4 – 10 years”; “11 – 18 years”; and “Over 19 years”) the following question: “For how long has your disability affected your capacity to walk”? (see Appendix D).

Design

In order to answer the study research questions, a with-in, quantitative, single group/case research design will be performed. The 50 physically disabled, male and female samples are going to be selected from the Pan-Hellenic Union of Paraplegic & Physically Challenged participant pool. Candidate selection is going to take place in accordance with certain criteria including participants’ age, type of disability, and severity.

To increase the sensitivity of the research and therefore limit the possibility of rival hypotheses, all fifty participants will be matched on type of disability and severity level. Specifically, participants of this study will be people diagnosed with spinal cord injury as well as people having multiple sclerosis. Both disabilities not only share similar symptoms and characteristics, but also are acquired later in patients’ lives, meaning that our subjects were once healthy. Furthermore, all participants will be identified as being in a moderate level of severity; subjects whose disability is mild or severe will be excluded from this study. Finally, no deception is going to be used; participants will be informed on the subject and purpose of this study.

Procedure

The surveys are going to take place at the Pan-Hellenic Union of Paraplegic & Physically Challenged in a face to face format (one person at a time). Subjects choosing to participate in the study will first read and sign the consent form (see Appendix A), and then proceed with filling-out a demographic questionnaire, a disability specific questionnaire, the Relationship Assessment Scale, and the Depression Anxiety Stress Scale. Finally, after collecting back all three questionnaires, a debriefing form (see Appendix B) that includes supplementary information on the subject of research as well contact information in the case they have questions, objections, or comments will be administered as well.

Overall, it is expected that the whole process, from the moment each subject gets the research material to the completion of questionnaires, is going to take from 10 to 15 minutes.

Plans for data analysis

1. To test the hypothesis that relationship satisfaction correlates with disability, need for physical assistance, educational level, and financial situation, I am going to apply a multiple regression analysis. The criterion variable here is relationship satisfaction/dissatisfaction whereas, the predictor variables include participants’ disability, education, financial situation, and degree of assistance need.
2. To test the hypothesis that relationship experience is affected by participants’ gender, I intend to apply a 2×2 (male/female x satisfied/unsatisfied) with-in group analysis of variance (ANOVA). The dependent variable here is subjects’ level of relationship satisfaction while, the independent variable is participants’ gender.
3. To test the hypothesis that relationship satisfaction affects depression and anxiety levels, I am going to apply a 2×2 (satisfied/unsatisfied x high levels of depression-anxiety/ low levels of depression-anxiety) with-in group analysis of variance (ANOVA). The dependent variable here is subjects’ psychological adjustment level (depression, anxiety) while, the independent variable is relationship satisfaction/dissatisfaction.

Appendix A

Informed Consent Form

Relationship Satisfaction and Emotional Well-being Among Greek People with Physical Disabilities.

This research attempts to investigate the degree to which people with physical disabilities experience satisfaction with their loving relationships and the effect of it on their emotional well-being. For this reason we need to collect and analyse data from people with physical disabilities.

The entire process will approximately last for 10 to 15 minutes and as a participant in this study, you will be asked to complete two questionnaires; one measuring the degree to which you feel satisfied with your relationship, and another assessing your emotional status. Moreover, you are going to be asked for general information about your physical disability including type, onset, and duration.

Some of the questions we ask may be upsetting, or you may feel discomfort while answering them. If you do not wish to answer a question, you may skip it and go to the next question. If you wish you may withdraw from the study at any time. Your participation can be beneficial to you given that you will gain experience of being in a study as such.

Your participation in this research is entirely voluntary and you may refuse to complete the study at any point. You may also stop at any time and ask me any questions you may have. The study is going to be anonymous and therefore there is no way to connect your responses on the questionnaires or the results with your identity. The data will be accessible only to those working on the project.

“This research study has been reviewed and approved by the Committee on Research with Human Participants of the Graduate School of The American College of Greece”

Name of Investigator___________ ______________ ____

Signature of Investigator____________________________________________

I have read the above information, I have asked any questions I had regarding the experimental procedure and they have been answered to my satisfaction. I consent to participate in this study.

Name of Participant_________________________________________ Date: __________

(please print)

Signature of Participant ____________________________________________

Age: (Note: You must be 18 years of age or older to participate in this study. Let the experimenter know if you are under 18 years old.)

Thanks for your participation!

Appendix B

Debriefing Form

Relationship Satisfaction and Emotional Well-being Among Greek People with Physical Disabilities.

Physical disability is characterized by dramatic changes in one’s lifestyle affecting others the formation of new relationships, as well as the quality of existing ones. Moreover, it has been proposed that low level of relationship happiness is associated with high levels of depression and anxiety. Focusing on an important area of human life that is largely neglected is important because it can have a positive impact not only because it sheds light on issues disabled people face that researchers and clinicians overlook, but also because it can help health professionals develop more efficient intervention strategies.

The questionnaires you answered included one measure on sadness and anxiety, along with a measure on the extent to which you feel satisfied with your relationship.

The purpose of this study is to examine if disability and related factors such as education, financial and employment status, as well as need for assistance limit ones opportunities to experience happiness in accordance with his/her romantic involvement, and to determine participants’ feelings and sense of self based on their level of relationship contentment.

It is difficult to answer these types of questions, and your generosity and willingness to participate in this study are greatly appreciated. Your contribution will help to improve the field of disability research. Many people find the topic of these questionnaires distressing. If answering any of these questions led you feel upset and wish to talk with someone regarding your feelings and thoughts, please call one of the following help lines:

• Emergency Phone Help Unit of Aeginitio Psychiatric Clinic: (210)722-2333
• National Centre for Social Solidarity: 197
• Mental Health Research Institute Hot Line (EPIPSI): (210)651-5600

We would ask you to maintain confidentiality about the purpose of this experiment since any pre-knowledge will bias the responses of that person, and eventually affect the quality of our data.

If you have any complaints, concerns, or questions about this research, please feel free to contact the Principal Investigator or the Advisor to the study, listed below.