Journal of Family Psychology Copyright 2005 by the American Psychological Association

2005, Vol. 19, No. 3, 465– 469 0893-3200/05/$12.00 DOI: 10.1037/0893-3200.19.3.465

BRIEF REPORTS

Dyadic Adjustment in Chronic Illness:

Does Relationship Talk Matter?
Hoda Badr Linda K. Acitelli
The University of Texas M. D. Anderson Cancer Center University of Houston

Relationship talk involves talking about the nature and state of one’s relationship. To
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

determine the effectiveness of talking about the relationship when one spouse has a chronic
This document is copyrighted by the American Psychological Association or one of its allied publishers.

illness, the study involved completion of a confidential questionnaire by 182 married couples.
Ninety of these were couples in which both partners were healthy, and 92 were couples in
which one spouse had a chronic illness. Results of multilevel modeling analyses showed that
the association between relationship talk and dyadic adjustment was stronger for women than
for men and for couples with an ill spouse than for couples where both spouses were healthy.
These findings highlight the importance of taking a relationship perspective and suggest that
relationship talk is a potentially useful tool couples can use in their repertoire of relationship-
enhancing behaviors during chronic illness.

Keywords: dyadic adjustment, relationship talk, chronic illness, gender

Chronic illnesses seriously restrict physical functioning
and the performance of social roles for 1 in every 10
Americans (Centers for Disease Control, 2002). Different
illnesses place different physical demands on patients; how-
ever, the relationship challenges they impose are surpris-
ingly similar (Lyons, 1999). Over the course of illness,
finances, division of labor, social activities, and interaction
patterns can change (Kaye & Gracely, 1993). These types of
relationship stressors increase the likelihood of negative
spousal interaction, placing couples at greater risk for mar-
ital distress. Applying a relationship perspective to the study
of chronic illness involves seeing illness in interpersonal
terms. Most researchers who adopt a relationship perspec-
tive focus on the link between partners’ coping and psycho-
logical adjustment. Few have examined the strategies cou-
ples use to sustain their marriages during chronic illness.
Chronic Illness and Relationship Talk
Relationship talk involves talking about one’s relation-
ship as an entity, talking in relational terms, or talking about
specific aspects of a relationship (Acitelli, 1996; Goldsmith
& Baxter, 1996). Relationship awareness (Acitelli, 1992)
provides a framework for the study of relationship talk and
Hoda Badr, Department of Behavioral Science, The University
of Texas M.D. Anderson Cancer Center; Linda K. Acitelli, De-
partment of Psychology, University of Houston.
Correspondence concerning this article should be addressed to
Hoda Badr, Department of Behavioral Science—Unit 1330, The
University of Texas M.D. Anderson Cancer Center, P.O. Box
301439, Houston, TX 77230-1439. E-mail: hbadr@mdanderson.org
relates to the frequency of thinking about one’s relationship.
Cognitive attention focused in this way is associated with
higher levels of happiness, commitment, and love (Fletcher,
Fincham, Cramer, & Heron, 1987), and can be expressed
through relationship talk (Acitelli, 2002).
Relationship talk is associated with global measures of
marital satisfaction (Acitelli & Young, 1996) and may differ
from other spousal communication in its effect on the rela-
tionship. For example, couples in conflict are less likely to
remain in conflict if their conversations shift from being
partner focused to more relationship focused (Bernal &
Baker, 1979). Relationship talk may help alleviate distress
and buffer couples from the negative effects of chronic
illness by providing support to the relationship (Badr,
Acitelli, Duck, & Carl, 2001). This support is conceptually
different from other types of support because it is conver-
sational, dyadic, and relationship specific.
Methodological Concerns in the Study of
Relationship Talk
There is a lack of consensus regarding how to operation-
alize relationship talk. Some scholars assess it using open-
ended interviews (Acitelli, 1992); others use Likert-style
questionnaires. Some questionnaires tap how often couples
talk about their relationships in general; others assess the
frequency with which specific relationship issues are dis-
cussed. There is also no clear distinction between relation-
ship talk and other types of spousal communication, making
it difficult to discern the effects of relationship talk on
relationship outcomes such as dyadic adjustment. One ob-
jective is thus to synthesize existing measures into a single
relationship talk measure and to distinguish that measure

465
 466 BRIEF REPORTS
from other forms of spousal communication and dyadic
adjustment.
Gender differences may also exist with regard to rela-
tionship talk (Stafford, Dainton, & Haas, 2000). These
differences likely reflect social expectations about how part-
ners should relate to each other as opposed to biological sex
differences. Research shows that women in North American
cultures focus more attention on relationships and engage in
more positive thinking about their relationships than do men
(Cate, Koval, Lloyd, & Wilson, 1995). Wives’ marital sat-
isfaction also seems more strongly influenced by relation-
ship talk than husbands’ satisfaction (see Acitelli, 2002).
Despite this, studies suggesting gender differences often
analyze men’s and women’s data separately (Kashy &
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Kenny, 2000). A second objective is thus to explore gender
differences in the association between relationship talk and
relationship functioning using multilevel modeling, which
allows for the inclusion of husbands and wives’ data in the
same analysis and tests interactions with gender.
Because chronic illness burdens marital relationships and
couples use relationship talk to solve relationship problems,
a final goal is to explore the relation of dyadic adjustment
and relationship talk for chronic illness and healthy couples.
We expect the positive association between relationship talk
and dyadic adjustment to be stronger for chronic illness
couples than for healthy couples.
Method
Data were collected from 182 married couples. In 90 couples,
both spouses were healthy. In 92 couples, one spouse had a chronic
illness. In 50 couples the wife was ill, and in 42 couples the
husband was ill. Couples were ineligible if one or both spouses had
cognitive impairment or a mental illness. Physical illnesses repre-
sented in the sample were the following: cancer (active treatment;
24%), Type I diabetes (16%), autoimmune diseases (13%), heart
disease (12%), arthritis (8%), chronic pain (7%), gynecological
problems (i.e., fibroids with chronic bleeding; 4%), Parkinson’s
disease or multiple sclerosis (4%), renal failure (3%), and other
(9%). Average length of marriage was 17.67 years (SD ⫽ 11.96,
range ⫽ 2 to 52 years). Chronic illness couples were married an
average of 13.45 years before diagnosis (SD ⫽ 11.45, range ⫽ 1
to 43 years). The sample consisted of: Caucasian (49%), Asian
(17%), African American (16%), Hispanic (15%), other (2%), and
less than 1% not reponding. Approximately 64% reported some
college education, and 65% reported household incomes over
$50,000. Wives’ mean age was 42 years (SD ⫽ 11.87, range ⫽ 19
to 75 years) and husbands’ mean age was 45 years (SD ⫽ 11.90,
range ⫽ 20 to 75 years).
Participants were recruited from a physician’s office and illness
support groups in Houston, Texas. Additionally, undergraduate
University of Houston students were trained to deliver the recruit-
ment script and were given extra credit for recruiting couples
(healthy or chronic illness) in the community. Participants returned
individually sealed questionnaires in separate postage-paid enve-
lopes. A packet return-rate of 45% was calculated by dividing the
number of packets returned by the number distributed. A series of
univariate analyses of variance (ANOVAs) were conducted but
found the three recruitment groups did not significantly differ on
income, education, dyadic adjustment, or relationship talk.
Chronic illness couples from the three recruitment groups did not
differ in terms of illness severity.
Measures
Couples’ health. The 21-item SF-36 Physical Component
Summary (PCS) assesses bodily pain, general health, and the
degree to which activities of daily living are affected by illness.
Scores range from 0 to 100, with lower scores indicating greater
impairment. Compared with healthy individuals, the average effect
of various chronic conditions on PCS scores is ⫺2 to ⫺4 points,
with the largest effects in the ⫺6 to ⫺8 point range (Ware &
Kosinski, 2001). This point spread is similar to PCS scores at or
below the 50th percentile for the general U.S. population.
Couples with both spouses scoring above the 50th percentile on
the PCS who did not report a chronic illness were classified as
healthy. Couples in which one spouse was healthy and one spouse
had a chronic illness (scoring below the cutoff) were classified as
chronic illness couples. Among chronic illness patients, 82% fell
between the 25th and 50th percentiles on the PCS. Fourteen
couples were dropped because either one or both spouses did not
meet these criteria, yielding a sample of 182 couples.
Relationship functioning. The Dyadic Adjustment Scale
(DAS; Spanier, 1976) was scored such that higher scores indicated
greater adjustment. Overall, our sample consisted of maritally
satisfied couples (M ⫽ 107.5, SD ⫽ 22.98, range ⫽ 54 to 146).
Chronic illness couples (M ⫽ 104.10, SD ⫽ 24.18) were less
satisfied in their marriages than healthy couples (M ⫽ 110.95,
SD ⫽ 17.01).
Relationship talk was measured using eight Likert-type items
rated on a scale ranging from 1 (often) to 4 (never) (Veroff,
Douvan, & Hatchett, 1995). Two items developed by Acitelli
(1997) rated on a scale ranging from 1 (often) to 5 (never) were
also included (see Table 1). To synthesize the two measures, we
conducted an exploratory principal components factor analysis
with Oblimin rotation using standardized scores. Results yielded a
two-factor solution accounting for 69% of the variance (see Table
1). Six of the 10 items clustered to form a single relationship talk
factor; the remaining items clustered on a general spousal com-
munication factor. No item cross-loadings were observed. Next,
we conducted a confirmatory factor analysis for both husbands and
wives using LISREL 8 (Jöreskog & Sörbom, 1996) to determine
whether the constructs measured by the DAS (which measures
satisfaction with specific marital domains) and the 6-item relation-
ship talk measure obtained from the exploratory factor analysis
were distinct. Adjusted for sample size, results show that the
constructs of dyadic adjustment and relationship talk, as measured
here, are distinct (root mean square error of approximation ⫽ .06,
goodness-of-fit index ⫽ .93, comparative fit index ⫽ .95).
Results
Exploratory analyses revealed that relationship talk did
not significantly vary as a function of household income,
F(1, 175) ⫽ .09, or education, F(1, 176) ⫽ 1.13. However,
relationship talk was significantly correlated with length of
marriage (r ⫽ ⫺.18, p ⫽ .05). Thus, length of marriage was
statistically controlled in subsequent analyses. Average time
since diagnosis was 5.9 years (SD ⫽ 4.07) but was not
significantly correlated with dyadic adjustment (r ⫽ .08) or
relationship talk (r ⫽ .07).
Remaining analyses were guided by the Actor–Partner
Interdependence Model (APIM; Kashy & Kenny, 2000).
The APIM suggests that one’s independent variable score
affects one’s dependent variable score (actor effect) and
one’s partner’s dependent variable score (partner effect).
 BRIEF REPORTS 467

Table 1
Questionnaire Items and Factor Loadings of Relationship Talk Measure
Subscale Eigenvalue % variance explained Factor loading
Relationship talk (␣ ⴝ .65) 5.07 50.72
How often do you talk about your relationship with your spouse?a .85
In the past two weeks, how often did you talk about your relationship
with your spouse?a .89
In the past month, how often did you. . .
reveal very intimate things about yourself or your personal feelings?b .58
discuss and try to work out problems between the two of you?b .57
talk about the quality of your relationship; for example, how good it is,
how satisfying it is, or how to improve it?b .77
tell your spouse what you want from the relationship?b .80
Talk in the context of a relationship (␣ ⴝ .75) 1.52 15.23
In the past month, how often did . . .
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you chat about everyday things together?b .83

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you talk about important things?b .79

you tell your spouse that you love him/her?b .72
your spouse tell you that they love you?b .69
a b
Acitelli (1997). Veroff, Douvan, and Hatchett (1995).

Using SAS PROC MIXED, we estimated actor and partner
effects as well as interactions within dyads, between dyads,
and among mixed variables (i.e., variation both between and
within dyads).
Relationship Talk and Dyadic Adjustment: Gender
Differences
Actors’ perceptions of relationship talk (mixed variable)
was centered to make interpretation of the intercept more
direct. Effect coding was used for the within-dyads variable
of actors’ gender (women ⫽ ⫺1, men ⫽ 1). An interaction
term was created to test whether the relationship between
perceptions of relationship talk and dyadic adjustment differ
for men and women by multiplying the mixed predictor and
within-dyads variables. Length of marriage, actors’ gender,
and actors’ perceptions of relationship talk were entered
into the model, followed by the interaction term. The inter-
action was significant (see Table 2). Taking the intercept
and main effect coefficients into account, we calculated
actor effects for perceptions of relationship talk within
gender showing a stronger association with dyadic adjust-
ment for women (b ⫽ 11.08) than for men (b ⫽ 3.92).
Relationship Talk and Dyadic Adjustment:
Differences Between Chronically Ill and Healthy
Couples
Actors’ perceptions of relationship talk (mixed variable)
was centered. Effect coding was used for actor’s gender and
couples’ health (healthy couple ⫽ 1, chronic illness cou-
ple ⫽ ⫺1). To test whether the relationship between per-
ceptions of relationship talk and dyadic adjustment differs
for chronic illness and healthy couples, we created an in-
teraction term (actors’ perceptions of relationship talk ⫻
couples’ health). The interaction was significant (see Table
3). Actor effects were calculated for perceptions of relation-
ship talk within each level of health, showing a stronger
association with dyadic adjustment for chronic illness (b ⫽
9.88) than for healthy couples (b ⫽ 5.05).
Discussion
This study represents a preliminary effort to synthesize a
single measure of relationship talk from existing measures
and to distinguish that measure from other forms of spousal
communication as well as from items on the DAS. We
conducted an exploratory factor analysis on two existing

Table 2
Results of Hierarchical Linear Modeling Analysis Showing Dyadic Adjustment as a
Function of Actors’ Gender and Perceptions of Relationship Talk
Variable b SE t(178)
Intercept 1.50
Length of marriage 0.09 0.10 0.84
Actors’ gender 0.01 0.64 0.01
Actors’ perceptions of relationship talk 7.50 1.26 5.94**
Actors’ Gender ⫻ Actors’ Perceptions of Relationship Talk 3.59 1.75 2.05*
Note. Analysis was conducted with SAS Proc Mixed. N ⫽ 182 couples.
* p ⬍ .05. ** p ⬍ .01.
 468 BRIEF REPORTS
Table 3
Results of Hierarchical Linear Modeling Analysis Showing Dyadic Adjustment as a
Function of Actors’ Perceptions of Relationship Talk and Health
Variable
Intercept
Length of marriage
Actors’ gender
Couples’ health (chronic illness or healthy)
Actors’ perceptions of relationship talk
Couples’ Health ⫻ Actors’ Perceptions of Relationship Talk
Note. Analysis was conducted with SAS Proc Mixed. N ⫽ 182 couples.
* p ⬍ .05. ** p ⬍ .01.
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relationship talk measures. Using items that loaded on the
relationship talk factor in the exploratory factor analysis, we
conducted a confirmatory factor analysis and confirmed that
relationship talk and dyadic adjustment are distinct con-
structs. Despite this, it is important to note that moderate
reliabilities were obtained. Further verification of the factor
structure of the relationship talk measure in future indepen-
dent samples is therefore warranted.
One limitation of our relationship talk measure is that
items focused almost exclusively on the quantity as opposed
to the quality or tone of relationship discussions. Despite
this, our measure assessed the frequency of both positive
and negative relationship talk. Perhaps the frequency with
which couples engage in open, relationship-oriented talk is
important in its own right (regardless of tone) because it
suggests greater relationship awareness.
Previous work suggests gender differences in relationship
talk. Unlike past studies, our multilevel modeling analyses
simultaneously included husbands’ and wives’ data. Results
suggested that relationship talk is associated with dyadic
adjustment for both spouses and that chronic illness couples
may benefit more than healthy couples from engaging in
relationship talk. It is important to keep in mind, however,
that gender roles adopted within marriage are often cultur-
ally defined. If both spouses identify with norms that value
relationship talk, then such talk may be of greater benefit.
Our study had insufficient power to examine sociocultural
differences with regard to relationship talk; however, future
research would benefit from such examination.
Whereas our data collection procedures were atypical,
our goal was to examine the association between relation-
ship processes and relationship outcomes in the context of
chronic illness and not the effects of a particular illness per
se. One benefit to our approach was the inclusion of a
chronic illness and a healthy comparison group. It should be
noted, however, that the majority of our sample was mari-
tally satisfied. This limits generalizability because satisfied
couples may have more positive things to talk about and
find it more rewarding to talk together about their
relationship.
Despite our findings, the links between spousal commu-
nication and relationship outcomes are complex. Discus-
sions should be suitably matched to the needs of the couple
and the situation at hand. Although it was not assessed here,
the type of problem being discussed is potentially impor-
b SE t(178)
1.04
0.07 0.10 0.68
0.01 0.63 0.02
2.52 1.22 2.07*
7.47 1.25 5.96**
2.41 1.25 1.94*
tant. Relationship talk may be more beneficial for couples
discussing shared problems as opposed to individual ones.
Additionally, consistent with other studies, relationship talk
was negatively associated with length of marriage, suggest-
ing its frequency may decrease with time spent in the
relationship. However, our study was cross-sectional, and
the effects of relationship talk over time cannot be inferred.
Future research would benefit from an examination of the
patterns of relationship talk over the course of illness to
determine its effect in times of acute stress (e.g., at diagno-
sis) versus chronic stress (e.g., day-to-day hassles of living
with chronic illness). Future studies might also focus on
identifying situations in which relationship talk is more
beneficial and for whom. This may help clinicians tailor
future interventions for those couples who are likely to
benefit most.
In conclusion, this study suggests that talking about the
spousal relationship is a potentially useful tool couples can
use in their repertoire of relationship-enhancing behaviors
and highlights the importance of having a relational focus
when studying and treating chronic illness.
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Received November 4, 2003
Revision received August 30, 2004
Accepted September 7, 2004 䡲