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Discrepant illness perceptions in stroke survivor-partner dyads : relationship to psychological adjustment and expressed emotion

Avison, Rachel


Rachel Avison


Chris Clarke


This research portfolio is divided into three parts:

Part one is a systematic literature review titled ?Factors associated with relationship stability following brain injury: A systematic review of the literature?. Research frequently documents the negative effects of brain injury and the difficulties faced by survivors and their families. Couples in particular may experience a range of life changes and challenges, which have been shown to place considerable strain on the stability of their relationship. This systematic literature review explores the positive and negative factors associated with marital and relationship stability following acquired and traumatic brain injury, in order to examine what keeps couples together and what pushes them apart. The review process uncovered 18 studies that contained evidence relating to factors associated with relationship stability after brain injury. All studies were assessed for methodological quality and the strengths and weaknesses of papers are discussed. Findings revealed 20 different factors that may contribute to relationship stability following brain injury. Although the evidence for 14 of these factors appeared contradictory, six factors were identified with consistent evidence. The following may have important implications for the stability of relationships following brain injury: The extent of physical disability, particular neurobehavioural characteristics including mood swings and unpredictability, changes in communication between couples and finally, un-injured partners? difficulty understanding the effects of the brain injury.

Part two is an empirical paper titled ?Discrepant illness perceptions in stroke survivorpartner dyads: Relationship to psychological adjustment and expressed emotion?. Previous research has shown that relationships between couples can become strained after brain injury and that those partners who adopt a carer role may be more likely to express negative or critical reactions towards the person they care for. This study explores a cognitive component that may underlie the extent of carers expressed emotions: The difference or discrepancy between carers understanding of their partners stroke and stroke survivors understanding of their stroke. Findings from the health research literature have shown that following an illness event, patients and carers create unique personal models or illness perceptions around five distinct components, these include identity, cause, time-line, consequences and cure-control. This study investigates whether couples differ in their illness perceptions and if so, whether this relates to carers level of negative or critical reactions towards their partner (expressed emotion) and stroke survivors level of psychological adjustment (anxiety and depression). A correlational design was used to explore the associations between discrepant illness perceptions, expressed emotion and anxiety and depression. A total of 51 couples participated in the research and results showed that although the correlations between variables were not statistically significant, there was a statistically significant correlation between stroke survivors? level of anxiety and partners? level of expressed emotion. The implications and possible avenues for further research are discussed.

Part three contains the appendixes, which provide further information for the systematic literature review and empirical paper. A reflective statement on the process of carrying
out the research is also provided.


Avison, R. (2009). Discrepant illness perceptions in stroke survivor-partner dyads : relationship to psychological adjustment and expressed emotion. (Thesis). University of Hull. Retrieved from

Thesis Type Thesis
Deposit Date Aug 16, 2011
Publicly Available Date Feb 22, 2023
Keywords Medicine
Public URL
Additional Information Postgraduate Medical Institute, The University of Hull
Award Date Jul 1, 2009


Thesis (534 Kb)

Copyright Statement
© 2009 Avison, Rachel. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.

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