Dyadic coping in patients with autoimmune diseases and spouses: a latent profile analysis and nursing implications

To identify the latent profiles of dyadic coping in patients with autoimmune diseases and their spouses, and to analyze the influencing factors associated with different profiles, thereby providing a theoretical basis for developing couple-based collaborative intervention programs.

A cross-sectional survey design was used to conveniently recruit 262 dyads of patients with autoimmune diseases and their spouses. Demographic and disease-related data were collected using a self-designed general information questionnaire. Single three-level self-reported items (mild/moderate/severe) within this questionnaire were used to measure patients'disease-related economic burden and spouses'caregiving burden. Patients and their spouses completed the Dyadic Coping Inventory (DCI) and the Illness Perception Questionnaire. The Marital Adjustment Scale was additionally administered to identify distinct dyadic coping latent profiles. Mplus version 8.7 was employed to conduct latent profile analysis to identify different profiles of dyadic coping. SPSS version 27.0 was used for univariate analysis and multivariate logistic regression to explore factors associated with class membership.

A total of 282 questionnaires were distributed, and 262 valid dyads were included in the analysis, yielding an effective response rate of 92.91%. Four latent profiles of dyadic coping in patients and their spouses were identified via latent profile analysis: High Dyadic Coping Profile (Class 1, n = 39, 14.9%), Moderate Dyadic Coping Profile (Class 2, n = 118, 45%), Spouse-Moderate/Patient-Low Dyadic Coping Profile (Class 3, n = 58, 22.1%), and Patient-Moderate/Spouse-Low Dyadic Coping Profile (Class 4, n = 47, 18%). The entropy value of the model was 0.941, indicating good classification accuracy. Multinomial logistic regression analysis showed that multiple factors were significantly associated with membership in different dyadic coping subgroups. Using the High Dyadic Coping Profile as the reference category, illness perception was a strong and consistent positive predictor for all non-high-level subgroups (OR ranging from 1.683 to 3.188, all p < 0.001). Marital adjustment of both patients and spouses (OR ranging from 0.704 to 0.949, all p < 0.05) and mild economic/caregiving burden (OR ranging from 0.004 to 0.113, all p < 0.05) were protective factors for the different subgroups. Additionally, patient age was a positive predictor for the Patient-Moderate/Spouse-Low Dyadic Coping Profile (OR = 1.323, p < 0.05), whereas spouse age was a negative predictor for this profile (OR = 0.662, p < 0.05).

Four heterogeneous subtypes of dyadic coping were identified among couples affected by autoimmune diseases, with 40.1% of couples exhibiting asymmetric imbalanced coping patterns. Illness perception emerged as the strongest predictor of imbalance, whereas marital adjustment served as a protective factor. The influence of economic and caregiving burden on dyadic coping exhibited a threshold effect: mild burden was protective, whereas moderate-to-severe burden may be associated with persistent coping impairment that is difficult to reverse. Clinical practice should implement stratified, targeted couple-based interventions according to the characteristics of each subtype.