This is an open access article distributed under the terms of the Creative Commons
Attribution License (The marital between parents forms the basis of a family (Paajanen, 2007). Several studies have suggested that embarking on parenthood decreases marital satisfaction (e.g. Lawrence, Rothman, Cobb, Rothman, & Bradbury, 2008; Salmela-Aro, Aunola, Nurmi, Saisto, & Halmesmäki, 2003; Twenge, Campbell, & Foster, 2003). In today’s world, neither shared possessions nor children no longer guarantee the continuation of a relationship. Instead, people value the quality of the marital relationships they have (Malinen, 2011). Forming and maintaining a high-quality marital relationship has emerged as a special life goal (Kontula, 2013). However, such relationships are hard to sustain (Rosen-Grandon, Myers, & Hattie, 2004).
The marital relationship between parents is not only about interaction between two spouses. On the contrary, the well-being or suffering of any family member affects the other members of the family as well. The quality of the parents’ marital relationship is a significant factor for a child’s mental well-being (Salo, 2011). Marital satisfaction has an impact on parenthood – a happy spouse is often a happy parent as well (Malinen, 2011). In addition, a satisfactory relationship and support from one’s spouse can provide protection against emotional exhaustion and hopelessness (Murphy, Christian, Caplin, & Young, 2007). Every year, over 500 children with congenital heart disease (CHD) are born in Finland (Rovamo & Rautiainen, 2014). No known research exists in Finland on the marital satisfaction of parents to heart children, and very few international studies have been carried out on the topic. Thus, it is an important focus of study.
Marital Relationship
The term marital relationship refers to an emotional relationship between two people. The quality of this relationship is the basis for marital satisfaction (Rosen-Grandon, Myers, & Hattie, 2004). A good marital relationship is considered to be one of the most important aspects of life, in addition to good parenting and spending time with one’s family (Paajanen, 2005). Most people regard their spouse and other members of their family as their most important source of well-being and happiness in life (Kontula, 2013).
Marital satisfaction can be accomplished through love, faithfulness, and good communication (Rosen-Grandon et al., 2004). In a good and long-lasting relationship, spouses have the ability to solve any emerging conflicts through communication and conflict resolution skills (Kiiski, 2011; Pukkala, 2006). A good marital relationship also involves mutual appreciation and respect and having a strong trust in one’s spouse in all matters (Kontula, 2013). The degree of happiness in a relationship affects the degree of happiness in other areas of life, too: research suggests that people who are happy in their marital relationships are also happier overall compared to people are unhappy in their relationships (Dyrdal, Røysamb, Nes, & Vittersø, 2011; Kontula, 2009).
Child With a Heart Defect
A heart child refers to a child with a congenital heart defect. Heart defects are the most common birth defects in children (Rovamo & Rautiainen, 2014). Nearly all structural heart defects can be treated, and their prognoses have improved substantially during the past twenty years due to developments in diagnosis and treatment (Kaarne, Jokinen, Pesonen, & Leijala, 2008). The parents of a heart child experience constant worry over their child’s illness (Van Horn, DeMaso, Gonzalez-Heydrich, & Dahlmeier Erickson, 2001) and encounter various sources of stress (Karsdorp, Everaerd, Kindt, & Mulder, 2007; Lawoko, 2007), such as challenges related to working while their child is ill (Lawoko & Soares, 2002, 2003) and, as a consequence, potential changes to their financial situation (Karsdorp et al., 2007; Lawoko, 2007; Van Horn et al., 2001). Because of these stress factors, special attention needs to be paid to supporting the marital relationships between the parents of heart children. A good relationship helps parents cope with stress factors (Goldbeck & Melches, 2006) and acts as a buffer against posttraumatic stress, depression, and anxiety, whereas low marital satisfaction has been linked to increased levels of depression and anxiety (Rychik et al., 2013).
Factors Associated With Marital Satisfaction
There is limited data available on the factors associated with marital satisfaction among the parents of heart children. Mothers of heart children have been shown to experience higher levels of anxiety (Rychik et al., 2013) and emotional exhaustion (Lawoko & Soares, 2002) compared to fathers of heart children. Emotional support has been found to have a positive correlation with marital satisfaction among the parents of heart children (Rychik et al., 2013). The age of a heart child has not been identified as a relevant factor with regard to the level of stress experienced by the family or the mother’s ability to cope (Tak & McCubbin, 2002). A child’s heart defect has nonetheless not been associated with the marital satisfaction of the child’s parents: already during pregnancy, mothers expecting children with heart defects have been found to have lower levels of marital satisfaction compared to mothers expecting healthy children (Rychik et al., 2013). Having children with serious heart malformations reflects negatively on the mental health of mothers (Solberg, Dale, Holmstrøm, Eskedal, Landolt & Vollrath, 2012). By contrast, other studies have discovered no link between a child’s heart defect, regardless of its severity, and decreased marital satisfaction between parents (Dale et al., 2013) or between a child’s heart defect and parents’ stress levels (Tak & McCubbin, 2002; Uzark & Jones, 2003).
It is generally known that several factors, such as the gender of the parent, are linked to the marital satisfaction of parents. Mothers are less satisfied with their relationships compared to fathers (Twenge et al., 2003). The health status of the parents of a newborn has also been associated with marital satisfaction: the higher the level of depression in the parents of a newborn, the lower the level of their marital satisfaction (Salmela-Aro et al., 2003).
In addition, the support received from one’s spouse – caring for one’s spouse, providing emotional support, showing appreciation, and offering help – is related to communication and happiness in a relationship (Kontula, 2013). The age of the child has also been shown to play a role in marital satisfaction: mothers of small children have been found to be more dissatisfied with their relationships compared to mothers of older children (Twenge et al., 2003).
Aim of the Study
The aim of this study was to describe the marital satisfaction of parents to children with heart defects and the factors associated with it. The goal was to produce knowledge that can be utilized while planning and developing support schemes for the parents of heart children.
Research questions:
1. What is the level of marital satisfaction among the parents of heart children?
2. Which parent and heart child background factors are associated with marital satisfaction among the parents of heart children?
Methods
Participants and Procedure
The study focuses on the parents of heart children, and it is a quantitative cross-sectional study. The data for the study was collected between 2015 and 2016 through a link to an electronic form on the website of the Finnish Association for Heart Children and Adults (www.sydanlapsetja-aikuiset.fi) as well as through a closed Facebook group where the parents of heart children were members. To participate to this study there was one inclusion criterion: having a heart child in the family was a prerequisite for participating in the study. Both parents of a heart child could participate in the study, responding to the questionnaire separately.
Each stage of the study was guided by the principles of good scientific practice (Polit & Beck, 2012). Participation in the study was entirely voluntary, and the introduction to the questionnaire stated that the parents may terminate their participation in the study at any stage. The Finnish Association for Heart Children and Adults, as well as the administrators of the Facebook group, gave their consent to carrying out the study. By responding to the questionnaire, the parents gave informed consent to participate in the study. Participation was anonymous (Burns & Grove, 2005).
The data comprises the answers of 104 parents of heart children. The questionnaire contained structured questions concerning parents and their heart children. The questions solicited background variables (Table 1) and parents’ views on their marital satisfaction (ENRICH). The background variables were chosen based on existing research (Goldbeck & Melches, 2006; Lawoko & Soares, 2003; Rychik et al., 2013; Solberg et al., 2012).
Table 1
Parent’s And Children’s Demographic Characteristics (N = 99–104)
| Variable | n | % |
|---|---|---|
| Parents | ||
| Mother | 86 | 82.7 |
| Father | 18 | 17.3 |
| Age | ||
| 22–30 year | 26 | 25.0 |
| 31–35 year | 27 | 26.0 |
| 36–40 year | 32 | 30.8 |
| 41–53 year | 19 | 18.3 |
| Marital status | ||
| Partnered | 96 | 92.3 |
| Not partnered | 8 | 7.7 |
| Family structure | ||
| Nuclear family | 76 | 73.1 |
| Blended family | 20 | 19.2 |
| Others | 8 | 7.7 |
| Education | ||
| No education | 13 | 12.5 |
| Vocational education | 42 | 40.4 |
| College or polytechnic degree | 27 | 26.0 |
| University degree | 22 | 21,2 |
| Employment status | ||
| Employment | 65 | 62.5 |
| Not employment or working | 39 | 37.5 |
| Religious community | ||
| Yes | 78 | 75.0 |
| No | 26 | 25.0 |
| Parent’s health status | ||
| Very poor, quite poor or satisfactory | 16 | 15.4 |
| Quite good | 69 | 66.3 |
| Very good | 19 | 18.3 |
| Support amount from a spouse | ||
| Not at all, very little, little or moderately support | 13 | 13.1 |
| Much support | 23 | 23.2 |
| Very much support | 63 | 63.6 |
| Significant illness or injury during the last year | ||
| No | 87 | 83.7 |
| Yes | 17 | 16.3 |
| Problems with a spouse during the last year | ||
| No | 72 | 69.2 |
| Yes | 31 | 29.8 |
| Sicnificant change in economic status | ||
| No | 61 | 58.7 |
| Yes | 43 | 41.3 |
| Adaptation to the child’s heart decease | ||
| Very poor, quite poor or moderately | 18 | 17.3 |
| Quite good | 57 | 54.8 |
| Very good | 29 | 27.9 |
| Got advance information about the child’s heart disease | ||
| No advance warning | 77 | 74.0 |
| Advance warning before birth | 27 | 26.0 |
| Number of children in the family | ||
| 1 | 19 | 18.3 |
| 2 | 44 | 42.3 |
| 3 | 19 | 18.3 |
| 4 or more | 22 | 21.2 |
| Age of the child | ||
| 0 – ≤ 12 month | 18 | 17.3 |
| > 1 – ≤ 3 year | 20 | 19.2 |
| > 3 – ≤ 7 year | 28 | 26.9 |
| > 7 – ≤ 12 year | 30 | 28.8 |
| > 12 – ≤ 22 year | 8 | 7.7 |
| Child’s health status | ||
| Very poor, quite poor, satisfactory | 22 | 21.2 |
| Quite good | 50 | 48.1 |
| Very good | 32 | 30.8 |
Instrument
Marital satisfaction was measured with the ENRICH Marital Satisfaction (EMS) instrument. The EMS instrument consists of 15 statements that are used to evaluate marital satisfaction (10 statements) and idealistic distortion (5 statements). The statements about marital satisfaction addressed personality issues, communication, conflict resolution, financial management, leisure activities, sexual relationships, children and parenting, family and friends, role relationships, and spiritual beliefs. The statements used to measure idealistic distortion describe the relationship in an exaggeratedly positive manner. The idealistic distortion scores are used to correct for the potential bias in the marital satisfaction scores. The statements are answered with a 5-point Likert scale (ranging from strongly agree to strongly disagree) (Fowers & Olson, 1993). No known Finnish study has previously used the instrument, making this study a pilot for the instrument in the Finnish context. The instrument was double translated for the purpose of this study, and the response scale was expanded to a 7-point scale to increase precision for further inquiry. The background variables were examined individually in relation to both sum variables since the idealistic distortion scale could not be used for score adjustment due to altering the original response scale.
An existing statistical instrument, established as a reliable measure of marital satisfaction, was used in the data collection (Fowers & Olson, 1993). The developers of the instrument consented to its use in this study. The Cronbach alpha values of the sum variables created (marital satisfaction α = 0.850; idealistic distortion α = 0.854) exceeded 0.7 and can thus be considered internally consistent (Polit & Beck, 2012). The comparability of the results to previous results based on the instrument’s mean sum variables is weakened by the fact that points were added to the scale.
Data Analysis
The variables were described by frequencies, percentages, and dispersion measures (Md = median, Q1 = lower quartile, Q3 = upper quartile). Background variables were recategorized based on frequencies. The EMS instrument includes both positive and negative statements, and they were translated following the instrument guidelines prior to the analysis (Fowers & Olson, 1993). Next, two sum variables were created: marital satisfaction (10 statements) and idealistic distortion (5 statements), whose internal consistency was tested by Cronbach’s alpha. Since the group sizes were small, the links between the background variables and relationship satisfaction were examined through nonparametric tests (the Mann-Whitney U test / the Kruskall-Wallis test). If a qualitative variable had more than two values, the Mann-Whitney U test with a corrected p-value was applied in the paired comparison. The limit of statistical significance was p < .05 (Polit & Beck, 2012). The data were analyzed using the IBM SPSS 23.0 program.
Results
Background Information on Heart Children and Their Parents
The parents (N = 104) were on average 35 years of age (SD = 6.6, range 22–53). 83 per cent of the respondents were mothers of heart children. The majority were living in a marital relationship (92%) and in a nuclear family (73%). 40 per cent of the parents had a vocational degree, 26 per cent had an applied sciences degree, and 21 per cent an academic degree. The majority of the parents were working (63%), and belonged to a religious community (75%). The parents of heart children mostly considered themselves healthy (85%). The heart children were on average 6 years of age (SD = 4.5, range 0–22). The current health status of the heart children varied between very good (31%), fairly good (48%), and satisfactory or worse (21%; Table 1). The three most common heart defects among the respondents’ children were ventricular septal defect (VSD), atrial septal defect (ASD), and coarctation of the aorta (CoA). 101 of the respondents’ children were born with their condition (Table 1).
Marital Satisfaction Among the Parents of Heart Children
The vast majority of the parents surveyed were at least fairly satisfied with their marital relationships. Nearly a third of the respondents (31%) were very happy with their relationships. About a quarter (28%) were happy with their relationships, while a little over a quarter (30%) were fairly satisfied with their relationships. Among the parents surveyed, 12 per cent were dissatisfied or not satisfied/dissatisfied with their relationships.
The parents were predominately fairly satisfied with their marital relationships (Md = 48.5, Q1 = 39.3, Q3 = 56.8). Over half of the parents (53%) were satisfied with the communication they had with their spouses and felt understood by their spouses. Over two thirds (70%) of respondents were satisfied with decision-making and conflict resolution in their relationships. More than a third (40%) were dissatisfied with their financial situation and the way financial decisions were made in the household. A third (33%) of the parents were satisfied with the time they shared with their spouses, and over half (52%) were satisfied with the way both spouses regarded their responsibilities as parents. Half (50%) of the respondents were happy with the way spirituality and values were expressed in the household, but it is worth noting that 28 per cent of the respondents had no opinion on the matter.
Some of the parents of heart children surveyed presented an idealistically distorted view of their relationships (Md = 23.0, Q1 = 16.0, Q3 = 27.0). Almost half of the respondents (46%) stated they and their spouses understand each other almost perfectly, and 10 per cent saw their relationships as perfect successes. Nearly a fifth of the parents (17%) fully agreed that they had never, not even for a moment, regretted their relationship with their spouses. However, almost half of the respondents (48%) felt that some of their needs were not met in their relationships.
The Parent and Heart Child Background Factors Associated With the Marital Satisfaction of the Parents of Heart Children
Among the parental background factors included, the gender of the parent, the current health status of the parent, the degree of support received from one’s spouse, problems with one’s spouse, and significant changes in one’s financial situation were found to have a statistically significant link to the marital satisfaction of the parents. The fathers of heart children (Md = 52.2, Q1 = 46.8, Q3 = 59.5) rated their relationships higher compared to the mothers (Md = 46.5, Q1 = 38.0, Q3 = 56.0). The parents who regarded their current health status as very good (Md = 51.0, Q1 = 41.0, Q3 = 57.0) were more satisfied with their relationships compared to the parents who regarded their health as satisfactory or worse (paired comparison p = .027). The parents who received a high degree of support (Md = 49.0, Q1 = 39.0, Q3 = 51.0) (paired comparison p = .045) or a very high degree of support (Md = 51.0, Q1 = 43.0, Q3 = 58.0) (paired comparison p < .001) were more satisfied with their relationships compared to the parents who received a moderate or lower degree of support from their spouses (Md = 34.0, Q1 = 28.5, Q3 = 45.0). The parents who had experienced problems with their spouses over the previous year were less satisfied with their relationships (Md = 38.0, Q1 = 33.0, Q3 = 46.0) compared to the parents who had not faced problems during the same time period (Md = 51.0, Q1 = 44.0, Q3 = 58.0). The parents who had seen a significant change in their financial situation during the previous year were less satisfied with their relationships (Md = 45.0, Q1 = 33.0, Q3 = 46.0) compared to the parents whose financial situation had remained similar during the same time period (Md = 50.0, Q1 = 44.0, Q3 = 58.0). There was no link between other background factors and marital satisfaction (Table 2).
Table 2
The Factors Associated With the Marital Satisfaction of Parents (N = 99–104)
| Demographic | Marital satisfaction
|
||||
|---|---|---|---|---|---|
| n | Md | Q1 | Q3 | p-value | |
| Parent | .038* | ||||
| Mother | 86 | 46.5 | 38.0 | 56.0 | |
| Father | 18 | 52.2 | 46.8 | 59.5 | |
| Age | .830 | ||||
| 22–30 year | 26 | 47.5 | 41.5 | 51.8 | |
| 31–35 year | 27 | 46.0 | 43.0 | 60.0 | |
| 36–40 year | 32 | 49.5 | 35.5 | 56.8 | |
| 41–53 year | 19 | 49.0 | 41.0 | 55.0 | |
| Education | .063 | ||||
| No education | 13 | 50.0 | 43.5 | 59.0 | |
| Vocational education | 42 | 43.5 | 35.0 | 52.3 | |
| College or polytechnic degree | 27 | 50.0 | 40.0 | 56.0 | |
| University degree | 22 | 54.5 | 43.8 | 60.3 | |
| Employment status | .835 | ||||
| Employment | 65 | 49.0 | 40.0 | 56.0 | |
| Not employment or working | 39 | 47.0 | 38.0 | 58.0 | |
| Parent’s health status | .034* | ||||
| Very poor, quite poor or satisfactory | 16 | 42.0 | 33.3 | 49.0 | |
| Quite good | 69 | 49.0 | 40.5 | 58.0 | |
| Very good | 19 | 51.0 | 41.0 | 57.0 | |
| Support amount from a spouse | < .001*** | ||||
| Not at all, very little, little or moderately | 13 | 34.0 | 28.5 | 45.0 | |
| Much | 23 | 49.0 | 39.0 | 51.0 | |
| Very much | 63 | 51.0 | 43.0 | 58.0 | |
| Problems with a spouse during the last year | < .001*** | ||||
| No | 72 | 51.0 | 44.0 | 58,0 | |
| Yes | 31 | 38.0 | 33,0 | 46,0 | |
| Sicnificant changes in a economical situation | .010* | ||||
| No | 61 | 50.0 | 44.0 | 58.0 | |
| Yes | 43 | 45.0 | 33.0 | 46.0 | |
| Adaptation to the child’s heart disease | .157 | ||||
| Very poor, quite poor or moderately | 18 | 46.5 | 33.8 | 51.0 | |
| Quite good | 57 | 47.0 | 40.0 | 56.0 | |
| Very good | 29 | 51.0 | 40.0 | 58.5 | |
| Got advance information about the child’s heart disease | .470 | ||||
| No advance warning | 77 | 49.0 | 38.5 | 56.0 | |
| Advance warning before birth | 27 | 48.0 | 41.0 | 59.0 | |
| Number of children in the family | .318 | ||||
| 1 | 19 | 47.0 | 39.0 | 56.0 | |
| 2 | 44 | 48.5 | 40.5 | 56.0 | |
| 3 | 19 | 44.0 | 34.0 | 53.0 | |
| 4 or more | 22 | 50.5 | 40.3 | 59.3 | |
| Age of the child | .047* | ||||
| 0 – ≤ 12 month | 18 | 47.0 | 38.0 | 56.5 | |
| > 1 – ≤ 3 year | 20 | 39.0 | 33.0 | 50.0 | |
| > 3 – ≤ 7 year | 28 | 52.5 | 44.3 | 59.8 | |
| > 7 – ≤ 12 year | 30 | 50.0 | 41.8 | 56.0 | |
| > 12 – ≤ 22 year | 8 | 45.0 | 40.3 | 55.8 | |
| Child’s health status | .550 | ||||
| Very poor, quite poor, satisfactory | 22 | 46.5 | 35.0 | 54.0 | |
| Quite good | 50 | 46.5 | 38.8 | 58.0 | |
| Very good | 32 | 50.5 | 41.0 | 57.0 | |
*p < .05. **p < .01. ***p < .001.
Among the heart child background factors included, the age of the child had a significant link to the relationship satisfaction of the parents. The parents of children above the 3 – 7 years age group (Md = 52.5, Q1 = 44.3, Q3 = 59.8) were on average more satisfied with their relationships. However, the paired comparison showed no differences in the relationship satisfaction of the parents between children in different age groups. The current health status of heart children was not identified as a significant factor for the marital satisfaction of the parents (Table 2).
The parental background factors that were statistically significant in relation to idealistic distortion were the gender of the parent, the degree of support received from one’s spouse, and problems with one’s spouse over the previous year. The fathers of heart children (Md = 26.5, Q1 = 23.0, Q3 = 28.0) idealized their relationships more compared to the mothers (Md = 22.5, Q1 = 15.8, Q3 = 27.0). The parents who received a very high degree of support from their spouses (Md = 25.0, Q1 = 20.0, Q3 = 29.0) idealized their relationships more compared to the parents who received a moderate or lower degree of support from their spouses (Md = 14.0, Q1 = 9.0, Q3 = 23.5) (paired comparison p = .003). The parents who had experienced problems with their spouse over the previous year perceived their relationships less idealistically (Md = 15.0, Q1 = 13.0, Q3 = 20.0) compared to the parents who had not experienced problems with their spouses during the same time period (Md = 25.0, Q1 = 22.0, Q3 = 28.0). Other parental background factors had no significant statistical link to idealistic relationship positions. The data showed no association between the heart child background factors and the parents’ idealistic views about their marital satisfaction (Table 3).
Table 3
The Factors Associated With the Idealistic Distortion of Parents (N = 99-104)
| Demographic | Idealistic distortion
|
||||
| n | Md | Q1 | Q3 | p-value | |
| Parent | .047* | ||||
| Mother | 86 | 22.5 | 15.8 | 27.0 | |
| Father | 18 | 26.5 | 23.0 | 28.0 | |
| Age | .817 | ||||
| 22–30 year | 26 | 21.5 | 14.8 | 25.8 | |
| 31–35 year | 27 | 23.0 | 18.0 | 29.0 | |
| 36–40 year | 32 | 23.0 | 14.5 | 28.0 | |
| 41–53 year | 19 | 24.0 | 19.0 | 27.0 | |
| Education | .633 | ||||
| No education | 13 | 25.0 | 16.0 | 26.5 | |
| Vocational education | 42 | 22.0 | 13.8 | 28.0 | |
| College or polytechnic degree | 27 | 24.0 | 17.0 | 27.0 | |
| Academic degree | 22 | 23.0 | 18.5 | 28.3 | |
| Employment status | .901 | ||||
| Employment | 65 | 23.0 | 17.0 | 27.0 | |
| No employment or working | 39 | 23.0 | 15.0 | 28.0 | |
| Parent’s health status | .235 | ||||
| Very poor, quite poor or satisfactory | 16 | 21.0 | 11.5 | 26.5 | |
| Quite good | 69 | 24.0 | 16.5 | 28.0 | |
| Very good | 19 | 23.0 | 20.0 | 28.0 | |
| Support amount from a spouse | < .001*** | ||||
| Not at all, very little, little or moderately | 13 | 14.0 | 9.0 | 23.5 | |
| Much | 23 | 22.0 | 16.0 | 25.0 | |
| Very much | 63 | 25.0 | 20.0 | 29.0 | |
| Problems with a spouse during the last year | < .001*** | ||||
| No | 72 | 25.0 | 22.0 | 28.0 | |
| Yes | 31 | 15.0 | 13.0 | 20.0 | |
| Sicnificant changes in a economical situation | .127 | ||||
| No | 61 | 23.0 | 18.0 | 28.0 | |
| Yes | 43 | 21.0 | 14.0 | 27.0 | |
| Adaptation to the child’s heart decease | .084 | ||||
| Very poor, quite poor or moderately | 18 | 19.0 | 12.5 | 28.0 | |
| Quite good | 57 | 23.0 | 16.0 | 27.0 | |
| Very good | 29 | 26.0 | 21.5 | 28.5 | |
| Got advance information about the child’s heart disease | .856 | ||||
| No advance warning | 77 | 23.0 | 16.0 | 27.0 | |
| Advance warning before birth | 27 | 23.0 | 16.0 | 29.0 | |
| Number of children in the family | .590 | ||||
| 1 | 19 | 24.0 | 17.0 | 27.0 | |
| 2 | 44 | 23.5 | 16.3 | 28.0 | |
| 3 | 19 | 21.0 | 10.0 | 27.0 | |
| 4 or more | 22 | 23.0 | 16.8 | 28.3 | |
| Age of the child | .106 | ||||
| 0 – ≤ 12 month | 18 | 21.5 | 14.0 | 28.5 | |
| > 1 – ≤ 3 year | 20 | 15.5 | 12.3 | 26.5 | |
| > 3 – ≤ 7 year | 28 | 25.5 | 20.0 | 28.8 | |
| > 7 – ≤ 12 year | 30 | 23.0 | 17.0 | 26.3 | |
| > 12 – ≤ 22 year | 8 | 24.5 | 21.5 | 28.5 | |
| Child’s health status | .659 | ||||
| Very poor, quite poor, satisfactory | 22 | 22.0 | 14.8 | 27.3 | |
| Quite good | 50 | 24.0 | 17.5 | 28.3 | |
| Very good | 32 | 23.0 | 15.5 | 26.8 | |
*p < .05. **p < .01. ***p < .001.
Discussion
This study describes marital satisfaction among the parents of heart children and the factors associated with it. A majority of the parents surveyed were satisfied with communication in their relationships and felt understood by their spouses. Moreover, a majority of the parents surveyed were satisfied with decision-making and conflict resolution in their relationships. Previous research has indicated that good communication and arguing skills are essential in conflict resolution and overcoming crises in relationships (Kiiski, 2011; Pukkala, 2006). On the other hand, the results show that a significant proportion of the parents were dissatisfied with the communication they had with their spouses and the level of understanding between them and their spouses. For this reason, more attention needs to paid on boosting the communication skills of the parents of heart children, since that will also contribute to better conflict resolution skills.
The parents of heart children who participated in the study also overidealized their marital satisfaction. Higher marital satisfaction correlated with higher idealistic distortion. Previous research has produced similar results (Fowers, Applegate, Olson, & Pomerantz, 1994). This signifies that parents who are very satisfied with their marital relationships tend to see their relationships in an exaggeratedly positive light. Idealistic distortion manifested for instance as a significant number of parents stating they have a perfect understanding with their spouse, something which, according to Fowers and Olson (1993), is theoretically impossible.
The results show that several background factors relating to heart children and their parents are linked to the marital satisfaction of the parents. The gender of the parent is connected to marital satisfaction: the fathers were more satisfied in their relationships compared to the mothers. This has also been shown in previous studies (Lawoko & Soares, 2003; Rychik et al., 2013; Twenge et al., 2003). Only 17 per cent of the parents who participated in this study were fathers.
According to the results, the parents who had a very good perception of their health status were more satisfied with their marital relationships. Previous research has discovered a link between depression in the parents of newborns and low levels of relationship satisfaction. (Salmela-Aro et al., 2003). It is worth noting that relationship dissatisfaction may stem from having poor health, but it is also possible that dissatisfaction in one’s relationship is the reason for the deterioration of one’s health. Previous studies have shown a correlation between low marital relationship satisfaction among the parents of heart children and increased mental health issues. Meanwhile, a good marital relationship has been found to provide protection from depression and anxiety (Rychik et al., 2013) and to help cope with stress factors (Goldbeck & Melches, 2006).
The results indicate that the parents of heart children who had received a high degree of support from their spouses were the most satisfied in their marital relationships. Previous research has provided similar results (Kontula, 2013; Rychik et al., 2013). Potential problems encountered with one’s spouse over the previous year also played a role in the marital satisfaction of the parents. Relationships may face various problems, and communication and conflict resolution skills are essential to overcome them, since these skills have been associated with marial satisfaction (Kiiski, 2011; Kontula, 2013; Paajanen, 2003). Confiding in one’s spouse and receiving support can increase the level of intimacy and affection in a relationship, which in turn will improve marital satisfaction. Mutual support between spouses can be strengthened through good communication skills, which also help with tackling and solving problems.
The results of this study reveal that the parents who had experienced a significant change in their financial situation over the previous year were less satisfied in their marital relationships. Previous research has stated that household financial conditions may generate stress in families with heart children (Lawoko & Soares, 2002; 2003; Van Horn et al., 2001). This study does not specify whether the significant change described is a positive or a negative one, but it is nevertheless clear that significant changes in household finances, prompted by changes in employment situation, for instance, are linked to marital relationship satisfaction.
The results show a link between the age of a heart child and the marital satisfaction of parents: the parents of children above the 3 – 7 years age group were the most satisfied with their relationships. The heart defect of the child was congenital in nearly all of the respondents’ cases, which suggests that these families have been able to adapt to the situation over time through information and potential treatment. Moreover, the heart condition of the child may have stabilized over time and may therefore not cause as much anxiety in the family as perhaps previously. This result corresponds to the results of Twenge et al. (2003), whose study found that the mothers of small children are less satisfied compared to the mothers of older children. It must be noted, however, that the paired comparison showed no statistically significant differences between different age groups of heart children and their parents’ marital satisfaction.
Limitations
The study was a cross-sectional in a nature. Thus, the data were collected only once indicating the situation at this time. Due the cross-sectional nature of this study causality cannot be determined.
The link on the web page of the Finnish Association for Heart Children was open to everyone, so it was theoretically possible for people other than the parents of heart children to submit responses to the questionnaire. However, the fact that the parents of heart children who do not frequent the websites used for data collection were excluded has to be taken into consideration when examining the results. For this reason, extrapolating the results to all parents of heart children must be done with reservation.
Conclusion
The parents of heart children surveyed were relatively satisfied with their marital relationships. The marital satisfaction among the parents of heart children and the factors associated with it have to be included when considering the well-being of families, as the relationship between parents reflects on the whole family in significant ways.
In the future, studying marital satisfaction among the fathers of heart children is especially important, since the majority of the participants of this study were mothers. More information is also needed on the kind of support the parents of heart children wish to have for their marital relationships.
Implications
Health care needs to focus on improving and boosting the communication skills of the parents of heart children, since good communication plays an important role in conflict and problem resolution in relationships. Moreover, good communication nurtures mutual support between spouses, something that correlates highly with marital satisfaction.