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This study examined two types of illness-related communication (disclosure and holding back) and their associations with psychological adjustment and marital satisfaction in patients with knee osteoarthritis (OA) and their spouses. A sample of 142 couples reported on disclosure and holding back of OA-related concerns, marital satisfaction, and depressive symptoms at two time points across 1 year. Results from dyadic analyses indicated that holding back was associated with decreases in one’s own marital satisfaction for patients and spouses and increases in one’s own depressive symptoms for spouses over 1 year. In addition, increases in disclosure were associated with increases in marital satisfaction for patients and spouses over time. Holding back and disclosure did not have significant interpersonal effects on the partner’s psychological adjustment or marital satisfaction. These results provide support for the hypothesized intrapersonal effects of disclosure and holding back on marital satisfaction and psychological adjustment over time for both OA patients and their spouses, and highlight the importance of open communication for dyadic coping among couples dealing with chronic illness.