Marriage and health: Difference between revisions
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'''Marriage and health''' are closely related.<ref name=Robles2013> |
'''Marriage and health''' are closely related.<ref name=Robles2013>{{cite journal |pmid=23527470}}</ref> Married people experience lower [[morbidity]] and [[Mortality rate|mortality]] across such diverse health threats as [[cancer]], [[heart attacks]], and [[surgery]].<ref name=KiecoltGlaser2001>{{cite journal |pmid=11439708}}</ref> There are [[gender]] differences in these effects which may be partially due to men's and women’s relative status.<ref name=wanic2011>{{cite journal |doi=10.1007/s11199-011-9968-6}}</ref> Most research on [[marriage]] and [[health]] has focused on [[Heterosexuality|heterosexual]] couples, and more work is needed to clarify the health affects on [[same-sex marriage]].<ref name=Robles2013 /> Simply being married, as well as the quality of one’s marriage, has been linked to diverse measures of health. Research has examined the social-cognitive, emotional, behavioral and biological processes involved in these links. |
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==Compared to other relationships== |
==Compared to other relationships== |
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Beyond marriage, social relationships more broadly have a powerful impact on health. A [[meta-analysis]] of 148 studies found that those with stronger social relationships had a 50% lower risk of all-cause mortality.<ref> |
Beyond marriage, social relationships more broadly have a powerful impact on health. A [[meta-analysis]] of 148 studies found that those with stronger social relationships had a 50% lower risk of all-cause mortality.<ref>{{cite journal |doi=10.1371/journal.pmed.1000316}}</ref> Conversely, [[loneliness]] is associated with increased risk for [[cardiovascular disease]], and all-cause mortality.<ref>{{cite journal |doi=10.1007/s12160-010-9210-8}}</ref> Little work has directly compared the health impacts of marriage compared to those of non-romantic relationships, such as connections with friends or colleagues.<ref name=Robles2013 /> However, there are several reasons why marriage may exert a greater health impact than other relationships, even other cohabiting relationships: married couples spend time together during a wide variety of activities, such as eating, leisure, housekeeping, child-care and sleep.<ref name=Robles2013 /> Spouses also share resources and investments such as joint finances or home-ownership. Relative to other relationships, the increased [[interdependence]] of marriage serves as a source for more intense support.<ref name=Robles2013 /> |
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Romantic couples who live together, but are unmarried, may represent a middle ground in health benefits between those who are married, and those who self-identify as single.<ref> |
Romantic couples who live together, but are unmarried, may represent a middle ground in health benefits between those who are married, and those who self-identify as single.<ref>{{cite journal |doi=10.1111/j.1741-3737.2012.00983.x}}</ref> However, people live together without getting married for many different reasons; [[cohabitation]] may serve as a prelude to marriage. Selection factors of race, ethnicity, and social-economic status predispose certain groups to cohabit unmarried, and these factors also affect the health benefits of marriage and cohabitation.<ref name=Robles2013 /> |
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==Same-sex marriage== |
==Same-sex marriage== |
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Most research on marriage and health has studied heterosexual couples. Same-sex and opposite-sex couples share many similarities. Both begin marriage with high levels of relationship satisfaction, followed by later declines, and both argue with similar frequency about the similar issues.<ref name=kurdek2004> |
Most research on marriage and health has studied heterosexual couples. Same-sex and opposite-sex couples share many similarities. Both begin marriage with high levels of relationship satisfaction, followed by later declines, and both argue with similar frequency about the similar issues.<ref name=kurdek2004>{{cite journal |doi=10.1111/j.0022-2445.2004.00060.x}}</ref><ref name=kurdek2005>{{cite journal |doi=10.1111/j.0963-7214.2005.00375.x}}</ref> |
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However, same-sex couples resolve conflicts more effectively, and distribute household labor more fairly compared their heterosexual counterparts.<ref name=kurdek2004 /><ref name=kurdek2005 /> [[Same-sex marriage]] remains illegal in many countries, and in many parts of the [[United States]] (where much research on marriage and health has been conducted).<ref name=Robles2013 /> In these regions same-sex couples are not granted the institutional protections of marriage or its accompanying legal barriers to relationship dissolution.<ref> |
However, same-sex couples resolve conflicts more effectively, and distribute household labor more fairly compared their heterosexual counterparts.<ref name=kurdek2004 /><ref name=kurdek2005 /> [[Same-sex marriage]] remains illegal in many countries, and in many parts of the [[United States]] (where much research on marriage and health has been conducted).<ref name=Robles2013 /> In these regions same-sex couples are not granted the institutional protections of marriage or its accompanying legal barriers to relationship dissolution.<ref>{{cite journal |first1=Lawrence A. |last1=Kurdek |month=August |year=1998 |title=Relationship Outcomes and Their Predictors: Longitudinal Evidence from Heterosexual Married, Gay Cohabiting, and Lesbian Cohabiting Couples |journal=Journal of Marriage and Family |volume=60 |issue=3 |pages=553–68 |jstor=353528}}</ref> Moreover, same-sex couples are more likely to experience discrimination against their sexual orientation, contributing to problems with mental health and relationship quality.<ref>{{cite journal |doi=10.1146/annurev.psych.58.110405.085701}}</ref> |
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==Gender differences== |
==Gender differences== |
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The health-protective effect of marriage is stronger for men than women.<ref name=KiecoltGlaser2001 /><ref name=wanic2011 /> Marital status — the simple fact of being married — confers more health benefits to men than women.<ref name=KiecoltGlaser2001 /> Women’s health is more strongly impacted than men’s by marital conflict or satisfaction, such that unhappily married women do not enjoy better health relative to their single counterparts.<ref name=KiecoltGlaser2001 /><ref name=wanic2011 /><ref name=saxbe2008> |
The health-protective effect of marriage is stronger for men than women.<ref name=KiecoltGlaser2001 /><ref name=wanic2011 /> Marital status — the simple fact of being married — confers more health benefits to men than women.<ref name=KiecoltGlaser2001 /> Women’s health is more strongly impacted than men’s by marital conflict or satisfaction, such that unhappily married women do not enjoy better health relative to their single counterparts.<ref name=KiecoltGlaser2001 /><ref name=wanic2011 /><ref name=saxbe2008>{{cite journal |doi=10.1037/0278-6133.27.1.15}}</ref> Laboratory studies indicate that women have stronger physiological reactions than men in response to marital conflict.<ref name=KiecoltGlaser2001 /><ref name=wanic2011 /> |
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These gender differences may be partially due to men's and women’s relative status in a relationship.<ref name=wanic2011 /> Research in humans and animals suggests subordinate status is linked to greater physiological reactions to [[social stress]].<ref name=wanic2011 /> Indeed subordinate spouses show greater physiological reactions to arguments with their partner.<ref> |
These gender differences may be partially due to men's and women’s relative status in a relationship.<ref name=wanic2011 /> Research in humans and animals suggests subordinate status is linked to greater physiological reactions to [[social stress]].<ref name=wanic2011 /> Indeed subordinate spouses show greater physiological reactions to arguments with their partner.<ref>{{cite journal |doi=10.1111/j.0022-2445.2004.00040.x}}</ref> Both husbands and wives show stronger physiological reactions to arguments when making demands for change from their partner.<ref>{{cite journal |doi=10.1023/A:1012278209577}}</ref><ref>{{cite journal |doi=10.1037/0278-6133.22.3.270}}</ref> Women’s heightened physiological reactions to marital conflict may be due to their relative subordinate position in marriage.<ref name=wanic2011 /> |
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==Measuring health== |
==Measuring health== |
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Research on the links between marriage and health has measured diverse outcomes. These are broadly categorized as [[clinical endpoint]]s, and [[clinical endpoint|surrogate endpoint]]s, and biological mediators.<ref name=biodef> |
Research on the links between marriage and health has measured diverse outcomes. These are broadly categorized as [[clinical endpoint]]s, and [[clinical endpoint|surrogate endpoint]]s, and biological mediators.<ref name=biodef>{{cite journal |doi=10.1067/mcp.2001.113989}}</ref> Clinical endpoints are variables which affect how people feel, function, and survive.<ref name=biodef /> They are recognized as important outcomes by health care providers and patients, for instance being hospitalized, or having a heart-attack.<ref name=biodef /> |
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Surrogate endpoints and biological mediators are types of [[Biomarker (medicine)|biomarkers]]—objective indicators of normal or [[Pathology|pathological]] [[Physiology|physiological]] processes.<ref name=biodef /> Surrogate endpoints serve to substitute for clinical endpoints. They are expected to predict clinical endpoints, based on [[scientific evidence]].<ref name=biodef /> For example, elevated blood pressure has been found to predict cardiovascular disease.<ref name=treiber2003> |
Surrogate endpoints and biological mediators are types of [[Biomarker (medicine)|biomarkers]]—objective indicators of normal or [[Pathology|pathological]] [[Physiology|physiological]] processes.<ref name=biodef /> Surrogate endpoints serve to substitute for clinical endpoints. They are expected to predict clinical endpoints, based on [[scientific evidence]].<ref name=biodef /> For example, elevated blood pressure has been found to predict cardiovascular disease.<ref name=treiber2003>{{cite journal |pmid=12554815}}</ref> |
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Biological mediators reflect short-term sources of stress which affect health outcomes through repeated or persistent activation.<ref> |
Biological mediators reflect short-term sources of stress which affect health outcomes through repeated or persistent activation.<ref>{{cite journal |doi=10.1017/S095457941100040X}}</ref> These processes do not have a sufficient evidence base linking them to clinical endpoints in order be elevated to the class of surrogate endpoints.<ref name=Robles2013 /> Examples include changes in [[hormone]] levels, or [[Immune system|immune]] measures. |
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==Links to health== |
==Links to health== |
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===Selection and protection=== |
===Selection and protection=== |
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The health benefits of marriage are a result of both selection and protection effects.<ref name=Umberson1992> |
The health benefits of marriage are a result of both selection and protection effects.<ref name=Umberson1992>{{cite journal |pmid=1604380}}</ref> People with better health, more resources, and less stress are more likely to marry, and marriage brings resources, and social support.<ref name=Umberson1992 /> The health benefits of marriage persist even after controlling for selection effects, indicating that being married is protective of health.<ref>{{cite journal |doi=10.1177/0192513X03254519}}</ref> |
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===Social support: two models=== |
===Social support: two models=== |
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Research on marriage and health is part of the broader study of the benefits of social relationships. Social ties provide people with a sense of identity, purpose, belonging and support.<ref> |
Research on marriage and health is part of the broader study of the benefits of social relationships. Social ties provide people with a sense of identity, purpose, belonging and support.<ref>{{cite journal |doi=10.1177/0022146510395592}}</ref> Two main models describe how [[social support]] influences health. |
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The main-effects model proposes that social support is good for one’s health, regardless of whether or not one is under stress.<ref name=cohen2004> |
The main-effects model proposes that social support is good for one’s health, regardless of whether or not one is under stress.<ref name=cohen2004>{{cite journal |doi=10.1037/0003-066X.59.8.676}}</ref> The stress-buffering model proposes that social support acts as a buffer against the negative effects of stress occurring outside the relationship.<ref name=cohen2004 /> Both models have received empirical support, depending on how social support is conceptualized and measured.<ref name=cohen2004 /> Marriage should be a strong source of social support in both models.<ref name=Robles2013 /> |
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==Marital quality== |
==Marital quality== |
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While simply being married is associated on average with better health, the health impacts of marriage are affected by marital quality.<ref name=KiecoltGlaser2001 /> High marital quality is typically characterized as high [[Self-report study|self-reported]] satisfaction with the relationship, generally positive [[Attitude (psychology)|attitudes]] toward one’s spouse, and low levels of hostile and negative behavior.<ref name=Robles2013 /> Conversely, low marital quality is characterized as low self-reported satisfaction with the relationship, generally negative attitudes toward one’s spouse, and high levels of hostile and negative behavior.<ref name=Robles2013 /> A troubled marriage is a significant source of stress, and limits one’s ability to seek support from other relationships.<ref> |
While simply being married is associated on average with better health, the health impacts of marriage are affected by marital quality.<ref name=KiecoltGlaser2001 /> High marital quality is typically characterized as high [[Self-report study|self-reported]] satisfaction with the relationship, generally positive [[Attitude (psychology)|attitudes]] toward one’s spouse, and low levels of hostile and negative behavior.<ref name=Robles2013 /> Conversely, low marital quality is characterized as low self-reported satisfaction with the relationship, generally negative attitudes toward one’s spouse, and high levels of hostile and negative behavior.<ref name=Robles2013 /> A troubled marriage is a significant source of stress, and limits one’s ability to seek support from other relationships.<ref>{{cite journal |pmid=3745597}}</ref> Unmarried people are, on average, happier than those unhappily married.<ref>{{cite journal |doi=10.2307/351426}}</ref> A meta-analysis of 126 studies found that greater marital quality is related to better health, with effect sizes comparable to those of health behaviors such as diet and exercise.<ref name=Robles2013 /> Explanations for the links between marital quality and health focus on social-cognitive and emotional processes, health behaviors, and a bidirectional association with mental illness.<ref name=Robles2013 /> |
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===Social-cognitive processes=== |
===Social-cognitive processes=== |
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People in happy marriages may think about their relationship differently than people in troubled marriages. Unhappily married people often hold their partner responsible for negative behaviors, but attribute positive behavior to other factors<ref> |
People in happy marriages may think about their relationship differently than people in troubled marriages. Unhappily married people often hold their partner responsible for negative behaviors, but attribute positive behavior to other factors<ref>{{cite journal |doi=10.1111/j.1741-3729.2011.00655.x}}</ref>—for example, “she came home late because she doesn’t want to spend time with me; she came home early because her boss told her to.” Blaming one’s partner for their negative behavior is associated with prolonged elevations of the stress hormone cortisol after an argument.<ref>{{cite journal |doi=10.1177/0265407506065991}}</ref> Spouses in troubled marriages are also likely to misattribute their partners’ communication as criticism.<ref>{{cite journal |doi=10.1016/j.brat.2009.02.012}}</ref> However, the links between these social-cognitive processes and health remain understudied.<ref name=Robles2013 /> |
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===Emotional processes=== |
===Emotional processes=== |
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Higher levels of negative emotions and less effective emotional disclosure may be involved in linking marital quality and health. People in troubled marriages experience more negative emotions, particularly hostility.<ref> |
Higher levels of negative emotions and less effective emotional disclosure may be involved in linking marital quality and health. People in troubled marriages experience more negative emotions, particularly hostility.<ref>{{cite journal |doi=10.1037/1040-3590.13.1.5}}</ref> Negative emotions have been linked to elevated blood pressure and heart rate, and to increased levels of [[stress hormone]]s, which may lead to ill health.<ref name=robles2003>{{cite journal |doi=10.1016/S0031-9384(03)00160-4}}</ref> Emotional disclosure often occurs in well-functioning marriages, and is linked to a host of health benefits, including fewer physician visits and missed work days.<ref name=Robles2013 /> However, people in troubled marriages are less skillful in emotional disclosure.<ref>{{cite journal |doi=10.1521/jscp.24.2.218.62270}}</ref> |
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===Health behaviors=== |
===Health behaviors=== |
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Health behaviors such as diet, exercise and substance use, may also affect the interplay of marital quality and health. The health behaviors of married couples converge over time, such that couples who have been married many years have similar behavior.<ref> |
Health behaviors such as diet, exercise and substance use, may also affect the interplay of marital quality and health. The health behaviors of married couples converge over time, such that couples who have been married many years have similar behavior.<ref>{{cite journal |doi=10.5993/AJHB.32.6.19}}</ref> One explanation is that spouses influence or control one another’s health behaviors.<ref>{{cite journal |doi=10.1016/j.socscimed.2011.11.011.Gender}}</ref> A spouse’s positive control techniques, such as modeling a healthy behavior, increase their partner’s intentions to improve health behaviors, whereas negative control techniques, such as inducing fear, do not affect intentions.<ref>{{cite journal |doi=10.1111/j.0021-9029.2007.00161.x}}</ref> Marital support may increase the psychological resources—such as self-efficacy, and self-regulation—needed to improve one’s health behaviors.<ref>{{cite journal |doi=10.1037/0278-6133.23.2.207}}</ref> |
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===Mental illness=== |
===Mental illness=== |
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Marital problems predict the onset of [[mental illness]], including anxiety, mood, and substance use disorders.<ref> |
Marital problems predict the onset of [[mental illness]], including anxiety, mood, and substance use disorders.<ref>{{cite journal |doi=10.1007/s10567-011-0107-2}}</ref> Much research has focused on depression, showing a bidirectional connection with marital conflict.<ref>{{cite journal |doi=10.1146/annurev.psych.50.1.47}}</ref> Marital distress interacts with existing susceptibility, increasing risk for [[Depression (mood)|depression]].<ref>{{cite journal |doi=10.1146/annurev.clinpsy.1.102803.143938}}</ref> Conversely, depressive behavior such as excessive reassurance-seeking can be burdensome for one’s spouse, who may respond with criticism or rejection.<ref>{{cite journal |pmid=1254779}}</ref> The links between depression and ill health are well established;<ref>{{cite journal |doi=10.1146/annurev.psych.53.100901.135217}}</ref> depression is associated with immune system dysregulation, and poor health behaviors, such as lack of exercise, poor sleep and diet, and increased [[substance abuse]].<ref name=Robles2013 /> |
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===Biological pathways=== |
===Biological pathways=== |
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====Cardiovascular reactivity==== |
====Cardiovascular reactivity==== |
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Marital conflict, and seeking change from one’s spouse evokes a cardiovascular reaction, increasing heart rate and blood pressure.<ref> |
Marital conflict, and seeking change from one’s spouse evokes a cardiovascular reaction, increasing heart rate and blood pressure.<ref>{{cite journal |doi=10.1037/0278-6133.10.3.155}}</ref> Couples who are more hostile during arguments have stronger cardiovascular reactions.<ref name=robles2003 /> Heightened cardiovascular reactions are associated with increased risk for cardiovascular disease.<ref name=treiber2003 /> |
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====Neuroendocrine system==== |
====Neuroendocrine system==== |
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Hormones produced by the sympathetic-adrenal-medullary axis (SAM) and [[Hypothalamic–pituitary–adrenal axis|hypothalamic-pituitary-adrenal axis]] (HPA) have wide ranging effects across the body.<ref name=mcewen1998> |
Hormones produced by the sympathetic-adrenal-medullary axis (SAM) and [[Hypothalamic–pituitary–adrenal axis|hypothalamic-pituitary-adrenal axis]] (HPA) have wide ranging effects across the body.<ref name=mcewen1998>{{cite journal |doi=10.1056/NEJM199801153380307}}</ref> Both axes have been implicated in the links between psychological factors and physical health.<ref name=mcewen1998 /> SAM activity can be measured by levels of circulating [[catecholamine]]s—[[epinephrine]] and [[norepinephrine]]. Negative interactions with one’s spouse have been linked to elevated catecholamine levels, both during and after conflict.<ref name=Robles2013 /> |
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Daily fluctuations in the level of [[cortisol]]—a stress hormone—are an important marker of health; flatter slopes of cortisol change throughout the day are strongly associated with [[cardiovascular disease]] and related mortality.<ref name=whitehall> |
Daily fluctuations in the level of [[cortisol]]—a stress hormone—are an important marker of health; flatter slopes of cortisol change throughout the day are strongly associated with [[cardiovascular disease]] and related mortality.<ref name=whitehall>{{cite journal |doi=10.1210/jc.2010-2137}}</ref> Lower marital satisfaction has been linked with flatter cortisol slopes across the day,<ref name=saxbe2008 /> lower waking levels of cortisol,<ref name=saxbe2008 /> and higher overall cortisol levels.<ref>{{cite journal |doi=10.1097/PSY.0b013e318185c4fc}}</ref> However a meta-analysis found no relationship between marital quality and cortisol slopes.<ref name=Robles2013 /> |
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====Immune pathways==== |
====Immune pathways==== |
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Low marital satisfaction, and hostility during arguments with one’s spouse are associated with increased [[inflammation]].<ref> |
Low marital satisfaction, and hostility during arguments with one’s spouse are associated with increased [[inflammation]].<ref>{{cite journal |doi=10.1037/a0026902}}</ref><ref name=robles2005>{{cite journal |doi=10.1111/j.0963-7214.2005.00345.x}}</ref> Inflammation is part of a healthy response to injury and infection, however chronic and persistent inflammation damages the surrounding tissue.<ref name=robles2005 /> Chronic inflammation is implicated as a central mechanism linking psychosocial factors and diseases such as atherosclerosis and cancer.<ref name=robles2005 /> Beyond inflammation, lower marital quality is also related to poorer functioning of the [[adaptive immune system]].<ref name=Robles2013 /> Marital dissatisfaction and hostility during arguments with one’s spouse are related to poorer ability to control the [[Epstein-Barr virus]], a latent [[virus]] which infects most adults.<ref name=Robles2013 /> |
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==See also== |
==See also== |
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Revision as of 23:28, 19 January 2014
Marriage and health are closely related.[1] Married people experience lower morbidity and mortality across such diverse health threats as cancer, heart attacks, and surgery.[2] There are gender differences in these effects which may be partially due to men's and women’s relative status.[3] Most research on marriage and health has focused on heterosexual couples, and more work is needed to clarify the health affects on same-sex marriage.[1] Simply being married, as well as the quality of one’s marriage, has been linked to diverse measures of health. Research has examined the social-cognitive, emotional, behavioral and biological processes involved in these links.
Compared to other relationships
Beyond marriage, social relationships more broadly have a powerful impact on health. A meta-analysis of 148 studies found that those with stronger social relationships had a 50% lower risk of all-cause mortality.[4] Conversely, loneliness is associated with increased risk for cardiovascular disease, and all-cause mortality.[5] Little work has directly compared the health impacts of marriage compared to those of non-romantic relationships, such as connections with friends or colleagues.[1] However, there are several reasons why marriage may exert a greater health impact than other relationships, even other cohabiting relationships: married couples spend time together during a wide variety of activities, such as eating, leisure, housekeeping, child-care and sleep.[1] Spouses also share resources and investments such as joint finances or home-ownership. Relative to other relationships, the increased interdependence of marriage serves as a source for more intense support.[1]
Romantic couples who live together, but are unmarried, may represent a middle ground in health benefits between those who are married, and those who self-identify as single.[6] However, people live together without getting married for many different reasons; cohabitation may serve as a prelude to marriage. Selection factors of race, ethnicity, and social-economic status predispose certain groups to cohabit unmarried, and these factors also affect the health benefits of marriage and cohabitation.[1]
Same-sex marriage
Most research on marriage and health has studied heterosexual couples. Same-sex and opposite-sex couples share many similarities. Both begin marriage with high levels of relationship satisfaction, followed by later declines, and both argue with similar frequency about the similar issues.[7][8]
However, same-sex couples resolve conflicts more effectively, and distribute household labor more fairly compared their heterosexual counterparts.[7][8] Same-sex marriage remains illegal in many countries, and in many parts of the United States (where much research on marriage and health has been conducted).[1] In these regions same-sex couples are not granted the institutional protections of marriage or its accompanying legal barriers to relationship dissolution.[9] Moreover, same-sex couples are more likely to experience discrimination against their sexual orientation, contributing to problems with mental health and relationship quality.[10]
Gender differences
The health-protective effect of marriage is stronger for men than women.[2][3] Marital status — the simple fact of being married — confers more health benefits to men than women.[2] Women’s health is more strongly impacted than men’s by marital conflict or satisfaction, such that unhappily married women do not enjoy better health relative to their single counterparts.[2][3][11] Laboratory studies indicate that women have stronger physiological reactions than men in response to marital conflict.[2][3]
These gender differences may be partially due to men's and women’s relative status in a relationship.[3] Research in humans and animals suggests subordinate status is linked to greater physiological reactions to social stress.[3] Indeed subordinate spouses show greater physiological reactions to arguments with their partner.[12] Both husbands and wives show stronger physiological reactions to arguments when making demands for change from their partner.[13][14] Women’s heightened physiological reactions to marital conflict may be due to their relative subordinate position in marriage.[3]
Measuring health
Research on the links between marriage and health has measured diverse outcomes. These are broadly categorized as clinical endpoints, and surrogate endpoints, and biological mediators.[15] Clinical endpoints are variables which affect how people feel, function, and survive.[15] They are recognized as important outcomes by health care providers and patients, for instance being hospitalized, or having a heart-attack.[15]
Surrogate endpoints and biological mediators are types of biomarkers—objective indicators of normal or pathological physiological processes.[15] Surrogate endpoints serve to substitute for clinical endpoints. They are expected to predict clinical endpoints, based on scientific evidence.[15] For example, elevated blood pressure has been found to predict cardiovascular disease.[16]
Biological mediators reflect short-term sources of stress which affect health outcomes through repeated or persistent activation.[17] These processes do not have a sufficient evidence base linking them to clinical endpoints in order be elevated to the class of surrogate endpoints.[1] Examples include changes in hormone levels, or immune measures.
Links to health
Selection and protection
The health benefits of marriage are a result of both selection and protection effects.[18] People with better health, more resources, and less stress are more likely to marry, and marriage brings resources, and social support.[18] The health benefits of marriage persist even after controlling for selection effects, indicating that being married is protective of health.[19]
Social support: two models
Research on marriage and health is part of the broader study of the benefits of social relationships. Social ties provide people with a sense of identity, purpose, belonging and support.[20] Two main models describe how social support influences health.
The main-effects model proposes that social support is good for one’s health, regardless of whether or not one is under stress.[21] The stress-buffering model proposes that social support acts as a buffer against the negative effects of stress occurring outside the relationship.[21] Both models have received empirical support, depending on how social support is conceptualized and measured.[21] Marriage should be a strong source of social support in both models.[1]
Marital quality
While simply being married is associated on average with better health, the health impacts of marriage are affected by marital quality.[2] High marital quality is typically characterized as high self-reported satisfaction with the relationship, generally positive attitudes toward one’s spouse, and low levels of hostile and negative behavior.[1] Conversely, low marital quality is characterized as low self-reported satisfaction with the relationship, generally negative attitudes toward one’s spouse, and high levels of hostile and negative behavior.[1] A troubled marriage is a significant source of stress, and limits one’s ability to seek support from other relationships.[22] Unmarried people are, on average, happier than those unhappily married.[23] A meta-analysis of 126 studies found that greater marital quality is related to better health, with effect sizes comparable to those of health behaviors such as diet and exercise.[1] Explanations for the links between marital quality and health focus on social-cognitive and emotional processes, health behaviors, and a bidirectional association with mental illness.[1]
Social-cognitive processes
People in happy marriages may think about their relationship differently than people in troubled marriages. Unhappily married people often hold their partner responsible for negative behaviors, but attribute positive behavior to other factors[24]—for example, “she came home late because she doesn’t want to spend time with me; she came home early because her boss told her to.” Blaming one’s partner for their negative behavior is associated with prolonged elevations of the stress hormone cortisol after an argument.[25] Spouses in troubled marriages are also likely to misattribute their partners’ communication as criticism.[26] However, the links between these social-cognitive processes and health remain understudied.[1]
Emotional processes
Higher levels of negative emotions and less effective emotional disclosure may be involved in linking marital quality and health. People in troubled marriages experience more negative emotions, particularly hostility.[27] Negative emotions have been linked to elevated blood pressure and heart rate, and to increased levels of stress hormones, which may lead to ill health.[28] Emotional disclosure often occurs in well-functioning marriages, and is linked to a host of health benefits, including fewer physician visits and missed work days.[1] However, people in troubled marriages are less skillful in emotional disclosure.[29]
Health behaviors
Health behaviors such as diet, exercise and substance use, may also affect the interplay of marital quality and health. The health behaviors of married couples converge over time, such that couples who have been married many years have similar behavior.[30] One explanation is that spouses influence or control one another’s health behaviors.[31] A spouse’s positive control techniques, such as modeling a healthy behavior, increase their partner’s intentions to improve health behaviors, whereas negative control techniques, such as inducing fear, do not affect intentions.[32] Marital support may increase the psychological resources—such as self-efficacy, and self-regulation—needed to improve one’s health behaviors.[33]
Mental illness
Marital problems predict the onset of mental illness, including anxiety, mood, and substance use disorders.[34] Much research has focused on depression, showing a bidirectional connection with marital conflict.[35] Marital distress interacts with existing susceptibility, increasing risk for depression.[36] Conversely, depressive behavior such as excessive reassurance-seeking can be burdensome for one’s spouse, who may respond with criticism or rejection.[37] The links between depression and ill health are well established;[38] depression is associated with immune system dysregulation, and poor health behaviors, such as lack of exercise, poor sleep and diet, and increased substance abuse.[1]
Biological pathways
Dysregulation of the cardiovascular, neuroendocrine and immune systems is implicated in the links between marital quality and health.[1]
Cardiovascular reactivity
Marital conflict, and seeking change from one’s spouse evokes a cardiovascular reaction, increasing heart rate and blood pressure.[39] Couples who are more hostile during arguments have stronger cardiovascular reactions.[28] Heightened cardiovascular reactions are associated with increased risk for cardiovascular disease.[16]
Neuroendocrine system
Hormones produced by the sympathetic-adrenal-medullary axis (SAM) and hypothalamic-pituitary-adrenal axis (HPA) have wide ranging effects across the body.[40] Both axes have been implicated in the links between psychological factors and physical health.[40] SAM activity can be measured by levels of circulating catecholamines—epinephrine and norepinephrine. Negative interactions with one’s spouse have been linked to elevated catecholamine levels, both during and after conflict.[1]
Daily fluctuations in the level of cortisol—a stress hormone—are an important marker of health; flatter slopes of cortisol change throughout the day are strongly associated with cardiovascular disease and related mortality.[41] Lower marital satisfaction has been linked with flatter cortisol slopes across the day,[11] lower waking levels of cortisol,[11] and higher overall cortisol levels.[42] However a meta-analysis found no relationship between marital quality and cortisol slopes.[1]
Immune pathways
Low marital satisfaction, and hostility during arguments with one’s spouse are associated with increased inflammation.[43][44] Inflammation is part of a healthy response to injury and infection, however chronic and persistent inflammation damages the surrounding tissue.[44] Chronic inflammation is implicated as a central mechanism linking psychosocial factors and diseases such as atherosclerosis and cancer.[44] Beyond inflammation, lower marital quality is also related to poorer functioning of the adaptive immune system.[1] Marital dissatisfaction and hostility during arguments with one’s spouse are related to poorer ability to control the Epstein-Barr virus, a latent virus which infects most adults.[1]
See also
References
- ^ a b c d e f g h i j k l m n o p q r s t u . PMID 23527470.
{{cite journal}}: Cite journal requires|journal=(help); Missing or empty|title=(help) - ^ a b c d e f . PMID 11439708.
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