The physiology of marriage: pathways to health
Introduction
For humans and a wide variety of animal species, social relationships have important physiological consequences, often with implications for health [1], [2]. Social relationships are also important contributors to health and well-being. Epidemiological studies suggest that social isolation is a major risk factor for morbidity and mortality, comparable to well-established health risk factors such as cigarette smoking, blood pressure, blood lipids, obesity, and physical activity [3]. Although both the quality and quantity of social ties have been related to morbidity and mortality, the support provided by certain relationships may be more important than others. The central relationship for most adults is marriage; 56% of adults in the United States are married and living with their spouse [4].
Across a number of surveys, married individuals report greater happiness and life satisfaction [5] and have a lower risk of depression [6] than their unmarried counterparts. Moreover, findings from the National Longitudinal Mortality Study illustrate the scope of impact that marital status has on mortality [7]. Across all causes of mortality and across different nonmarried populations (never married, divorced/separated, and widowed), nonmarried individuals had elevated rates of mortality compared to married individuals. Although elevated risk was observed for cardiovascular disease and cancer, significant risk was also observed for other causes, notably pneumonia and influenza, chronic obstructive pulmonary disease, and liver disease and cirrhosis. The relationship between marital status and mortality exhibits a generally consistent pattern in longitudinal studies, with marital status affording greater protection from mortality for men compared to women (50% higher among women, 250% higher among men [8], [9], [10]).
What are the processes by which marriage promotes health and well-being? Several explanations have been proposed, including cohabitation, economic well-being, and social support [10]. Research supports the two latter explanations, as cohabiting adults are more likely to report poorer health than married adults [11], and are as likely to report distress as adults living alone [12]. In terms of economic well-being, married persons have higher median household incomes than the nonmarried (US$54,300 vs. US$23,400 [13]), but after controlling for income, married persons still have lower rates of mortality than nonmarried persons [7].
The prevailing explanatory framework proposed to account for the protective benefits of marriage is the stress/social support hypothesis, which accounts for both protective and deleterious health correlates of marriage [14]. Stress and support in the marital relationship influence health status through a number of pathways. These include influences on the marital relationship itself, on the individual's cognitions, emotions or affect, health-related behaviors, coping behaviors, and physiology [14], [15].
This paper focuses on physiological pathways through which marital relationships influence health. In addition to informing marriage and health research, studies of marriage and physiology offer important insights into biobehavioral aspects of human social relationships. We briefly review recent evidence of the health consequences of marital relationships, with a focus on consequences of distressed and unhappy marriages, as negative aspects of marital functioning have traditionally received greater emphasis compared to positive aspects. We then turn to physiological pathways through which marital functioning influences health: the cardiovascular, endocrine, and immune systems [2]. Evidence for the influence of marital functioning on physiological pathways is primarily derived from paradigms used by marital interaction researchers. Finally, we discuss future implications of current research for understanding the relationships among marital functioning, physiology, and health.
Section snippets
Marital strain and health outcomes
Burman and Margolin [14] termed their explanatory framework as the stress/social support hypothesis, noting that marital factors may be a source of stress. Distressed marriages are a major source of stress, and in general, unhappily married persons are worse off in well-being than unmarried persons [16]. Given the centrality of the marital relationship for most adults, it is likely that marital stress would have consequences for physical health as well.
Several prospective longitudinal studies
Physiological pathways
In their stress/social support framework, Burman and Margolin [14] proposed several interrelated pathways from marital status to health, including interpersonal mediators, intraindividual variables, psychological processes, coping strategies, and physiological consequences. In their review of more recent research on marriage and health, Kiecolt-Glaser and Newton [15] refined this model, focusing on affective, behavioral, and physiological pathways from marital factors to health outcomes. There
Physiological responses and health
The past decade of research has yielded important evidence for the influence of behaviors during marital interaction on physiological functioning, providing solid, mechanistic evidence of how marital functioning can have direct physiological consequences. Cardiovascular, endocrine, and immune pathways are critically important for the organism's adaptation to changing environmental demands. Thus, they play a central role in the ability of the organism to maintain physiological stability through
Conclusion
This review described relationships between marital functioning and health outcomes, and the physiological pathways that may mediate these relationships. In particular, evidence from marital interaction studies suggests that marital strain has deleterious effects on cardiovascular, endocrine, and immune functions. Marital strain can be viewed as a repeated, perhaps even chronic, social stressor. As such, in spouses who fail to physiologically recover following a marital disagreement, or fail to
Acknowledgements
Work on this paper was supported by grants K02 MH01467, P01 AG16321, MO1-RR-00034, and an NSF Graduate Research Fellowship to the first author.
References (73)
- et al.
Marital status and mortality: the National Longitudinal Mortality Study
Ann. Epidemiol.
(2000) Marital status and quality of relationships: the impact on health perception
Soc. Sci. Med.
(1997)- et al.
Prognostic importance of marital quality for survival of congestive heart failure
Am. J. Cardiol.
(2001) - et al.
Marital therapy in the treatment of depression: toward a third generation of therapy and research
Clin. Psychol. Rev.
(1998) - et al.
A psychophysiological analysis of spouse solicitousness towards pain behaviors, spouse interaction, and pain perception
Behav. Res. Ther.
(1995) - et al.
Factors characterizing marital conflict states and traits: physiological, affective, behavioral and neurotic variable contributions to marital conflict and satisfaction
Pers. Individ. Differ.
(1998) Norman Cousins Memorial Lecture 1998. Stress, personal relationships, and immune function: health implications
Brain Behav. Immun.
(1999)- et al.
Chronic stress in elderly carers of dementia patients and antibody response to influenza vaccination
Lancet
(1999) - et al.
Slowing of wound healing by psychological stress
Lancet
(1995) - et al.
Chronic stress in caregivers of dementia patients is associated with reduced lymphocyte sensitivity to glucocorticoids
J. Neuroimmunol.
(2000)