The physiology of marriage: pathways to health

Abstract

Marriage is the central relationship for most adults and has beneficial effects for health. At the same time, troubled marriages have negative health consequences. This review outlines the physiological pathways through which marital relationships influence health based on a stress/social support model. In addition, we review recent findings suggesting that unhappy marriages are associated with morbidity and mortality. We then turn to studies of marital interaction that include assessment of physiological pathways through which marital functioning influences health: the cardiovascular, endocrine, and immune systems. Across these studies, negative and hostile behaviors during marital conflict discussions are related to elevations in cardiovascular activity, alterations in hormones related to stress, and dysregulation of immune function. Using recent conceptualizations of the physiological impact of chronic stress, we illustrate how physiological changes associated with marital functioning in these studies have long-term implications for health outcomes. Finally, we discuss future implications of current research for understanding the relationships among marital functioning, physiology, and 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.