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Can marriage make you sick?

This story was originally published by Knowable Magazine.

Is ongoing hostility in your marriage making you stressed or
depressed? Do you have a good relationship, but your partner has a
chronic disorder? In either case, watch out. Though married people,
on average, have better health than others, partners in these two
situations can face an increased risk of obesity, cardiovascular
disease and other conditions. The risks vary, of course, but take
note: If one spouse is obese, the other person’s risk for that
condition doubles
.

Janice K. Kiecolt-Glaser, director of the Institute for
Behavioral Medicine Research at Ohio State University, and
Stephanie J. Wilson, a postdoctoral researcher in Kiecolt-Glaser’s
lab, study the health effects of intimate relationships and
recently reviewed the topic in “Lovesick: How Couples’ Relationships
Influence Health
” in the Annual Review of Clinical
Psychology
. Here, they explain some of the more intriguing
findings. The interview has been edited for clarity.

Is it true that, overall, being married is good for
you?

JKG: A bunch of different studies show that
marriage, on average, is beneficial for rates of disease, recovery
from surgery, cancer risk — most of the things you can look at. The
effects of being single are similar in magnitude to the health
risks of smoking, high blood pressure, obesity or a sedentary
lifestyle.

SW: A recent meta-analysis showed that the
effect of a quality marriage on physical health was about
equivalent to that of daily exercise or a healthy
diet
. Maybe over a short time span the effects are not large,
but over the course of longer periods, the benefits of a satisfying
marriage add up.

Now the flip side. Studies show that the risks for
obesity-related conditions rise dramatically in a person if a
partner has the condition — risk doubles in the case of obesity
itself and rises by more than 25 percent for diabetes and metabolic
syndrome. What explains this “contagion”?

JKG: If your partner has less healthy
behaviors, it gives you license, and perhaps subtle social
pressure, to adopt them as well.

Being stressed by ongoing marital discord also aligns
with poor health. What are common effects?

JKG: Cardiovascular disease has been well
described, hypertension has been described in a
variety of cases — the whole metabolic syndrome group of diseases. Marital
discord doubles the risk for metabolic syndrome.

SW: A lot of the chronic illnesses that develop
at higher rates in couples who are unhappy than in satisfied
couples may be caused in part by
inflammation
. Beyond that, once a person has vulnerability to a
disease, its severity can be exacerbated by marital discord. I am
thinking of certain pain conditions that may not be rooted in
inflammation or stress per se but, once they arise, might escalate
more quickly in someone who is in a poor marriage.

Also, marital distress and depression are
strong fellow travelers
. An unhappy marriage is really, really
fertile ground for depression, and depression has very well
documented health consequences. And it goes back and forth. People
who are depressed are more likely to have marital troubles, because
it’s not fun to be around someone who is depressed.

It sounds as if most roads lead through
inflammation.

JKG: It’s one of the central pathways we know
the most about these days, although there are certainly others.
Inflammation is associated with a variety of different diseases.
And psychological stress can promote inflammation.

What is the biological route from stress to
inflammation?

JKG: When you are stressed, stress hormones
respond. For instance, norepinephrine, otherwise known as
noradrenaline, is clearly very stress-responsive, and it is also a
hormone that is important on the pathway to inflammation.

“If your partner has less healthy behaviors, it gives you
license, and perhaps subtle social pressure, to adopt them as
well.”

Janice Kiecolt-Glaser

Behaviors also change as a result of marital stress. How
do they link to ill health?

JKG: Most of us don’t tend to eat more broccoli
when we’re stressed, or all the things our mothers told us to do:
eat healthily, exercise, drink moderately. Those are all behaviors
that, with stress, get worse.

SW: Sleep is particularly important for health,
too, and is disrupted by marital stress.

Can these effects contribute to
inflammation?

JKG: All the behaviors we’ve been talking about
are also lovely for inflammation. When you are eating a high-fat,
unhealthy diet, it’s inflammation-producing. Drinking heavily,
smoking, sedentary behavior — they are all associated with
inflammation. Depressive symptoms have inflammatory consequences,
too.

SW: Sleep disorders are also associated with
much higher levels of inflammation and predispose you to a range of
chronic illnesses, but we have also found that just a night or two
of less sleep primes couples to have a larger inflammatory response
to conflict than couples who had more sleep in the past two nights.

How does one go about showing that marital discord
affects physiology?

JKG: In the earlier studies in our lab,
we would bring couples in and put a
catheter in their arm
and ask them to discuss a disagreement,
and we could watch stress hormones in the blood respond to the
quality of the disagreement. When people were more nasty or
hostile, we would see much larger increases in stress hormones. You
could actually watch the biological consequences related to the
quality of the discussion.

“So we have a triad of really unhealthy things happening
associated with depression and couples’ negativity or discord.”

Janice Kiecolt-Glaser

How do you get people to have disagreements in the
lab?

JKG: We have people fill out an “areas of
disagreement” questionnaire, where they rate the intensity and
chronicity of common marital problems — in-laws, finances, sex.
Then they are asked to resolve problems they have identified as
current issues, such as, “What are you going to do about Mrs.
Jones’s mother who keeps dropping by unexpectedly?” We videotape
that discussion and then code what the partners are doing.

What do you look for, specifically?

JKG: Bad marriages often have the same kinds of
symptoms. One classic signature of distress is the demand-withdraw
pattern, where one person will be saying they want a change in
something and the other person doesn’t want to discuss it. Another
signature is negative escalation: One person says something
negative, the other person responds in kind, and it goes up and up
and up.

Jan, you did a study showing that marital distress can
alter metabolism in ways that promote weight gain. How did you make
that discovery?

JKG: We were trying to mimic the amount of fat
and calories in fast-food meals — the things that people would turn
to when stressed. We brought couples into the laboratory and we fed
them one of two high-fat meals (one with a healthier fat, high
oleic sunflower oil, and one with a saturated fat). Both were 60
percent fat and 930 calories. We drew blood and made metabolic
measurements at baseline and every two hours after the meal
throughout the day, including one and four hours after the
disagreement discussion.

We found a whole series of things, for both meals. When a person
had a history of depression and the conflict was nastier, they had
higher and more sustained rises in triglycerides, and their
metabolic rate was lower: Energy expenditure went down by 128
calories. That’s not a big deal for an afternoon, but it could add
more than 7 pounds of weight a year for someone with continuous
stress over time. There was also higher insulin production, which
is a way of telling cells to store fat.

So we have a triad of really unhealthy things happening
associated with depression and couples’ negativity or discord.

Marriage and health flow chart

Do you see gender differences in responses to marital
distress?

JKG: I would argue that it’s more the woman who
gets affected. A meta-analysis by a former grad student did not find that, but they did not look at the kinds
of laboratory studies we do (they are costly and intense and not
commonly done). In those, we clearly see that women are responding
more physiologically.

There is a large psychological literature, too, showing that
women remember both positive and negative events in much more
detail than men; women ruminate or think about those relationship
events much more than men. So it would be surprising if there were
not greater health effects for women. In our laboratory studies
where we had the catheter in the arm and were drawing blood during
the conversation, we could really see the differences in
how the women were responding compared to the men.

Research also shows that, at the other end of the
spectrum, having a really good relationship can put a person at
risk for health problems if the partner is ill. What goes on
there?

JKG: Some of the best evidence comes from the
extreme case of spouses caring for partners with Alzheimer’s
disease. Years ago, we showed that the spouses’ immune systems were less likely to respond to
vaccination as they should; spouses healed wounds more slowly; they had higher levels of inflammation. That’s the more
extreme case, but there is now good evidence across less-dramatic
illnesses that a spouse’s illness matters. And it appears to matter
more in a better-quality relationship — because it affects you more
directly, in some ways.

SW: Another type of lab study brings in a
couple where one person has a chronic pain condition, such as knee
osteoarthritis that affects the ability to get around. The pain
patient would be asked to do a painful task and would be
video-recorded. That video would be shown to the spouse. Spouses
react with greater blood pressure increases to watching the patient in pain compared to
somebody they don’t know, and beyond that, spouses who are in happy
marriages show even more exaggerated effects.

Is the mechanism similar to what happens when partners
have marital discord?

SW: The stressors and experiences are likely to
be different — empathic processes and the stresses of care-giving,
rather than noxious conflictual patterns. But the physiological
pathways might be the same.

JKG: What happens in partner illness, too, is
that the ill person is typically less available, so the partner
loses many of the positives of marriage, such as the give and take
of conversation and shared experiences.

Elderly couples in a happy marriage face a greater
health risk than younger people do when a partner is ill.
Why?

JKG: Older couples have longer, more intense
relationships. Also, the older someone is, the more vulnerable they
are physiologically. Stress for someone in their 20s is not likely
to make them sick or have huge health effects, but we know that
when someone is 65 or 70, noticeable declines in the immune
response begin, and age-related increases in inflammation. So
you’re adding stress onto physiology that is already functioning
more poorly. But there is also a psychological explanation.

SW: In general, as people age, there is a
decrease in the size of the social network, a greater emphasis on
relationships that are emotionally meaningful. Because of that,
psychological weight is placed on the marital relationship.

“Over the course of longer periods, the benefits of a satisfying
marriage add up.”

Stephanie Wilson

What about the health effects of stress on gay couples
or people who cohabitate?

SW: Most of the studies only recruit
heterosexual married couples, and that’s the only group we can
strongly generalize to. But the existing data don’t show marked
differences in the process in cohabitating or homosexual
couples.

Is there a particularly good way to protect health when
couples have marital problems?

JKG: There is some evidence that marital
problems are going to be most responsive to marital therapy (as
opposed to individual therapy). It can address the utility, or lack
of utility, of the way couples are thinking about particular
problems.

SW: And it can encourage making an effort to
take the other person’s perspective and to approach problems as a
team. We only have a few studies to look to. But they’ve shown
that, regardless of the specific approach, if the therapy is
effective at reducing marital problems, we see a reduction in stress hormone reactivity.

To limit marital tension when one partner is ill, the
advice to a spouse seems to be “Be supportive.” But how do you do
that without seeming to be a nag or too critical?

SW: A lot of this work has shown that
supporting the person in their independence — essentially saying,
“I believe in you; this is a challenge, but you can do this” — can
build a partner’s self-confidence, which is often going to be
beneficial. Being empathic has also been shown to be effective —
listening actively when the partner wants to share, to show that
you are there as a support, and being generally loving and
warm.

Elderly couple in the rain

CREDIT: MARMAX/PIXABAY (CC0)

In your own relationships, have you used anything you’ve
learned from the research?

JKG: Yes — the idea that you pay attention to
your relationship; that it matters how you talk about it and think
about it. And it matters that you take good care of yourself, as
well as attending to your partner, when your partner is ill.

My husband has Alzheimer’s disease. When he was first diagnosed
with mild cognitive impairment, I saw the train coming down the
tracks. Ours is a case where our lives were very much intertwined.
He was my primary research collaborator and we had a really good
relationship and a closeness. So I tried to make sure that I had my
own life aside from the marriage, in terms of friendships — not
just couple friendships — and I tried very hard to take care of my
own health. I knew all too well what happened when people didn’t
take care of themselves.

Don’t breakups cause all kinds of anxiety, depression
and stress too? And then there is loneliness. Which is worse for
one’s health — staying in a non-ideal relationship or going it
alone?

SW: The evidence is mixed. One study found that
singles had lower resting blood pressure than
unhappily married people but a study of people with rheumatoid arthritis found that singles and the
unhappily married were in an equal amount of pain. In both cases,
happily married people fared best. As for divorce, most people cope well and
recover quickly post-marriage, but a consistent minority (10-15
percent) do struggle and face heightened health risks as a result.
As for loneliness, it is possible to feel lonely in a marriage;
surrounding oneself with other friends and family seems to be
especially important for staving off loneliness in
the unmarried.

Where is your research heading now?

JKG: Stephanie and I are working on a
microbiome project. We are recruiting couples and getting fecal
samples to look at how marital quality and marital stress are
reflected in the mix of bacteria in the gut.

What would you do with that information?

JKG: The microbiome may well be an important
conduit to inflammation. With what’s called a “leaky gut,” you have
endotoxin, a bacterial toxin from certain bacteria, leaking across
the gut barrier. That fuels inflammation. We can look at how a
person’s diet affects their microbiome, whether dietary
interventions might be useful for reducing inflammation in people
experiencing stress in their marriage — a variety of things. So the
research offers the possibility for finding interventions that we
might not otherwise have thought about.

This story was originally published by Knowable Magazine. Knowable Magazine is an independent journalistic endeavor from Annual Reviews.

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