Good and Bad Marriage, Boon and Bane to Health

By SHARON LERNER, NY Times

 October 22, 2002

In the early 1970's, demographers began to notice a strange pattern in life span data: married people tended to live longer than their single, divorced and widowed counterparts.

The so-called marriage benefit persists today, with married people generally less likely to have surgery and to die from all causes, including stroke, pneumonia and accidents. At its widest, the gap is striking, with middle-aged men in most developed countries about twice as likely to die if they are unmarried.

Many have argued that the difference in life expectancy is actually because healthier people are more likely to marry. But an emerging group of marriage advocates has put a spotlight on the medical potential of the institution.

"Marriage is sort of like a life preserver or a seat belt," argues Dr. Linda Waite, a professor of sociology at the University of Chicago and an author of "The Case for Marriage," published in 2000. "We can put it in exactly the same category as eating a good diet, getting exercise and not smoking."

But even as marriage is being packaged as a boon to health, there is a new caveat. While people in good, stable partnerships do, on average, have less disease and later death, mounting evidence suggests that those in strained and unhappy relationships tend to fare worse medically. Women seem to bear the brunt of marriage's negative health consequences.

In some ways, the physical perils of bad pairings should be obvious, with domestic violence just the most drastic illustration of how romance can lead to bodily havoc.

At its best, marriage acts as a balm against loneliness and stress, each associated with ill health. The marriage benefit probably extends also to gay couples in committed romantic partnerships and to unmarried heterosexual couples who have been together for years, many researchers agree.

But at its worst, marriage can also be a cause of isolation. And, not surprisingly, the tensions and arguments of marriage can often lead to depression, with many studies finding increases in depressive symptoms among those who have reported marital discord compared with those who have not reported such discord.

Bad marriages can also have some unexpected negative consequences for health. Men and women who reported low-quality marriages had more gum disease and cavities than happily married people. Two studies found marital strain to be linked to ulcers in the stomach and intestine. And people's satisfaction with their relationships appears to alter how they experience pain.

Some of these physical effects seem to be direct results of behavior. A supportive partner can help a person stick to restrictive diets and exercise regimens, for instance. Perhaps more important, according to Dr. James Coyne, a professor of psychiatry at the University of Pennsylvania, who has studied the effects of marital quality on recovery from congestive heart failure, a good marriage can give a person a reason to stay alive.

"Even when your own determination to get better wavers, the commitment to your partner puts you back on track," Dr. Coyne said.

In contrast, he said, a bad marriage can be worse than none at all. "Some of these people," he said, "if their spouses said, `breathe for the next half-hour,' they'd try to hold their breaths. It can get that stubborn in a bad marriage."

That bullheadedness can turn into a matter of life and death, according to Dr. Coyne's study, published last year in The American Journal of Cardiology. It found that the quality of patients' marriages predicted their recoveries as well as the pumping ability of their hearts.

Dr. Coyne and his colleagues videotaped couples' arguments in their homes and grouped them according to the negativity of their interactions.

Those heart patients who were more negative with their spouses were 1.8 times as likely to die within four years as those who were given less negative ratings.

"That's powerful stuff," Dr. Coyne said. "We never expected the effect to be that big."

Perhaps even more surprising is the evidence that relationship strain can take a direct physiological toll.

According to Dr. Janice Kiecolt-Glaser, a professor of psychiatry at Ohio State University, and her husband, Dr. Ronald Glaser, an immunologist, marital arguments cause changes in the endocrine and immune systems.

During and after stressful conversations, levels of the hormones epinephrine and cortisol rise and can stay elevated for more than 22 hours afterward. Blood pressure and heart rate also tend to go up with relationship stress.

A 1998 study showed that women who were unhappy with their marriages experienced increases in blood pressure readings just from thinking about fights they had had with their husbands.

And while these biological markers suggest that marital tension can make a person vulnerable to health problems, several researchers have documented that relationship problems affect the actual severity of illnesses.

One study of patients with Parkinson's disease documented an association between marital distress and symptoms like eye-blinking. Research on married people with Alzheimer's disease has shown that criticism from a spouse predicted symptoms.

And, in what may be the oddest study in the field, Dr. Kiecolt-Glaser and Dr. Glaser are now researching how the quality of a marriage affects the body's ability to repair itself.

In the continuing study, the scientists admit subjects to a hospital, inflict minor wounds on their arms, and then chart their interactions with their spouses and their progress in healing.

As with the overall "marriage benefit," which for women is smaller than for men — and possibly even nonexistent, according to some researchers — women are more vulnerability to relationship-related health problems.

Illustrating the strong negative effect on women, a 15-year study of members of a large health maintenance organization in Oregon found that having unequal decision making power in marriage was associated with a higher risk of death for women, though not for men.

In Dr. Coyne's study of congestive heart failure, there was a stronger association between marital discord and death among women. Seven of the eight women with the poorest marital quality died within two years of the first assessment.

Studies consistently show that the physiological effects of marital stress are stronger and last longer in women.

"We don't know why women are so much more sensitive to negativity or hostility than men," Dr. Kiecolt-Glaser said. Nor do people agree on how to make use of the new data.

Dr. Waite of the University of Chicago, who is also a board member of the pro-marriage Institute for American Values, suggests that H.M.O.'s should create programs to help people have better marriages. And Dr. Coyne is hoping cardiologists will begin to consider their patients' interpersonal relationships as well as their hearts.

For Dr. Alex Zautra, a professor of psychology at Arizona State University in Tempe, who has shown an association between criticism from intimate partners and joint pain in women with rheumatoid arthritis, the lesson from this growing literature is not to think of interpersonal ties as either all positive or negative.

"In truth, all relationships have both good and bad aspects to them," Dr. Zautra said. The point, he said, is that, in all their complexity, they matter. "At the heart of this is how people's emotions affect their health. People need to start thinking about that."