newsletter of the ucla Center for the JUN08 study of women

by Theodore F. Robles CSW

Close Relationships and Studying the effects of and relationship quality on health

very December, U.S. News and World their unmarried counterparts. In addition to compared to people in satisfactory and happy Report publishes a list of “50 Ways to these benefits, marriage has benefits for physi- . The most dramatic examples of the EImprove your Life” for the coming year. cal health. However, marriages characterized by relationship between marital quality and health In the December 19th issue of 2004, one of the low marital satisfaction and high conflict have come from studies of patients with existing recommendations in the “Get Well” section damaging effects on physical health, and the ef- chronic medical conditions. Low marital quality, that dealt with ways to improve your health fect of poor marital quality on health may differ typically measured through self-report, predicted was to “Get Married.” Indeed, across a number between men and women. earlier mortality over long-term follow-up (be- of epidemiological surveys, married individuals While marriage on average is related to better tween 4 and 8 years) in end stage renal report greater happiness and life satisfaction, overall physical health, people in troubled mar- and congestive heart failure patients. Beyond and have a lower risk of clinical depression than riages have worse mental and physical well-being mortality, low marital quality is also related to 1 Close Relationships and Health, continued from page 1 increased risk of coronary events (including The prevailing explanation for the health benefits cardiac death, acute , and of healthy marriages and the detrimental health revascularization procedures) in patients with consequences of unhealthy marriages is the “stress/ cardiovascular disease and in a large 9,000-per- hypothesis.” son cohort of British civil servants, increased illness symptoms over longitudinal follow-up (4 years) in healthy married couples, and increased pain flares in patients with rheumatoid arthritis. In contrast to research on differences in marital status on health, where men derive greater health benefits from marriage compared to women, research on marital quality and health shows an opposite pattern. Specifically, the effects of marital quality on health are gener- ally stronger for women compared to men. For instance, in a longitudinal study of participants in the Alameda County Study, increased marital strain was related to increased self-reported ulcer symptoms at 8- to 9-year follow-up in women but not men. In addition, large, prospective that stress and support in marriages influences with physician recommendations) are important, longitudinal studies also show that lower marital health through a number of pathways. These relationship quality may have a direct impact on quality is related to increased risk of disability pathways include influences on the individual’s our biology as well, independent of these health and mortality over long-term follow-up (6–15 cognitions, emotions, health behaviors, coping behaviors. years), again in women but not men. behaviors, and biological systems. The model Marital quality can also directly impact bio- The prevailing explanation for the health was further elaborated on by Janice Kiecolt- logical systems that are involved in psychological benefits of healthy marriages and the detrimen- Glaser and Tamara Newton, who suggested responses to stress and physical health. The three tal health consequences of unhealthy marriages additional pathways, including mental health biological systems that have received the most is the stress/social support hypothesis, originally put and psychopathology, and individual differences attention in studies of marriage and health are: forth by Bonnie Burman and Gayla Margolin. in personality such as hostility. While health Thecardiovascular system, which is responsible for The stress/social support hypothesis suggests behaviors (like physical activity, diet, compliance circulating oxygen, nutrients, and numerous cells JUN08 4 CSupdateW throughout the body; the neuroendocrine system, pressure and heart rate compared to less hostile which helps the brain regulate important func- couples. Similarly, greater hostile behavior dur- tions like energy balance and reproduction via ing marital discussions is related to elevated chemical messengers called ; and the hormones that are involved in regulating energy , which defends the body against balance and that mediate the body’s response to threats such as bacteria, , and parasites. psychological stress (including catecholamines Beyond serving a wide range of life-sustaining such as , and hormones of the functions for the body, malfunctions or deficien- hypothalamic-pituitary-adrenal axis such as cies in these systems are involved in most major ). Greater hostile behavior during mari- chronic . tal discussions is related to suppression of the Studies that focus on the impact of relation- immune system’s ability to fight off infectious ship quality on biology involve healthy couples disease and aid wound healing, and exacerbation that are disease-free and have very healthy of the immune system’s systemic inflammatory lifestyles, and others statistically control for the response. presence of unhealthy behaviors. These stud- Are there gender differences in biological ies typically involve studying married couples responses to marital conflict?Y es, it turns out while they discuss problems in their relationship, that overall, women show larger cardiovascular coupled with measuring activity in one or more and endocrine responses to marital problem of the biological systems. Marital quality is typi- discussions compared to men, and in some stud- cally measured by coding levels of hostile behav- ies, larger impacts on immune function. Is this ior during these discussions, such as put-downs because women are more biological responsive and criticism, during marital discussions. Thus, to stress? The answer is no; in other types of studies of marriage and biological systems have psychological stressors in the laboratory, such as been mostly restricted to interpersonal interac- giving a speech to an unfriendly audience, men tions in laboratory settings. have larger biological responses to these types of What do these studies find? Hostile behaviors stressors compared to men. Therefore, there must during discussions are accompanied by cardio- be something specific to talking about relation- vascular, neuroendocrine, and immune changes. ship issues that explains why women have larger Couples who show greater hostile behavior dur- biological responses. Kiecolt-Glaser and Newton ing marital discussions have more elevated blood argue that the pathways that explain relation-

JUN08 5 CSupdateW ships between marital quality and health, and What else might explain gender differenc- marital quality and physiology, are influenced by gender-related traits and cognitive schemas (like relational interdependence, where one’s goals es in biological responses to conflict? More and self-concepts center around close relation- ships, like “It is important for me to care for and give to others”), and social roles (like the “second shift”) which explain why marital quality has recent research suggests that other traits, stronger effects on health for women compared to men. What else might explain gender differences like sensitivity to rejection, and the social in biological responses to conflict? More recent research suggests that other traits, like sensitiv- ity to rejection, and the social dynamics of the dynamics of the relationship, like who has relationship, like who has more power in the rela- tionship and who is in the position of demanding change, also play important roles. Notably, while attributes like relational interdependence and more power in the relationship and who is sensitivity to rejection, or social dynamics like power and demanding change, tend to “cluster” with women in relationships, these attributes in the position of demanding change, also are by no means exclusive to women. Indeed, in more recent studies, men who are sensitive to rejection, have low status in the relationship, or play important roles. are in the position of demanding change in the relationship also have large cardiovascular or en- docrine responses to marital conflict. Overall, this suggests that while psychological characteristics that explain larger biological responses to mari- tal problem discussions tend to be observed in women, they are by no means limited to women.

JUN08 6 CSupdateW Moreover, while personality is generally stable, now suggest that low marital quality and increased tions, particularly interventions that focus on the power dynamics within a couple can fluctuate over hostility within marriages are related to changes in relationship between the partner and the patient, time and can differ at different stages of the life- biological measures that reflect the plaque accumu- also improve the mental health of the partner. course. We study dating couples and are beginning lation process (for example, ultrasound measures However, these studies focus primarily on coping a program of research to study retiring couples. of carotid artery thickness, computerized tomogra- with illness, rather than improving relationships, Preliminary data from our research in dating phy scans of the heart). These studies suggest that which is the usual focus of marital therapy. couples shows an opposite pattern of biological being in an unhappy marriage is related to greater There is still a lot that we do not know about responses to the same types of discussions—the accumulation of artery blockage over several years. the links between marriage and health. For in- men are showing larger responses to these discus- In our laboratory, we study the effects of rela- stance, few studies have focused on marriages or sions than women. We are particularly interested tionship quality on health by focusing on a very relationships and health in non-Western cultures, in what happens to relationships and health when short-term health outcome, the skin’s ability to or in same-sex relationships. We do know that one spouse retires and the other continues work- heal following a minor irritation. We and oth- the links between marriage and health are strong ing. Other research suggests that husbands’ retire- ers have demonstrated that such relatively brief and that helping people develop healthy relation- ment and wives’ continuing to work can adversely psychological stressors as giving a speech in front ships may pay off with large dividends for both affect marital satisfaction in both spouses. We are of an unfriendly audience or such naturalistic psychological and physical well-being. interested in studying the physiological and health stressors as final exams can delay wound healing. effects of this pattern. Moreover, recent work demonstrates that high Theodore F. Robles is an As- While marital quality affects biological sys- hostile couples take longer to heal a standard size sistant Professor in the UCLA tems that impact health, does marital quality or wound compared to low hostile couples. Our Department of Psychology, and a behavior in the laboratory impact on disease- preliminary data suggests similar results in dating member of the Health Psychology relevant outcomes? Any number of psychological couples, where couples reporting high relation- core faculty. He is the director of or physical stimuli can cause changes in heart rate, ship satisfaction and commitment heal a standard the Relationships and Health blood pressure, stress hormones, or immune func- minor wound faster compared to couples reporting Laboratory at UCLA. His cur- tion, without any measurable impact on health low satisfaction and commitment. rent research interests include close relationships, or disease. Recent studies have begun to address If marital quality is an important predictor physiology, and health; stress, skin barrier recovery, whether links between marital functioning and of health and if people’s relationships and mar- and biological mechanisms involved in skin disease; biological systems are relevant for actual disease. riages can improve through interventions, can we sleep and wound healing. He received a Faculty For example, coronary artery disease results from improve their health? Psychosocial interventions Development Grant from CSW to support this the buildup of plaques within the walls of arteries that focus on intimate partners or other family research. A videocast of his public lecture on May that supply the heart, a process that takes place members of chronically ill patients are effective in 13, 2008, is available on the CSW website: http:// over several decades before an individual actually improving mental health outcomes and in some www.csw.ucla.edu/podcasts.html experiences a heart attack. A number of studies limited cases, patient survival. These interven- JUN08 7 CSupdateW