MARRIAGE AND HEALTH OVER THE MIDDLE YEARS: LINKING ECONOMIC HARDSHIP TO HEALTH OUTCOMES THROUGH MARITAL PROCESSES by SEONHWA LEE (Under the Direction of Kandauda K.A.S. Wickrama) ABSTRACT The current collection of studies investigated the association between marriage and health for middle-aged couples, focusing on how external stress shapes adaptive marital processes, and how this stress proliferation process impacts individuals’ mental and physical health. Study 1, using longitudinal couple data, explored how family financial stress and individuals’ trait hostility influenced adaptive marital processes, resulting in husbands’ and wives’ depressive symptoms. The findings affirmed the longitudinal stress proliferation in marriage, whereby family financial stress increased couples’ perceptions of spousal hostility leading to increases in depressive symptoms. In addition, while individuals’ trait hostility influenced wives’ perceptions of spouse’s hostile behaviors, this personality did not intensify the effect of financial stress on hostile marital interactions. Beyond depressive symptoms, Study 2 investigated various mechanisms such as behavioral, psychological, and physiological stress-related processes linking couples’ consistent hostile marital interactions to physical health outcomes. The research outcomes illustrated that sustained hostile marital interactions negatively impacted later physical health through behavioral, psychological, and physiological mechanisms. The findings also supported the stress-related dyadic processes in couples especially for psychological process, whereby husbands’ and wives’ perceived spousal hostility increased both their own and their partners’ psychological distress. Furthermore, examining physical health within three different aspects, which were global health, physical illness, and physical impairment, the current study provided additional information regarding how each mechanism influenced physical health differently. Frequent health risk behaviors were strong predictors of a long-term risk of physical illness, and high levels of body mass index were closely related to higher physical impairment. In addition, psychological distress was detrimental in all three features of physical health, reinforcing a salient role of psychological distress in physical health. This comprehensive investigation including biopsychosocial stress-response mechanisms contributes to the growing literature on life stress, marital adaptation, and health consequences, by providing precise information on how marriages change, and how marital distress gets “under the skin” of married individuals. INDEX WORDS: Marriage, Stress, Middle-aged couples, Hostile marital interactions. Biopsychosocial processes, Physical health, Cumulative effects MARRIAGE AND HEALTH OVER THE MIDDLE YEARS: LINKING ECONOMIC HARDSHIP TO HEALTH OUTCOMES THROUGH MARITAL PROCESSES by SEONHWA LEE B.S., Hankuk University of Foreign Studies, Republic of Korea, 2000 M.A., Seoul Women’s University, Republic of Korea, 2004 M.S., University of Rochester Medical Center, 2010 A Dissertation Submitted to the Graduate Faculty of The University of Georgia in Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY ATHENS, GEORGIA 2017 © 2017 Seonhwa Lee All Rights Reserved MARRIAGE AND HEALTH OVER THE MIDDLE YEARS: LINKING ECONOMIC HARDSHIP TO HEALTH OUTCOMES THROUGH MARITAL PROCESSES by SEONHWA LEE Major Professor: Kandauda K.A.S. Wickrama Committee: Jay A. Mancini Ted G. Futris Electronic Version Approved: Suzanne Barbour Dean of the Graduate School The University of Georgia May 2017 iv DEDICATION To my parents, Sujin Lee and Sung Duk Yang, And my husband, Woo Jang, Without whom none of my success would be possible. v ACKNOWLEDGEMENTS I would like to express my deepest gratitude to Dr. Kandauda K.A.S. Wickrama, my advisor, who has been a constant source of knowledge and inspiration to me. His genuine enthusiasm for family science consistently motivated me to engage with my research, and his advice and support helped me to bring the dissertation to a successful conclusion. I would like to extend my sincere appreciation to Dr. Jay Mancini for his mentoring and encouragement, and his continued support has been especially valuable in all my academic endeavors. My gratitude also goes to Dr. Ted Futris, whose expertise, valuable ideas, and thoughtful comments were extremely helpful over the course of this research. All the guidance they have generously given to me has helped me to grow as a scholar. I am indeed indebted to my family, friends, and colleagues for their endless support and love over the years. Last but not least, I want to thank God Almighty for blessing me and always being with me on every step of my journey toward the completion of my doctoral study since I first stepped into the United States in 2007. vi TABLE OF CONTENTS Page ACKNOWLEDGEMENTS .............................................................................................................v LIST OF TABLES ....................................................................................................................... viii LIST OF FIGURES ....................................................................................................................... ix CHAPTER 1 GENERAL INTRODUCTION ......................................................................................1 Introduction ..............................................................................................................1 Overview of the Studies ...........................................................................................4 2 FAMILY ECONOMIC PRESSURE, TRAIT HOSTILITY, MARITAL PROCESSES, AND DEPRESSIVE SYMPTOMS .......................................................8 Introduction ..............................................................................................................8 Theoretical Background .........................................................................................11 Literature Review...................................................................................................13 Method ...................................................................................................................17 Results ....................................................................................................................21 Discussion ..............................................................................................................25 3 STUDY 2: THE ASSOCIATION BETWEEN CHRONIC MARITAL HOSTILITY AND PHYSICAL HEALTH OUTCOMES: THROUGH PHYSIOLOGICAL, PSYCHOLOGICAL, AND BEHAVIORAL MECHANISMS ...................................35 Introduction ............................................................................................................35 vii Literature Review...................................................................................................37 Method ...................................................................................................................50 Results ....................................................................................................................55 Discussion ..............................................................................................................60 4 DISCUSSION AND CONCLUSION .........................................................................75 Discussion ..............................................................................................................75 Conclusion .............................................................................................................85 REFERENCES ..............................................................................................................................87 viii LIST OF TABLES Page Table 2.1: Correlation Matrix and Descriptive Statistics for Study 1 Variables ...........................31 Table 2.2: Estimate for Univariate Growth Curves of Family Economic Pressure and Perceived Spouse’s Hostile Martial Behaviors for Husbands and Wives in 1990, 91, 92, and 94 ....32 Table 3.1: Correlation Matrix and Descriptive Statistics for Study 2 Variables ...........................68 Table 3.2: Estimate for Univariate Growth Curves of Perceived Spouse’s Hostile Martial Behaviors for Husbands and Wives in 1990, 91, 92, and 94 .............................................69 Table 3.3: Comparison for Associations between Husbands and Wives.......................................70 ix LIST OF FIGURES Page Figure 1.1: Conceptual Model of Whole Study ...............................................................................7 Figure 2.1: Conceptual Model of Study 1 ......................................................................................33 Figure 2.2: Trajectories of Family Economic Pressure and Perceived Spousal Hostile Behaviors, Trait Hostility, and Depressive Symptoms in Middle-Aged Husbands and Wives ...........34 Figure 3.1: Conceptual Model of Study 2 ......................................................................................71 Figure 3.2: The Effects of Husbands’ and Wives’ Hostile Marital Interactions on Global Health Through Health-Risk Behaviors, Psychological Distress, and Body Mass Index .............72 Figure 3.3: The Effects of Husbands’ and Wives’ Hostile Marital Interactions on Physical Illness Through Health-Risk Behaviors, Psychological Distress, and Body Mass Index .............73 Figure 3.4: The Effects of Husbands’ and