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’Marital strain’ increases women’s risk of death, heart disease

18.02.2005

American Heart Association meeting report

Married women who avoid conflict with their spouses have an increased risk of dying from any cause, researchers report today at the Second International Conference on Women, Heart Disease and Stroke. Researchers also found that men whose wives’ come home upset with work outside the home have an increased risk of developing heart disease.

Researchers examined information on participants of the Framingham Offspring Study, a large, ongoing community study that tracks the incidence and prevalence of cardiovascular disease and other social and demographic characteristics such as marital strain in the Framingham, Mass., community.

Previous studies have shown a link between levels of marital strain and the health of people with heart disease. However, few studies have looked into the effects of marital strain on contributing to heart disease or death from any cause, said Elaine D. Eaker, Sc.D., president of Eaker Epidemiology Enterprises, LLC, in Chili, Wis., and principal investigator of the ancillary study of the Framingham Offspring Study.

Together with researchers from Boston University, Eaker collected data that analyzed marital discord. They determined traditional measures (satisfaction and disagreements) and more contemporary ones (conflict resolution and other interpersonal communication issues).

The study included 1,769 men and 1,913 women between ages 18 and 77. Researchers conducted the baseline examinations from 1984–87. Of these participants, 1,493 men and 1,501 women were married or "living in a marital situation." The researchers tracked the health of the participants for 10 years to determine if they developed heart disease or died. "Married men were heavier, older, and had higher blood pressure and a less favorable lipid profile compared to unmarried men," Eaker said. "Unmarried men were more likely to be smokers."

After the researchers made statistical adjustments for age, systolic blood pressure, body mass index, cigarette smoking, diabetes, and the ratio of total and high-density (or "good") cholesterol, married men were about half as likely to die compared to unmarried men. On the other hand, marital status and the more traditional measures of marital strain had no effect on women developing heart disease or dying over 10 years of follow up. However, when considering more contemporary measures, two types of marital strain were found to be significantly related to the health of married women as well as men.

Men who reported that their wives’ work was disruptive to their home life because their wives came home upset with work were more than two times more likely to develop heart disease. Women who reported usually or always keeping their feelings to themselves when in conflict with their husbands, known as self-silencing, had more than four times the risk of dying from any cause compared to women who always show their feelings.

Eaker noted that this is the first time marital strain -- as measured by disruption to one’s life due to a spouse’s work situation and self-silencing during conflict with one’s spouse -- has been included in a longitudinal study of the development of heart disease and death. "These findings are unique," Eaker said. "We believe we have found characteristics of marriages that have an impact on peoples’ health and longevity. Based on the strength of the associations we observed and the strengths of the design of the Framingham Offspring Study, we also believe there are some practical implications for clinical practice. While medical care providers are not specifically trained to intervene on psychosocial issues such as marital characteristics, they may be the most likely contact to observe or uncover these characteristics or emotions."

Eaker suggested that screening questions be added to medical history questionnaires to uncover psychosocial stressors, allowing for counseling referrals if appropriate.

The research substantiates previous studies that found married men have a survival advantage over unmarried men. Eaker recommended that healthcare providers should also consider the physical and emotional risk factors among unmarried men.