Is marriage good for your health?

[Stephen Bezruchka]

it depends, according to this article, and it is better for men than
women.  Stephen

***
NYT October 22, 2002  Good and Bad Marriage, Boon and Bane to Health  By
SHARON LERNER

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."