March 5, 2009 – Women in strained marriages are more likely to feel depressed and suffer high blood pressure, obesity and other signs of “metabolic syndrome,” a group of risk factors for heart disease, stroke and diabetes, University of Utah psychologists found.

The same study found men in strained marriages also are more likely to feel depressed, yet – unlike women – do not face an increased risk of metabolic syndrome, which is characterized by five symptoms: hypertension, obesity around the waistline, high blood sugar, high triglycerides and low levels of HDL, which is “good cholesterol.”

“We hypothesized that negative aspects of marriages like arguing and being angry would be associated with higher levels of metabolic syndrome,” says the study’s first author, Nancy Henry, a doctoral student in psychology. “We further anticipated that this relationship would be at least partly due to depressive symptoms.”

“In other words, those who reported experiencing more conflict, hostility and disagreement with their spouses would more depressed, which in turn would be associated with a higher risk of heart disease due to metabolic syndrome,” she adds.

“We found this was true for wives in this study, but not for husbands,” says Henry, who was scheduled to present the findings Thursday, March 5 in Chicago during the American Psychosomatic Society’s annual meeting.

“The gender difference is important because heart disease is the number-one killer of women as well as men, and we are still learning a lot about how relationship factors and emotional distress are related to heart disease,” she says.

Putting Your Heart into Your Marriage

Does the study suggest women should avoid men to reduce heart disease risks?

“We know they should,” jokes Tim Smith, a psychology professor and study co-a2009-02-17uthor who heads a larger University of Utah study of the role of marriage quality in heart disease. The new study is part of the larger effort.

Smith, turning serious, says: “The reason you have to be careful about ‘what does it mean?’ is that this study is a simple, preliminary test of what might be unhealthy about relationships for women.”

“There is good evidence they [women] should modify some of the things that affect metabolic syndrome – like diet and exercise – but it’s a little premature to say they would lower their risk of heart disease if they improved the tone and quality of their marriages – or dumped their husbands,” he says.

Other data from the larger study indicate “that a history of divorce is associated with coronary disease,” he adds, noting the researchers are pursuing the hypothesis that improving marriage might improve health.

“The immediate implication is that if you are interested in your cardiovascular risk – and we all should be because it is the leading killer for both genders – we should be concerned about not just traditional risk factors [such as blood pressure and cholesterol] but the quality of our emotional and family lives,” Smith says.

In addition to possible health benefits, more immediate benefits include “getting along better and enjoying each other more, improving your mood,” he says.

Some critics have questioned the concept and clinical usefulness of metabolic syndrome – also known as syndrome X or insulin resistance syndrome – and have asserted that it is nothing more than the sum of its parts, namely, a group of five risk factors for heart disease, stroke and diabetes.

“It is defined as a syndrome, but there still is controversy in the medical community – what should be included, how the different factors should be measured, whether all the factors hang together as a distinct syndrome or are they just separate things,” Henry says.

She says she chose to study metabolic syndrome because there is no question its components are risk factors for cardiovascular disease and because the syndrome was a possible explanation for how “psychosocial risk factors” in marriage are related to cardiovascular disease.

“Strained marriages can increase your risk of heart disease, and that may in part be because strained marriages increase the risk of metabolic syndrome and thus heart disease,” Smith says. “The reason strained marriages might be related to metabolic syndrome is that strained marriages can be depressing, and depression is then the link to metabolic syndrome.”

Smith says the endocrinology of depression’s psychological stress may explain why the five risk factors that comprise metabolic syndrome fit together.

He hypothesizes that perhaps “the hormonal effects of stress are why you are depositing fat [around the waist], why your insulin resistance goes up, why your lipids and blood pressure get out of whack. Part of the reason these things may be clumping together is because they are part of an unhealthy body response to stress.”

How the Study Was Performed

Henry and Smith conducted the new study with University of Utah psychologists Jonathan Butner, an associate professor; Bert Uchino, a professor; and Cynthia Berg, a professor and chair of the university’s Department of Psychology.

For their wider study, the psychologists used the Dan Jones & Associates polling firm and newspaper ads during 2001-2005 to recruit 276 couples, who were married an average of 20 years and from ages 40 to 70.

Each couple filled out several questionnaires for both the encompassing study and for Henry’s study. The questionnaires included 10 scales: three to assess positive aspects of marriage quality, such as mutual support, emotional warmth and friendliness, and confiding in each other; three scales to measure negative aspects of marital quality such as arguments, feelings of hostility and extent of disagreement over various topics such as kids, sex, money and in-laws; and four scales to gauge symptoms of depression (not necessarily full-blown clinical depression).

Each couple also went to a university clinic, where their waists and blood pressure were measured and they were given lab tests for “good” cholesterol, fasting glucose and triglycerides. Together, those data determined if a study participant had metabolic syndrome. They also underwent a screening test designed to exclude any couple that already had cardiovascular disease.

The findings:

• Women who reported more marital strain were more likely to also report depressive symptoms, Henry says.
• “Women who reported more marital strain had more metabolic syndrome symptoms, and that association can be explained by the fact they also reported more depressive symptoms,” says Smith.
• “Men in bad marriages also reported more depression, but neither marital strain nor depression was related to their levels of metabolic syndrome,” he adds.

“We know from previous research that women are more sensitive and responsive to relationship problems than men,” Henry says. “The results of this study suggest those problems could harm their health. Understanding the emotional and relationship health of couples can be an important overall factor in understanding physical health. Improving aspects of intimate relationships might help your emotional and physical well-being.”