“Sticks and stones can break my bones, but words can never hurt me” is a fairly universal playground rhyme, but the long- and short-term effects of hostility and conflict in romantic relationships may affect our physical (and mental) health in unforeseen ways, as evidenced by a growing body of epidemiological literature.

Although many studies have investigated the implications of a lack or loss of a romantic partner on health, less is known about the impacts of a troubled marriage, itself a significant source of stress. In studying risk factors for major depression, one early study found that in a sample of individuals were were either separated/divorced, single, married in a happy relationship, or married and do not get along with their spouse, rates of major depression were lowest in men and women who are married and get along with their spouse, and highest in married women in unhappy marriages1. A similar study found significant correlations between depressive symptomatology and marital discord at 18 and 30 months post-marriage in a community population of married couples2. Odds ratios showed that odds of showing symptoms of depression in a maritally discordant individual was approximately ten times greater than the odds of depressive symptomatology in an individual without marital discord2.

Additional works have also demonstrated the link between hostile or unhappy marriages and physiological indicators. Morbidity and mortality outcomes such as recurrent coronary events and death risk among those with congestive heart failure and undergoing hemodialysis3,4,5. 

So, what physiological mechanisms are responsible for this association? One study proposes that the immune system plays an important role in the relationship between marital discord and negative health implications, because marital strife causes psychological and physiological stress, which is detrimental to the immune system6. 

“Overall, blister wounds healed more slowly following couples’ conflict discussions than after more supportive interchanges, and couples who were more hostile toward each other during both discussions had wounds that healed more slowly than couples whose interactions were less hostile”

Kiecolt-Glaser et al. 2005

The study recruited a sample of married couples and collected data on each couple, including a measure of the level of hostility in their relationship. They were then brought in on two separate occasions, once to engage in a social support interaction with each other and once to undergo a conflict situation; time to healing of blister wounds induced after each visit was subsequently tracked. The researchers found that blister wounds healed more slowly following couples’ conflict discussions than after more supportive interchanges (1 day later after conflict interaction than social support regardless of the hostility of the couple)6. Additionally, couples who were generally more hostile toward each other during both discussions had wounds that healed more slowly (with blister wounds in high hostility couples healing at 60% the rate of low hostility couples) than couples whose interactions were less hostile6. Immunological measures, specifically quantities of inflammatory cytokines (molecules important for wound healing) both locally (drawn from blister fluid) and distally (in the blood) indicate a maladaptive immune response in both couples exhibiting long-term hostility and in all couples after engaging in conflict6. 

“Short term marital strife magnify these relationships such that more hostile couples show greater deficits on these dimensions relative to low hostility couples following conflict visit”6

In sum, it isn’t reasonable to expect marriage to be sunshine and rainbows all the time, but too much discord and conflict, especially compiling over time, can have serious negative effects on the immune system. This is an important area of research, and crucial for general audiences to understand, as the impact of psychological stressors on immune responses affects health outcomes like wound healing and age-related diseases later in life.

  1. Weissman MM. Advances in psychiatric epidemiology: rates and risks for major depression. Am J Public Health. 1987; 77:445-451. ↩︎
  2. O’Leary KD, Christian JL, Mendell NR. A closer look at the link between marital discord and depressive symptomatology. J Soc Clin Psychol. 1994;13:33- 41. ↩︎
  3. Orth-Gomer K, Wamala SP, Horsten M, Schenck-Gustafsson K, Schneiderman N, Mittleman MA. Marital stress worsens prognosis in women with coronary heart disease. JAMA. 2000;284:3008-3014. ↩︎
  4. Coyne JC, Rohrbaugh MJ, Shoham V, Sonnega JS, Nicklas JM, Cranford JA. Prognostic importance of marital quality for survival of congestive heart failure. Am J Cardiol. 2001;88:526-529. ↩︎
  5. Kimmel PL, Peterson RA, Weihs KL, Shidler N, Simmens SJ, Alleyne S, Cruz I, Yanovski JA, Veis JH, Phillips TM. Dyadic relationship conflict, gender, and mor- tality in urban hemodialysis patients. J Am Soc Nephrol. 2000;11:1518-1525. ↩︎
  6. Kiecolt-Glaser JK, Loving TJ, Stowell JR, Malarkey WB, Lemeshow S, Dickinson SL, Glaser R. Hostile Marital Interactions, Proinflammatory Cytokine Production, and Wound Healing. Arch Gen Psychiatry. 2005;62:1377-1384. ↩︎

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