Marital conflict and health: Processes and protective factors
Introduction
The relation between marriage and physical health has been recognized for many decades and explored in various forms. Initially, it was thought that marital status per se was protective of the health of marriage partners. This idea spawned many large-scale studies examining the relation between marital status and health (e.g., Berkson, 1962, Carter & Glick, 1976, Gove, 1973, Ortmeyer, 1974, Verbrugge, 1979). Although these studies partially supported the proposed association between marital status and health, they also indicated that the relation was more complex than previous formulations indicated. Following this first generation of research, a movement developed that continues to the present to explore specific characteristics of marriage that relate to the physical health of the partners and children of the marriages. Presently, missing from this literature to our knowledge is an explication of the physiological processes that can account for the relation and particularly those that act as moderators (i.e., factors that change the relation between risk and outcome variables when present; Baron & Kenny, 1986).
This paper posits to connect some of the gaps in a portion of this body of literature by reviewing research related to the effects of martial conflict on physical health, providing a conceptualization of the physiological processes active in the association, and proposing a physiological model of moderation of the relation. As such, the first aim of this paper is to review empirical explorations of the relations between marital conflict and the physical health of marriage partners and their children. After the review, this paper will present a potential pathway by which conflict may influence health, namely through chronic or excessive sympathetic activation. In this context, the literature related to physiological reactivity (changes from baseline levels of arousal in response to challenging or stressful conditions) to conflict will be presented. Finally, the primary objective will be addressed by explicating the role of vagal regulation as a moderator in the relation between marital conflict and physical health, drawing heavily from the Polyvagal Theory that will be explained in more detail in following section Porges, 1995b, Porges, 1997, Porges, 1998, which implicates sympathetic arousal as more detrimental than parasympathetic arousal.
Although vagal regulation has not been studied among adults as a moderator of the association between marital conflict and physical health, assertion of its usefulness for study is supported by empirical literature in other areas. Validation comes from the implication that vagal regulation can avoid pernicious sympathetic arousal (such as the arousal that occurs during marital conflict) which is linked to the development of health ailments Burns et al., 1992, Cacioppo et al., 1995. Further support stems from research demonstrating that vagal regulation is associated with adaptive emotional regulation (the capacity to manage strong emotion and organize resources towards the attainment of an external goal; Katz & Gottman, 1997) and is protective for children exposed to marital conflict in behavioral problems, peer relations, academics, and physical health domains El-Sheikh et al., in press, Katz & Gottman, 1995, Katz & Gottman, 1997.
Research explicating the role of moderators, such as vagal regulation, in the relations between marital variables (e.g., conflict) and physical health is essential due to the pertinence of the results to a vast population of individuals. Furthermore, there has been a recent call in the literature to examine psychophysiological mechanisms that underlie the relations between social circumstances and health in order to “unravel” the association (Carroll & Sheffield, 1998). In addition, although a robust negative association between marital conflict and health has been established, not all individuals are at equal risk. Therefore, examination of moderating variables improves prediction by identifying those individuals at differential levels of risk.
Of note, this paper is intentionally limited in scope to the critical examination of the influence of marital conflict on physiological predecessors of physical ailments and subsequent incidence of health problems. Absent are reviews of research relating marital variables to disease progress and outcome, as well as the impact of disease states on marriage. These areas, although pertinent, are not as intimately tied to the main premise of vagal regulation as a moderating variable. Thus, they fall outside of the scope of this endeavor.
Section snippets
Marital status and health
The progression of research exploring the association between marriage and health fits well with the spirit of Fincham's (1994) heuristic distinction between research that documents a direct, general relation (first generation) and that which attempts to explain the association and specifics of the relation (second generation). First generation research examining marital status and health established that married individuals have better concurrent physical health and reduced mortality risks
Marital conflict and health
Marital conflict has been found to be longitudinally predictive of health among adults (particularly men) who divorce and those who remain married to an extent that elevated conflict is associated with greater risk of health ailments among both groups (Jones, 1992). Furthermore, among married individuals, cohesion, which included a question regarding marital conflict, was more consistently and robustly associated with the health and well-being of the partners than other measures of marital
Conceptual frameworks
The protection hypothesis is one first-generation theory used to explain the relation between marital status and health. The protection hypothesis stems from the stress/social support framework and it asserts that marriage affects health by decreasing vulnerability to stress, providing material resources, facilitating health promoting behaviors, and/or increasing the availability and/or quality of social support Berkman & Syme, 1979, Gove, 1973, Kobrin & Hendershot, 1977, Ortmeyer, 1974,
Marital conflict, physiological processes, and health
Given the connection between marital conflict and health, the question arises: through what mechanism does conflict influence physical health in such a manner that it could at least partially account for the relation between marriage and the health outcomes reviewed? It has been proposed that risk factors such as marital conflict are associated with sustained, repetitive, and possibly extreme reactivity in endocrine and cardiovascular domains (Smith & Christensen, 1992) and result in health
Conflict characteristics and health
Although marital conflict is generally arousing, specific characteristics of conflict such as negativity and hostility have been found to be associated with exaggerated physiological responses as demonstrated in immune, cardiovascular, and endocrine domains. These physiological changes, although beneficial in a physically threatening situation, are potentially harmful when chronic or frequent and are proposed to be the link between negative aspects of the marriage and disease states (Uchino,
The Polyvagal Theory
In the literature, the physiological components of emotion have traditionally been attributed to the influence of the sympathetic nervous system (SNS). This pervasive attribution is most apparent in the nomenclature of the components of the autonomic nervous system as the sympathetic, meaning “with feeling,” and the parasympathetic, meaning “guards against feeling” (Porges, 1997). This view of emotional arousal as exclusively sympathetically based not only limits the explication of the richness
The protective function of the vagus
This three-tiered conception of emotional responding provided by the Polyvagal Theory leads to the assertion of this paper that individuals who are more adept at regulating emotion via the NA vagus are able to produce an adaptive behavioral response (e.g., flexible, appropriately aroused, and soothable) in the context of marital conflict (a chronic stressor). In addition and more pertinent, these individuals also avoid the metabolic expenditure and health risks associated with resorting to
Vagal regulation and response strategies
When faced with stressful events, vagal regulation may facilitate the use of coping strategies including motion, attention, emotion, and communication (Porges, 1995b). As previously mentioned, the NA vagus is anatomically and functionally linked with several other cranial nerves involved in the expression of emotion (Porges, 1995b). Regarding anatomy, the glossopharyngeal and accessory nerves, which control the pharyngeal and neck muscles, also originate in the NA Porges, 1995b, Porges, 1997.
Summary and conclusions
Based on this literature, it is apparent that characteristics of marriage, particularly conflict, have impact on the health of individuals. Conflict generally results in physiological arousal, particularly arousal of the SNS. Chronic and sustained SNS arousal is associated with decrements in immune functioning. Such processes likely account at least partially for the relation between marital status and health. Therefore, individuals with adaptive vagal regulation may not only avoid this
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