This review focuses on the pathway leading from the marital relationship to physical health. Evidence from 64 articles published in the past decade, particularly marital interaction studies, suggests that marital functioning is consequential for health; negative dimensions of marital functioning have indirect influences on health outcomes through depression and health habits, and direct influences on cardiovascular, endocrine, immune, neurosensory, and other physiological mechanisms. Moreover, individual difference variables such as trait hostility augment the impact of marital processes on biological systems. Emerging themes in the past decade include the importance of differentiating positive and negative dimensions of marital functioning, the explanatory power of behavioral data, and gender differences in the pathways from the marital relationship to physiological functioning. Contemporary models of gender that emphasize self-processes, traits, and roles furnish alternative perspectives on the differential costs and benefits of marriage for men's and women's health.

Although increased morbidity and mortality have been reliably associated with social isolation and less satisfying personal relationships, relatively little is known about the underlying biopsychosocial mechanisms. We assessed problem-solving behaviors and changes in immune function in 90 newlywed couples who were admitted to a hospital research unit for 24 hours. Subjects who exhibited more negative or hostile behaviors during a 30-minute discussion of marital problems showed greater decrements over 24 hours relative to low negative subjects on four functional immunological assays (natural killer cell lysis, blastogenic response to two mitogens, and the proliferative response to a monoclonal antibody to the T3 receptor), as well as larger increases in the numbers of total T lymphocytes and helper T lymphocytes. High negative subjects had higher antibody titers to latent Epstein-Barr virus than low negative subjects, consistent with down-regulated immune function. Women were more likely to show negative immunological changes than men. The discussion of marital problems also led to larger increases in blood pressure that remained elevated longer in high negative subjects than low negative subjects. Positive or supportive problem-solving behaviors were not related to either immunological or blood pressure changes. These physiological differences were particularly noteworthy because marital satisfaction was high in both groups, and couples had been selected on the basis of stringent mental and physical health criteria. These data provide additional support for the link between personal relationships and immune function.

This study examined whether verbal-autonomic response dissociation in repressive copers is potentiated by conditions that enhance social evaluative concerns. Women classified as repressive, low-anxious, or high-anxious gave a self-disclosing speech in either a private condition (a single researcher observed) or a public condition (3 researchers ostensibly observed). Repressors exhibited heart rate elevations that were greater in magnitude than their self-reports of negative affect, but only in the public condition. High-anxious Ss in both conditions showed an opposite pattern of verbal-autonomic dissociation in which self-reported negative affect exceeded cardiac response. Low-anxious Ss in both conditions showed little responsivity in either channel. Results are interpreted within a self-regulatory framework in which differences in self-concept in the domain of emotionality predispose repressive and high-anxious individuals to engage in contrasting, emotion-focused coping styles.

This study assessed marital conflict behavior and endocrine function in 90 newlywed couples. Blood samples acquired hourly from 8:00 a.m. through 10:00 p.m. were combined to provide composite daytime values for 3 stress hormones-epinephrine (EPI), norepinephrine (NEPI), and cortisol and 3 related hormones (ACTH, growth hormone, and prolactin). These pooled data provided a window on endocrine function in couples for whom the day included a conflict. For wives, higher probabilities of husband's withdrawal in response to wife's negative behavior were associated with higher NEPI and cortisol levels. In addition, higher frequencies of positive behaviors were associated with lower EPI and higher prolactin levels among wives. Husbands' endocrine data were not associated with behavioral data. These findings are discussed in the context of gender models of marital conflict. There is growing evidence that personal relationships have significant consequences for physiological functioning. Data from large, well-controlled epidemiological studies suggest that social isolation constitutes a major risk factor for morbidity and mortality, with statistical effect sizes comparable with those of such wellestablished health risk factors as smoking, blood pressure, blood lipids, obesity, and physical activity (House, Landis, & Umberson, 1988). The endocrine system serves as one important gateway between personal relationships and health; stress can provoke the release of pituitary and adrenal hormones that have multiple effects, including alterations in cardiovascular and immune function (Ader,

The relationship between psychosocial factors and an increased risk for disease has been related to a heightened pro-inflammatory status reflected in increased circulating levels of pro-inflammatory cytokines and/or C-reactive protein (CRP). Routinely, epidemiological studies rely on measurements of inflammatory markers in serum or plasma, but the use of biological fluids such as saliva or oral mucosal transudate (OMT) may offer potential advantages. This study investigated correlations among plasma CRP and levels of IL-6 and soluble IL-6 receptor (sIL-6R) in plasma, saliva and OMT in a population of middle aged women with histories of past intimate partner violence (IPV). A total of 67 women without existing chronic diseases participated in the study, which included two visits each in which psychological tests were administered, and blood, saliva and OMT samples were collected. Although significantly higher plasma CRP levels were found in past IPV sufferers compared to controls, there were no significant differences in IL-6 or sIL-6R levels in plasma, saliva or OMT between the two groups. There were only relatively modest correlations between IL-6 levels in plasma and those in saliva or OMT and between plasma IL-6 and CRP levels. A significant correlation between IL-6 and sIL6R levels in both saliva and OMT, but not in plasma, was also detected. No significant correlations were found between levels of IL-6 in saliva or OMT and periodontal health measures. Results indicate that IL-6 and sIL-6R levels in saliva or OMT do not closely reflect those in plasma, and therefore are not a good surrogate for systemic levels. KeywordsC-reactive protein (CRP); interleukin-6 (IL-6); intimate partner violence (IPV); oral mucosal transudate (OMT); plasma; saliva; soluble interleukin-6 receptor (sIL-6R)