The health consequences of stress in couples: A review and new integrated Dyadic Biobehavioral Stress Model

Abstract

Despite marriage's health benefits, all couples experience stress that can increase morbidity and mortality risks. Marital stress can alter endocrine, cardiovascular, and immune function—key pathways from troubled relationships to poor health. This review discusses how partners “get under each other's skin” to influence psychological, behavioral, and biological health. Then, I offer a comprehensive Dyadic Biobehavioral Stress Model to build on this foundational work and inspire transdisciplinary research integrating psychoneuroimmunological and relational lenses. This conceptual and empirically driven model provides promising new directions to investigate mechanisms linking individuals' relationships behaviors to their own and their partners' health, with particular emphasis on biological pathways. These mechanisms may impact each partner's physical health outcomes, such as disease development, illness severity, and accelerated biological aging. Risk and protective factors across developmental stages and diverse contexts are also discussed to help explain how, and under what conditions, partners influence each other's health. Research applying this model can push the boundaries of our current understanding on dyadic stress its far-reaching health effects on self-report and biological markers across the lifespan.

More often than not, we’re in sync: patient and caregiver well-being over time in stem cell transplantation

“…In addressing health behavior, interventions targeting partners can help patients make behavior change, by reinforcing positive behaviors [ 42 ]. This model has been extended to how shared health behaviors and emotional experience can impact biobehavioral pathways that impact health and disease [ 43 ] and our group has demonstrated how the shared behavior withing couples (e.g., sleep quality) can impact immune reconstitution in HSCT [ 44 ]. Overall, dyadic interdependence remains an important consideration in designing and testing interventions, particularly in HSCT.…”

Intimate Relationships and Coronary Heart Disease: Implications for Risk, Prevention, and Patient Management

“…In contrast, strained and conflictual intimate relationships and interactions are associated with more frequent, pronounced, and prolonged physiologic stress responses [5, 6,]. In studies manipulating the tone of marital interactions, conflict evokes substantial increases in heart rate, blood pressure, and related neuroendocrine responses [ 5 , 6 , 50 , 51 ]. Furthermore, the magnitude of these changes is associated with the degree of hostile and controlling behavior in those interactions and with prior levels of marital strain [ 6 , 52 , 53 ].…”

“…Despite these benefits of marriage and similar relationships, strain (e.g., recurring conflict, and dissatisfaction) and disruption (i.e., separation, divorce) in intimate relationships are commonplace and have clear implications for physical health [ 5 , 21 , 22 ]. Strained relationships are associated with increased risk of incident CHD [ 23 , 24 ], more severe atherosclerosis [ 25 – 28 ], and poor prognosis (i.e., increased risk of recurrent events, reduced survival) among CHD patients [ 29 – 31 ].…”

“…Three issues illustrate the embeddedness of CHD patients in their relational contexts. First, the presence and quality of intimate relationships may influence coronary artery disease progression and the course of clinically apparent CHD through physiological effects of stress and emotion [ 5 – 7 ]. Second, health behaviors that confer risk and serve as prevention targets are affected by these relationships [ 8 , 9 ].…”

Editorial commentary on the special issue emerging psychoneuroimmunology research: Future leaders in focus

“…The lockdowns imposed during the COVID-19 pandemic changed many of our daily routines and affected many of our personal relationships. In their review, Shrout (2021) discussed how psychological, behavioral, and biological health is influenced by marriage. Here, an intriguing Dyadic Biobehavioral Stress Model is proposed to inspire transdisciplinary research integrating psychoneuroimmunological and relational lenses.…”