Marriage and Health

Marital Status and Health

Across a number of large-scale epidemiological studies, nonmarried individuals have higher rates of mortality compared with their married counterparts from all causes. In addition, morbidity among married persons is lower compared with unmarried persons across a variety of health conditions, including cancer, heart attacks, and surgery. Across several studies, the health benefits of marriage are also greater for men compared with women, such that the additional risk for mortality in comparing nonmarried men to married men is much larger than in comparing nonmarried to married women.

The two primary explanations for why marital status is related to morbidity and mortality are selection and protection. According to selection, marriage itself does not cause decreased morbidity and mortality; instead, a selection bias exists such that individuals who are healthier and engage in less health-destructive and more health-protective behaviors are more likely to get married. The protection explanation suggests that regardless of an individual's premarital health or functioning, marriage confers specific economic and psychological benefits, such as increased household income and social support, which contributes to better health. The selection and protection explanations are not mutually exclusive, and epidemiological findings support both explanations. Unfortunately, because relationship scientists cannot experimentally manipulate marital status, definitive resolution of these explanations is unlikely.

Marital Quality and Health

Although marriage on average is related to better overall physical health, people in troubled marriages have worse mental and physical well-being compared with people in satisfactory and happy marriages and, in some studies, nonmarried people. The most dramatic examples of the relationship between marital quality and health come from studies of patients with existing chronic medical conditions. Low marital quality, typically measured through self-report, predicted earlier mortality over long-term follow-up in end-stage renal disease (46 percent increase in risk for mortality over 3-year follow-up) and congestive heart failure patients (65 percent increase in risk for mortality over 4-year follow-up). Beyond mortality, low marital quality is also related to increased risk of coronary events (including cardiac death, acute myocardial infarction, and revascularization procedures) in patients with cardiovascular disease and in a large 9,000-person cohort of British civil servants, increased illness symptoms over longitudinal follow-up (4 years) in healthy married couples, and increased pain flares in patients with rheumatoid arthritis.

In contrast to research on gender differences in marital status on health, where men derive greater health benefits from marriage compared with women, research on marital quality and health shows an opposite pattern. Specifically, the effects of marital quality on health are generally stronger for women compared with men. For instance, in a longitudinal study of participants in the Alameda County Study, increased marital strain was related to increased self-reported ulcer symptoms at 8- to 9-year follow-up in women, but not men. In addition, large, prospective longitudinal studies also show that lower marital quality is related to increased risk of disability and mortality over long-term follow-up (6–15 years), again in women, but not men.

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