Affiliation and control during marital disagreement, history of divorce, and asymptomatic coronary artery calcification in older couples

Depression and Low Social Support Mediate the Association of Marital Stress and 12-Month Cardiac-Specific Quality of Life in Young Adults With Acute Myocardial Infarction

OBJECTIVE

This study explored whether and how depression and low social support mediate the association between marital stress and cardiac-specific quality of life (QoL) in young adults (≤55 years) with acute myocardial infarction (AMI).

METHODS

Data were obtained from 1593 married/partnered AMI survivors aged 18-55 years enrolled in the VIRGO study (2008-2012). Marital stress (Stockholm Marital Stress Scale) was self-reported at 1 month post-AMI and categorized as absent/moderate or severe. Significant depressive symptoms (Patient Health Questionnaire-9 score ≥10), low social support (ENRICHD Social Support Instrument score ≤3 on ≥2 items and total score ≤18), and cardiac-specific QoL (Seattle Angina Questionnaire) were assessed at 12 months post-AMI. Natural direct effect (NDE) of marital stress and indirect effects (NIE) through depression or low social support and the proportion mediated (PM) were estimated by causal mediation methods with adjustment for baseline QoL and sociodemographic factors.

RESULTS

There was a significant direct effect from severe marital stress to lower cardiac-specific QoL after covariate adjustment (NDE = -4.83, 95% CI = -6.98 to -2.49, p < .001). Categorized depression and low social support mediated 11.5% (NIE = -0.63, 95% CI = -1.15 to -0.10, p = .014) and 13.5% (NIE = -0.69, 95% CI = -1.10 to -0.29, p < .001) of the total effect between marital stress and QoL, respectively. When examined as continuous scores, both mediator effects were of borderline significance (PHQ-9: PM = 38.2%, p = .086; social support: PM = 46.1%, p = .051).

CONCLUSIONS

Depression and low social support partially mediated the relationship between marital stress and cardiac-specific QoL, underscoring the need for further exploration of additional mediators to inform more comprehensive secondary prevention strategies.

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

PURPOSE OF REVIEW

Research and clinical services addressing psychosocial aspects of coronary heart disease (CHD) typically emphasize individuals, focusing less on the context of intimate relationships such as marriage and similar partnerships. This review describes current evidence regarding the role of intimate relationships in the development, course, and management of CHD.

RECENT FINDINGS

Having an intimate partner is associated with reduced risk of incident CHD and a better prognosis among patients, but strain (e.g., conflict) and disruption (i.e., separation, divorce) in these relationships are associated with increased risk and poor outcomes. These associations likely reflect mechanisms involving health behavior and the physiological effects of emotion and stress. Importantly, many other well-established psychosocial risk and protective factors (e.g., low SES, job stress, depression, and optimism) are strongly related to the quality of intimate relationships, and these associations likely contribute to the effects of those other psychosocial factors. For better or worse, intimate partners can also affect the outcome of efforts to alter health behaviors (physical activity, diet, smoking, and medication adherence) central in the prevention and management CHD. Intimate partners also influence-and are influenced by-stressful aspects of acute coronary crises and longer-term patient adjustment and management. Evidence on each of these roles of intimate relationships in CHD is considerable, but direct demonstrations of the value of couple assessments and interventions are limited, although preliminary research is promising. Research needed to close this gap must also address issues of diversity, disparities, and inequity that have strong parallels in CHD and intimate relationships.

Adiposity and the role of diverse social supports: an observational, gender-sensitive study using the baseline Canadian Longitudinal Study on Aging

OBJECTIVE

To quantify associations between four types of social support and measured adiposity among women and men.

DESIGN

The cross-sectional sample from the Canadian Longitudinal Study on Aging (CLSA, 2012-2015). Height, weight and waist circumference (WC) were clinically measured, and perceived availability of informational, tangible, emotional and belonging social supports was self-reported.

SETTING

Canada.

PARTICIPANTS

28 779 adults aged 45-85 years from the CLSA.

RESULTS

All social support types were associated with WC and BMI among women but not among men. Women reporting the lowest informational support had significantly higher mean BMI (28·84 kg/m2 (95 % CI 28·63, 29·05)) and WC (90·81 cm (95 % CI 90·31, 91·30)) compared with women reporting maximum support (respectively, 28·09 kg/m2 (95 % CI 27·88, 28·30) and 88·92 cm (95 % CI 88·43, 89·4)). Women's abdominal obesity was associated with low levels of informational, emotional and belonging support, and women's general obesity with informational and emotional support. Notably, informational and emotional support were associated with both obesity outcomes independent of other supports among women. Only a low level of informational support was significantly independently associated with higher odds of obesity among men.

CONCLUSIONS

Our study provides novel insights into gender-specific associations between different types of social support and adiposity. Prospective studies are needed to further investigate potential causality of these associations between the specific social supports and future weight status, especially among women.

Social connections and hypertension in women and men: a population-based cross-sectional study of the Canadian Longitudinal Study on Aging

BACKGROUND

Associations between social ties and hypertension are poorly understood in women and men. We investigated the association between marital status, living arrangement, social network size and social participation and hypertension by sex/gender.

METHODS

Cross-sectional analysis of 28 238 middle-age and old-age adults (45-85 years) was conducted using the baseline Canadian Longitudinal Study on Aging Comprehensive cohort data. Blood pressure (BP) was measured using the automated BpTRU device and hypertension was defined as BP more than 140/90 mmHg, or more than 130/80 mmHg in participants with diabetes, self-reported history or receiving antihypertensive therapy.

RESULTS

Being nonpartnered, having limited social participation (≤2 social activities per month) or a small social network size was associated with higher odds of having hypertension in women. Odds of hypertension were higher among widowed women [odds ratio 1.33 (95% confidence interval (CI): 1.16, 1.51)] compared with married women. The largest difference in adjusted mean SBP in women was between widowed [3.06 mmHg (95% CI: 2.01, 4.11)], vs. married women. For men, lone-living (vs. coliving) was linked to a lower odds of hypertension [odds ratio 0.85 (95% CI: 0.75, 0.96)] When considering two social ties simultaneously, the adverse associations between nonpartnership (mainly for singles and divorced) and BP were mitigated with increased social participation, especially among women.

CONCLUSION

Social ties appear to be more strongly associated with hypertension in middle and older aged women than men. Women who are nonpartnered or who engage in few social activities and men who are coliving represent at risk groups for having hypertension. Healthcare professionals may need to consider these social factors in addressing risk for hypertension and cardiovascular disease prevention.

Autonomic influences on heart rate during marital conflict: Associations with high frequency heart rate variability and cardiac pre-ejection period

Psychosocial factors predict the development and course of cardiovascular disease, perhaps through sympathetic and parasympathetic mechanisms. At rest, heart rate (HR) is under parasympathetic control, often measured as high-frequency heart rate variability (HF-HRV). During stress, HR is influenced jointly by parasympathetic and sympathetic processes, the latter often quantified as pre-ejection period (PEP). In studies of cardiovascular risk factors that involve social interaction (e.g. marital conflict), HF-HRV might be altered by speech artifacts, weakening its validity as a measure of parasympathetic activity. To evaluate this possibility, we tested associations of HF-HRV and PEP with HR at rest and across periods of marital conflict interaction that varied in experimentally-manipulated degrees of speech in 104 couples. At rest, only HF-HRV was independently related to HR, for both husbands and wives. During speaking, listening, and recovery periods, husbands' and wives' HF-HRV and PEP change independently predicted HR change. These findings support interpretation of HF-HRV as a parasympathetic index during stressful social interactions that may confer risk for cardiovascular disease.

Emotion, Social Relationships, and Physical Health: Concepts, Methods, and Evidence for an Integrative Perspective

Emotional characteristics and processes are robust predictors of the development and course of major medical illnesses and premature mortality, as are a variety of indicators of the presence and quality of personal relationships. Despite clear evidence of close interconnection between these two domains of risk and protection, affective characteristics and relationships have largely been studied separately as influences on health. After a recent conference on integrative perspectives on emotions, relationships and health co-sponsored by the American Psychosomatic Society and the Society for Affective Science, the present review builds on prior calls for integration, related theory, and current research to outline what is known about the interconnection of these domains as it specifically relates to their overlapping influences on health. Areas of interest include the following: their interconnected roles over the course of development, which may inform current efforts to understand the influence of early life events on adult health; the parallel positive and negative factors in both domains that could have distinct influences on health; the role of emotion regulation in relationship contexts; and measurement, design, and analysis approaches to capture the dyadic and dynamic aspects of these interconnected influences on health. We conclude with a discussion of an emerging research agenda that includes the following: common biological foundations of affective and relationship processes, the cultural embeddedness of affective and relationship processes, the potential contribution of affective-relational processes to health disparities, and implications for intervention research.

Relationships Matter: Progress and Challenges in Research on the Health Effects of Intimate Relationships

Social connections play an important role in health and disease and provide opportunities for clinical and public health interventions. Marriage and similar intimate relationships play a central role in the potential health benefits of positive social connections. This editorial provides an integrative perspective on three papers in this issue of Psychosomatic Medicine that examine intimate relationships and health and illustrates the application of current areas in relationship science. The importance of integrated conceptual models and statistical techniques to disentangle common third factors and overlapping constructs are highlighted, as well as the need for a multi-method approach that goes beyond self-report questionnaires. This editorial concludes with a summary of biobehavioral and psychological mechanisms and directions for future research.

Close social ties and health in later life: Strengths and vulnerabilities

The world is aging at an unprecedented rate, with older adults representing the fastest-growing segment of the population in most economically developed and developing countries. This demographic shift leaves much uncharted territory for researchers who study social relationships and health. Social relationships exert powerful influences on physical health in later adulthood, a critical consideration given age-related increases in the prevalence of chronic health conditions and physical disability. A large body of research indicates that older adults report greater satisfaction with their social networks than do younger adults, and that they often take measures to minimize their exposure to negative social encounters. These emotionally satisfying and generally positive social ties afford some health protection against a backdrop of mounting physical limitations and play an important role when juxtaposed with the potentially health-damaging frictions that sometimes emerge in older adults' social relationships. Although most older adults report that they are satisfied with their social ties, some older adults experience frequent conflicts or ambivalent exchanges with members of their social networks, and these experiences detract from their health. In addition, many older adults will experience the loss of one or more close relationships during the course of their lives, with ramifications for their health and, often, for the reorganization of their social lives over time. Understanding how both the strengths and vulnerabilities of close social relationships affect health and well-being in later life is an important goal, particularly in view of the accelerating rate of population aging worldwide. (PsycINFO Database Record

Interpersonal mechanisms linking close relationships to health

Close relationships play a vital role in human health, but much remains to be learned about specific mechanisms of action and potential avenues for intervention. This article provides an evaluation of research on close relationships processes relevant to health, drawing on themes from major relationship science theories to present a broad conceptual framework for understanding the interpersonal processes and intrapersonal pathways linking relationships to health and disease outcomes. The analysis reveals that both social connection and social disconnection broadly shape biological responses and behaviors that are consequential for health. Furthermore, emerging work offers insights into the types of social dynamics that are most consequential for health, and the potential pathways through which they operate. Following from this analysis, the authors suggest several research priorities to facilitate the translation of discoveries from relationship science into relationship-based interventions and public health initiatives. These priorities include developing finer grained theoretical models to guide research, the systematic investigation of potential mediating pathways such as dyadic influences on health behavior and physiological coregulation, and taking into account individual differences and contextual factors such as attachment style, gender, socioeconomic status, and culture. In addition, a pressing need exists for laboratory and field research to determine which types of interventions are both practical and effective. (PsycINFO Database Record

Relationships and Health: The Critical Role of Affective Science

High-quality social relationships predict a range of positive health outcomes, but no broadly accepted theory can explain the mechanisms of action in this area. The central argument of this article is that affective science can provide keys for integrating the diverse array of theoretical models concerning relationships and health. From nine prominent theories, we cull four components of relational affect that link social resources to health-related outcomes. This component model holds promise for integrating research from the different theoretical perspectives and for generating new, mechanistic questions about the connection between relationships and health. The article closes by outlining three empirical study ideas that illustrate ways in which the different components can be studied together in the context of mechanism-focused research.

The Association between Social Network Betweenness and Coronary Calcium: A Baseline Study of Patients with a High Risk of Cardiovascular Disease

Aim: The association of social networks with cardiovascular disease (CVD) has been demonstrated through various studies. This study aimed to examine the association between social network betweenness–a network position of mediating between diverse social groups–and coronary artery calcium.

Methods: The data of 1,384 participants from the Cardiovascular and Metabolic Disease Etiology Research Center–High Risk Cohort, a prospective cohort study enrolling patients with a high risk of developing CVD (clinicaltrials.gov: NCT02003781), were analyzed. The deficiency in social network betweenness was measured in two ways: only-family networks, in which a respondent had networks with only family members, and no-cutpoint networks, in which the respondent does not function as a point of bridging between two or more social groups that are not directly connected.

Results: Participants who had higher coronary artery calcium scores (CACSs) were likely to have a smaller network size (p < 0.001), only-family networks (p < 0.001), and no-cutpoint networks (p < 0.001). Multiple logistic regression analyses revealed no significant association between network size and CACS. Only no-cutpoint networks had a significant relationship with CACS > 400 (odds ratio, 1.72; 95% confidence interval, 1.07–2.77; p = 0.026). The association was stronger among older (age > 60 years) and female respondents.

Conclusion: Deficiency in social network betweenness is closely related to coronary calcium in participants with a high risk of CVD. To generalize these results to a general population, further study should be performed.

Informative Disagreements: Associations Between Relationship Distress, Depression, and Discrepancy in Interpersonal Perception Within Couples

This study evaluated the associations between relationship distress, depression symptoms, and discrepancy in interpersonal perception within couples. After completing a series of discussion tasks, couples (N = 88) rated their behavior using the circumplex-based Structural Analysis of Social Behavior Model (SASB; Benjamin, 1979, 1987, 2000). Overall, couple members were strikingly similar in their interpersonal perceptions, and tended to see themselves as friendly, reciprocal in their focus, and balanced between connection and separateness. As hypothesized, however, perceptual discrepancy was related to relationship distress and depression. Relationship distress was associated with discrepancy regarding transitive behavior focused on the partner, while depression was associated with disagreement about intransitive, self-focused behavior. Analysis of affiliation and autonomy revealed that relationship distress was associated with seeing oneself as reacting with more hostility than the partner sees, and perceiving one's partner as more hostile, more controlling, and less submissive than he or she does. Partners of depressed individuals viewed themselves as more controlling than their mate did. Men's depression was associated with disagreement between partners regarding men's self-focused behavior. Results underscore the importance of considering interpersonal perception when conceptualizing relationship distress and depression within intimate relationships.

Battling on the Home Front: Posttraumatic Stress Disorder and Conflict Behavior Among Military Couples

This study evaluated interpersonal behavior differences among male military service members with and without PTSD and their female partners. Couples (N = 64) completed a 17-minute videotaped conflict discussion, and their interaction behavior was coded using the circumplex-based Structural Analysis of Social Behavior model (SASB; Benjamin, 1979, 1987, 2000). Within couples, the behavior of partners was very similar. Compared to military couples without PTSD, couples with PTSD displayed more interpersonal hostility and control. Couples with PTSD also exhibited more sulking, blaming, and controlling behavior, and less affirming and connecting behavior, than couples without PTSD. Results advance our understanding of the relational impacts of PTSD on military service members and their partners, and underscore the value of couple-based interventions for PTSD in the context of relationship distress.

Heart Rate Variability Moderates the Association Between Separation-Related Psychological Distress and Blood Pressure Reactivity Over Time

Divorce is a stressor associated with long-term health risk, though the mechanisms of this effect are poorly understood. Cardiovascular reactivity is one biological pathway implicated as a predictor of poor long-term health after divorce. A sample of recently separated and divorced adults (N = 138) was assessed over an average of 7.5 months to explore whether individual differences in heart rate variability-assessed by respiratory sinus arrhythmia-operate in combination with subjective reports of separation-related distress to predict prospective changes in cardiovascular reactivity, as indexed by blood pressure reactivity. Participants with low resting respiratory sinus arrhythmia at baseline showed no association between divorce-related distress and later blood pressure reactivity, whereas participants with high respiratory sinus arrhythmia showed a positive association. In addition, within-person variation in respiratory sinus arrhythmia and between-persons variation in separation-related distress interacted to predict blood pressure reactivity at each laboratory visit. Individual differences in heart rate variability and subjective distress operate together to predict cardiovascular reactivity and may explain some of the long-term health risk associated with divorce.

Marital disruption is associated with shorter salivary telomere length in a probability sample of older adults

RATIONALE

Marital disruption (i.e., marital separation, divorce) is associated with a wide range of poor mental and physical health outcomes, including increased risk for all-cause mortality. One biological intermediary that may help explain the association between marital disruption and poor health is accelerated cellular aging.

OBJECTIVE

This study examines the association between marital disruption and salivary telomere length in a United States probability sample of adults ≥50 years of age.

METHOD

Participants were 3526 individuals who participated in the 2008 wave of the Health and Retirement Study. Telomere length assays were performed using quantitative real-time polymerase chain reaction (qPCR) on DNA extracted from saliva samples. Health and lifestyle factors, traumatic and stressful life events, and neuroticism were assessed via self-report. Linear regression analyses were conducted to examine the associations between predictor variables and salivary telomere length.

RESULTS

Based on their marital status data in the 2006 wave, people who were separated or divorced had shorter salivary telomeres than people who were continuously married or had never been married, and the association between marital disruption and salivary telomere length was not moderated by gender or neuroticism. Furthermore, the association between marital disruption and salivary telomere length remained statistically significant after adjusting for demographic and socioeconomic variables, neuroticism, cigarette use, body mass, traumatic life events, and other stressful life events. Additionally, results revealed that currently married adults with a history of divorce evidenced shorter salivary telomeres than people who were continuously married or never married.

CONCLUSION

Accelerated cellular aging, as indexed by telomere shortening, may be one pathway through which marital disruption is associated with morbidity and mortality.

Behavioral Symptoms after Breast Cancer Treatment: A Biobehavioral Approach

Being diagnosed and treated for breast cancer is emotionally and physically challenging. Breast cancer is the most commonly diagnosed cancer and the second leading cause of death for women in the United States. Accordingly, women with a breast cancer history are the largest group of female cancer survivors. Psychological stress substantially augments adverse autonomic, endocrine, and immune discharge, including enhanced production of proinflammatory cytokines. Importantly, inflammation is a key biological mechanism underlying the symptom cluster of pain, depression, fatigue, and sleep disturbances; there is also good evidence that inflammation contributes to breast cancer recurrence. Stress may exert direct effects on psychological and physiological risk processes. In this review, we take a biobehavioral approach to understanding predictors and mechanisms underlying somatic symptoms in breast cancer survivors.

Trait hostility is associated with systemic inflammation in married couples: an actor-partner analysis

Trait anger and hostility predict the development of coronary heart disease, and systemic inflammation may partly mediate this association. In a sample of 94 middle-aged and older married couples, we replicate research showing a within individuals (i.e., actor effect) association of trait hostility with high sensitivity C-reactive protein (hsCRP). As a novel extension of that research, the present study also examined the association of individuals' trait hostility with their partners' hsCRP (i.e., partner effect). Controlling for potential confounds, trait hostility, measured with the Buss-Perry Aggression Questionnaire, was significantly associated with both participants' own hsCRP, b=.0528 (SE=.0196), p=.008 and their partners' levels b=.0473 (SE=.0194), p=.016. Hence, the inflammatory correlates of trait hostility occur not only within individuals but between them, as well. The effects of unhealthy personality traits may extend to intimate partners and possibly other social network members.

Daily marital interaction quality and carotid artery intima-medial thickness in healthy middle-aged adults

OBJECTIVE

To examine the association between marital interaction quality during daily life and subclinical cardiovascular disease (CVD). Studies have shown that marital status and quality of marriage are associated with cardiovascular health. However, little is known about the role of marital interaction quality during daily life in contributing to these effects.

METHODS

The sample consisted of 281 healthy, employed middle-aged adults who were married or living with a partner in a marital-like relationship (mean age = 42.0 years, 88% white, 52% men). Marital interaction quality was assessed using hourly real-time ecological momentary assessments for 4 days, with participants rating their current or recent partner interactions on positive and negative characteristics (e.g., agreeableness and conflict). Carotid artery intima-medial thickness (IMT) was assessed using ultrasound imaging.

RESULTS

Adjusting for demographics, positive marital interaction was inversely associated with IMT (b = -0.02, F(1,275) = 9.18, p = .002), and negative marital interaction was positively associated with IMT (b = 0.02 F(1,275) = 10.29, p = .001). These associations were not accounted for by behavioral and biological CVD risk factors and were consistent across age, sex, race, and education. The associations were also independent of marital interaction frequency, nonmarital social interaction quality, and personality factors. Global reports of marital quality, in contrast, were not associated with IMT.

CONCLUSIONS

Marital quality as measured during real-time interactions between partners was associated with subclinical CVD in healthy middle-aged adults. This study supports the use of real-time social interaction assessment for characterizing links between social relationships and cardiovascular health.

Spousal relationship quality and cardiovascular risk: dyadic perceptions of relationship ambivalence are associated with coronary-artery calcification

The quality of spousal relationships has been related to physical-health outcomes. However, most studies have focused on relationship positivity or negativity in isolation, despite the fact that many close relationships are characterized by both positive and negative aspects (i.e., ambivalence). In addition, most work has not accounted for the reciprocal nature of close-relationship processes that can have an impact on health. Using a sample of 136 older married couples, we tested whether actor-partner models of relationships that were either primarily positive or ambivalent (i.e., perceived as having both helpful and upsetting aspects) predicted measures of coronary-artery calcification. Results revealed an Actor × Partner interaction whereby coronary-artery calcification scores were highest for individuals who both viewed and were viewed by their spouse as ambivalent. These data are discussed in light of the importance of considering both positive and negative aspects of relationship quality and modeling the interdependence of close relationships.

Socioeconomic status and health: education and income are independent and joint predictors of ambulatory blood pressure

Epidemiological research suggests that different indicators of socioeconomic status (SES) such as income and education may have independent and/or interactive effects on health outcomes. In this study, we examined both simple and more complex associations (i.e., interactions) between different indicators of SES and ambulatory blood pressure (ABP) during daily life. Our sample consisted of 94 married couples who completed a one-day ABP protocol. Both income and education were independently related to systolic blood pressure and only income was significantly related to diastolic blood pressure. There were also statistical interactions such that individuals with high levels of both income and education evidenced the lowest ABP. Gender moderated these findings. Three-way interactions revealed that, in general, women appear to benefit from either indicator of SES, whereas men appear to benefit more from income. The findings are consistent with epidemiological research and suggest one important physiological mechanism by which income and education may have independent and interactive effects on health.

Effects of couple interactions and relationship quality on plasma oxytocin and cardiovascular reactivity: empirical findings and methodological considerations

Cardiovascular reactivity is a potential mechanism underlying associations of close relationship quality with cardiovascular disease. Two models describe oxytocin as another mechanism. The "calm and connect" model posits an association between positive relationship experiences and oxytocin levels and responses, whereas the "tend and befriend" model emphasizes the effects of negative relationship experiences in evoking oxytocin release. In this study of 180 younger couples, relationship quality had a small, marginally significant inverse association with plasma oxytocin levels, and neither positive nor negative couple interactions evoked change in plasma oxytocin. Negative couple interactions evoked significant cardiovascular reactivity, especially among women. Hence, in the largest study of these issues to date, there was little support for key tenets of the "calm and connect" model, and only very modest support for the "tend and befriend" model. However, findings were consistent with the view that CVR contributes to the effects of relationship difficulties on health.

Marital discord and coronary artery disease: a comparison of behaviorally defined discrete groups

OBJECTIVE

Marital difficulties can confer risk of coronary heart disease, as in a study of outwardly healthy couples (T. W. Smith et al., 2011) where behavioral ratings of low affiliation and high control during marital disagreements were associated with asymptomatic coronary artery disease (CAD). However, taxometric studies suggest that marital discord is more accurately represented by discrete groups, rather than continuous dimensions. To determine if a categorical representation of marital discord was also related to CAD, discordant and nondiscordant groups were identified via cluster analysis in further analyses of the T. W. Smith et al. (2011) study.

METHOD

One hundred fifty healthy couples (M age = 63.5) completed a marital disagreement discussion, self-reports of anxiety and anger during the disagreement, and self-report measures of marital adjustment. CAD was measured as coronary artery calcification (CAC) via computed tomography scans.

RESULTS

In a 2-group cluster solution, 31% of couples were characterized as discordant, with higher levels of hostility and dominance and lower levels of warmth compared with the nondiscordant group. Discordant couples reported lower marital adjustment and greater negative affect during the discussion. Controlling biomedical and behavioral risk factors, discordant couples had greater CAC (p = .029, η² = .035). Discordant and nondiscordant groups defined via self-reported marital adjustment did not differ in CAC (p = .17, η² = .014).

CONCLUSIONS

Marital discord defined categorically and with behavioral observations was associated with greater levels of asymptomatic CAD. Marital discord is associated with higher risk at early stages of coronary heart disease, but commonly used self-reports may underestimate this risk.

Incremental validity of spouse ratings versus self-reports of personality as predictors of marital quality and behavior during marital conflict

The personality traits of neuroticism and agreeableness are consistently related to marital quality, influencing the individual's own (i.e., actor effect) and the spouse's marital quality (i.e., partner effect). However, this research has almost exclusively relied on self-reports of personality, despite the fact that spouse ratings have been found to have incremental validity over self-reports for a variety of other important outcomes. In a study of 300 middle-aged and older married couples, we examined the incremental validity of spouse ratings of neuroticism and agreeableness in predicting concurrent levels of self-reported marital quality, observations of behavior during a marital disagreement task, and depressive symptoms. Neuroticism and agreeableness had expected actor and partner effects on each of these outcomes. Spouse ratings of these traits demonstrated incremental validity in estimates of actor and partner effects on marital quality, marital behavior, and depressive symptoms. Results suggest that spouse ratings of personality may be important additions to the typical reliance on self-reports for research and clinical assessment in marriage.