Tamara L. Newton

Marriage and health: his and hers.

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 mens and womens health.

Negative Behavior During Marital Conflict Is Associated With Immunological Down-Regulation

&NA; 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.

Correlations among inflammatory markers in plasma, saliva and oral mucosal transudate in post-menopausal women with past intimate partner violence.

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 sIL-6R 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.

Markers of Inflammation in Midlife Women with Intimate Partner Violence Histories

BACKGROUND Lifetime occurrence of intimate partner violence (IPV) in women has been associated with increased prevalence of aging-related chronic diseases, including those with a pathophysiology involving inflammation. To begin to identify potential biologic mediators of this relationship, this cross-sectional study examined associations between past IPV and circulating levels of C-reactive protein (CRP) and interleukin-6 (IL-6)-measures linked with emergence of aging-related diseases-along with in vitro IL-6 production by peripheral blood mononuclear cells (PBMC) stimulated with either phytohemagglutinin A (PHA) or lipopolysaccharide (LPS). METHODS Apparently healthy, midlife women with divorce histories were recruited from the community. Histories of intimate partner psychological aggression, physical assault, sexual coercion, and stalking were assessed, along with current depression, posttraumatic stress symptoms, and health-related characteristics. At two visits, blood was drawn for assessment of biologic measures; measures were averaged across visits. RESULTS In this sample (n=68), a history of being stalked was significantly positively correlated with CRP levels; in a multiple regression analysis that included body mass index (BMI) and current symptoms, this association was attenuated by adjusting for BMI. Physical assault history was significantly negatively correlated with PHA-stimulated IL-6 production. This was most apparent for severe assault and was not accounted for by BMI or symptoms. CONCLUSIONS IPV histories remitted for an average of 10 years were associated with biologic mediators of inflammation. The profile was not uniformly proinflammatory, suggesting that in situations of traumatic or chronic stress, different aspects of the inflammatory response are differentially regulated and subjected to diverse compensatory mechanisms.

Interleukin-6 and Soluble Interleukin-6 Receptor Levels in Posttraumatic Stress Disorder: Associations with Lifetime Diagnostic Status and Psychological Context

This study correlated lifetime PTSD diagnostic status with interleukin-6 (IL-6) and soluble IL-6 receptor (sIL-6R) levels, and tested whether these correlations are sensitive to psychological context. Midlife women attended two research visits where blood was drawn (beginning of visits) and saliva and oral mucosal transudate were collected (beginning and end of visits) to measure IL-6 and sIL-6R. Women were classified as PTSD-/- (past and current symptoms below subsyndromal levels), PTSD+/- (past symptoms at or above subsyndromal levels), or PTSD+/+ (past and current symptoms at or above subsyndromal levels). PTSD+/+ women, compared to the other women, showed more negative emotion at the beginning of the visits, higher salivary IL-6 levels at the beginning versus end of visits, and positive correlations between negative emotion, salivary IL-6, and plasma sIL-6R. Their plasma sIL-6R levels exceeded those of the PTSD+/- women. Overall, IL-6 sensitivity to anticipation and to negative emotions, and higher sIL-6R levels, differentiated persistent versus remitted PTSD.

Ambulatory cardiovascular functioning in healthy postmenopausal women with victimization histories

Criminal victimization is a prevalent stressor among women, with potentially long-lasting emotional consequences. The present study examined associations among severity of lifetime victimization, current posttraumatic stress disorder (PTSD) symptoms, and ambulatory blood pressure (ABP) and heart rate (AHR) levels and variability. Thirty-nine healthy post-menopausal women who endorsed a history of criminal victimization completed a measure of PTSD symptom severity and participated in an average of 18 h of ambulatory cardiovascular monitoring. PTSD symptom clusters were associated with AHR. Symptom clusters and lifetime victimization severity jointly predicted ABP, with ABP the highest among severely victimized women with high levels of current intrusions. Given the prevalence of criminal victimization, biopsychosocial research on womens cardiovascular disease risk may benefit from increased attention to this stressor and its psychological sequelae.

Intimate Partner Stalking Victimization and Posttraumatic Stress Symptoms in Post-Abuse Women

This study aimed to further understanding of intimate partner stalking victimization in post-abuse women, with particular attention to the definition of stalking (with or without fear and threat) most predictive of posttraumatic stress (PTS) symptoms. In community midlife women with histories of divorce (N = 192), a history of stalking victimization accompanied by fear and threat was positively correlated with PTS symptom severity, after accounting for other partner abuse. The presence, compared with absence, of fear-and-threat stalking history doubled the odds of symptomatic levels of hyperarousal. Greater physical assault and injury chronicity differentiated fear-and-threat stalked women from other stalked women. Stalking contributed to a fuller understanding of PTS symptoms in women, showing particular relevance for hyperarousal.

Posttraumatic Stress Symptoms and Emotion Experience in Women: Emotion Occurrence, Intensity, and Variability in the Natural Environment

ABSTRACT This study examined emotion occurrence, intensity, and variability in the natural environment in a sample of women with histories of interpersonal victimization. Using paper-and-pencil diaries, women rated emotion experiences (joyful/happy, sad, angry, anxious, tense/frustrated, worried) over an average of 13 hr. Posttraumatic stress symptom severity was uniquely correlated with greater intensity and variability, but not occurrence, of certain negative emotions, and with less frequent occurrence but greater variability of joy/happiness. Intrusive reexperiencing was uniquely associated with greater variability of both anxiety and joy/happiness. Results suggest that women with more severe posttraumatic stress symptoms do not experience more episodes of negative emotion but, once emotion occurs, they have difficulty modulating its intensity. Problems with emotions may motivate treatment seeking among traumatized individuals, and such problems may endure even when PTSD symptoms per se remit. This underscores the potential practical implications of naturalistic studies of emotion among individuals who have experienced psychological trauma.

Rumination and posttraumatic stress symptoms in trauma-exposed adults: a systematic review and meta-analysis

ABSTRACT Background and objectives: Rumination is a correlate of increased posttraumatic stress (PTS) symptoms. This study quantitatively reviewed the literature on rumination and PTS symptoms in trauma-exposed adults, extending prior research by using an inclusive definition of trauma, addressing PTS symptom clusters, and conducting moderator analyses. Method: Searches were conducted in PsycINFO, PubMed, PILOTS, EBSCO Psychology and Behavioral Sciences Collection, Google Scholar, and Dissertation Abstracts. Sixty-four unique samples from 59 articles were included. Results: Results showed a moderate, positive relationship between rumination and PTS symptoms (r = .50, p < .001). This was not moderated by time since trauma, gender, prior trauma history, Criterion A congruence of events, type of rumination or PTS symptom measure, or sample setting. However, trauma-focused rumination yielded smaller effect sizes than trait rumination. The association between rumination and intrusive re-experiencing was stronger than that between rumination and avoidance (t (13) = 9.18, p < .001), or rumination and hyperarousal (t (9) = 2.70, p = .022). Conclusions: Results confirm that rumination is associated with increased PTS symptoms. Future research should identify mechanisms underlying this association and their potential specificity by symptoms cluster, as well as further examine the potential moderating roles of gender and prior trauma history.

Subjective Sleep Quality in Women With Divorce Histories The Role of Intimate Partner Victimization

A marital status of divorced or separated, as opposed to married, predicts increased risk of health problems, but not for all persons. Focusing on one established health risk that has been linked with divorce—poor subjective sleep quality—the present cross-sectional study examined whether a history of physical intimate partner victimization (IPV) helps identify divorced women at potentially greater risk of health problems. Community midlife women with divorce histories, all of whom were free of current IPV, reported on their past month sleep quality and lifetime IPV. The predicted odds of poor sleep quality were significantly greater for women with, versus without, IPV histories. This held after adjusting for socioemotional, medical, or sociodemographic risks. A dose–response relationship between IPV chronicity and poor quality sleep was observed. IPV history may help identify divorced women at increased risk of poor quality sleep and, more broadly, poor health.