Wendy Birmingham

Is There Something Unique about Marriage? The Relative Impact of Marital Status, Relationship Quality, and Network Social Support on Ambulatory Blood Pressure and Mental Health

BackgroundHaving close social relationships and being married specifically have been reliably associated with health benefits including lower morbidity and mortality.PurposeThe purpose of this study was to examine the influence of marital status, relationship quality, and network support on measures of psychological and cardiovascular health.MethodWe examined ambulatory blood pressure (ABP) among 204 married and 99 single males and females (N = 303).ResultsWe found that both marital status and marital quality were important. Married individuals had greater satisfaction with life (SWL) and blood pressure dipping than single individuals. High marital quality was associated with lower ABP, lower stress, less depression, and higher SWL. Importantly, contrasting those who are unmarried with those in low-quality marriages, we find that single individuals had lower ABP—suggesting that single individuals fare better than their unhappily married counterparts. Likewise, having a supportive network did not moderate (i.e., buffer) the effects of being single or unhappily married.ConclusionsFindings indicate being married per se is not universally beneficial, rather, the satisfaction and support associated with such a relationship is important. However, marriage may be distinctive, as evidence further suggests that support from one’s network does not compensate for the effect of being single. These results highlight the complexities in understanding the influence of social relationships on long-term health, and they may help clarify the physiological pathways by which such associations exist.

Psychological pathways linking social support to health outcomes: A visit with the “ghosts” of research past, present, and future

Contemporary models postulate the importance of psychological mechanisms linking perceived and received social support to physical health outcomes. In this review, we examine studies that directly tested the potential psychological mechanisms responsible for links between social support and health-relevant physiological processes (1980s-2010). Inconsistent with existing theoretical models, no evidence was found that psychological mechanisms such as depression, perceived stress, and other affective processes are directly responsible for links between support and health. We discuss the importance of considering statistical/design issues, emerging conceptual perspectives, and limitations of our existing models for future research aimed at elucidating the psychological mechanisms responsible for links between social support and physical health outcomes.

Are Older Adults Less or More Physiologically Reactive? A Meta-Analysis of Age-Related Differences in Cardiovascular Reactivity to Laboratory Tasks

In this meta-analytic review of 31 laboratory studies, we examined if relatively older adults showed lower or higher cardiovascular reactivity compared with relatively younger adults. Results revealed that age was associated with lower heart rate reactivity but higher systolic blood pressure (SBP) reactivity during emotionally evocative tasks. Consistent with the predictions of dynamic integration theory, the result for SBP was moderated by the degree of task activation. These data are discussed in light of existing self-regulatory models and important future research directions.

Social support and the reactivity hypothesis: Conceptual issues in examining the efficacy of received support during acute psychological stress

Social support has been reliably related to better physical health outcomes. One influential model suggests that social support is related to lower cardiovascular disease mortality because it reduces the potentially deleterious consequences of cardiovascular reactivity during acute stress. However, received support and perceived support are separable constructs and epidemiological research suggests variability in links between received support and health. This is important because most social support and acute laboratory stress studies are essentially based on the receipt of support. In this paper, we focus on the conceptualization of received support and its implications for understanding links to support laboratory reactivity paradigms. This analysis highlights the role of theoretically important task, recipient, and provider categories of factors that moderate the effectiveness of received support, as well as the need to examine links between naturalistic perceptions of support and cardiovascular reactivity during stress.

Social Relationships and Health: Is Feeling Positive, Negative, or Both (Ambivalent) about your Social Ties Related to Telomeres?

OBJECTIVES The quality of ones personal relationships has been linked to morbidity and mortality across different diseases. As a result, it is important to examine more integrative mechanisms that might link relationships across diverse physical health outcomes. In this study, we examine associations between relationships and telomeres that predict general disease risk. These questions are pursued in the context of a more comprehensive model of relationships that highlights the importance of jointly considering positive and negative aspects of social ties. METHOD One hundred thirty-six individuals from a community sample (ages 48 to 77 years) completed the social relationships index, which allows a determination of relationships that differ in their positive and negative substrates (i.e., ambivalent, supportive, aversive, indifferent). Telomere length was determined from peripheral blood mononuclear cells via quantitative polymerase chain reaction. RESULTS Participants who had a higher number of ambivalent ties in their social networks evidenced shorter telomeres. These results were independent of other relationship types (e.g., supportive) and standard control variables (e.g., age, health behaviors, and medication use). Gender moderated the links between ambivalent ties and telomere length, with these associations seen primarily in women. Follow-up analyses revealed that the links between ambivalent ties and telomeres were primarily due to friendships, parents, and social acquaintances. CONCLUSION Consistent with epidemiological findings, these data highlight a novel and integrative biological mechanism by which social ties may affect health across diseases and further suggest the importance of incorporating positivity and negativity in the study of specific relationships and physical health.

Evaluative threat and ambulatory blood pressure: cardiovascular effects of social stress in daily experience.

OBJECTIVE Physiological effects of social evaluation are central in models of psychosocial influences on physical health. Experimental manipulations of evaluative threat evoke substantial cardiovascular and neuroendocrine responses in laboratory studies, but only preliminary evidence is available regarding naturally occurring evaluative threats in daily life. In such nonexperimental ambulatory studies, it is essential to distinguish effects of evaluative threat from related constructs known to alter stress, such as ability perceptions and concerns about appearance. METHODS 94 married, working couples (mean age 29.2 years) completed a 1-day (8 a.m. to 10 p.m.) ambulatory blood pressure protocol with random interval-contingent measurements using a Suntech monitor and Palm Pilot-based measures of control variables and momentary experiences of social-evaluative threat, concerns about appearance, and perceived ability. RESULTS In hierarchical analyses for couples and multiple measurement occasions (Proc Mixed; SAS) and controlling individual differences (BMI, age, income) and potential confounds (e.g., posture, activity), higher reports of social-evaluative threat were associated with higher concurrent systolic (estimate = .87, SE = .34) and diastolic blood pressure (estimate = 1.06; SE = .26), both p < .02. Effects of social-evaluative threat remained significant when perceived ability and appearance concerns were controlled. CONCLUSIONS Naturally occurring social-evaluative threat during daily activity is associated with increased systolic and diastolic blood pressure. Given associations between ambulatory blood pressure and risk of cardiovascular disease, the findings support conceptual models of threats to the social self as a potentially important influence on physical health.

Relationships and cardiovascular risk: Perceived spousal ambivalence in specific relationship contexts and its links to inflammation

OBJECTIVES Although perceiving ones social ties as sources of ambivalence has been linked to negative health outcomes, the more specific contexts by which such relationships influence health remain less studied. We thus examined if perceived spousal relationship quality in three theoretically important contexts (i.e., support, capitalization, everyday life) predicted inflammation. METHOD Ninety-four married couples completed measures of perceived spousal positivity and negativity in support, capitalization, and everyday contexts. These scores were used to derive an index of relationship ambivalence whereby interactions were rated as containing both positive and negative aspects. Serum levels of IL-6, fibrinogen, and CRP were assessed from plasma. RESULTS Perceiving ambivalence toward ones spouse in a support context was linked to greater inflammation even when considering health behaviors, relationship-specific romantic attachment style, spouse negativity/positivity ratings, and overall marital satisfaction. Perceiving ambivalence toward a spouse during capitalization predicted higher fibrinogen levels only, whereas no links were found with perceived spousal ambivalence in everyday life contexts. CONCLUSION Perceptions of ambivalence during support may be a particularly important relational context in which marital ties influence health.

Social ties and cardiovascular function: An examination of relationship positivity and negativity during stress☆

The quality and quantity of ones relationships have been reliably linked to morbidity and mortality. More recently, studies have focused on links between relationships and cardiovascular reactivity as a physiological mechanism via the stress-buffering hypothesis. However, not all social relationships are consistently positive which points to the importance of a more comprehensive examination of relationship that includes negative qualities. In this study, we manipulated relationship positivity and negativity with an experimenter and examined its influence on cardiovascular reactivity. Results revealed that relationship positivity was associated with lower systolic blood pressure (SBP) reactivity for men and women. Relationship negativity, on the other hand, was related to less of an increase in diastolic blood pressure (DBP) reactivity in men. Internal analyses showed that perceptions of positivity and negativity interacted such that high positivity/high negativity perceptions (ambivalence) were related to the highest SBP reactivity. Results of this study suggest that the quality of ones relationships is an important moderator of cardiovascular reactivity during stress.

The stress-buffering effects of functional social support on ambulatory blood pressure.

OBJECTIVE Social support is a reliable predictor of cardiovascular health. According to the buffering hypothesis, stress is 1 mechanism by which support is able to affect physiological processes. However, most of the experimental evidence for the hypothesis comes from laboratory studies. Ambulatory blood pressure (ABP) protocols examine participants in their natural environment, where they are more likely to encounter personally relevant real-world stressors. Furthermore, prior work shows that examining support by its specific functional components reveals additional independent links to health. METHODS The current study aimed to examine the stress-buffering effects of functional social support on ABP. One hundred eighty-eight participants completed a 1-day ABP assessment along with measures of functional social support and both global perceived stress and momentary stress at time of reading. RESULTS RESULTS indicated main effects for both stress measures. Global support, emotional, tangible, and informational support only moderated the effects of momentary stress, but not global stress, in predicting ABP. Informational support was the most consistent stress-buffering predictor of ABP, predicting both ambulatory systolic and diastolic blood pressure. CONCLUSIONS The predicted values in ABP for informational support achieved health-relevant differences, emphasizing the value of examining functional support beyond global support alone.

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.