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Annals of Behavioral Medicine
Published in: Annals of Behavioral Medicine 5/2015

01-10-2015 | Original Article

It’s Complicated: Marital Ambivalence on Ambulatory Blood Pressure and Daily Interpersonal Functioning

Authors: Wendy C. Birmingham, Ph.D., Bert N. Uchino, Ph.D., Timothy W. Smith, Ph.D., Kathleen C. Light, Ph.D., Jonathan Butner, Ph.D.

Published in: Annals of Behavioral Medicine | Issue 5/2015

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Abstract

Background

Marriage decreases cardiovascular morbidity although relationship quality matters. While some marriages contain highly positive aspects (supportive), marriages may also simultaneously contain both positive and negative aspects (ambivalent). Individuals whose spouses or own behavior is ambivalent may not experience the same cardiovascular-protective benefits of marriage.

Purpose

The purpose of this study is to elucidate the physiological pathways by which marital quality may influence long-term health and examine ambivalent behavior on interpersonal-functioning and ambulatory blood pressure (ABP).

Methods

Interpersonal functioning and ABP were examined in 94 couples.

Results

Spousal and own ambivalent behavior was associated with lower intimacy (ps < .01) and higher systolic ABP (ps < .01). Spousal ambivalent behavior was associated with lower ratings of partner responsiveness (p < .01) and less self- and spousal-disclosure (ps < .05). Mediational analyses indicated that own behavior mediated links between spousal ambivalent behavior and ABP.

Conclusions

Despite the positivity in relationships, individuals whose spouses’ or own behavior is ambivalent may not receive cardiovascular protection from this positivity.
Literature
1.
Broadhead WE, Kaplan BH, James SA, et al. The epidemiologic evidence for a relationship between social support and health. Am J Epidemiol. 1983; 117(5): 521-537.PubMed
2.
House JS, Landis KR, Umberson D. Social relationships and health. Science. 1988; 24(4865): 540-545.CrossRef
3.
Seeman TE. Health promoting effects of friends and family on health outcomes in older adults. Am J Health Promot. 2000; 14(6): 362-370.CrossRefPubMed
4.
Uchino BN, Cacioppo JT, Kiecolt-Glaser JK. The relationship between social support and physiological processes: A review with emphasis on underlying mechanisms and implications for health. Psychol Bull. 1996; 119(3): 488-531.CrossRefPubMed
5.
6.
Gallo LC, Smith TW, Kircher JC. Cardiovascular and electrodermal responses to support and provocation: interpersonal methods in the study of psychophysiological reactivity. Psychophysiology. 2000; 37(3): 289-301.CrossRefPubMed
7.
Gallo LC, Troxel WM, Matthews KA, Kuller LH. Marital status and quality in middle-aged women: Associations with levels and trajectories of cardiovascular risk factors. Health Psychol. 2003; 22(5): 453-463.CrossRefPubMed
8.
Berkman LF. Social support, social networks, social cohesion and health. Soc Work Health Care. 2000; 31(2): 3-14.CrossRefPubMed
9.
Berkman LF, Glass T, Brissette I, Seeman TE. From social integration to health: Durkheim in the new millennium 11. Soc Sci Med. 2000; 51(6): 843-857.CrossRefPubMed
10.
Johnson NJ, Backlund E, Sorlie PD, Loveless CA. Marital status and mortality: The national longitudinal mortality study. Ann Epidemiol. 2000; 10(4): 224-238.CrossRefPubMed
11.
Gove WR, Hughes M, Style CB. Does marriage have positive effects on the psychological well-being of the individual? J Health Soc Behav. 1983; 24(2): 122-131.CrossRefPubMed
12.
Robins L, Regier D. Psychiatric disorders in America. New York, NY: Free Press; 1991.
13.
Robles TF, Slatcher RB, Trombello JM, McGinn MM. Marital quality and health: a meta-analytic review. Psychol Bull. Mar 25 2013.
14.
Holt-Lunstad J, Birmingham W, Jones BQ. 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. nn. Behav Med. 2008; 35(2): 239-244.CrossRef
15.
Koerner K, & Jacobson, N. Emotion and behavioral couple therapy. The heart of the matter: Perspectives on emotion in marital therapy. Philadelphia, PA: Brunner/Mazel; 1994:207–226.
16.
Sullivan KT, Pasch LA, Johnson MD, Bradbury TN. Social support, problem solving, and the longitudinal course of newlywed marriage. J Pers Soc Psychol. 2010; 98(4): 631-644.CrossRefPubMed
17.
Newsom JT, Mahan TL, Rook KS, Krause N. Stable negative social exchanges and health. Health Psychol. 2008; 27(1): 78-86.CrossRefPubMed
18.
Newsom JT, Nishishiba M, Morgan DL, Rook KS. The relative importance of three domains of positive and negative social exchanges: A longitudinal model with comparable measures. Psychol Aging. 2003; 18(4): 746-754.CrossRefPubMed
19.
Coyne JC, Rohrbaugh MJ, Shoham V, Sonnega JS, Nicklas JM, Cranford JA. Prognostic importance of marital quality for survival of congestive heart failure. Am J Cardiol. 2001; 88(5): 526-529.CrossRefPubMed
20.
Gallo LC, Troxel WM, Kuller LH, Sutton-Tyrrell K, Edmundowicz D, Matthews KA. Marital status, marital quality, and atherosclerotic burden in postmenopausal women. Psychosom Med. 2003; 65(6): 952-962.CrossRefPubMed
21.
Janicki DL, Kamarck TW, Shiffman S, Sutton-Tyrrell K, Gwaltney CJ. Frequency of spousal interaction and 3-year progression of carotid artery intima medial thickness: The Pittsburgh Healthy Heart Project. Psychosom Med. 2005; 67(6): 889-896.CrossRefPubMed
22.
Smith TW, Uchino BN, Berg CA, et al. Conflict and collaboration in middle-aged and older couples: II. Cardiovascular reactivity during marital interaction. Psychol Aging. 2009; 24(2): 274-286.CrossRefPubMed
23.
Rusbult CE, Martz JM. Remaining in an abusive relationship: An investment model analysis of nonvoluntary dependence. Personal Soc Psychol Bull. 1995; 21(6): 558-571.CrossRef
24.
Fincham FD, Linfield KJ. A new look at marital quality: Can spouses feel positive and negative about their marriage? J Fam Psychol. 1997; 11(4): 489-502.CrossRef
25.
Uchino BN, Holt-Lunstad J, Uno D, Flinders JB. Heterogeneity in the social networks of young and older adults: Prediction of mental health and cardiovascular reactivity during acute stress. J Behav Med. 2001; 24(4): 361-382.CrossRefPubMed
26.
Uchino BN. Social support and physical health: Understanding the health consequences of our relationships. New Haven, CT: Yale University Press; 2004.CrossRef
27.
Birmingham W, Uchino BN, Smith TW, Light KC, Sanbonmatsu DM. Social ties and cardiovascular function: An examination of relationship positivity and negativity during stress. Int J Psychophysiol. 2009; 74(2): 114-119.PubMedCentralCrossRefPubMed
28.
Uchino BN. What a lifespan approach might tell us about why distinct meaures of social support have differential links to physical health. J Soc Pers Relat. 2009; 26(1): 53-62.PubMedCentralCrossRefPubMed
29.
Holt-Lunstad J, Uchino BN, Smith TW, Olson-Cerny C, Nealey-Moore JB. Social relationships and ambulatory blood pressure: Structural and qualitative predictors of cardiovascular function during everyday social interactions. Health Psychol. 2003; 22(4): 388-397.CrossRefPubMed
30.
Uchino BN, Smith TW, Berg CA. Spousal relationship quality and cardiovascular risk: Dyadic perceptions of relationship ambivalence are associated with coronary-artery calcification. Psychol Sci. 2014; 25(4): 1037-1042.PubMedCentralCrossRefPubMed
31.
Uchino BN, Bosch JA, Smith TW, et al. Relationships and cardiovascular risk: Perceived spousal ambivalence in specific relationship contexts and its links to inflammation. Health Psychol. 2013; 32(10): 1067-1075.CrossRefPubMed
32.
Broadwell SD, Light KC. Family support and cardiovascular responses in married couples during conflict and other interactions. Int J Behav Med. 1999; 6(1): 40-63.CrossRefPubMed
33.
Pickering TG, Shimbo D, Haas D. Ambulatory blood-pressure monitoring. N Engl J Med. 2006; 354(22): 2368-2374.CrossRefPubMed
34.
Marler MR, Jacob RG, Lehoczky JP, Shapiro AP. The statistical analysis of treatment effects in 24-hour ambulatory blood pressure recordings. Stat Med. 1988; 7(6): 697-716.CrossRefPubMed
35.
Perloff D, Sokolow M, Cowan R. The prognostic value of ambulatory blood pressures. JAMA. 1983; 249(20): 2792-2798.CrossRefPubMed
36.
Reis HT, Clark MS, Holmes JG. Perceived partner responsiveness as an organizing construct in the study of intimacy and closeness. In: Mashek DJ, Aron AP, eds. Handbook of closeness and intimacy. Mahwah, NJ US: Lawrence Erlbaum Associates Publishers; 2004: 201-225.
37.
Sadler P, Woody E. Is who you are who you’re talking to? Interpersonal style and complementarity in mixed-sex interactions. J Pers Soc Psychol. 2003; 84(1): 80-96.CrossRefPubMed
38.
Markey PM, Kurtz JE. Increasing acquaintanceship and complementarity of behavioral styles and personality traits among college roommates. Personal Soc Psychol Bull. 2006; 32(7): 907-916.CrossRef
39.
Goodwin J, Bilous M, Winship S, Finn P, Jones SC. Validation of the Oscar 2 oscillometric 24-h ambulatory blood pressure monitor according to the British Hypertension Society protocol. Blood Press Monit. 2007; 12(2): 113-117.CrossRefPubMed
40.
Laurenceau JP, Barrett LF, Rovine MJ. The interpersonal process model of intimacy in marriage: A daily-diary and multilevel modeling approach. J Fam Psychol. 2005; 19(2): 314-323.CrossRefPubMed
41.
Reis HT, Wheeler L. Intimacy as an interpersonal process. In: Duck S, Hay DF, Hobfoll SE, Ickes W, Mongomery BM, eds. Handbook of personal relationships: Theory, research and interventions. Oxford, England: John Wiley & Sons; 1991: 367-389.
42.
Uchino BN, Kiecolt-Glaser JK, Cacioppo JT. Age-related changes in cardiovascular response as a function of a chronic stressor and social support. J Pers Soc Psychol. 1992; 63(5): 839-846.CrossRefPubMed
43.
Uchino BN, Cawthon RM, Smith TW, et al. Social relationships and health: Is feeling positive, negative, or both (ambivalent) about your social ties related to telomeres? Health Psychol. Jan 9 2012.
44.
Park T, Lee YJ. Covariance models for nested repeated measures data: analysis of ovarian steroid secretion data. Stat Med. 2002; 21(1): 143-164.CrossRefPubMed
45.
Campbell L, Kashy DA. Estimating actor, partner, and interaction effects for dyadic data using PROC MIXED and HLM: A user-friendly guide. Pers Relat. 2002; 9(3): 327-342.CrossRef
46.
Guyll M, Contrada RJ. Trait hostility and ambulatory cardiovascular activity: Responses to social interaction. Health Psychol. 1998; 17(1): 30-39.CrossRefPubMed
47.
Kamarck TW, Shiffman SM, Smithline L, et al. Effects of task strain, social conflict, and emotional activation on ambulatory cardiovascular activity: Daily life consequences of recurring stress in a multiethnic adult sample. Health Psychol. 1998; 17(1): 17-29.CrossRefPubMed
48.
Steptoe A. Stress, social support and cardiovascular activity over the working day. Int J Psychophysiol. 2000; 37(3): 299-308.CrossRefPubMed
49.
Steptoe A, Lundwall K, Cropley M. Gender, family structure and cardiovascular activity during the working day and evening. Soc Sci Med. 2000; 50(4): 531-539.CrossRefPubMed
50.
Krull JL, MacKinnon DP. Multilevel modeling of individual and group level mediated effects. Multivar Behav Res. 2001; 36(2): 249-277.CrossRef
51.
Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008; 40(3): 879-891.CrossRefPubMed
52.
Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008; 40(3): 879-891.CrossRefPubMed
53.
Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986; 51(6): 1173-1182.CrossRefPubMed
54.
McEwen BS. Protective and damaging effects of stress mediators. N Engl J Med. 1998; 338(3): 171-179.CrossRefPubMed
55.
Selig JPP, K. J. Monte Carlo method for assessing mediation: An interactive tool for creating confidence intervals for indirect effects [Computer software]. 2008.
56.
Smith JJ, Kampine JP. Circulatory Physiology-the essentials. Baltimore, Maryland: Williams & Wilkins Press; 1990.
57.
Hodgkinson J, Wood S, Martin U, McManus R. ABPM is best for diagnosing hypertension in primary care. Practitioner. 2011; 255(1744): 21-23. 22.PubMed
58.
Thoits PA. Mechanisms linking social ties and support to physical and mental health. J Health Soc Behav. 2011; 52(2): 145-161.CrossRefPubMed
59.
Mason PJ, Manson JE, Sesso HD, et al. Blood pressure and risk of secondary cardiovascular events in women: the Women’s Antioxidant Cardiovascular Study (WACS). Circulation. 2004; 109(13): 1623-1629.CrossRefPubMed
60.
Psaty BM, Furberg CD, Kuller LH, et al. Association between blood pressure level and the risk of myocardial infarction, stroke, and total mortality: The cardiovascular health study. Arch Intern Med. 2001; 161(9): 1183-1192.CrossRefPubMed
61.
Borghi C, Dormi A, L’Italien G, et al. The relationship between systolic blood pressure and cardiovascular risk–results of the Brisighella Heart Study. J Clin Hypertens. 2003; 5(1): 47-52.CrossRef
62.
Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003; 289(19): 2560-2572.CrossRefPubMed
63.
MacMahon S, Peto R, Cutler J, et al. Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: Prospective observational studies corrected for the regression dilution bias. Lancet. 1990; 335(8692): 765-774.CrossRefPubMed
64.
Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Porcellati C. White-coat hypertension. Lancet. 1996; 348(9039): 1444.CrossRefPubMed
65.
Blumenthal JA, Thyrum ET, Siegel WC. Contribution of job strain, job status and marital status to laboratory and ambulatory blood pressure in patients with mild hypertension. J Psychosom Res. 1995; 39(2): 133-144.CrossRefPubMed
66.
Pickering TG, Harshfield GA, Kleinert HD, Blank S, Laragh JH. Blood pressure during normal daily activities, sleep, and exercise. Comparison of values in normal and hypertensive subjects. JAMA. 1982; 247(7): 992-996.CrossRefPubMed
67.
Gottman JM. What predicts divorce? The relationship between marital processes and marital outcomes. Hillsdale, England: Lawrence Erlbaum Associates, Inc.; 1994.
68.
Reis HT, Shaver P. Intimacy as an interpersonal process. In: Duck S, Hay DF, Hobfoll SE, Ickes W, Montgomery BM, eds. Handbook of personal relationships: Theory, research and interventions. Oxford England: John Wiley & Sons; 1988: 367-389.
69.
Reis HT, Gable SL. Toward a positive psychology of relationships. In: Keyes CM, Haidt J, eds. Flourishing: Positive psychology and the life well-lived. Washington, D.C.: American Psychological Association; 2003: 129-159.CrossRef
70.
Huston TL, Vangelisti AL. Socioemotional behavior and satisfaction in marital relationships: A longitudinal study. J Pers Soc Psychol. 1991; 61(5): 721-733.CrossRefPubMed
71.
Leary T. Interpersonal diagnosis of personality; a functional theory and methodology for personality evaluation. Oxford England: Ronald Press; 1957.
72.
Markey PM, Funder DC, Ozer DJ. Complementarity of interpersonal behaviors in dyadic interactions. Personal Soc Psychol Bull. 2003; 29(9): 1082-1090.CrossRef
73.
Rusbult CE, Verette J, Whitney GA, Slovik LF, Lipkus I. Accommodation processes in close relationships: Theory and preliminary empirical evidence. J Pers Soc Psychol. 1991; 60(1): 53-78.CrossRef
74.
Smith TW, Cribbet MR, Nealey-Moore JB, et al. Matters of the variable heart: Respiratory sinus arrhythmia response to marital interaction and associations with marital quality. J Pers Soc Psychol. 2011; 100(1): 103-119.CrossRefPubMed
75.
Thayer JF, Lane RD. The role of vagal function in the risk for cardiovascular disease and mortality. Biol Psychol. 2007; 74(2): 224-242.CrossRefPubMed
76.
Campo RA, Uchino BN, Holt-Lunstad J, Vaughn A, Reblin M, Smith TW. The assessment of positivity and negativity in social networks: The reliability and validity of the social relationships index. J Community Psychol. 2009; 37(4): 471-486.CrossRef
77.
Uchino BN. Understanding the links between social support and physical health: A lifespan perspective with emphasis on the separability of perceived and received support. Perspect Psychol Sci. 2009; 4: 236-255.CrossRefPubMed
Metadata
Title
It’s Complicated: Marital Ambivalence on Ambulatory Blood Pressure and Daily Interpersonal Functioning
Authors
Wendy C. Birmingham, Ph.D.
Bert N. Uchino, Ph.D.
Timothy W. Smith, Ph.D.
Kathleen C. Light, Ph.D.
Jonathan Butner, Ph.D.
Publication date
01-10-2015
Publisher
Springer US
Published in
Annals of Behavioral Medicine / Issue 5/2015
Print ISSN: 0883-6612
Electronic ISSN: 1532-4796
DOI
https://doi.org/10.1007/s12160-015-9709-0

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