Married women who keep silent during marital disputes have a greater chance of dying from heart disease and other conditions than women who speak their minds, new research shows.
But the same can't be said of married men who keep disagreements to themselves. They had the same life expectancy during the 10-year study as men who spoke out.
The research, which spanned from the mid-1980s to the mid-1990s, was the latest to show that how couples fight affects not only their relationship but their health.
Lead author Elaine A. Eaker, a Gaithersburg, Md., epidemiologist, said the message for women was clear. "When in conflict with your spouse, it helps to express yourself," she said.
The study of 3,000 men and women published online in July by the journal Psychosomatic Medicine set out to examine the relationship between marital stress and coronary heart disease or death. Participants were asked what topics they fought over and whether workplace problems spilled into their lives at home.
In general, marriage benefits health, particularly that of men. Married men live seven years longer, and married women live two years longer, than single men and women, respectively. Married people as a group have better psychological health than never-marrieds.
When happy couples are compared with unhappy ones, however, the impact of marriage on health is more nuanced. Studies have linked marital discord to a higher risk of recurrent heart attack in women 30 to 65 and the severity of congestive heart failure in male and female patients.
Recently, researchers studying married couples have identified certain behaviors that appear to worsen health risks, particularly for women.
Michael J. Rohrbaugh, co-director of the University of Arizona's Family Research Laboratory, who is conducting a study of heart patients, said the pronouns that couples use in speech -- whether "me" or "us" -- seem to predict the course of a spouse's heart disease during the subsequent six months.
"There is something about 'we talk' -- the collective or communal idea that 'we are in it together' that is important," Rohrbaugh said. Although that study is not completed, Rohrbaugh said the connection between the phrase "we talk" and health appears to be stronger in women than in men. For women with heart disease, repeatedly using the words "I" or "me," he said, "is like the kiss of death."
And a 2003 study in the journal Archives of General Psychiatry found that after marital spats, blisters generally healed more slowly, a sign that stress interfered with immune system functioning.
In hostile couples -- those who hurled insults or rolled their eyes when arguing about such topics as in-laws or money -- healing was 60% slower than in couples who didn't display antagonistic behaviors, the study showed. Women tended to take longer to heal than men.
Ohio State University psychology professor Janice Klecolt-Glaser, who led that study, said men are less sensitive than women to negative emotional nuances.
When shown videotapes of their behavior, men give softer scores to negative behaviors than do women or trained observers. "It's not that discussing disagreements is wrong. Couples should argue or discuss things that don't work," she said. "It is the quality of the discussion that matters."
The latest report was consistent with her own findings, Klecolt-Glaser said.
Eaker and colleagues at Boston University tracked 1,768 men and 1,912 women between the ages of 18 and 77. They were drawn from the Framingham offspring study, a large epidemiological study of people whose parents were from Framingham, Mass.
All participants received extensive physical examinations and completed detailed questionnaires. When asked what they fought over, men said sex, and women cited money, children and chores.
Men were more likely than women to report their marriages were happy and that their spouses loved them.
The study, initiated in the mid-1980s when women were entering the workforce in large numbers, asked men whether wives' jobs disrupted the home.
Men who said their wives came home from work upset were 2.7 times more likely to develop coronary heart disease than other men. (Women weren't asked whether job stress affected them.)
Change in roles
Eaker speculated the men were frustrated that they could not help their wives or felt stressed by the change in traditional roles. The finding, she said, "had a lot to do with expectations on the family and the husband 20 years ago" and might not hold true for today's couples.
When it came to dealing with conflicts, about 30% of men said they usually or always kept their feelings to themselves, compared to about 20% of women who followed the same behavior. But women who "self-silenced" were four times more likely to die during the study than women who said they always spoke out.
The study data didn't provide much insight into the result, Eaker said. During the 10-year study, 1% of men and 0.05% of women died.
Psychologists said men often are silent during conflicts to avoid subjects they would rather not discuss, a pattern called demand-withdraw. Women engage in this behavior, but less frequently.
"We see this pattern in studies in which the wife pushes her husband to stop drinking or smoking and he withdraws," said the University of Arizona's Rohrbaugh.
Dana Crowley Jack, a professor at Western Washington University and author of the 1991 book "Silencing the Self," said women's motivations for avoiding conflict are more complex.
They are socialized to keep feelings of conflict with their spouses to themselves, she said, believing that their behavior will protect their marriages or family relationships, she said.
"One way of being pleasing is to go along with what the other person wants -- whether or not that other person wants you to," she said.