"The secret of a happy remains a secret." —Henny Youngman

The number of studies connecting positive health outcomes with good relationship quality and negative health outcomes with poor relationship quality are too numerous to cite in detail. Per Roberson, Shorter, Woods, and Priest, authors of a recent groundbreaking study examining relationship dysfunction and health outcomes over a 20-year span, intimate and mutually supportive relationships in various prior studies have been associated with reduced risky behavior, lower illness and mortality, and better physical and emotional wellness. On the other hand, they report that poor relationship quality has been associated with dying younger and more frequent physical and mental health problems. Yet, no single study has looked at what specific health behaviors are affected when poor relationship quality leads to health issues.

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The MIDUS touch

To address this gap in our understanding, Roberson and colleagues analyzed data from the in the United States (MIDUS) study to test a model of how several factors interact to link relationship quality with health outcomes. They looked at data from 1995, 2002, and 2011, which includes multiple measures from several thousand participants at each stage of information collection. They looked at people who either said they were married or were in close, long-term relationships tantamount to marriage.

Their model is based on a view of the family as a whole (a “general systems” model) called the biobehavioral family model (BBFM). With the BBFM, multiple factors are included in a web of possible interactions: physical health, relationship dysfunction, biobehavioral reactivity — essentially a measure of related to stress response, emotional, psychological, and related factors — and actual health behaviors (e. ., exercise improves health; tobacco reduces health). The same model can be used to understand the dynamic factors governing married couples' behavior, as well.

Researchers looked at how three factors unfolded in relation to one another over the 20 years: marital dysfunction at Time 1, and depressive disorder at Time 2, and physical health at the end of the period studied (Time 3).

Source: Roberson et al., 2018

Their research approach, using Structural Equation Modeling and Confirmatory Factor Analysis, tests the weight of the connections among the different factors to see if they are correlated to a statistically significant extent, and whether the various health behaviors tested are directly and/or indirectly associated with relationship quality and general health when taking anxiety and into account. In other words, they consider all the possible ways that different factors can fit together to connect the quality of relationships, and determine which of the factors are accounting for any observed connections among relationship quality, behaviors which affect health, and participants’ health.

The MIDUS study surveyed positive and negative behaviors which affect general health — smoking, eating, consumption, sleep quality, and exercise. MIDUS also surveyed for anxiety disorders, , physical health issues (number of symptoms and chronic conditions, number of prescriptions, and self-reported health), and marital dysfunction (marital strain across several items, including the degree of criticism, thoughts that the marriage might be in “trouble,” and whether they thought they might separate in the future).

They found that, overall, the emotional components of biobehavioral reactivity were a significant factor in how relationship dysfunction in the 1995 group predicted overall physical health in the 2011 group. Emotional health, in the form of coping, stress reactivity, and other psychological factors, is key for couples, determining to a significant extent how healthy or unhealthy they are as they grow older together. This makes sense, because couples who have good individual and shared coping styles and approaches to self-care and care for others are likely to bolster one another’s healthful behaviors and gently but effectively discourage unhealthy behaviors. Building shared resilience and bolstering relationship efficacy is just good common sense.

Healthy behavior pays off

We know that independently the factors they looked at — smoking, alcohol consumption, eating habits, sleep quality, physical activity — influence future health. But what specific behaviors are affected by relationship function? In this study, researchers found that only eating and physical exercise were significant mediators between relationship dysfunction at Time 1 and physical health at Time 3, though sleep quality came close to significance. Although smoking and alcohol consumption may be affected by couples’ factors, in this study they did not account for the health issues stemming from poor relationship quality. The significant interactions between relationship dysfunction and eating and physical activity held even after researchers factored out the effects of depression and anxiety, showing that these factors are independently important.

This research is important and moves the ball down the field when it comes to understanding how couples’ health is determined over time. Based on the current study, eating habits and physical activity — exercise, among other things — are the two clearest factors where couples naturally co-influence one another’s health. Sleep quality is almost significant, and interestingly, smoking and alcohol use are not significantly correlated. It may be that although individuals in a situation may drink and smoke, they would be prone to do this regardless of marital problems — it may also be that people who smoke and drink tend to get together in the first place, blurring the interactional picture.

Deploying limited resources

Armed with this information, addressing relation dysfunction is most likely to pay off for couples hoping to improve their own health by making changes in eating and physical activity. Taking the time to discuss how marital issues may be affecting self-care in these important domains, couples can plan together to ensure healthier eating and more physical activity. Couples can both plan things together, such as strenuous walks and shared meals (which may also improve relationship quality), as well as supporting each person’s efforts by providing emotional and practical support, for example through encouragement (and especially “esteem support”) and carving out time to cover for the other person so they can go to the gym. Relevant to the current study, addressing relationship dysfunction may improve health by improving eating and increasing physical activity.

This is not to say that getting enough sleep and avoiding unhealthy behaviors are not important as well. While relation quality does not appear to impact personal health via sleep, smoking, and alcohol consumption, improving these (and other) factors could nevertheless improve relationship quality. For instance, if alcohol use is interfering with emotional and sexual , reducing such problematic use may help couples to grow closer, though alcohol is often used to cover up other issues.

As good as gold

In general, the findings from the MIDUS study suggests that couples in dysfunctional relationships would be wise to pay special to their eating habits and physical activity levels, while working to improve their overall relationship. If the relationship is not supporting health in these areas, then cultivating self-care may be necessary to compensate. In other cases, separation may allow individuals to pursue greater personal health and well-being. Regardless, if one is in a dysfunctional relationship, the chances are good that dragging it out may come with a big price tag. A happy relationship and good health are at least as good as gold.