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Review
. 2014 Jan;140(1):140-187.
doi: 10.1037/a0031859. Epub 2013 Mar 25.

Marital quality and health: a meta-analytic review

Theodore F Robles  1 , Richard B Slatcher  2 , Joseph M Trombello  1 , Meghan M McGinn  3
Affiliations
Review

Marital quality and health: a meta-analytic review

Theodore F Robles et al. Psychol Bull. 2014 Jan.

Abstract

This meta-analysis reviewed 126 published empirical articles over the past 50 years describing associations between marital relationship quality and physical health in more than 72,000 individuals. Health outcomes included clinical endpoints (objective assessments of function, disease severity, and mortality; subjective health assessments) and surrogate endpoints (biological markers that substitute for clinical endpoints, such as blood pressure). Biological mediators included cardiovascular reactivity and hypothalamic-pituitary-adrenal axis activity. Greater marital quality was related to better health, with mean effect sizes from r = .07 to .21, including lower risk of mortality (r = .11) and lower cardiovascular reactivity during marital conflict (r = -.13), but not daily cortisol slopes or cortisol reactivity during conflict. The small effect sizes were similar in magnitude to previously found associations between health behaviors (e.g., diet) and health outcomes. Effect sizes for a small subset of clinical outcomes were susceptible to publication bias. In some studies, effect sizes remained significant after accounting for confounds such as age and socioeconomic status. Studies with a higher proportion of women in the sample demonstrated larger effect sizes, but we found little evidence for gender differences in studies that explicitly tested gender moderation, with the exception of surrogate endpoint studies. Our conclusions are limited by small numbers of studies for specific health outcomes, unexplained heterogeneity, and designs that limit causal inferences. These findings highlight the need to explicitly test affective, health behavior, and biological mechanisms in future research, and focus on moderating factors that may alter the relationship between marital quality and health.

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Figures

Figure 1
Figure 1
Summary of conceptual models explaining links between marital quality and health
Figure 2
Figure 2
Flowchart describing identification and screening of studies.
Figure 3
Figure 3
Aggregated effects of marital quality on health across studies and selected subsets of studies: Summary effect size, heterogeneity, and publication bias statistics, and forest plots. Positive correlation coefficients indicate that greater marital quality is related to better health. Diamond and box height is proportional to estimate precision – taller shapes are more precise. Width of the diamonds and error bars represents the 95% confidence interval. The number of studies (k) within an outcome/design category may not add up to the total k due to overlap of studies across categories (e.g., a study can contribute a pain disability and pain severity effect size) and overlap of studies across designs (e.g., a study can contribute a cross-sectional and longitudinal effect size). CV = cardiovascular. Nfs = fail-safe N. * Significant publication bias by Egger’s test, p < .10 ** Significant publication bias by Egger’s test, p < .05
Figure 4
Figure 4
Funnel plot depicting the relationship between effect size and precision (publication bias) in cross-sectional studies of self-rated health and symptoms. The diamond depicts the mean effect size, and each circle depicts a single effect size. The solid horizontal line depicts no effect.
Figure 5
Figure 5
Relationship between longer follow-up interval and smaller effect sizes in longitudinal studies. Each circle represents a single study (k = 36). Circle diameter is proportional to sample size (using random effects meta-regression).
Figure 6
Figure 6
Word cloud depicting covariate frequencies in studies with both minimal and maximal covariate adjustment. Font size is proportional to the number of studies (out of k = 21) including the covariate in rmax analyses. Numbers indicating the frequency of studies including the covariate are also shown.
Figure 7
Figure 7
Aggregated effects of marital quality on biological mediators across studies: Summary effect size, heterogeneity, and publication bias statistics, and forest plots. Diamonds indicate average effect size across cardiovascular reactivity measures. Squares indicate average effect sizes within an outcome category. Diamond and box height is proportional to estimate precision – taller shapes are more precise. Width of the diamonds and error bars represents the 95% confidence interval. Positive correlation coefficients indicate that greater marital quality is related to greater reactivity or flatter cortisol slope. For cardiovascular reactivity studies, not all 14 studies provided effect size estimates for HR, SBP, or DBP. HR = heart rate; SBP = systolic blood pressure; DBP = diastolic blood pressure.
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