Unhappy marriages increase men’s risk of stroke and all-cause mortality

After more than three decades of follow-up, a prospective cohort study of nearly 9,000 men finds dissatisfaction with married life to be associated with increased long-term risk of stroke and all-cause mortality.

All of the 8,945 male Israeli civil servants and municipal employees who participated in the study completed a structured psychosocial questionnaire at baseline, where every participant was asked to record the degree to which they were satisfied with their marriage (marriage perceived as 1 – very successful, 2 – successful, 3 – not so successful, 4 – unsuccessful). Participants also underwent clinical and biochemical blood evaluations.

During 32 years of follow-up, 5,736 participants (64.1 percent) died, with 595 (6.7 percent) dying of stroke. Rates of stroke mortality increased by 69.2 percent from 24.0 per 10,000 person-years (PY) in the most satisfied group to 40.6 per 10,000 PY in the least satisfied group. Rates of all-cause mortality increased by 19 percent from 248.5 per 10,000 PY in the most satisfied group to 295.3 per 10,000 PY in the least satisfied group. [J Clin Med 2021;10:1729]

“The association persisted even when the analysis was adjusted for established risk factors of mortality [ischaemic heart disease, diabetes mellitus, systolic blood pressure and smoking, leisure-time physical activity, socioeconomic status, and family problems],” wrote the researchers.

The relationship between marital satisfaction and mortality was similar to that of smokers (hazard ratio [HR], 1.37; 95 percent confidence interval [CI], 1.30 to 1.48) compared with never-smokers and that of physically inactive (HR, 1.21; 95 percent CI, 1.14 to 1.37) compared with physically active participants. “Our study suggests that marital dissatisfaction is an equally important health factor for consideration as a risk for specific and all-cause mortality,” commented the researchers.

Participants with low marital satisfaction had higher levels of systolic (p=0.01) and diastolic blood pressure (p<0.01), lower socioeconomic status (p<0.01), and higher rates of family problems (p<0.01) than participants with high marital satisfaction. About two-thirds of the participants had smoked at some time, with the number rising with decreased marital satisfaction.

A sensitivity analysis found that mortality rate of younger (<50 years old) participants in the least satisfied category at recruitment was 39.4 percent higher than those in the most satisfied category (p=0.0007). A less dramatic increase of 6.5 percent was seen in older (>50 years old) participants (p=0.314). “Developmental and accommodation theories have proposed that conflict, emotional behaviours, and dissatisfaction may diminish over time as couples become more tolerant of one another,” noted the researchers. [Psychol Aging 1995;10:140-149; J Marriage Fam 2010;72:1188-1204]

“Strategies such as educating and training young couples on positive psychology techniques, communication skills, and parenting approaches may be beneficial for developing family resilience and enhancing marital satisfaction, and may be usefully implemented as part of health promotion campaigns designed for the general population,” suggested the researchers. [Fam Relat 2002;51:130-137; J Fam Commun 2005;5:1-24]