BC Council for Families

Healthy Relationships: Their influence on physical health

The Connection Between Relationships and Physical Health

dad and kids
The World Health Organization defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (World Health Organization, 2001). This definition of health articulates the interconnectedness between social support/interpersonal relationships and overall health and wellness.

Although the connection between social support/relationships and emotional/psychological health has been well documented, more recent literature has also focused on the connection between social support/relationships and physical health (Valliant, Meyer, Mukamal,&Soldz, 1998). This research has shown that certain relationship characteristics serve as protective functions against physical disease/illnesses and their outcomes. These characteristics include “family closeness and connectedness, problem focused family coping skills, clear family organization and decision making, and direct communication” (Fisher&Weihs, 2000, p.562). Characteristics that have shown to increase the risk of disease and illness include a lack of social support, hostility, criticism, and blame within the family, family perfectionism and rigidity, and the presence of psychopathology (Fisher&Weihs, 2000; Nyamthi, Wenzel, Keenan, Leake,&Gelberg, 1999). For example:

  • An unhappy marriage can increase the likelihood that you become ill by 35% and shorten your life an average of four years (Gottman & Silver, 1999).
  • Children growing up in distressed marriages tend to have higher levels of chronic stress resulting in increased physical illness (Gottman & Fainsilber Katz, 1989)

There is a significant amount of research that substantiates the connection between social support/relationships (and the quality of social support/relationships) and the development, onset, and/or recovery of several physical diseases/illnesses. For example, a lack of effective social support and interpersonal relationships has been linked with conditions such as heart disease (Glynn, Christenfeld, & Gerin, 1999; Smith & Gallo, 1999; Steptoe, Lundwall, & Cropley, 2000; Venters, Jacobs, Pirie, Luepker, Folsom, & Gillum, 1986), different forms of cancer (Goodwin, Hunt, & Samet, 1987), epilepsy (Langfitt, Wood, Brand, & Erba, 1999; and Krawetz, Fleisher, Pillay, Staley, Arnett, & Maher, 2001), inflammatory bowel disease (Vaughn, Leff, & Sarner, 1999), and arthritis (Prigerson, Maciejewski, & Rosenheck, 1999). Some examples include:

  • Stressful marital interactions lead to an increase in cardiovascular reactivity which in turn increases the risk of coronary heart disease and premature mortality (Smith & Gallo, 1999).
  • Unmarried people with cancer have an 8-17% lower survival rate than their married counterparts due to the lower amount of care and support they receive (Goodwin et al., 1987).
  • People who experience undefined organic seizures are more likely to have grown up in a family that had difficulty defining family roles and that had dysfunctional communication patterns (Krawetz et al., 2001).
  • People with little social support and unstable families have more difficulty adapting to inflammatory bowel disease than those with stable family relationships and strong social supports (Vaughn et al., 1999).
  • Intense grief for the loss of a relationship through death or divorce has been linked to higher rates of arthritis in women (Prigerson et al., 1999).

Social support and interpersonal relationships have also been reported to influence the physical health of the elderly (Johnson, 1996; Raina, Waltner-Toews, Bonnett, Woodward, Abernathy, 1999; Schone & Weinick, 1998), the immune system (Gottman & Silver, 1999; Kiecolt-Glaser, Malarkey, Chee, Newton, Cacioppo, Mao, & Glaser, 1993), reproductive health/puberty (Keye, Hammond, & Strong, 1986; and Ellis, McFaden-Ketchum, Dodge, Pettit, & Bates, 1999), smoking and drinking habits (Prigerson et al., 1999; Wolfinger,1998), as well as risk taking behavior (Nyamathi et al., 1999). More examples include:

  • A lack of perceived social support and attachment to other people is associated with increased mortality rates in older people (Blazer, 1982).
  • Couples who are more negative and/or hostile while discussing marital problems experience an increase in negative immunological change up to 24 hours after their discussion (Kiecolt-Glaser et al., 1993).
  • Low father involvement in the family is associated with early onset of puberty in daughters which is known to increase the risks for unhealthy weight gain, distorted body image, high rates of alcohol consumption, promiscuity, teenage pregnancy, low birth-weight babies, and breast cancer (Ellis et al., 1999).
  • Parental divorce greatly increases the likelihood of becoming a smoker. Men from divorced families also tend to have higher rates of problem drinking. (Wolfinger, 1998).
  • Bereavement caused by the loss of a loved one increases the likelihood of alcohol and tranquilizer use (Prigerson et al., 1999).
  • Women who are not in close contact with their extended families and have little sense of family heritage are more likely to take sexual risks that lead to contracting STDs/HIV (Landau, Cole, Tuttle, Clements, Stanton, 2000).

The Influence of Interpersonal Relationships on Physical Health

The role of interpersonal relationships and social support is to provide intimacy (provides an emotional climate where people are able to express themselves openly without being self-conscious), a sense of belonging (provides people with shared experiences, information, and ideas), an opportunity for nurturant behavior (emphasizes the value of having obligations and duties toward other people in addition to receiving support in return), reassurance of worth (affirms to individuals that they are competent and worthy in the roles that they fulfill), assistance (provides people with help in acquiring and giving goods and services), guidance and advice (feedback is given regarding actions that people are doing/considering doing, or by offering insight into how to process information about events that have occurred or are about to occur), and access to new contacts and different information (through relationships we meet new contacts and/or new sources of information that may be useful under particular conditions) (Berkman, 1984).

It is important to note these roles as they are directly related to several suggested models for how and why relationships influence physical health. These models include:

1) Relationships provide people with information. People in relationships provide information, advice, services and new social contacts to one another. Individuals with stronger/healthier social networks have access to more resources, are better able to access services, and know how to utilize health services more effectively. As a result, these people obtain better medical care and have better physical health (Berkman, 1984; Sherbourne & Hays).

2) Relationships provide people with a caring environment. Better functioning social networks/relationships take better care of their members independently of professional medical services by providing help and financial assistance (Berkman, 1984; Jou, & Fukada, 1997; Sherbourne & Hays, 1990).

3) Relationships provide a group identity. Individuals in social networks feel social control and peer pressure to behave like other group members. Groups of individuals that have health-promoting behavior have members with better health status (Berkman, 1984; Valliant et al., 1998).

4) Relationships provide a buffer to stress. People that lack intimate ties, a sense of belonging, opportunities for nurturance, and reassurance of worth are physiologically stressed. Negative psychosocial factors act as signs of danger which in turn alter the neuroendocrine system, increasing susceptibility to disease agents (Berkman, 1984; Cobb, 1976; Jou, & Fukada, 1997; Valliant et al., 1998).

5) Relationships provide a purpose for living a healthy lifestyle. People in stable well functioning relationships develop a larger meaning and purpose in life and are more motivated to protect themselves against disease/illness/injury (Sullivan, 1997).

Based on these models, effective social support and interpersonal relationships empower individuals with information, knowledge, skills, care from others, encouragement from others, protective factors, and motivation that helps to 1) prevent disease/illness/injury, 2) reduce the risks for disease/illness/injury, 3) detect disease/illness early, and 4) improve treatment outcomes for disease/illness/injury.

Improving Relationships to Reverse Health Conditions

The majority of the research on the connections between interpersonal relationships and physical health has focused on proving that the structure, quality, and/or effectiveness of our relationships with other people influences the development, onset, and/or occurrence of certain diseases, illnesses, and/or injuries. Findings from this research provide a very strong argument for supporting individuals, families, and communities through preventative psychosocial education programs (teaching people relationship skills, how to take care of themselves, and how to take care of their loved ones) to improve their relationships and in turn increase their chances for remaining physically healthy. Such psychosocial education programs consist generally of courses in marriage preparation, relationship enrichment, parenting, grand parenting, employee relations, etcetera. More current studies are beginning to examine the influence that relationships and social support have on reversing illness/disease and/or the factors that are known to cause them. In a study reported by Sullivan (1997), results found that the symptoms and need for hospital procedures for coronary artery disease could be reduced by incorporating psychosocial education into lifestyle intervention programs (that generally provide information on eating low fat diets and exercise) offered to cardiac patients. Sullivan reported that psychosocial education programs reduce the risk factors of coronary artery disease (social isolation, sleep disorders, depression, repression of emotion, work stress, loss of meaning, and low affiliation) which in turn reduce the process of atherosclerosis by 40-60%, increasing blood flow to the heart and reducing negative physical consequences by 50-60%.

Improving Relationships to Reduce Health Care Costs

With evidence that disease/illness/injury can be prevented and treated by supporting individuals, families, and communities in their relationships, costs to the health care system could be reduced if psychosocial education were readily available and provided. Costs would be saved not only from the prevention of disease/illness and the reduced costs of long term treatment for disease/illness, but also from a decrease in the general use of the health care system. It is important to note that most visits to the health care system are made by a small number of people. In Canada, 12-15% of the patients account for 50% of the health care visits and are responsible for 64% of the total health care costs (Bellon, Delagado, Luna, & Lardelli, 1999). People who have readily available, strong social support networks tend to participate in more self-care behavior and seek medical attention less often (Bellon et al., 1999) while those in unstable relationships increase their health care visits not only due to their increased chances of disease/illness, but to obtain the social support that they are missing in their personal circles (Kouzis & Eaton, 1998; Prigerson et al., 1999).

As the connection between our interpersonal relationships and our physical health is being explored, it is important that research continues to examine the correlations between people’s social relationships and particular diseases/illnesses. Further research is also needed on prevention and intervention strategies that support individuals, families, and communities in achieving physical health by attaining and maintaining healthy relationships. Based on what has been learned from the research to date, it is expected that further studies will provide a scientific basis for greater involvement of health care, education, and social service professionals in the efforts to empower patients to reduce family stress, increase family support, and maximize utilization of existing family support systems. This should increase the opportunity for individuals to achieve a state of complete physical, mental, and social well-being, where overall health is achieved (Parkerson, Michener, Wu, Finch, Muhlbaier, Magruder-Habib, Kertesz, Clapp-Channing, Morrow, Chen, & Jokerst, 1988).

References

Bellon, J.A., Delgado, A., Luna, J.D., & Lardelli, P. (1999). Psychosocial and health belief variables associated with frequent attendance in primary care. Psychological Medicine, 29,(6),1347-1357.

Berkman, L.F. (1984). Assessing the physical health effects of social networks and social support. Annual Review of Public Health, 5, 413-432.

Blazer, D.G., (1982). Social support and mortality in an elderly community population. American Journal of Epidemiology, 115,(5),684-694.

Cobb, S. (1976). Social support as a moderator of life stress. Psychosomatic Medicine, 38,(5),300-314.

Ellis, B.J., McFaden-Ketchum, S., Dodge, K.A., Pettit, G.S., & Bates, J.E. (1999). Quality of earyly family relationships and individual differeneces in the timing of pubertal maturation in girls: a longitudinal test of an evolutionary model. Journal of Personality and Social Psychology, 77,(2),387-401.

Fisher, L., & Weihs, K.L. (2000). Can addressing family relationships improve outcomes in chronic disease? Report of the Narional Working Group on Family-Based Interventions in Chronic Disease. Journal of Family Practice, 49,(6),561-566).

Glynn, L.M., Christenfeld, N., & Gerin, W. (1999). Gender, social support, and cardiovascular responses to stress. Pyschosomatic Medicine, 61,(2),234-242.

Goodwin, J.S., Hunt, W.C., & Samet, J.M. (1987). The effect of marital status on stage, treatment, and survival of cancer patients. Journal of the American Medical Association, 258,3152-3130.

Gottman, J.M., & Fainsilber Katz, L. (1989). Effects of marital discord on young children’s peer interaction and health. Developmental Psychology, 25,373-381.

Gottman, J.M., & Silver, N. (1999). The Seven Principles of Making Marriage Work. Crown Pulishers Inc.: New York.

Johnson, J.E. (1996). Social support and physical health in the rural elderly. Applied Nursing Research, 9,(2),61-66.

Jou, Y.H., & Fukada, H. (1997). Stress and social support in mental and physical health of Chinese Students in Japan. Psychological Reports, 81,(3):1303-1312.

Keye,W.R., Hammond, D.C., & Strong, T. (1986). Medical and psychological characteristics of women presenting with premenstrual symptoms. Obstetrics and Gynecology, 68,(5),634-637.

Kiecolt-Glaser, J.K., Malarkey, W.B., Chee, M., Newton, T., Cacioppo, J.T., Mao, H.Y., & Glaser, R. (1993). Negative behavior during marital conflict is associated with immunological down-regualtion. Psychosomatic Medicine, 55,395-409.

Kouzis, A.C., & Eaton, W.W. (1998). Absence of social networks, social support and health services utilization. Psychological Medicine, 28,(6),1301-1310.

Krawetz, P., Fleisher, W., Pillay, N., Staley, D., Arnett, J., & Maher, J. (2001). Family functioning in subjects with pseudoseizures and epilepsy. Journal of Nervous and Mental Disease, 189,(1),38-43.

Krishnasamy, M. (1996). Social support and the patient with cancer. Journal of Advanced Nursing, 23,(4),757-762.

Landau, J., Cole, R.E., Tuttle, J., Clements, C.D., Stanton, M.D. (2000). Family connectedness and women’s sexual risk behaviors: implications for the prevention/intervention of STD/HIV infection. Family Process, 39,(4), 461-475.

Langfitt, J.T., Wood, B.L., Brand, J., & Erba, G. (1999). Family interactions as targets for intervention to improve social adjustment after epilepsy surgery. Epilepsia, 40,(6),735-744.

Nyamathi, A., Wenzel, S., Keenan, C., Leake, B., & Gelgerg, L. (1999). Assoications between homeless women’s intimate relationships and their health and well-being. Research in Nursing & Health, 22,(6),486-495.

Parkerson, G.R., Michener, L., Wu, L.R., Finch, J.N., Muhlbaier, L.H., Magruder-Habib, K., Kertesz, J.W., Clapp-Channing, N., Morrow, D.S., Chen, A.L.T., & Jokerst, E. (1988). Associations among family support, family stress, and personal functional health status. Journal of Clinical Epidemiology, 42,(3),217-229.

Prigerson, H.G., Maciejewski, P.K., & Rosenheck, R.A. (1999). The Effects of marital dissolution and marital quality on health and health service use among women. Medical Care, 37,(9),858-873.

Raina, P., Waltner-Toews, D., Bonnett, B., Woodward, C., & Abernathy, T. (1999). Inflience of companion animals on the physical and psychological health of older people: an analysis of a one-year longitudinal study. Journal of the American Geriatrics Society, 47,(3),323-329.

Schone, B.S., & Weinick, R.M. (1998). Health-related behaviors and the benefits of marriage for elderly persons. Gerontologist, 38,(5),618-627.

Sherbourne, C.D., & Hays, R.D. (1990). Marital status, social support, and health transitions in chronic disease patients. Journal of Health and Social Behavior, 31,(4),328-343.

Smith, T.W., & Gallo, L.C. (1999). Hostility and cardiovascular reactivity during marital interaction. Psychosomatic Medicine, 61,(4),436-445.

Steptoe, A., Lundwall, K., & Cropley, M. (2000). Gender, family structure and cardiovascular activity during the working day and evening. Social Science & Medicine, 50,(4),531-539.

Sullivan, M. (1997). Relationships skills and heart disease: a new frontier. Plenary Presentation for Marriage, Family and Couple’s Education Conference, Smart Marriages. Retrieved December 20, 2001, from http://www.smartmarriages.com/healthyheart.html

Valliant, G.E., Meyer, S.E., Mukamal, K., & Soldz, S. (1998). Are social supports in late midlife a cause or a result of successful physical ageing? Psychological Medicine, 28,(5),1159-1168.

Vaughn, C., Leff, J., & Sarner, M. (1999). Relatives’ expressed emotion and the course of inflammatory bowel disease. Journal of Psychosomatic Research, 47,(5),461-469.

Venters, M., Jacobs, D.R., Pirie, P., Luepker, R.V., Folsom, A.R., & Gillum, R.F. (1986). Marital status and cardiovascular risk: the Minnesota Heart Survey and the Minnesota Heart Health Program. Preventive Medicine, 15,(6),591-605).

Wolfinger, N.H. (1998). The effects of parental divorce on adult tobacco and alcohol consumption. Journal of Health and Social Behavior, 39,254-269.

World Health Organization (2001). WHO as an Organization. Retrieved December 20, 2001, from http://www.who.int/m/topicgroups/who_organization/en/index.html

Prepared by: Jennifer Holmes, M.A., for BC Council for Families, the Relationships Affiliate of the Canadian Health Network.


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