How Spouses View Each Other Tied to Cardiac Risk

The quality of social relationships has been reliably related to physical health in a number of studies, and a recent meta-analysis has suggested that social support was related to a 50 percent increase in survival rates. In particular, the quality of a marriage seems to be particularly important. However, much prior research on the impact of marriage quality tends to focus on either the positive or negatives aspects of marriage, ignoring or statistically controlling for the other side. Yet like other social relationships, marriage can be sources of both positivity and negativity. In particular, researchers have identified what they have labeled “ambivalent relationships.” This ambivalence may come from interactions stemming from criticism, less provided support, unsolicited advice, personality differences, disagreements about child-rearing, or past relationship problems. Earlier research has shown that perceiving another person in a social network as ambivalent has been associated with health outcomes ranging from cardiovascular reactivity to inflammation to blood pressure. However, how both members of a marriage mutually perceive each other, and the ways that their perceptions impact interactions and the health outcomes that may be associated with these interactions, have been less studied.

A recent study examined how both spouses in a marriage perceived the other partner. Researchers looked at whether each spouse viewed the other as primarily helpful, or ambivalent—that is, helpful but also upsetting. The ways that both members perceived each other were then used to predict measures of coronary artery calcification, which is a strong predictor of cardiovascular risk.

In the analysis of how spouses perceived each other, 30 percent of individuals were viewed by their spouses as primarily a source of positivity, and 70 percent viewed their spouse as ambivalent. When looking only at how an individual viewed a spouse, perceiving a spouse as being ambivalent was not statistically associated with a greater degree of coronary artery calcification. However, when looking at both spouses’ perceptions of each other simultaneously, the researchers found that when both partners viewed each other as ambivalent, there was a statistically significant association with coronary artery calcification. This result remained even after traditional measures of marital satisfaction were controlled for. When one spouse was viewed as supportive but viewed the other spouse as ambivalent, the average calcification score was around 2.2, but compared to an average of 3.1 when both spouses viewed each other ambivalently.

In their discussion of these findings, the authors suggest that this pattern of health outcomes may reflect less support-seeking behavior by partners who view the other partner as ambivalent. Ambivalence has also been associated with receiving poorer quality support, so that what support is received may be less beneficial than from a partner characterized as primarily helpful.

Overall, these findings suggest that it is important to recognize and account for the possibility that individuals in relationships can simultaneously experience feelings of positivity and negativity. This study also indicates the importance of taking into account both individuals’ views toward the other when looking at health outcomes that may come from social support from a relationship.


Uchino BN, Smith TW and Berg CA. Spousal relationship quality and cardiovascular risk: dyadic perceptions of relationship ambivalence are associated with coronary-artery calcification. Psychological Science. (2014). DOI: 10.1177/0956797613520015


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