March 4, 2009 - Women in tense, strained marriages are more likely than men to suffer from mental problems like depression, but also dangerous physiological conditions, such as high blood pressure and obesity, a new study shows.

Strained marriages also cause depression in men, says study researcher Nancy Henry of the University of Utah.

But she says that men in such relationships, unlike women, aren't at increased risk of developing the physiological conditions of metabolic syndrome. Aside from having excess belly fat and elevated blood pressure, other characteristics of metabolic syndrome include elevated triglycerides, elevated blood sugar, and low levels of HDL "good" cholesterol.

If you have at least three of the five characteristics, you qualify as having metabolic syndrome, which is known to increase risk of heart disease, stroke, and diabetes.

For the study, Henry and her colleagues recruited 276 couples married an average of two decades, in which men and women were between 40 and 70 years old. Participants filled out questionnaires that covered positives, such as emotional warmth and mutual support; and areas of tension, such as frequency of arguments and extent of disagreements over issues like sex, kids, and money.

Participants also had medical screening that included blood tests and measurements of blood pressure and waist circumference.

The researchers found:

• Women reporting more marital strain were more likely to report depressive symptoms.
• Women with marital strain had more metabolic syndrome symptoms.
• Men in bad marriages reported depressive symptoms unrelated to any signs of metabolic syndrome.

Why Bad Marriages May Affect Women's Health

"Women seem to be more relationship oriented," says Henry, a doctoral student at the University of Utah who also works at the Veteran Affairs Salt Lake City Medical Center. "We know by research that women tend to base their self-concept on relationships, how they are doing, how things are going for them. And we think that's the reason we've shown that negative relationship issues seem to take a greater toll on women emotionally and physically."

Tim Smith, PhD, a professor of psychology at the University of Utah, tells WebMD that although bad marriages can contribute to depression in men, the physiological problems seem to show up only in women.

"It's not like men were not troubled in our study. But the results were clear that women in this situation were more likely to gain weight. Stress hormones facilitate depositing of intra-abdominal fat, so the stress might make them heavier, and also raise cholesterol," he says.

A large body of research shows that divorce is associated with coronary calcification in both men and women, but "in our data, it's clear that the association of stress and heart health is stronger in women," Smith says.

Viola Vaccarino, MD, PhD, director of the cardiovascular outcomes program at Emory University in Atlanta, tells WebMD that it's just as likely that metabolic syndrome difficulties cause depression, rather than the other way around.

"We can clearly say that people with depression are more likely to have a metabolic syndrome, and vice versa," she says. "People with depression may be more likely to develop metabolic syndrome due to lack of physical activity, or inability to choose a healthy diet. But this is the first time I have seen this gender difference, that depression can affect women more than men."

Henry and Smith are to present the study March 5 at the American Psychosomatic Society's annual meeting in Chicago.

Are Bad Marriages More Stressful for Women?

Henry says the gender difference they found is important because heart disease is the biggest killer of women, as well as men, and "we are still learning a lot about how relationship factors and emotional distress are related to heart disease."

Smith, who is heading a larger University of Utah study on the role of marriage quality in heart disease, says it's too soon to conclude that stress may make women more vulnerable to physical problems than men, but that's what this latest research suggests.

However, he adds, "it's a little premature to say they would lower their risk of heart disease if they improved the tone and quality of their marriages, or dumped their husbands."

Other studies, he says, are trying to determine whether improving marriage might boost the health of marital partners.

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