Academic journal article Journal of Marriage and Family

Family Influence on Physical Health during the Middle Years: The Case of Onset of Hypertension

Academic journal article Journal of Marriage and Family

Family Influence on Physical Health during the Middle Years: The Case of Onset of Hypertension

Article excerpt

Using survival analysis for 367 married women and 340 married men, this article investigates (a) change in hazard rates and survival probabilities with age for the onset of hypertension and (b) the influences of stressful marital and parental relationships on the hazard rates and survival probabilities of hypertension. Hazard and survival plots show that the risk for hypertension increases during the middle years to maximum, then decreases with age for both men and women. Log-- logistic survival models demonstrate that although marital stress significantly increases the likelihood of earlier hypertension among these long-- time married men and women, parental stress increases the likelihood of earlier hypertension only for women. These models control for the effects of stressful work conditions, health behaviors, hostility, and education. Employing a longitudinal research design strengthens confidence in the findings. The findings demonstrate that stressful close relationships may be more important determinants of physical health than is generally assumed.

Key Words: family, middle years, physical health.

The middle years in the lives of many men and women are marked by the onset of chronic health conditions. Although these conditions show up with increasing frequency as the body ages, there is still considerable heterogeneity in the timing of their onset. For some, chronic conditions show up early in the middle years; for others, not until late in the middle years; for still others, not at all. This heterogeneity in timing of chronic conditions may be attributable, at least in part, to variability in the level of exposure and reactivity to stressful life conditions.

A growing body of socioepidemiological research provides evidence that health conditions are sensitive to social stressors in general terms (House et al., 1994), but this research lacks specificity in linking the health conditions of men and women to stressors. One specific source of stress is the family; and one health condition that deserves particular attention in the middle years is hypertension, a major chronic condition that puts people at risk for cardiovascular diseases, which are responsible for one third of U.S. yearly deaths (Krantz et al., 1991). The onsets of chronic conditions such as hypertension begin to occur in the middle years because of both increased impact of psychosocial risk factors and increased biological vulnerability with age (House et al.).

This study links the timing of the onset of hypertension to troubled family relationships. In addition, we examine the differential impact of these family stressful conditions for wives and husbands.


Both physiological experiments and socioepidemiological research provide strong evidence linking stressful environmental and life situations to health conditions. First, using laboratory experiments, physiologists have demonstrated that stressful environmental conditions exert direct deleterious effects on the biological processes of organisms. They have observed that when confronted with a stressful situation, the brain of an organism causes the secretion of corticotrophinreleasing hormones from the adrenal gland and adrenocorticortrophic hormones from pituitary glands. These hormones trigger the production of cortisol. Cortisol at first sustains the stress response and later slows it down so the body can return to normal functioning. When the source of stress is chronic, however, excessive production of cortisol may produce a sustained level of elevated blood pressure or hypertension (Harvard Medical School Health Publications Group, 1998, p. 3). In addition, this hormonal process contributes to immune changes that might alter susceptibility to immune-mediated diseases (Herbert et al., 1994). Although these observations have been made in laboratory settings with animals in interaction with the physical environment, there are good reasons to believe that these mechanisms also extend to human beings and their social environment (Cohen, Kessler, & Gordon, 1995). …

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