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Original Article
December 2005

Hostile Marital Interactions, Proinflammatory Cytokine Production, and Wound Healing

Author Affiliations

Author Affiliations: Departments of Psychiatry (Dr Kiecolt-Glaser) and Internal Medicine (Drs Malarkey and Glaser), Institute for Behavioral Medicine Research (Drs Kiecolt-Glaser, Malarkey, Lemeshow, and Glaser), Comprehensive Cancer Center (Drs Malarkey and Glaser), School of Public Health (Dr Lemeshow), and Center for Biostatistics (Dr Lemeshow and Ms Dickinson), Ohio State University, Columbus; Department of Human Ecology, University of Texas, Austin (Dr Loving); Department of Psychology, Eastern Illinois University, Charleston (Dr Stowell).

Arch Gen Psychiatry. 2005;62(12):1377-1384. doi:10.1001/archpsyc.62.12.1377

Context  A growing epidemiological literature has suggested that marital discord is a risk factor for morbidity and mortality. In addition, depression and stress are associated with enhanced production of proinflammatory cytokines that influence a spectrum of conditions associated with aging.

Objective  To assess how hostile marital behaviors modulate wound healing, as well as local and systemic proinflammatory cytokine production.

Design and Setting  Couples were admitted twice to a hospital research unit for 24 hours in a crossover trial. Wound healing was assessed daily following research unit discharge.

Participants  Volunteer sample of 42 healthy married couples, aged 22 to 77 years (mean [SD], 37.04 [13.05]), married a mean (SD) of 12.55 (11.01) years.

Interventions  During the first research unit admission, couples had a structured social support interaction, and during the second admission, they discussed a marital disagreement.

Main Outcome Measures  Couples’ interpersonal behavior, wound healing, and local and systemic changes in proinflammatory cytokine production were assessed during each research unit admission.

Results  Couples’ blister wounds healed more slowly and local cytokine production (IL-6, tumor necrosis factor α, and IL-1β) was lower at wound sites following marital conflicts than after social support interactions. Couples who demonstrated consistently higher levels of hostile behaviors across both their interactions healed at 60% of the rate of low-hostile couples. High-hostile couples also produced relatively larger increases in plasma IL-6 and tumor necrosis factor α values the morning after a conflict than after a social support interaction compared with low-hostile couples.

Conclusions  These data provide further mechanistic evidence of the sensitivity of wound healing to everyday stressors. Moreover, more frequent and amplified increases in proinflammatory cytokine levels could accelerate a range of age-related diseases. Thus, these data also provide a window on the pathways through which hostile or abrasive relationships affect physiological functioning and health.