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“It’s Not a Matter of Life and Death”

September 27, 2011

“It’s Not a Matter of Life and Death”

“It’s not a matter of life and death.” That’s what my mother used to say when someone would come to her with a problem they were having getting along with someone else. This was after patiently listening to the person describe their problem – a fight with a romantic partner or sibling, being left out of some social event, or occasionally even a breakup or separation. After a while, she’d say this, presumably as a well-intentioned way of encouraging her troubled confider to feel a little less sad, a little more hopeful that life will go on and that the future will be better.

But was she right? Are relationship problems really not a matter of life and death? Recently, my colleague Kathleen King and I conducted new analyses on a sample we had originally studied in the late 1980s. These were people who had had coronary artery bypass graft surgery (CABG), then the most common way of treating blockages in the major arteries of the heart. That study, published in 1993, had shown that social support – believing that friends and family were available to assist one in fulfilling important psychological needs – helped people cope with the stress of recovery from CABG. Now we were interested in something more elemental: Fifteen years later, who was still alive and who was not? And in particular, did marriage affect survival? Were happily married people more likely to be alive than their less happily married counterparts?

Our findings confirmed our hunch: 61% of people who were married at the time of their surgery were still alive, compared to only 30% of the not-married folks. This was true for both men and women, and the results held even after we controlled for important potential confounds like age, education, depressed mood, tobacco use, hypertension, and the degree of pre-surgery disease. The results were similarly striking for marital satisfaction. About one year post-surgery, we had asked our participants a simple question: what is the “degree of happiness, considering everything, of your present marriage?” Fifteen years after surgery, 83% of the happily married persons were still alive, but only 56% of those who were not happily married were still alive. Again, the results held up when potential confounds were controlled. But men and women differed here: Although marital satisfaction mattered for both men and women, it was more influential among women. Unhappily married women were only slightly more likely to still be alive than non-married women. (Other researchers have also observed this difference between men and women.)

If this were the first time that relationship success had been linked to survival, it’d be front-page news. But it turns out that this is just another example of what is by now one of the best-replicated results in the behavioral sciences. For example, in one meta-analysis that spanned 148 studies, Julianne Holt-Lunstad, Timothy Smith, and J. Bradley Layton (2010) found that people with better relationship circumstances had about a 50% greater likelihood of survival than people with poorer relationship circumstances. In another meta-analysis, David Sbarra, Rita Law, and Robert Portlet (2011) examined 32 studies comprising 160,000 deaths and over 755,000 divorces in 11 countries. Divorce revealed a significant risk of premature death among divorced and separated individuals compared to people in intact marriages. Other reviews – for example, of the effects of social isolation, social integration, and loneliness, or of survival during cancer treatment – have reached a similar conclusion: People who participate in successful relationships are less likely to die prematurely.

Given the robustness of these findings, one would think that research designed to  help people establish, maintain, and improve their relationships would have high priority for funding by the National Institutes of Health (NIH). But it doesn’t. In fact, relationship research is not even mentioned as a funding goal by most NIH programs. Of course there are lots of programs targeting other risk factors for premature mortality, such as tobacco use, alcohol abuse, and hypertension. Even though the relative risk of early death associated with lack of social integration or divorce is roughly the same as from those factors, far less research funding is dedicated to basic or translational research on relationships. Maybe this is because Congress has often singled out relationship research for criticism, such as in 1975, when Sen. William Proxmire infamously awarded the first of his Golden Fleece awards, “for wasteful, ironic or ridiculous uses of the taxpayers’ money,” to Ellen Berscheid and Elaine Hatfield, two of our field’s best scientists, for their studies of romantic love.

Why is research funding so badly needed? Despite the wealth of evidence, we don’t really know why relationship problems are associated with a risk of premature death. In other words, all that has been established is a correlation – researchers have yet to identify the mechanism(s) responsible. Correlations are useful, of course, but until a cause is convincingly established, it will be difficult to know where or how to begin interventions.

To be sure, many hypotheses have been offered. Studies examining the stress-response model have shown that relationship problems and distress create biochemical changes in the body (for example, down-regulation of the immune system and increased cardiovascular stress) that over the long term may erode the functioning of bodily systems. Another strong candidate is the teamwork approach: Relationship partners encourage each other to adopt healthier life-styles, reminding one to eat less fat, floss regularly, exercise, and use seat belts. There may be selection effects, too, such that healthier people are more likely to achieve and maintain good social relations. And finally, we shouldn’t forget the “life is good” hypothesis: Because satisfying connections with others are a wellspring of human well-being – one Time Magazine survey found that more than three-quarters of Americans nominated close relationships with friends, romantic partners, or children as their major source of happiness – relationships contribute joy and purpose to life, both factors that seem likely to foster longevity.

Incidentally, it may not be marriage per se that is responsible for these effects. Many researchers believe that what matters most is the existence of long-term, committed relationships between persons who share important life activities and help each other satisfy major psychological needs. These qualities can be found in families or among friends, although in the contemporary Western world, romantic relationships are their most common source. In principle romantic partners might not need to be legally married to obtain these benefits, but clearly our society places significant hurdles in the way of persons who seek this sort of life-partnership without marrying, or who, because of their sexual orientation, are not legally entitled to marry in 44 of these United States. How ironic that in this era of concern about the cost of health care, so many states still deny this potent health-promoting benefit to gay men and lesbians.

In short, research is surely needed to determine how these various processes play out when a person’s relationships fall short. Just as surely, research is needed on how to translate these processes into action, helping people with distressed relationships find and enhance satisfying connections with others. Notice the plural “processes” here. Given what we know already, it is very unlikely that a single cause will win out as the explanation. All of them, and undoubtedly others waiting to be discovered, will be implicated.

It turns out, then, that my mother was wrong. Over the long term, relationship problems can be a matter of life and death.


Holt-Lunstad, J., Smith, T. B., & Layton, J. B.  (2010).  Social relationships and mortality risk: A meta-analytic review.  PLoS Medicine, 7: e1000316 doi: 10.1371/journal.pmed.1000316.

King, K. B., Reis, H. T., Porter, L. A., & Norsen, L. H. (1993). Social support and long-term recovery from coronary artery surgery: Effects on patients and spouses. Health Psychology, 12, 56-63.

King, K. B., & Reis, H. T. (in press). Marriage and long-term survival after coronary artery bypass grafting. Health Psychology.

Sbarra, D. A., Law, R. W., & Portley, R. M. (2011). Divorce and death: A meta-analysis and research agenda for clinical, social, and health psychology. Perspectives on Psychological Science, 6, 454-474.


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