Personality, emotional adjustment, and cardiovascular risk: marriage as a mechanism.

A variety of aspects of personality and emotional adjustment predict the development and course of coronary heart disease (CHD), as do indications of marital quality (e.g., satisfaction, conflict, strain, disruption). Importantly, the personality traits and aspects of emotional adjustment that predict CHD are also related to marital quality. In such instances of correlated risk factors, traditional epidemiological and clinical research typically either ignores the potentially overlapping effects or examines independent associations through statistical controls, approaches that can misrepresent the key components and mechanisms of psychosocial effects on CHD. The interpersonal perspective in personality and clinical psychology provides an alternative and integrative approach, through its structural and process models of interpersonal behavior. We present this perspective on psychosocial risk and review research on its application to the integration of personality, emotional adjustment, and marital processes as closely interrelated influences on health and disease.

PTSD in veterans, couple behavior, and cardiovascular response during marital conflict.

Posttraumatic stress disorder (PTSD) is associated with strain in marriage and similar intimate relationships, and such difficulties could contribute to associations of PTSD with risk of cardiovascular disease (CVD). Heightened cardiovascular reactivity (CVR) during stressful marital interactions may be an important mechanism in this regard. This study examined dysfunctional behavior during marital conflict as a mediator of the association of PTSD with heightened CVR during these interactions. In 64 couples comprising male military veterans and female partners, participants underwent a 17-min video-recorded conflict discussion, with assessment of blood pressure and cardiac sympathetic activation (i.e. preejection period). In half of the couples, veterans met interview and questionnaire criteria for PTSD. Behavior was coded for aspects of affiliation (e.g., warmth vs. hostility) and control (e.g., dominance vs. deference), as well as blends of these broader dimensions. Extending previous reports from this study, actor-partner mediational analyses indicated that PTSD contributed to larger increases in veterans' and spouses' systolic blood pressure during the interaction through effects of the individual's own expressions of low warmth. PTSD contributed to veterans' and spouses' greater cardiac sympathetic activation through effects of the individual's own expressions of hostile control (e.g., blame, criticism). Hence, expressions of low warmth and high hostile control contribute to effects of PTSD on veterans' and spouses' heightened CVR during marital conflict discussions, suggesting a mechanism linking PTSD with CVD risk and potential targets for risk-reducing behavioral interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Is it me or you? Marital conflict behavior and blood pressure reactivity.

Cardiovascular reactivity (CVR), such as increases in blood pressure, during stressful marital interactions have been identified as a possible mechanism linking marital discord with cardiovascular disease (CVD). Both expressions of and exposure to negative behavior during marital conflict may influence CVR, but analytic approaches to date have not permitted firm conclusions as to whether CVR during conflict reflects an individual's own actions, actions of the spouse, or both. Additionally, evidence suggests health-relevant marital interaction varies along the affiliation dimension (i.e., warmth vs. hostility) and control dimension (i.e., dominance vs. submissiveness) of social behavior, but there is much less research on the latter. To address these issues, the present study used the Actor-Partner Interdependence Model (APIM) to examine associations of behavioral measures of affiliation and control with concurrent changes in blood pressure (i.e., CVR) during a marital conflict discussion in 146 middle-aged couples. Factor analyses of observer-coded behaviors during conflict discussions revealed a single factor for husbands and for wives, characterized by high hostility and dominance, and low warmth. The validity of these behavioral factors was supported by their predicted associations with spouse ratings of behavior during the conflict discussions, concurrent increases in anger, and reports of overall marital quality. Although expression of and exposure to negative conflict behaviors were correlated, only expression independently predicted increases in blood pressure. Exposure to negative partner behavior might alter other elements of physiological burden contributing to CVD risk, but the individual's own behavioral expressions are more closely associated with concurrent blood pressure reactivity. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Relationship partner social behavior and continuous positive airway pressure adherence: The role of autonomy support.

OBJECTIVE: Obstructive sleep apnea (OSA), a serious respiratory disorder, confers increased risk of cardiovascular disease and mortality. Adherence to the standard and effective treatment, continuous positive airway pressure (CPAP), is often poor. Personal relationships can influence adherence, but some forms of partner involvement (e.g., support, encouragement) have positive effects on CPAP adherence, whereas others (e.g., criticism, blame) are counterproductive. In the former, constructive partner efforts may enhance a patient's sense of autonomy, an important foundation for self-care. The present study examined how patients' perceptions of autonomy support from an intimate partner predict adherence to CPAP, and whether it is an independent predictor, relative to generally positive partner behavior (i.e., partner responsiveness) and partner negativity (i.e., negative social control). METHOD: Ninety-two married or cohabiting OSA patients (mean age 49.7 years) completed measures of perceived partner autonomy support, responsiveness, and negative social control at Days 14 and 60 of CPAP treatment. Objective daily CPAP machine adherence data were collected for 60 days. RESULTS: Perceived partner autonomy support predicted more minutes of CPAP used per night and increasing CPAP use over time. These effects were independent of the significant adverse effects of partner negative social control and the more limited beneficial effects of partner responsiveness. CONCLUSION: The study findings establish perceived partner autonomy support as an interpersonal predictor of adherence that is independent of negative social control and perceived partner responsiveness, and may inform psychosocial interventions for CPAP adherence and more general couple approaches to chronic illness management. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Hierarchy and health: Physiological effects of interpersonal experiences associated with socioeconomic position.

OBJECTIVE: The inverse association between socioeconomic position (SEP) and cardiovascular disease may involve social psychophysiological processes. To test effects of aspects of SEP on physiological reactivity, we experimentally manipulated 3 features of social context related to social hierarchy-social rank or status relative to an interaction partner, the partner's degree of dominant behavior, and the presence of social-evaluative threat. METHOD: The study design was a 2 × 2 × 2 × 2 (Participant Relative Status [high vs. low] × Partner Dominance [high vs. low] × Evaluative Threat [high vs. low] × Sex [male vs. female]) factorial, and 180 undergraduates participated. Cardiovascular and salivary cortisol responses were measured while participants engaged in a controlled interaction task with a prerecorded confederate partner. RESULTS: Lower participant relative status resulted in greater increases in systolic (SBP) and diastolic blood pressure (DBP). Interacting with a more dominant partner resulted in greater increases in SBP and heart rate (HR), and larger changes in cardiac sympathetic and parasympathetic activation. Higher levels of social-evaluative threat evoked larger increases in HR and SBP. In some cases, these effects were stronger in men than in women, and aspects of the low status social context had synergistic effects on some physiological outcomes. CONCLUSION: Interpersonal interactions and experiences may contribute to the association between SEP and cardiovascular health through the mechanism of physiological activation. Recurring patterns of everyday social experiences and their physiological effects may be a pathway linking the broader social context to cardiovascular disease. (PsycINFO Database Record

Getting along and getting ahead: Affiliation and dominance predict ambulatory blood pressure.

OBJECTIVE: Based in interpersonal theory, the present study tested associations of trait affiliation (i.e., warmth vs. hostility) and control (i.e., dominance vs. submissiveness) with ambulatory blood pressure (ABP) and momentary affective experiences. METHODS: Ninety-four married couples (mean age 29.6) completed trait affiliation and control measures, and a 1-day protocol with random interval-contingent measurements of ABP and affective experience. RESULTS: Higher trait control (i.e., dominance) predicted higher systolic and diastolic blood pressure (SBP, DBP) in men, but not in women. For both men and women, high affiliation predicted lower SBP. These associations occurred within individuals (i.e., actor effects) but not between spouses (i.e., partner effects). Dominance and affiliation also predicted momentary affect. CONCLUSIONS: Associations of dominance and affiliation with ABP may indicate a mechanism by which trait social behavior influences CVD risk. These findings also illustrate the interpersonal perspective as an integrative framework for research on psychosocial risk for CVD.