Hostile marital interactions, proinflammatory cytokine production, and wound healing

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 alpha, and IL-1 beta) 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 a 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.