Improve Your Marriage -- Or Else

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June 10, 2000 (San Antonio) -- Jack Sprat could eat no fat, and his wife was really mean.

Poor Jack could be looking at some heavy-duty health problems. According to research presented Saturday at the annual meeting of the American Diabetes Association, high levels of marital stress can double your risk of developing diabetes.

The researchers looked at thousands of people who took part in the San Antonio Heart Study between 1984-88 and found that 15% of the ones in stressful marriages developed diabetes over the course of eight years. Only 7-8% of people in happier marriages became diabetic during the same time period, says lead researcher Sharon Fowler, MD.

And surprisingly, marital stress was found to play a bigger role in whether a person developed diabetes than did that person's family medical history. In fact, high stress at home was almost as important a factor as high blood pressure.

"Our results suggest that in addition to looking at height, weight, glucose levels, cholesterol levels, blood pressure, and other more traditional risk factors for diabetes, perhaps it would also be wise to look at stress levels, especially in people who are at high risk for developing diabetes," says Fowler, who is a member of the department of medicine at the University of Texas, San Antonio.

"The findings came as a little bit of a surprise," she adds, saying they thought that perhaps some hidden, contributing element could explain the startling results.

"But after adjusting for other factors," she says, "the effect of marital stress on diabetes risk was still significant. Also, the population was ethnically diverse. As a result, we think there is something real going on here."

The findings came from a study of 2,941 people, all between 25-64 years old. They were recruited for the study from three ethnically defined areas of San Antonio: a mostly Mexican-American barrio, mostly nonHispanic white suburbs, and a transitional area that is half Mexican-American and half nonHispanic white.

At the beginning of the study, 2,569 of the people were free of diabetes. Seven to 8 years later, 1,733 of them came back for a follow-up evaluation. Of that group, about 1,250 people indicated they were married or in long-term relationships.

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At entry and at follow-up, all study participants had physical examinations and laboratory tests to evaluate blood glucose levels and determine if they had diabetes or not. In addition, they completed three different questionnaires that asked about stress in their life, including one questionnaire specific to marital stress. The highest possible score on the marital stress questionnaire was 36, and the lowest possible score was 9.

The group with scores between 23-36, indicating high levels of stress, had twice the rate of diabetes than the group with scores from 9-22.

Marital stress remained a significant risk factor for diabetes after the researchers took into account the effects of age, obesity, ethnicity, neighborhood type, family history of diabetes, cholesterol levels, and blood pressure.

Fowler cautioned against drawing the wrong conclusions from the findings.

"One of the messages we would not want people to take away from this study is that if a person is in a high stress marriage, the person should jettison marriage to save his or her blood glucose levels," she says. "In fact, both ethics and facts would argue in favor of staying in the marriage.

"In our study, being single was a risk factor itself, except in people who had never been married," she says. "The data would suggest that working to improve and heal the marriage, and working on other diabetes risk factors, would be a better strategy."

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