Journal of Behavioral Medicine

, Volume 38, Issue 3, pp 497–506 | Cite as

Marital quality, depressive symptoms, and the metabolic syndrome: a couples structural model

  • Nancy J. M. HenryEmail author
  • Timothy W. Smith
  • Jonathan Butner
  • Cynthia A. Berg
  • Kelsey K. Sewell
  • Bert N. Uchino


The indirect association of marital quality with metabolic syndrome (MetS) through depressive symptoms was examined in 301 middle-aged and older couples. MetS components (i.e., waist circumference, blood pressure, blood draws to assess triglycerides, HDL cholesterol, and fasting glucose) were assessed following a 12-h fast, and were treated as a continuous latent variable for analyses. In structural equation modeling of this indirect effect, overall model fit was good, and husbands’ and wives’ marital quality was associated with MetS only through depressive symptoms. Joint tests of the parameters indicated that gender did not moderate this association. The best fitting, most parsimonious model, after nested model comparisons, was one in which husbands’ and wives’ indirect paths were equated. Overall, marital quality was related to MetS through its relationship to depressive symptoms for men and women. Associations of marital quality and depression with MetS may overlap, and couple-based approaches to psychosocial risk factors for cardiovascular disease may be useful in future research.


Metabolic syndrome Marital quality Depression 



Supported by NIH Grant No. AG018903 awarded to Timothy W. Smith.

Conflict of interest

Nancy J.M. Henry, Timothy W. Smith, Jonathan Butner, Cynthia A. Berg, Kelsey K. Sewell, and Bert N. Uchino declare that they have no conflict of interest.

Human and animal rights and Informed Consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Utah Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all patients for being included in the study.


  1. Beach, S. R., Katz, J., Kim, S., & Brody, G. H. (2003). Prospective effects of marital satisfaction on depressive symptoms in established marriages: A dyadic model. Journal of Social and Personal Relationships, 20, 355–371.CrossRefGoogle Scholar
  2. Bentler, P. M. (1990). Fit indexes, Lagrange multipliers, constraint changes and incomplete data in structural model. Multivariate Behavioral Research, 25, 163–172.CrossRefGoogle Scholar
  3. Bjorntorp, P. R., & Rosmond, R. (2000). The metabolic syndrome: A neuroendocrine disorder? The British Journal of Nutrition, 83, S49–S57.CrossRefPubMedGoogle Scholar
  4. Bradbury, T. N., Fincham, F. S., & Beach, S. R. (2000). Research on the nature and determinants of marital satisfaction. Journal of Marriage and the Family, 62, 964–980.CrossRefGoogle Scholar
  5. Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. Bollen & J. S. Long (Eds.), Testing structural equation models (pp. 136–162). Newbury Park: Sage.Google Scholar
  6. Davila, J., Karney, B. R., Hall, T. W., & Bradbury, T. N. (2003). Depressive symptoms and marital satisfaction: Within-subject associations and the moderating effects of gender and neuroticism. Journal of Family Psychology, 17, 557–570.CrossRefPubMedGoogle Scholar
  7. De Vogli, R., Chandola, T., & Marmot, M. G. (2007). Negative aspects of close relationships and heart disease. Archives of Internal Medicine, 167, 1951–1957.CrossRefPubMedGoogle Scholar
  8. Eckel, R. H., Grundy, S. M., & Zimmet, P. Z. (2005). The metabolic syndrome. Lancet, 365, 1128–1145.CrossRefGoogle Scholar
  9. Fincham, F. D. (1985). Attribution processes in distressed and nondistressed couples: Responsibility for marital problems. Journal of Abnormal Psychology, 94, 183–190.CrossRefPubMedGoogle Scholar
  10. Folkow, B. (1982). Physiological aspects of primary hypertension. Physiological Review, 62, 384–505.Google Scholar
  11. Goldbacher, E. M., & Matthews, K. A. (2007). Are psychological characteristics related to risk of metabolic syndrome? A review of the literature. Annals of Behavioral Medicine, 34, 240–252.CrossRefPubMedGoogle Scholar
  12. Golding, J. M., & Aneshensel, C. S. (1989). Factor structure of the Center for Epidemiologic Studies Depression Scale among Mexican Americans and non-Hispanic Whites. Psychological Assessment, 1, 163–168.CrossRefGoogle Scholar
  13. Grundy, S. M., Brewer, H. B., Cleeman, J. I., Smith, S. C., & Lenfant, C. (2004). Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation, 109, 433–438.CrossRefPubMedGoogle Scholar
  14. Henry, N. J. M., Berg, C. A., Smith, T. W., & Florsheim, P. (2007). Positive and negative characteristics of marital interaction and their association with marital satisfaction in middle-aged and older couples. Psychology and Aging, 22, 428–441.CrossRefPubMedGoogle Scholar
  15. Hyde, J. S. (2014). Gender differences and similarities. Annual Review of Psychology, 65, 373–398.CrossRefPubMedGoogle Scholar
  16. Kahn, R., Buse, J., Ferrannini, E., et al. (2005). The metabolic syndrome: Time for a critical appraisal: Joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care, 28, 2289–2304.CrossRefPubMedGoogle Scholar
  17. Kiecolt-Glaser, J. K., McGuire, L., Robles, T. F., & Glaser, R. (2002). Emotions, morbidity and mortality: New perspectives from psychoneuroimmunology. Annual Review of Psychology, 53, 83–107.CrossRefPubMedGoogle Scholar
  18. Kiecolt-Glaser, J. K., & Newton, T. L. (2001). Marriage and health: His and hers. Psychological Bulletin, 127, 472–503.CrossRefPubMedGoogle Scholar
  19. Lewinsohn, P. M., Seeley, J. R., Roberts, R. E., & Allen, N. B. (1997). Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychology and Aging, 12, 277–287.CrossRefPubMedGoogle Scholar
  20. Locke, J. J., & Wallace, K. M. (1959). Short marital adjustment and prediction tests: Their reliability and validity. Marriage and Family Living, 21, 251–255.CrossRefGoogle Scholar
  21. Lockhard, G., MacKinnon, D. P., & Ohlrich, V. (2011). Mediation analysis in psychosomatic medicine research. Psychosomatic Medicine, 73, 29–43.CrossRefGoogle Scholar
  22. Low, C. A., Thurston, R. C., & Matthews, K. A. (2010). Psychosocial factors in the development of heart disease in women: Current research and future directions. Psychosomatic Medicine, 72, 842–854.CrossRefPubMedCentralPubMedGoogle Scholar
  23. MacCallum, R. C., Zhang, S., Preacher, K. J., & Rucker, D. D. (2002). On the practice of dichotomization of quantitative variables. Psychological Methods, 7, 19–40.CrossRefPubMedGoogle Scholar
  24. Macchia, A., Levantesi, G., Borrelli, G., et al. (2006). A clinically practicable diagnostic score for metabolic syndrome improves its predictivity of diabetes mellitus: The Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico (GISSI)-Prevenzione scoring. American Heart Journal, 151, e7–e17.CrossRefPubMedGoogle Scholar
  25. Martire, L. M., Schulz, R., Helgeson, V. H., Small, B. J., & Saghafi, E. M. (2010). Review and meta-analysis of couple-oriented interventions for chronic illness. Annals of Behavioral Medicine, 40, 325–342.CrossRefPubMedCentralPubMedGoogle Scholar
  26. Matthews, K. A., Woodall, K. L., & Allen, M. T. (1993). Cardiovascular reactivity to stress predicts future blood pressure status. Hypertension, 22, 479–485.CrossRefPubMedGoogle Scholar
  27. Maxwell, S. E., & Cole, D. A. (2007). Bias in cross-sectional analyses of longitudinal mediation. Psychological Methods, 12, 23–44.CrossRefPubMedGoogle Scholar
  28. Muthén, L. K., & Muthén, B. O. (1998–2010). Mplus user’s guide (6th ed.). Los Angeles, CA: Muthén & Muthén.Google Scholar
  29. Nicholson, A., Kuper, H., & Hemingway, H. (2006). Depression as an etiologic and prognostic factor in coronary heart disease: A meta-analysis of 6362 events among 146,538 participants in 54 observational studies. European Heart Journal, 27, 2763–2774.CrossRefPubMedGoogle Scholar
  30. Orth-Gomer, K., Wamala, S. P., Horsten, M., Schenck-Gustafsson, K., Schneiderman, N., & Mittleman, M. A. (2000). Marital stress worsens prognosis in women with coronary heart disease: The Stockholm Female Coronary Risk Study. Journal of the American Medical Association, 284, 3008–3014.CrossRefPubMedGoogle Scholar
  31. Pierce, G. R., Sarason, B. R., Sarason, I. G., Solky-Butzel, J. A., & Nagle, L. C. (1997). Assessing the quality of personal relationships. Journal of Social and Personal Relationships, 14, 339–356.CrossRefGoogle Scholar
  32. Pladevall, M., Singal, B., William, L. K., Brotons, C., Guyer, H., Sadurni, J., … Haffner, S. (2006). A single factor underlies the metabolic syndrome: A confirmatory factor analysis. Diabetes Care, 29, 113–122.Google Scholar
  33. Pulkki-Raback, L., Elovainio, M., Mattsson, N., Raitakari, O. T., Marniemi, J., Kivimaki, M., et al. (2009). Depressive symptoms and the metabolic syndrome in childhood and adulthood: A prospective cohort study. Health Psychology, 28, 108–116.CrossRefPubMedCentralPubMedGoogle Scholar
  34. Radloff, L. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
  35. Radloff, L., & Teri, L. (1986). Use of the center for epidemiological studies-depression scale with older adults. Clinical Gerontologist, 5, 119–136.CrossRefGoogle Scholar
  36. Raikkonen, K., Kajantie, E., Rautanen, A., & Eriksson, J. G. (2008). Metaboloc syndrome. In L. J. Luecken & L. C. Gallo (Eds.), Handbook of physiological research methods in health psychology (pp. 299–322). Thousand Oaks, CA: Sage.CrossRefGoogle Scholar
  37. Reed, R. G., Butler, E. A., & Kenny, D. A. (2013). Dyadic models for the study of health. Social and Personality Psychology Compass, 7, 228–245.CrossRefGoogle Scholar
  38. Robles, T. F., Slatcher, R. B., Trombello, J. M., & McGinn, M. M. (2014). Marital quality and health: A meta-analytic review. Psychological Bulletin, 140, 140–187.CrossRefPubMedGoogle Scholar
  39. Rohrbaugh, M., Shoham, V., & Coyne, J. (2006). Effect of marital quality on eight-year survival of heart patients with heart failure. American Journal of Cardiology, 98, 1069–1072.CrossRefPubMedGoogle Scholar
  40. Santos, A. C., Lopes, C., Guimaraes, J. T., & Barros, H. (2005). Central obesity as a major determinant of increased high-sensitivity C-reactive protein in metabolic syndrome. International Journal of Obesity, 29, 1452–1456.CrossRefPubMedGoogle Scholar
  41. Schmidt, J. A., Wagner, C. C., & Kiesler, D. J. (1999). Psychometric and circumplex properties of the octant scale impact message inventory (IMI-C): A structural evaluation. Journal of Counseling Psychology, 46, 325–334.CrossRefGoogle Scholar
  42. Shen, B.-J., Todaro, J. F., Niaura, R., McCaffery, J. M., Zhang, J., Spiro, A., & Ward, K. (2003). Are metabolic risk factors one unified syndrome? Modeling the structure of the metabolic syndrome X. American Journal of Epidemiology, 157, 701–711.CrossRefPubMedGoogle Scholar
  43. Smith, T. W., Baron, C. E., & Grove, J. L. (2014). Personality, emotional adjustment, and cardiovascular risk: Marriage as a mechanism. Journal of Personality, 82, 502–514.CrossRefPubMedGoogle Scholar
  44. Smith, T. W., & Cundiff, J. M. (2011). An interpersonal perspective on risk for coronary heart disease. In L. M. Horowitz & S. Strack (Eds.), Handbook of interpersonal psychology: Theory, research, assessment, and therapeutic interventions (pp. 471–489). Hoboken, NJ: Wiley.Google Scholar
  45. Smith, T. W., Glazer, K., Ruiz, J. M., & Gallo, L. C. (2004). Hostility, anger, aggressiveness, and coronary heart disease: An interpersonal perspective on personality, emotion, and health. Journal of Personality, 72, 1217–1270.CrossRefPubMedGoogle Scholar
  46. Smith, T. W., Traupman, E., Uchino, B. N., & Berg, C. A. (2010). Interpersonal circumplex descriptions of psychosocial risk factors for physical illness: Application to hostility, neuroticism, and marital adjustment. Journal of Personality, 78, 1011–1036.CrossRefPubMedGoogle Scholar
  47. Smith, T. W., Uchino, B., Berg, C., Florsheim, P., Pearce, G., Hawkins, M., et al. (2009). Conflict and collaboration in middle-aged and older couples: II. Cardiovascular reactivity during marital interaction. Psychology and Aging, 24, 274–286.CrossRefPubMedGoogle Scholar
  48. Smith, T. W., Uchino, B. N., Berg, C. A., Florsheim, P., Pearce, G., Hawkins, M., & Yoon, H. C. (2007). Hostile personality traits and coronary artery calcification in middle-aged and older married couples: Different effects for self-reports versus spouse-ratings. Psychosomatic Medicine, 69, 441–448.CrossRefPubMedGoogle Scholar
  49. Snyder, D. K., Heyman, R. E., & Haynes, S. N. (2005). Evidence-based approaches to assessing couple distress. Psychological Assessment, 17, 288–307.CrossRefPubMedGoogle Scholar
  50. Troxel, W., Matthews, K. A., Gallo, L. C., & Kuller, L. H. (2005). Marital quality and the occurence of the metabolic syndrome in women. Archives of Internal Medicine, 165, 1022–1027.CrossRefPubMedGoogle Scholar
  51. Weihs, K. L., Enright, T. M., & Simmens, S. J. (2008). Close relationships and emotional processing predict decreased mortality in women with breast cancer: Preliminary evidence. Psychosomatic Medicine, 70, 117–124.CrossRefPubMedGoogle Scholar
  52. Whisman, M. A. (2001). The association between depression and marital dissatisfaction. In S. R. H. Beach (Ed.), Marital and family processes in depression: A scientific foundation for clinical practice (pp. 3–24). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  53. Whisman, M. A., & Bruce, M. I. (1999). Marital distress and incidence of major depressive episode in a community sample. Journal of Abnormal Psychology, 108, 674–678.CrossRefPubMedGoogle Scholar
  54. Whisman, M. A., & Uebelacker, L. A. (2009). Prospective associations between marital discord and depressive symptoms in middle-aged and older adults. Psychology and Aging, 24, 184–189.CrossRefPubMedGoogle Scholar
  55. Whisman, M. A., & Uebelacker, L. A. (2012). A longitudinal invesitgation of marital adjustment as a risk factor for metabolic syndrome. Health Psychology, 31, 80–86.CrossRefPubMedGoogle Scholar
  56. Whisman, M. A., Uebelacker, L. A., & Settles, T. D. (2010). Marital distress and the metabolic syndrome: Linking social functioning with physical health. Journal of Family Psychology, 24, 367–370.CrossRefPubMedGoogle Scholar
  57. Widaman, K. E., & Reise, S. P. (1995). Exploring the measurement invariance of psychological instruments: Applications in the substance abuse domain. In K. J. Bryant, M. Windle, & S. G. West (Eds.), The science of prevention. Methodoligical advances from alcohol and substance abuse research (pp. 281–324). Washington, DC: American Psychological Association.Google Scholar
  58. Wilson, P. W., D’Agostino, R. B., Parise, H., et al. (2005). Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation, 112, 3066–3072.CrossRefPubMedGoogle Scholar
  59. Wong, Y. I. (2000). Measurement properties of the Center for Epidemiologic Studies-Depression Scale in a homeless population. Psychological Assessment, 12, 69–76.CrossRefPubMedGoogle Scholar
  60. Yuan, K., & Bentler, P. M. (2000). Three likelihood-based methods for mean and covariance structure analysis with nonnormal missing data. Sociological Methodology, 30, 167–202.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Nancy J. M. Henry
    • 1
    Email author
  • Timothy W. Smith
    • 1
    • 2
  • Jonathan Butner
    • 1
    • 2
  • Cynthia A. Berg
    • 1
    • 2
  • Kelsey K. Sewell
    • 1
    • 2
  • Bert N. Uchino
    • 1
    • 2
  1. 1.Division of Physical Medicine and Rehabilitation, University Health CareUniversity of Utah School of MedicineSalt Lake CityUSA
  2. 2.Department of PsychologyUniversity of UtahSalt Lake CityUSA

Personalised recommendations