Health concordance within couples: A systematic review
Introduction
Substantial research has connected marriage to positive physical and mental health outcomes and to positive health behaviors. The connection between spouses and their similar health statuses refers to concordance and there are two primary ways of assessing concordance. First, researchers can determine the level of correlation of health among spouses. Second, researchers can investigate whether the health characteristics of one spouse influence the same characteristics of the other spouse.
Research on marital concordance of health began with a general question around the role of genetics (Johnson, Epstein, & Kjelsberg, 1965). Early studies explored nature verses nurture for familial concordance. Many approached this question by comparing parents with children (Mayo, Fraser, & Stamatoyannopoulos, 1969; Schaefer, Adlersberg, & Steinberg, 1958). Spouses were analyzed too, but only to show that children were concordant (Johnson et al., 1965; Martin, Kurczynski, & Steinberg, 1973; Mayo et al., 1969; Mjøs, Thelle, Førde, & Vik-Mo, 1977). Studies also found that father–son and mother–daughter pairs were most similar (Johnson et al., 1965). Consequently, there was strong evidence for genetic influence. However, genetics did not explain all of the similarity, and shared environment was pointed to as a source of additional influence.
There were a few studies that explored concordance among spouses and found that as couples got older, their concordance increased (Cheraskin & Ringsdore, 1970; Cheraskin et al., 1968; Johnson et al., 1965). Early studies examined neurosis concordance (Buck, & Ladd, 1965; Hare & Shaw, 1965; Ovenstone, 1973; Pond, Ryle, & Hamilton, 1963; Ryle & Hamilton, 1962) or mental illness/disorder concordance (Kreitman (1962), Kreitman (1964); Nielsen, 1964; Penrose, 1944). However, much of the evidence on concordance was mixed, leading to debates on whether or not the driving force behind findings was simply that spouses marry those similar to themselves (du Fort, Bland, Newman, & Boothroyd, 1998; Gregory, 1959; Hagnell & Kreitman, 1974; Hall, Baldwin, & Robertson, 1971; Heun, & Maier, 1993; Kreitman, 1968; Maes et al., 1998). There was little discussion of spouse health concordance through the 1970s (Garrison, et al. 1979), but by the 1980s, researchers began to recognize spouse concordance in health.
Section snippets
Theories of concordance
Several theories have been proposed to explain concordance. Assortative mating refers to the idea that individuals are more likely to marry people who share similar characteristics such as demographics, attitudes, and behaviors (Lillard & Panis, 1996). Another hypothesis accounting for similarities in health behavior and health is referred to as the shared resource hypothesis (Smith & Zick, 1994), which suggests that when people marry, they share the same environment, financial resources, and
Methods
We identified studies on health concordance through a systematic search of scholarly databases, reference mining, and speaking with concordance researchers. We collected peer-reviewed literature based on the following criteria:
- 1.
Article had to explore mental health, physical health, or health behaviors.
- 2.
Health of the couple had to be the focus of the study.
- 3.
Couple defined as legally married or cohabiting (to include life partners).
- 4.
Both members of the couple were interviewed separately.
- 5.
Study sought
Concordance of mental health
Mental health concordance has been explored more than physical health or health behaviors, with much of the research focusing on depressive symptoms. Well-being studies have also been conducted, and a few studies that focus on additional aspects of mental health have been published (Table 1).
Concordance of physical health
Questions about genetics inspired early research into physical health concordance, but subsequent studies have focused primarily on cardiovascular health. The most heavily explored area of physical health research has been in the area of heart disease including blood pressure and other risk factors. Other physical health research can be categorized as exploring other various chronic diseases (Table 2).
Concordance of health behaviors
Studies exploring mental health and physical health concordance within couples can be found beginning in the 1940s. In contrast, the first study on health behavior concordance was published in 1980. In addition, fewer health behavior concordance studies were identified. Studies dealing with intake, such as diet, smoking, alcohol use, and illegal drug use, were the most common among research on health behavior concordance (Table 3).
The first article on health behaviors that fit our study
Conclusion
Although there is a long history of health concordance research among a variety of disciplines, there had not been a systematic review of the literature. We systematically reviewed 103 studies about concordance of mental health, physical health, and health behaviors among spouses. Most of the research is concentrated in mental health and cardiovascular disease. Nearly all studies find consistent evidence linking depressive symptoms among couples, but the evidence in other areas of health is
Acknowledgments
This manuscript was supported by grants from the National Institute on Aging (R01AG10939, R01AG021089, T32AG000270) and the National Cancer Institute (5P50CA105631) administered through the Sealy Center on Aging and the Center for Population Health and Health Disparities at the University of Texas Medical Branch.
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