This review focuses on the pathway leading from the marital relationship to physical health. Evidence from 64 articles published in the past decade, particularly marital interaction studies, suggests that marital functioning is consequential for health; negative dimensions of marital functioning have indirect influences on health outcomes through depression and health habits, and direct influences on cardiovascular, endocrine, immune, neurosensory, and other physiological mechanisms. Moreover, individual difference variables such as trait hostility augment the impact of marital processes on biological systems. Emerging themes in the past decade include the importance of differentiating positive and negative dimensions of marital functioning, the explanatory power of behavioral data, and gender differences in the pathways from the marital relationship to physiological functioning. Contemporary models of gender that emphasize self-processes, traits, and roles furnish alternative perspectives on the differential costs and benefits of marriage for men's and women's health.

The health-enhancing properties of personal relationships have been repeatedly documented. Data from well-controlled epidemiological studies suggest that social isolation constitutes a major risk factor for morbidity and mortality, with statistical effect sizes comparable to those of such well-established health risk factors as smoking, blood pressure, blood lipids, obesity, and physical activity (House, Landis, & Umberson, 1988). Marriage is the central relationship for a majority of adults, and morbidity and mortality are reliably lower for the married than the unmarried across a variety of acute and chronic conditions, including such diverse health threats as cancer, heart attacks, and surgery (Chandra, Szklo, Goldberg, & Tonascia, 1983; J. S. Goodwin, Hunt, Key, & Samet, 1987; Gordon & Rosenthal, 1995; House et al., 1988). The two major hypotheses for these disparities are selection and protection, that is,...