Loneliness, marriage and cardiovascular health

“The I in illness is isolation, and the crucial letters in wellness are we”.1 Social relationships, or the lack thereof, constitute a major psychosocial risk factor for health, rivaling the effect of well-established traditional cardiac risk factors.2 For example, the INTERHEART study, a case-control study of patients across 52 countries who had experienced an acute myocardial infarction, reported that adverse psychosocial factors accounted for a population attributable risk of 32.5%, which is similar to the population attributable risk for smoking of 35.7%.3 Social integration has been defined as the presence of social relationships that provide a sense of belonging, a subjective bond that individuals feel in relation to others and groups of others.4 A network of positive relationships can provide a tremendous source of support, meaning, and belonging,5 whereas the absence of relationships or a state of social isolation can have detrimental implications for health trajectories and well-being. Loneliness—the perception that one's desired social relationships or connectivity are not being fulfilled—has been identified as a significant risk factor for depression and poor health behaviours.6 Although the prevalence of loneliness can vary with age or life stage, being married or with a partner does not necessarily ensure protection from loneliness. Poor marital quality or dissatisfaction has been associated with higher levels of reported loneliness, new onset depression, and poor long-term survival.7–11 The Framingham Offspring Study further documented that repressed marital communication, conflict, and strain were all associated with adverse health outcomes, especially in women.12 These data strongly suggest that psychosocial factors such as loneliness and marital quality, a component of social integration, exert considerable influence on the biopsychosocial experience of recovery and resulting health outcomes.