title: Marital discord and coronary artery disease: a comparison of behaviorally defined discrete groups.
abstract: OBJECTIVE
  Marital difficulties can confer risk of coronary heart disease, as in a study of outwardly healthy couples (T. W. Smith et al., 2011) where behavioral ratings of low affiliation and high control during marital disagreements were associated with asymptomatic coronary artery disease (CAD). However, taxometric studies suggest that marital discord is more accurately represented by discrete groups, rather than continuous dimensions. To determine if a categorical representation of marital discord was also related to CAD, discordant and nondiscordant groups were identified via cluster analysis in further analyses of the T. W. Smith et al. (2011) study.
  
  
  METHODS
  One hundred fifty healthy couples (M age = 63.5) completed a marital disagreement discussion, self-reports of anxiety and anger during the disagreement, and self-report measures of marital adjustment. CAD was measured as coronary artery calcification (CAC) via computed tomography scans.
  
  
  RESULTS
  In a 2-group cluster solution, 31% of couples were characterized as discordant, with higher levels of hostility and dominance and lower levels of warmth compared with the nondiscordant group. Discordant couples reported lower marital adjustment and greater negative affect during the discussion. Controlling biomedical and behavioral risk factors, discordant couples had greater CAC (p = .029, η² = .035). Discordant and nondiscordant groups defined via self-reported marital adjustment did not differ in CAC (p = .17, η² = .014).
  
  
  CONCLUSIONS
  Marital discord defined categorically and with behavioral observations was associated with greater levels of asymptomatic CAD. Marital discord is associated with higher risk at early stages of coronary heart disease, but commonly used self-reports may underestimate this risk.
authors.affiliation: Department of Psychology, University of Utah, 380 South 1530 East, Salt Lake City, UT 84112, USA. tim.smith@psych.utah.edu
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Smith
authors.forename: Bert N
authors.initials: BN
authors.lastname: Uchino
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Berg
authors.forename: Paul
authors.initials: P
authors.lastname: Florsheim
mesh_terms: D000368:Aged; D000786:Anger; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology; D015984:Causality; D016000:Cluster Analysis; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000523:psychology*; D054541:Family Conflict / Q000523:psychology*; D005260:Female; D006791:Hostility; D006801:Humans; D008297:Male; D008393:Marriage / Q000523:psychology* / Q000706:statistics & numerical data*; D008875:Middle Aged; D012307:Risk Factors; D057566:Self Report; D012930:Social Dominance; D014057:Tomography, X-Ray Computed / Q000379:methods; D014589:Utah