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Strained relationships with parents, siblings, or extended family members may be more harmful to people’s health than a troubled relationship with a significant other, according to a study published by the American Psychological Association’s Journal of Family Psychology.

Patricia Roberson
Patricia Roberson

The study, conducted by Patricia N. E. Roberson, assistant professor in UT’s College of Nursing, and her longtime collaborators Sarah Woods, University of Texas Southwestern Medical Center, and Jacob Priest, University of Iowa, looked at data collected over a 20-year span.

Roberson studies marriage and family relationships and how they are linked to health outcomes, both broadly and specifically in rural and underserved Appalachian populations. Her work has looked at chronic conditions, breast cancer, and diabetes. Woods and Priest are licensed marriage and family therapists. In the trio’s work together, they began to focus on the fact that family and marriage are linked to levels of depression and anxiety as well as overall health.

“We wanted to understand how family relationships, as compared to marital relationships, are linked to health outcomes over time,” Roberson said. “The existing research tends to focus on marital relationships, but as we knew from our own experiences as therapists and from research broadly, family is really important, even into adulthood. What we found was that family relationships—both positive and negative aspects—completely blew marital relationships out of the water in health impacts.”

In their study, the researchers used data from 2,802 participants in the Midlife Development in the US survey, which included a nationally representative sample of adults. Three rounds of data were collected over a 20-year period from 1995 to 2014. The average participant was 45 years old during the first round.

The survey asked questions about family strain and family support as well as intimate partner strain and support.

Health was measured using participants’ total number of chronic conditions, such as stroke, headaches, and stomach trouble, experienced in the 12 months prior to each of the three data collection rounds. Participants also rated their overall health from excellent to poor at each round.

The researchers found that greater family relationship strain was associated with a greater number of chronic conditions and worse health appraisal 10 years later, during the second and third rounds of data collection.

“We thought that family relationships would be strongly connected to health because those relationships tend to be longer—we have them from when we’re a child all the way through our lives—but we didn’t think they would make the health impacts of marital relationships seem almost insignificant. It was quite surprising to us,” Roberson said.

Roberson invoked an adage attributed to Harper Lee—you can choose your friends, but you can’t choose your family—to explain why the relationships are so different in the way they affect long-term health.

“If you’re in a toxic marriage, you can choose to get a divorce—you can set yourself apart from that person,” she said. “Family relationships aren’t like that. Those people are around us from when we’re a child into adulthood; if those relationships are harmful or toxic, it’s very difficult to get away from that.”

But in addition to the negative effects, Roberson pointed out, positive relationships affect us as well.

“I’m fascinated by marriage and family in terms of health outcomes because we know those relationships can change,” she said. “We can identify facets of family and marital relationships that are linked to long-term health outcomes. These are untapped interventions to improve health care outcomes.

“When we’re considering how to improve our health, in addition to considering eating healthfully and exercising, we should think about how to reduce the stress and strain in our relationships. Not all relationships can change, but you can find the supportive ones to focus on. Rally those relationships around you because that can also influence your health.”

Podcast: Roberson, Woods, and Priest discuss the good, the bad, and the ugly advice about relationships in their podcast, Attached. Learn more about their research on family and marital relationships in episode 7.


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