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Research has long shown that service members and veterans with post-traumatic stress disorder have higher-than-average rates of marital conflict, as well as higher blood pressure, poorer sleep and more stress-related physical problems than those without the disorder.

Now, new research shows spousal disagreement itself may fuel physical health problems in military personnel and veterans with PTSD. Findings suggest that the way someone with PTSD reacts to marital conflict — with intense anger and cardiac symptoms like high blood pressure and heart rate, for example — may lead to poorer sleep and greater risk for cardiovascular disease.

But the most surprising finding is that this discord may influence the partner of the service person or veteran. In some cases, the research suggests, partners are more vulnerable to health problems than the military personnel and veterans themselves.

The heart knows

In the first-ever study to examine the relationship among marital conflict, PTSD and heart disease risk in military couples, Catherine Caska, PhD, a psychology fellow at the Veterans Administration Puget Sound Health Care System–Seattle Division, and colleagues at the University of Utah examined veterans' and their partners' emotional and physical changes when they were in conflict.

Sixty-five military couples came into the lab for testing: All of the men had fought in the Iraq or Afghanistan wars, or both, and all of the women were their spouses or partners. The men in 33 of the couples had screened positively for PTSD. The men in the other 32 couples had no PTSD or other Axis-I diagnosis.

The team first measured couples' marital functioning via self-report questionnaires. Over the next 10 minutes, they measured couples' state anxiety and anger, as well as a range of cardiac indicators including blood pressure, heart rate, heart rate variability and cardiac sympathetic activation. In elevated form, these factors make up a risk factor called cardiovascular reactivity, a physiological response to stress that research has shown can lead to bigger heart problems over time.

In the next stage of the study, the couples spent 17 minutes discussing a topic they disagreed about, and researchers measured their cardiac reactivity throughout the task. Afterward they assessed changes in levels of anger and anxiety as a result of the argument.

Couples with PTSD reported greater levels of relationship distress overall and greater increases in cardiovascular reactivity in response to the conflict, the study found.

But the biggest surprise of the results was the population most at risk. The female partners of PTSD veterans reported more anger and experienced more cardiovascular reactivity than both members of the control couple and their companions with PTSD.

The findings have important treatment implications, Caska says.

For one, clinicians need to consider PTSD partners more fully in treatment, not only as supports for their partners, but because of their own health vulnerability, she says.

"When we look at the risks associated with anger — heart disease, poor relationship functioning and poor mental health, for example — it's a really important avenue to continue researching," Caska says. Further, the striking increases in cardiovascular reactivity in these spouses clearly show the need to continue evaluating and addressing the health of military and veteran families, she says.

Given the study's strong association between marital conflict and cardiovascular reactivity, especially in couples with PTSD, researchers also could consider adding couples' conflict to other known risk factors for cardiovascular disease in veteran and military couples, such as poor diet and insufficient exercise, she says. Researchers also could look more closely at possible associations between the three clusters of PTSD symptoms — those related to reliving the event, avoiding reminders of the event and being constantly on guard — and marital satisfaction indicators like conflict and warmth, she says.

Perchance to sleep

Other psychologists are exploring how relationship conflict and stress might affect sleep among service members returning from deployments to Iraq or Afghanistan and their spouses or partners. Sleep problems are common in service members, due in part to inhospitable conditions and the need to be constantly vigilant in combat environments. However, sleep problems tend to persist even after service members return home, says Wendy Troxel, PhD, a clinical health psychologist and behavioral and social scientist at the Rand Corp. in Pittsburgh. In addition, sleep difficulties — widely linked to depression, suicide risk and cardiovascular disease — might also influence relationship quality, which, in turn, could foster more health problems down the road.

"After a bad night's sleep, you often feel irritable and more easily frustrated the next day, and you're likely to take those negative feelings out on your partner," she says. "Relationship conflict may then lead to further sleep problems the next night. It's this dynamic that may have long-term negative consequences for the relationship and for the overall health and well-being of both members of the couple." 

To find out more, Troxel and her team, which also includes University of Pittsburgh researchers Anne Germain, PhD, Karen A. Matthews, PhD, and Daniel J. Buysse, MD, are conducting a four-year study funded by the National Heart, Lung and Blood Institute that is the first to examine sleep and nocturnal physiology in service members and their spouses.

Now in the study's second year, the team has collected data on 31 couples, with plans to study about 70 couples in all. They are following each couple for 10 days as they go about their daily lives, gathering data on relationship quality, moods, and physiological indicators including depth of sleep, blood pressure and markers of inflammation.

So far, the researchers have found patterns both troubling and promising. "Some findings suggest risk for negative health outcomes, and others might indicate really healthy adjustment, even in the aftermath of an extended deployment," Troxel says.

Overall, these couples reported little depression, were well adjusted as couples, and reported extremely high sleep efficiency — that is, not waking up during sleep.

On the risk side, couples who reported more troubled unions tended to sleep more lightly and for shorter periods of time than happier couples. Meanwhile, 37 percent of the sample had clinically significant self-reported sleep disturbances, with male service members largely accounting for this problem. Average sleep length was 6.6 hours — too short for optimal health, but in line with the rest of the population.

In addition, the service members as well as their spouses reported moderate levels of lifetime PTSD symptoms in general, with those reporting more symptoms having more fragmented and less restful sleep, Troxel says.

"Especially as the United States continues to draw down troops, there has never been a more important time to study how military and veteran couples adjust in the post-deployment period, and to identify potential opportunities for intervention in those who appear to be at risk for poor adjustment and long-term health consequences," she says.

Tori DeAngelis is a writer in Syracuse, N.Y.