Marital distress, depression, and a leaky gut: Translocation of bacterial endotoxin as a pathway to inflammation

Psychoneuroendocrinology. 2018 Dec;98:52-60. doi: 10.1016/j.psyneuen.2018.08.007. Epub 2018 Aug 4.


Background: Marital distress and depression work in tandem to escalate risks for inflammation-related disorders. Translocation of bacterial endotoxin (lipopolysaccharide, LPS) from the gut microbiota to blood circulation stimulates systemic inflammatory responses.

Methods: To investigate increased gut permeability (a "leaky gut") as one potential mechanistic pathway from marital distress and depression to heightened inflammation, this secondary analysis of a double-blind, randomized crossover study examined serial assessments of two endotoxin biomarkers, LPS-binding protein (LBP) and soluble CD14 (sCD14), as well as C-reactive protein (CRP), interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α) during two separate 9.5 h visits. The 43 (N = 86) healthy married couples, ages 24-61 (mean = 38.22), discussed a marital disagreement during both visits; behavioral coding of these interactions provided data on hostile marital behaviors, a hallmark of marital distress. The Structured Diagnostic Interview for DSM-IV assessed participants' mood disorder history.

Results: Participants with more hostile marital interactions had higher LBP than those who were less hostile. Additionally, the combination of more hostile marital interactions with a mood disorder history was associated with higher LBP/sCD14 ratios. Higher LBP and LBP/sCD14 were associated with greater CRP production; for example, only 21% of low LBP participants (lowest quartile) had average CRP across the day > 3, compared to 79% of those in the highest quartile. Higher sCD14 was associated with higher IL-6.

Conclusions: These bacterial LPS translocation data illustrate how a distressed marriage and a mood disorder history can promote a proinflammatory milieu through increased gut permeability, thus fueling inflammation-related disorders.

Keywords: Depression; Inflammation; Intestinal permeability; Leaky gut; Marriage; Microbiome.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Acute-Phase Proteins / analysis
  • Acute-Phase Proteins / immunology
  • Acute-Phase Proteins / metabolism*
  • Adult
  • Biomarkers
  • C-Reactive Protein / analysis
  • Carrier Proteins / analysis
  • Carrier Proteins / immunology
  • Carrier Proteins / metabolism*
  • Cross-Over Studies
  • Depression / microbiology
  • Depression / physiopathology
  • Double-Blind Method
  • Endotoxins
  • Family Conflict / psychology*
  • Female
  • Gastrointestinal Microbiome / immunology*
  • Gastrointestinal Microbiome / physiology
  • Hostility
  • Humans
  • Inflammation
  • Interleukin-6 / analysis
  • Lipopolysaccharide Receptors
  • Lipopolysaccharides / immunology
  • Lipopolysaccharides / metabolism
  • Male
  • Marriage / psychology
  • Membrane Glycoproteins / analysis
  • Membrane Glycoproteins / immunology
  • Membrane Glycoproteins / metabolism*
  • Middle Aged
  • Tumor Necrosis Factor-alpha / analysis


  • Acute-Phase Proteins
  • Biomarkers
  • Carrier Proteins
  • Endotoxins
  • IL6 protein, human
  • Interleukin-6
  • Lipopolysaccharide Receptors
  • Lipopolysaccharides
  • Membrane Glycoproteins
  • Tumor Necrosis Factor-alpha
  • lipopolysaccharide-binding protein
  • C-Reactive Protein