The research, conducted from mid-1980s to mid-1990s, was the latest to show that how couples fight affects not only their relationship but their health.

Lead author Elaine A Eaker, a Gaithersburg epidemiologist, said the message for women was clear. “When in conflict with your spouse, it helps to express yourself,” she said.

The study of 3,000 men and women published online in Psychosomatic Medicine set out to examine the relationship between marital stress and coronary heart disease or death. Participants were asked what issues they fought over and whether workplace problems spilled into their lives at home. In general, marriage benefits health, particularly of men. Married men live seven years longer and married women live two years longer than single men and women. Married people as a group also have better psychological health than never-marrieds.

When happy couples are compared with the unhappy ones, however, the effect of marriage on health is more nuanced. Studies have linked marital discord to a higher risk of recurrent heart attack in women aged 30 to 65 and the severity of congestive heart failure in male and female patients.

Recently, researchers studying married couples have identified certain behaviors that appear to worsen health risks, particularly for women.

Michael J Rohrbaugh, co-director of the University of Arizona’s Family Research Laboratory, who is conducting a study of heart patients, said pronouns that couples use in speech, whether it is “me” or “us”, seem to predict the course of a spouse’s heart disease during the subsequent six months. “There is something about ‘we talk’, the collective or communal idea that ‘we are in it together’ which is important,” Rohrbaugh said.

Although that study is not completed, Rohrbaugh said the connection between “we talk” and health appears to be stronger in women than men.

For women with heart disease, repeatedly using the words “I” or “me,” he said, “is like the kiss of death”.

And a 2003 study in the journal Archives of General Psychiatry found that after marital spats, blisters generally healed more slowly, a sign that stress interfered with immune system functioning.

In hostile couples, those who hurled insults or rolled their eyes when arguing, the healing was 60 per cent slower than in couples who didn’t display antagonistic behaviors, the study showed. Women tended to take longer to heal than men.

Ohio State University psychology professor Janice Klecolt-Glaser, who led that study, said men are less sensitive than women to negative emotional nuances.

Eaker and colleagues at Boston University tracked 1,768 men and 1,912 women between the ages 18 and 77. They were drawn from the Framingham offspring study, a large epidemiological study of people whose parents were from Framingham, Massachusetts.

When asked what they fought over, men said sex and women said money, children and chores. Men were more likely than women to report that their marriages were happy and that their spouses loved them.

When it came to dealing with conflicts, about 30 per cent of men said they usually or always kept their feelings to themselves, compared to about 20 per cent of women. But women who “self-silenced” were four times more likely to die during the study than women who always spoke out. Psychologists said men often are silent during conflicts to avoid subjects they would rather not discuss, a pattern called “demand-withdraw”. Women engage in this behavior but less frequently.

“We see this pattern in studies in which the wife pushes her husband to stop drinking or smoking and he withdraws,” Rohrbaugh said.

Dana Crowley Jack, a professor at Western Washington University and author of the 1991 book Silencing the Self, said women’s motivations for avoiding conflict are more complex. They are socialised to keep feelings of conflict with their spouses to themselves, she said, believing that their behavior will protect their marriages or family relationships, she said. “One way of being pleasing is to go along with what the other person wants ,” she said.