Postpartum women in bad romantic relationships are not only more likely to suffer symptoms of depression, but are also at greater long-term risk of illness or death, according to a new study.

Researchers examined how relationships and partner behavior are linked to depression and heart rate variability (HRV) in women between the third trimester of pregnancy and one year postpartum.

“The quality of relationship with one’s spouse considerably affects one’s mental health as well as biological health and physiology,” says coauthor Lisa Christian, an associate professor of psychiatry and behavioral health at Ohio State University.

“We were interested in learning more about the effects of relationship quality on health during the postpartum period, due to substantial changes occurring physically, mentally and in social and interpersonal lives at this time.”

For the study, published in the journal Psychoneuroendocrinology, researchers used the Positive and Negative Quality in Marriage Scale to measure negative relationship qualities and the Center for Epidemiologic Studies Depression Scale to evaluate mental health. They also monitored HRV during regular check-ins with the study participants throughout the first year postpartum.

During pregnancy, HRV naturally drops. The researchers found that postpartum women who had poor relationships with their spouses or partners were more likely to report symptoms of depression. These were linked to HRV that was more likely to remain low following pregnancy.

This matters because HRV has a significant link to long-term health and wellness, says lead author Ryan Linn Brown, a Rice University psychology graduate student and researcher at the Biobehavioral Mechanisms Explaining Disparities (BMED) lab.

“High HRV is good. It means your body is well-equipped to deal with and recover from stressors,” she says. “Low HRV means your body isn’t as capable of managing stress, and previous research has demonstrated that poorly managed stress can put you at greater risk of a host of health problems.”

Brown says the research demonstrates a clear link between the quality of spousal relationships during pregnancy and postpartum depression and HRV, which ultimately can affect long-term wellness and mortality of new mothers.

The researchers hope the study findings will aid the development of mental health interventions that will help postpartum women live healthier lives.

Additional coauthors are from the University of California, Irvine and Rice.

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This article originally appeared on Futurity