Strained family relationships have a negative impact on long-term health, even more so than a troubled relationship with an intimate partner.

That’s according to an analysis of findings from the Midlife Development in the United States survey. Data collected over a 20-year period showed that participants who reported strained relationships with parents, siblings or extended family members had a greater number of chronic health conditions and a worse health appraisal at 10-year check-ins. 

The researchers said they were surprised by the results. “We thought that family relationships would be strongly connected to health because those relationships tend to be longer,” said Patricia N. E. Roberson, from the University of Tennessee at Knoxville. “But we didn’t think they would make the health impacts of marital relationships seem almost insignificant.”

The takeaway? Foster supportive familial relationships in addition to eating healthfully and exercising, said Roberson, a licensed marriage and family therapist. “Rally those relationships around you because that can also influence your health,” she concluded.

The study was published in the American Psychological Association’s Journal of Family Psychology.