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Hossain B, James KS. Widowhood status, morbidity, and mortality in India: evidence from a follow-up survey. J Biosoc Sci 2024; 56:574-589. [PMID: 37881942 DOI: 10.1017/s0021932023000226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
A known health effect of widowhood is an increased mortality risk among surviving spouses, with gender- and age-specific observations. While morbidity conditions with socio-economic factors may exacerbate the effect of widowhood on mortality, no research has attempted to predict mortality among the widowed over the married population with the presence of morbidity in India. Thus, the present study concurrently examines marital status and health in the Indian setting, bringing substantial empirical evidence to explore the link between marital status, morbidity, and mortality. The study used prospective data from India Human Development Survey (IHDS) wave 1 (2004-2005) and wave 2 (2011-2012). In total, 82,607 individuals aged 25 years and above were considered for the analysis. To present the preliminary findings, descriptive statistics and bivariate analysis were used. Using multivariable logistic regression, the interaction effect of marital status and morbidity status was estimated to predict the likelihood of mortality. Across all socio-economic groups, widowed individuals reporting any morbidity had a higher mortality proportion than married people. Young widowers with any morbidity are more susceptible to increased mortality. Asthma among young widowers and cardiovascular diseases among elderly widowers significantly elevate the probability of mortality. However, older widowed women with diabetes had a lower probability of mortality than older married women with diabetes. The widowers' disadvantage in mortality and morbidity may be attributable to less care-receiving and the greater incidence of unhealthy lifestyle practices during the post-widowhood period, indicating the need for more research.
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Affiliation(s)
- Babul Hossain
- International Institute for Population Sciences (IIPS), Mumbai, India
| | - K S James
- International Institute for Population Sciences (IIPS), Mumbai, India
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Lyu J, Min J, Kim G. Trajectories of cognitive decline by widowhood status among Korean older adults. Int J Geriatr Psychiatry 2019; 34:1582-1589. [PMID: 31276237 DOI: 10.1002/gps.5168] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 06/29/2019] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Given the limited evidence regarding the longitudinal impact of widowhood on cognitive function in later life, the present study aimed to investigate the longitudinal effect of widowhood status on cognitive change among Korean older adults. METHODS The study sample was drawn from a nationally representative data set, the Korean Longitudinal Study of Ageing (KLoSA); it consisted of 3,660 Korean adults aged 60 and over who were married at baseline. Our dependent variable, cognitive function, was measured by the Korean version of the Mini-Mental State Examination (K-MMSE). Widowhood status was measured with the combination of widowhood status and duration. Growth curve models were constructed using five waves of the KLoSA (2006-2014) to examine the longitudinal trajectories of cognitive changes. RESULTS In the unadjusted model, widowed older adults had significantly lower cognitive function than their nonwidowed counterparts regardless of widowhood duration. Adjusting for covariates, results from the growth curve models showed that widowed older adults with widowhood duration 4 to 6 years had a significantly steeper decline in cognitive function than nonwidowed older adults (P < 0.05). CONCLUSIONS These findings suggest that widowhood is detrimental for late-life cognitive function. Further research is required to understand the mechanisms underlying this relationship. Policy and practice implications are discussed according to the cultural context.
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Affiliation(s)
- Jiyoung Lyu
- Institute of Aging, Hallym University, Chuncheon, South Korea
| | - Joohong Min
- Faculty of Human Ecology and Welfare, Jeju National University, Jeju, South Korea
| | - Giyeon Kim
- Department of Psychology, Chung-Ang University, Seoul, South Korea
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Li YP, Lin SI, Fetzer SJ, Chen CH. The relationships between activity and quality of life for older men and women at different ages in Taiwan. J Women Aging 2015; 26:219-37. [PMID: 24919103 DOI: 10.1080/08952841.2014.888222] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study investigated the relationships between types of activity and quality of life (QOL) for older men and women at different ages. Based on cross-sectional data that included 220 community-dwelling elderly persons aged 65 and older in southern Taiwan, the results showed that the participation rates in many activities declined with age for both genders. Social activity and solitary leisure activity were significantly associated with QOL for old-old men, but not for young-old men. Only social activity was significantly associated with QOL for young-old women, but there was no significant association between any activity and QOL for old-old women.
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Affiliation(s)
- Yueh-Ping Li
- a Department of Nursing, College of Medicine and Life Science , Chung Hwa University of Medical Technology , Tainan , Taiwan
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Skulason B, Hauksdottir A, Ahcic K, Helgason AR. Death talk: gender differences in talking about one's own impending death. BMC Palliat Care 2014; 13:8. [PMID: 24618410 PMCID: PMC3975272 DOI: 10.1186/1472-684x-13-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 02/25/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND According to common practice based on a generally agreed interpretation of Icelandic law on the rights of patients, health care professionals cannot discuss prognosis and treatment with a patient's family without that patient's consent. This limitation poses ethical problems, because research has shown that, in the absence of insight and communication regarding a patient's impending death, patient's significant others may subsequently experience long-term psychological distress. It is also reportedly important for most dying patients to know that health care personnel are comfortable with talking about death and dying. There is only very limited information concerning gender differences regarding death talk in terminal care patients. METHODS This is a retrospective analysis of detailed prospective "field notes" from chaplain interviews of all patients aged 30-75 years receiving palliative care and/or with DNR (do not resuscitate) written on their charts who requested an interview with a hospital chaplain during a period of 3 years. After all study patients had died, these notes were analyzed to assess the prevalence of patient-initiated discussions regarding their own impending death and whether non-provocative evocation-type interventions had facilitated such communication. RESULTS During the 3-year study period, 195 interviews (114 men, 81 women) were conducted. According to the field notes, 80% of women and 30% of men initiated death talk within the planned 30-minute interviews. After evoking interventions, 59% (67/114) of men and 91% (74/81) of women engaged in death talk. Even with these interventions, at the end of the first interview gender differences were still statistically significant (p = 0.001). By the end of the second interview gender difference was less, but still statistically significant (p = 0.001). CONCLUSIONS Gender differences in terminal care communication may be radically reduced by using simple evocation methods that are relatively unpretentious, but require considerable clinical training.Men in terminal care are more reluctant than women to enter into discussion regarding their own impending death in clinical settings. Intervention based on non-provocative evocation methods may increase death talk in both genders, the relative increase being higher for men.
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Affiliation(s)
- Bragi Skulason
- University of Iceland, Saemundargata 2, Reykjavik IS101, Iceland
- National University Hospital, Eiriksgata 29, Reykjavik IS101, Iceland
- Reykjavík University, Menntavegur 1, Reykjavik IS101, Iceland
| | - Arna Hauksdottir
- Centre of Public Health Sciences, University of Iceland, Saemundargata 2, Reykjavik IS101, Iceland
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Vasagatan 33, 411 37 Gothenburg, Sweden
- Sahlgrenska University Hospital SE, Per dubbsgatan 16, 413 45 Gothenburg, Sweden
| | - Kozma Ahcic
- Karolinska Institute, Departments of Public Health Sciences and Oncology-Pathology, & Centre for Epidemiology and Community Medicine, Stockholm County Council Health Services, Stockholm SE171 77, Sweden
| | - Asgeir R Helgason
- Karolinska Institute, Departments of Public Health Sciences and Oncology-Pathology, & Centre for Epidemiology and Community Medicine, Stockholm County Council Health Services, Stockholm SE171 77, Sweden
- Reykjavík University, Menntavegur 1, Reykjavik IS101, Iceland
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Seifter A, Singh S, McArdle PF, Ryan KA, Shuldiner AR, Mitchell BD, Schäffer AA. Analysis of the bereavement effect after the death of a spouse in the Amish: a population-based retrospective cohort study. BMJ Open 2014; 4:e003670. [PMID: 24435888 PMCID: PMC3902313 DOI: 10.1136/bmjopen-2013-003670] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study investigates the association between bereavement and the mortality of a surviving spouse among Amish couples. We hypothesised that the bereavement effect would be relatively small in the Amish due to the unusually cohesive social structure of the Amish that might attenuate the loss of spousal support. DESIGN Population-based cohort study. SETTING The USA. PARTICIPANTS 10,892 Amish couples born during 1725-1900 located in Pennsylvania, Ohio and Indiana. All the participants are deceased. OUTCOME MEASURES The survival time is 'age'; event is 'death'. Hazard ratios (HRs) of widowed individuals with respect to gender, age at widowhood, remarriage, the number of surviving children and time since bereavement. RESULTS We observed HRs for widowhood ranging from 1.06 to 1.26 over the study period (nearly all differences significant at p<0.05). Mortality risks tended to be higher in men than in women and in younger compared with older bereaved spouses. There were significantly increased mortality risks in widows and widowers who did not remarry. We observed a higher number of surviving children to be associated with increased mortality in men and women. Mortality risk following bereavement was higher in the first 6 months among men and women. CONCLUSIONS We conclude that bereavement effects remain apparent even in this socially cohesive Amish community. Remarriage is associated with a significant decrease in the mortality risk among Amish individuals. Contrary to results from previous studies, an increase in the number of surviving children was associated with decreased survival rate.
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Affiliation(s)
- Ari Seifter
- Department of Medicine and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sarabdeep Singh
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, DHHS, Bethesda, Maryland, USA
| | - Patrick F McArdle
- Department of Medicine and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kathleen A Ryan
- Department of Medicine and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alan R Shuldiner
- Department of Medicine and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Geriatric Research and Education Clinical Center, Veterans Administration Medical Center, Baltimore, Maryland, USA
| | - Braxton D Mitchell
- Department of Medicine and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Geriatric Research and Education Clinical Center, Veterans Administration Medical Center, Baltimore, Maryland, USA
| | - Alejandro A Schäffer
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, DHHS, Bethesda, Maryland, USA
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Abstract
The study of spousal bereavement and mortality has long been a major topic of interest for social scientists, but much remains unknown with respect to important moderating factors, such as age, follow-up duration, and geographic region. The present study examines these factors using meta-analysis. Keyword searches were conducted in multiple electronic databases, supplemented by extensive iterative hand searches. We extracted 1,377 mortality risk estimates from 123 publications, providing data on more than 500 million persons. Compared with married people, widowers had a mean hazard ratio (HR) of 1.23 (95% confidence interval (CI), 1.19-1.28) among HRs adjusted for age and additional covariates and a high subjective quality score. The mean HR was higher for men (HR, 1.27; 95% CI, 1.19-1.35) than for women (HR, 1.15; 95% CI, 1.08-1.22). A significant interaction effect was found between gender and mean age, with HRs decreasing more rapidly for men than for women as age increased. Other significant predictors of HR magnitude included sample size, geographic region, level of statistical adjustment, and study quality.
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Skulason B, Jonsdottir LS, Sigurdardottir V, Helgason AR. Assessing survival in widowers, and controls - a nationwide, six- to nine-year follow-up. BMC Public Health 2012; 12:96. [PMID: 22299754 PMCID: PMC3295697 DOI: 10.1186/1471-2458-12-96] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 02/02/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to assess if widowers had an increased mortality rate during the first 6 to 9 years after the death of their wife, compared initially to an age-matched control group and also compared to the general population of Iceland. METHODS The study base was comprised of all 371 men born in 1924-1969 who were widowed in Iceland in 1999-2001 and 357 controls, married men, who were matched by age and residence.The widowers and controls were followed through the years 2002-2007 using information from Statistics Iceland. Mortality rates were compared between the groups and also with the general population. The mortality rate comparisons were: study group vs. control group, on the one hand, and study group vs. general population on the other. Causes of death were also compared between widowers and their wives. RESULTS A statistically significant increase in mortality in the widowers' group, compared to controls, was observed.Lifestyle-related factors could not be excluded as contributing to cause of death in these cases. CONCLUSIONS Being a widower was related to an increased risk of death for at least 9 years after the death of their wife.
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Affiliation(s)
- Bragi Skulason
- University of Iceland, Saemundargata, Reykjavik IS101, Iceland.
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Abstract
Background While the "widowhood effect" is well known, there is substantial heterogeneity in the magnitude of effects reported in different studies. We conducted a meta-analysis of widowhood and mortality, focusing on longitudinal studies with follow-up from the time of bereavement. Methods and Findings A random-effects meta-analysis was conducted to calculate the overall relative risk (RR) for subsequent mortality among 2,263,888 subjects from 15 prospective cohort studies. We found a statistically significant positive association between widowhood and mortality, but the widowhood effect was stronger in the period earlier than six months since bereavement (overall RR = 1.41, 95% CI: 1.26, 1.57) compared to the effect after six months (overall RR = 1.14, 95% CI: 1.10, 1.18). Meta-regression showed that the widowhood effect was not different for those aged younger than 65 years compared to those older than 65 (P = 0.25). There was, however, a difference in the magnitude of the widowhood effect by gender; for women the RR was not statistically significantly different from the null (overall RR = 1.04, 95% CI: 1.00, 1.08), while it was for men (overall RR = 1.23, 95% CI: 1.18, 1.28). Conclusions The results suggest that further studies should focus more on the mechanisms that generate this association especially among men.
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Momtaz YA, Ibrahim R, Hamid TA, Yahaya N. Mediating Effects of Social and Personal Religiosity on the Psychological Well Being of Widowed Elderly People. OMEGA-JOURNAL OF DEATH AND DYING 2010; 61:145-62. [DOI: 10.2190/om.61.2.d] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Spousal death is one the most stressful life events that seriously affects the psychological well being of widowed. This study examined the mediating effects of social and personal religiosity on the psychological well being of widowed elderly people. The sample for this study was comprised of 1367 widowed and married elderly Muslims from Malaysia. Psychological well being, religiosity, and physical health were measured using WHO-5 Well being Index, Intrinsic Extrinsic religiosity scale, and a checklist of 16 physical health problems, respectively. Data analysis was conducted using the Statistical Package for Social Sciences (version-13). As expected, bivariate correlation analysis revealed that widowhood is statistically and negatively associated with psychological well being. Results of multiple hierarchical regression analyses and Sobel test showed that only the indirect effect of widowhood through personal religiosity was statistically significant (Sobel = −2.79, p < .01). Sobel test for social religiosity was not significant (Sobel = −1.54, p > .05). The results of this study confirmed earlier studies, which found that widowhood negatively affects psychological well being of elderly people. Overall, the findings show that the potential solace provided by religiosity can decrease the negative effects of widowhood on the psychological well being of widowed elderly people.
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Abstract
Understanding the complex trajectories of disability and aging requires a biopsychosocial approach that considers disability in the broader context of later adulthood. Although disability service researchers and gerontologists have many shared interests and a similar mission, the fields are relatively new to one another and have had little historical interaction. The purpose of this article is to increase and improve collaboration among investigators in these fields by providing some background in social gerontology to the disability researcher, and by applying key theories in aging to the issue of growing older with physical disability. The article discusses particular problem areas for older adults, including social support, and also discusses the parallel paradoxes of aging and disability.
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Affiliation(s)
- Ivan R Molton
- Department of Rehabilitation Medicine, University of Washington School of Medicine, 1959 Northeast Pacific Street, Box 356490, Seattle, WA 98195-6490, USA
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Taga KA, Friedman HS, Martin LR. Early personality traits as predictors of mortality risk following conjugal bereavement. J Pers 2009; 77:669-90. [PMID: 20078734 DOI: 10.1111/j.1467-6494.2009.00561.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study explored pre-bereavement personality traits and gender as predictors of post-widowhood mortality risk, using newly derived life span data for participants originally recruited for Lewis Terman's classic study of the gifted. Personality traits measured in 1940 were used to predict mortality risk from 1940 through 2004 for married participants who were either widowed between 1940 and 1986 or who remained married. Results indicated that widowhood predicted a decrease in mortality risk for these (intelligent) individuals (relative hazard [rh]=0.68, N=843, p<.001) and neuroticism significantly moderated this effect. Specifically, neuroticism in young adulthood was significantly associated with decreased mortality risk among men who were later widowed (rh=0.50, N=66, p<.02) but not among women or consistently married men. Conclusions reveal the importance of personality-situation interactions and the adoption of a long-term perspective.
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Affiliation(s)
- Keiko A Taga
- University of California, Riverside, CA 92521, USA
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Espinosa J, Evans WN. Heightened mortality after the death of a spouse: marriage protection or marriage selection? JOURNAL OF HEALTH ECONOMICS 2008; 27:1326-1342. [PMID: 18513810 DOI: 10.1016/j.jhealeco.2008.04.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Revised: 03/27/2008] [Accepted: 04/03/2008] [Indexed: 05/26/2023]
Abstract
We test whether the heightened mortality after the death of a spouse represents correlation or causation by examining the heterogeneity in the bereavement effect based on the spouse's cause of death. Some causes of death are correlated with socioeconomic characteristics while others are not. Equality in the bereavement effect across these two types of death would signal a causal relationship while no bereavement effect for uncorrelated causes of death would indicate an omitted variables bias. Results indicate that the observed effect for women is subject to an omitted variables bias but the estimates for men indicate a causal relationship.
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Affiliation(s)
- Javier Espinosa
- Department of Economics, Rochester Institute of Technology, Rochester, NY 14623, USA.
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Abstract
In this Review, we look at the relation between bereavement and physical and mental health. Although grief is not a disease and most people adjust without professional psychological intervention, bereavement is associated with excess risk of mortality, particularly in the early weeks and months after loss. It is related to decrements in physical health, indicated by presence of symptoms and illnesses, and use of medical services. Furthermore, bereaved individuals report diverse psychological reactions. For a few people, mental disorders or complications in the grieving process ensue. We summarise research on risk factors that increase vulnerability of some bereaved individuals. Diverse factors (circumstances of death, intrapersonal and interpersonal variables, ways of coping) are likely to co-determine excesses in ill-health. We also assess the effectiveness of psychological intervention programmes. Intervention should be targeted at high-risk people and those with complicated grief or bereavement-related depression and stress disorders.
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Affiliation(s)
- Margaret Stroebe
- Research Institute for Psychology and Health, Utrecht University, Utrecht, Netherlands.
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Stimpson JP, Kuo YF, Ray LA, Raji MA, Peek MK. Risk of mortality related to widowhood in older Mexican Americans. Ann Epidemiol 2007; 17:313-9. [PMID: 17306987 PMCID: PMC2700854 DOI: 10.1016/j.annepidem.2006.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Revised: 09/08/2006] [Accepted: 10/16/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To examine the risk and correlates of mortality after death of a spouse and whether mortality risk varies by sex. METHODS Prospective cohort study (1993 to 2000) of 1693 Mexican Americans ages 65 years and older who were married at baseline. Mortality was confirmed by matching records with the National Death Index or through proxy report. Risk of death related to incidence of widowhood was estimated by using proportional hazard regression and adjusted for age, education, US nativity, financial strain, social support, health behaviors, medical conditions, disability, and depressive symptoms. RESULTS In the unadjusted Cox hazard analysis, widowed men are significantly more likely to die (HR=2.32, CI=1.48 to 3.61), but loss of spouse has no significant effect on the subsequent risk of death for widowed women (HR=1.50, CI=0.90 to 2.49). After adjustment for covariates known to influence survival, the association between widowhood and mortality in men remained significant, but the magnitude of the association decreased by 26%, which suggests a partial mediation effect of these factors on survival. The trajectory of the survival curve shows that the risk of death associated with widowhood is highest within the first 2 years. CONCLUSIONS Widowhood in older Mexican American men is a risk factor for mortality.
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Affiliation(s)
- Jim P Stimpson
- Department of Social and Behavioral Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107-2699, USA.
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Eng PM, Kawachi I, Fitzmaurice G, Rimm EB. Effects of marital transitions on changes in dietary and other health behaviours in US male health professionals. J Epidemiol Community Health 2005; 59:56-62. [PMID: 15598728 PMCID: PMC1763358 DOI: 10.1136/jech.2004.020073] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVE To examine the effect of change in marital status on health behaviours among men. DESIGN Longitudinal study of repeated measures of marital status and health behaviours collected at four year intervals (1986-90; 1990-94). SETTING US male health professionals. PARTICIPANTS 38 865 men aged 40-75 in 1986. MAIN RESULTS Relative to men who stayed married over four years, men who became widowed increased their alcohol consumption. Men who become divorced or widowed experienced decreases in body mass index. Compared with men who remained unmarried, men who remarried exhibited increases in body mass index along with decreased physical activity. Becoming divorced or widowed was associated with decreased vegetable intake while remarriage was linked to greater consumption. CONCLUSIONS Marital termination may adversely affect health and dietary behaviours among men.
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Affiliation(s)
- Patricia Mona Eng
- Department of Epidemiology, Harvard School of Public Health, MA, USA.
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Engström G, Khan FA, Zia E, Jerntorp I, Pessah-Rasmussen H, Norrving B, Janzon L. Marital Dissolution Is Followed by an Increased Incidence of Stroke. Cerebrovasc Dis 2004; 18:318-24. [PMID: 15359099 DOI: 10.1159/000080770] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2004] [Accepted: 05/05/2004] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Many studies have reported lower mortality in married people. The relation between marital status and incidence of haemorrhagic and ischaemic stroke is unclear. It is largely unknown whether the risk of stroke is increased the first years after divorce or death of spouse. METHODS Incidence of first-ever stroke (n = 6,184) was followed over 10 years in a cohort consisting of all 40- to 89-year-old inhabitants (n = 118,134) in the city of Malmö, Sweden. Marital dissolution (i.e. divorce or death of spouse) prior to the date of stroke was compared in a nested case-control design (3,134 initially married stroke cases, 9,402 initially married controls). RESULTS As compared to the married groups, the incidence of stroke was increased in divorced men and women (RR = 1.23, CI: 1.10-1.39 and RR = 1.26, CI: 1.12-1.41, respectively) and widowed men and women (RR = 1.13, CI: 0.99-1.28 and RR = 1.13, CI: 1.02-1.24, respectively) after adjustments for age, country of birth and socioeconomic indicators. The risk of stroke was not increased in never married men. Marital dissolution was followed by increased risk of stroke, which was significant for men (adjusted odds ratio: 1.23, CI: 1.03-1.5) and borderline significant for women below 65 years of age (odds ratio: 1.45, CI: 0.99-2.14). CONCLUSION The incidence of stroke is increased in divorced and widowed individuals. Never married men do not have an increased incidence. The risk of stroke is elevated during the first years after divorce or death of spouse.
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Affiliation(s)
- Gunnar Engström
- Department of Community Medicine, Malmö University Hospital, Malmö, Sweden.
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Nagata C, Takatsuka N, Shimizu H. The impact of changes in marital status on the mortality of elderly Japanese. Ann Epidemiol 2003; 13:218-22. [PMID: 12684186 DOI: 10.1016/s1047-2797(02)00409-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the impact of changes in marital status on the mortality of elderly Japanese men and women. METHODS In a baseline survey conducted in 1992, 2039 male and 1466 female residents in Takayama City, Gifu, who were married and aged 65 years or over responded to a detailed health and lifestyle questionnaire. Information regarding deaths of subjects and their spouses, the causes of death, and whether the subjects and spouses moved away from the city between 1992 and 1999 was obtained from the National Vital Statistics and the residential registers of the city. A proportional hazard model was used including marital status as time- varying independent variable. RESULTS During the study period, six men and two women became separated/divorced and 151 men and 448 women became widowed. Widowhood was not significantly associated with mortality in men. Duration of widowhood was significantly inversely associated with mortality in women (p = 0.04). A significant decreased hazard ratio (=0.40, p = 0.04) was observed for women widowed for 3 years or more. CONCLUSIONS We found no evidence indicating that widowed men and women have an increased mortality rate. Instead, the data suggested a decreased mortality rate among long-term widowed women.
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Affiliation(s)
- Chisato Nagata
- Department of Public Health, Gifu University School of Medicine, Gifu, Japan.
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Abstract
This study evaluates the effect of spousal death on mortality among Israeli adults and examines differences in this effect by duration of bereavement, age, sex, education, ethnic origin, household size, and number of children. Data are taken from the Israel Longitudinal Mortality Study which is based on a linkage of records from a 20% sample of the 1983 census to records of deaths occurring during the period 1983-1992. The study population comprised 49,566 men and 41,264 women, of whom 4,402 (9%) and 11,114 (27%), respectively, were bereaved during the follow-up period. Excess mortality among the bereaved was evident among both men and women, especially after bereavement of short duration. During the first 6 months, the excess mortality was about 50% among women and about 40% among men. For men, the effect of bereavement on mortality decreased linearly with age, with a relative risk of 3 among younger men during early widowhood. Bereavement had a greater impact on the more educated men. The effect of bereavement did not vary by ethnic origin or household size.
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Affiliation(s)
- Orly Manor
- School of Public Health and Community Medicine, Hebrew University-Hadassah Medical Organization, PO Box 12272, Jerusalem 91120, Israel.
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Abstract
OBJECTIVE This study examines the impact of marital closeness on survival over 6 years in a community-dwelling sample of 305 older couples. METHOD Closeness is defined as 1) naming one's spouse as a confidant or source of emotional support (vs. not naming) and 2) being named by spouse on at least one of the two dimensions (vs. not being named). The survival effects of both naming and being named are examined in Cox proportional hazard regressions, controlling for sociodemographic, health status, and behavioral variables. RESULTS Husbands who were named by their wives but did not name them were least likely to have died after 6 years. Compared with them, husbands in marriages with the other three styles of closeness were from 3.30 to 4.68 times more likely to be dead. Wives' results showed the same pattern of effects, with the same marital style being most protective as for husbands, but the effects were weaker. However, wives' results were strongly moderated by parenting status: those who had ever had children who were in the marital closeness pattern of wife naming husband but not being named by him were highly protected. Compared with these wives, others who had had children were from 8.26 to 10.95 times less likely to be alive after 6 years. CONCLUSIONS The same pattern of marital closeness most benefited husbands and those wives who had had children. These findings are not explained adequately by social support or marital role theory although they fit the latter more closely.
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Stroebe M, Stroebe W, Schut H. Gender Differences in Adjustment to Bereavement: An Empirical and Theoretical Review. REVIEW OF GENERAL PSYCHOLOGY 2001. [DOI: 10.1037/1089-2680.5.1.62] [Citation(s) in RCA: 177] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The loss of a marital partner results in substantial increases in morbidity and mortality among both men and women, but the effects are relatively greater for widowers than for widows in the acute grieving period. Evidence is reviewed, and explanations of the pattern are examined. An interpretation in terms of gender differences in social support (cf. M. Stroebe & W. Stroebe, 1983 ), although plausible, has not yet been empirically confirmed. Likewise, with respect to gender differences in coping styles, women are more confrontive and expressive of their emotions than men, but there has been little validation of the generally accepted grief work hypothesis (working through grief by women brings about their better recovery). Cognitive processes underlying effective coping with bereavement are analyzed, and a stressor-specific framework, the dual-process model of coping with loss, is suggested to help explain gender differences in health outcomes.
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Affiliation(s)
- Margaret Stroebe
- Research Institute for Psychology & Health, Utrecht University, Utrecht, the Netherlands
| | - Wolfgang Stroebe
- Research Institute for Psychology & Health, Utrecht University, Utrecht, the Netherlands
| | - Henk Schut
- Research Institute for Psychology & Health, Utrecht University, Utrecht, the Netherlands
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21
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Johnson NJ, Backlund E, Sorlie PD, Loveless CA. Marital status and mortality: the national longitudinal mortality study. Ann Epidemiol 2000; 10:224-38. [PMID: 10854957 DOI: 10.1016/s1047-2797(99)00052-6] [Citation(s) in RCA: 305] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE To examine the effect of marital status (married, widowed, divorced/separated, and never-married) on mortality in a cohort of 281,460 men and women, ages 45 years and older, of black and white races, who were part of the National Longitudinal Mortality Study (NLMS). METHODS Major findings are based on assessments of estimated relative risk (RR) from Cox proportional hazards models. Duration of bereavement for the widowed is also estimated using the Cox model. RESULTS For persons aged 45-64, each of the non-married groups generally showed statistically significant increased risk compared to their married counterparts (RR for white males, 1.24-1.39; white females, 1.46-1.49; black males, 1.27-1.57; and black females, 1. 10-1.36). Older age groups tended to have smaller RRs than their younger counterparts. Elevated risk for non-married females was comparable to that of non-married males. For cardiovascular disease mortality, widowed and never-married white males ages 45-64 showed statistically significant increased RRs of 1.25 and 1.32, respectively, whereas each non-married group of white females showed statistically significant increased RRs from 1.50 to 1.60. RRs for causes other than cardiovascular diseases or cancers were high (for white males ages 45-64: widowed, 1.85; divorced/separated, 2.15; and never-married, 1.48). The importance of labor force status in determining the elevated risk of non-married males compared to non-married females by race is shown. CONCLUSIONS Each of the non-married categories show elevated RR of death compared to married persons, and these effects continue to be strong after adjustment for other socioeconomic factors.
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Affiliation(s)
- N J Johnson
- Demographic Statistical Methods Division, U.S. Bureau of the Census, Washington, DC 20233, USA
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22
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Abstract
Although coronary heart disease is the leading cause of death in women in most industrialized countries, much less research has been carried out on this topic to date than in men. This article gives an overview of psychosocial factors of coronary heart disease in women, focussing on psychosocial risk factors for coronary heart disease in women such as socioeconomic status, employment status, chronic troubling emotions, social support and bereavement/widowhood. A second focus lies on psychosocial adjustment in women once coronary heart disease has become manifest, i.e. well-being, return to work, sexual activity and rehabilitation outcome after a myocardial infarction or coronary artery bypass grafting. Via a computerized literature research in Medline, Psychlit and Sociofile over the period 1980-1994 all studies on these topics were collected and reviewed. Comparatively more research has been undertaken on psychosocial risk factors for than on psychosocial adjustment to coronary heart disease in women. Low social class, low educational attainment, the double loads of work and family, chronic troubling emotions and lack of social support emerge as documented risk factors in women. Regarding psychosocial adjustment to coronary heart disease in women, there is a paucity of data, and studies including large samples of women and adjusting for gender are warranted. Psychosocial adjustment in women after a myocardial infarction seems to be worse than in men, whereas results on adjustment after coronary artery bypass grafting are inconclusive. Return to work rates after myocardial infarction or coronary artery bypass grafting are significantly lower in women than in men. Data on sexual activity of women after myocardial infarction or coronary artery bypass grafting are scarce, and there seems to be a complete lack of physician counseling on this topic. Studies on rehabilitation outcome report poorer programme uptake, poorer adherence and significantly higher drop-out rates for women than for men, yet those women who complete cardiac rehabilitation show the same or even greater functional improvements than men.
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Affiliation(s)
- V Brezinka
- Centre for Cardiopulmonary Rehabilitation, Rijnlands Zeehospitium, Katwijk ZH, The Netherlands
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Mendes de Leon CF, Kasl SV, Jacobs S. A prospective study of widowhood and changes in symptoms of depression in a community sample of the elderly. Psychol Med 1994; 24:613-624. [PMID: 7991743 DOI: 10.1017/s0033291700027768] [Citation(s) in RCA: 87] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This survey examines changes in depressive symptomatology (CES-D) during bereavement in 1046 elderly subjects, of whom 139 became widowed during follow-up. Depression scores increased during the first year of bereavement, but generally returned to pre-widowhood levels thereafter. However, depression scores remained elevated among young-old widows (65-74-year-olds) well after the first year of widowhood. Using cut-off scores, rates of high depressive symptoms remained somewhat elevated over baseline levels. Increases in depression scores during bereavement were not explained by socio-economic variables, health habits and health status. It is concluded that particularly young-old widows are at risk of developing chronic depressive symptomatology during bereavement that may warrant clinical attention.
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Affiliation(s)
- C F Mendes de Leon
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT 06520-8034
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