1
|
Ribeiro F, Geraets A, de Oliveira Duarte YA, Leist AK. Risk and protective factors for cognitive decline in Brazilian lower educated older adults: A 15-year follow-up study using group-based trajectory modelling. Arch Gerontol Geriatr 2024; 127:105555. [PMID: 38996782 DOI: 10.1016/j.archger.2024.105555] [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] [Received: 08/30/2023] [Revised: 01/10/2024] [Accepted: 06/26/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Patterns of cognitive change and modifiable factors for cognitive decline versus stable cognitive trajectories have rarely been described in lower-educated older adults. OBJECTIVES We aimed to identify long-term trajectories of cognitive functioning and possible factors associated with cognitive decline. DESIGN AND PARTICIPANTS We used data from 1,042 adults aged ≥ 60 participating in the Health, Welfare and Aging Study (SABE), São Paulo, Brazil, without cognitive impairment at baseline. Data were collected across four waves (2000-2015). Group-based trajectory modelling was used to identify cognitive trajectories. Associations with socioeconomic variables, childhood background, lifestyle, and cardiovascular risk factors were explored using weighted multinomial logistic regressions. MEASUREMENTS The abbreviated Mini-Mental State Examination was used to measure cognition. RESULTS Three cognitive trajectories were identified: stable (n= 754, 68.6%), mild-decline (n= 183, 20.8%), and strong-decline (n= 105, 10.7%). At baseline, respondents in the strong-decline group were more likely to be older than those with stable and mild-decline trajectories. Furthermore, participants in both the mild and strong-decline groups were more likely to have no schooling, be divorced/separated, receive less than 4 monthly wages, and be underweight (BMI < 18.5) compared to the stable group. Finally, the mild-decline group was more likely to have lived in rural areas during childhood than participants located in a stable trajectory. CONCLUSIONS Our findings suggest that interventions to reduce cognitive decline for low-educated older adults might include strategies addressing inequalities and improving modifiable risk factor burden.
Collapse
Affiliation(s)
- Fabiana Ribeiro
- Department of Social Sciences, University of Luxembourg. Belval Campus,11, Porte des Sciences, L-4366, Esch-sur-Alzette, Luxembourg.
| | - Anouk Geraets
- Department of Social Sciences, University of Luxembourg. Belval Campus,11, Porte des Sciences, L-4366, Esch-sur-Alzette, Luxembourg
| | | | - Anja K Leist
- Department of Social Sciences, University of Luxembourg. Belval Campus,11, Porte des Sciences, L-4366, Esch-sur-Alzette, Luxembourg
| |
Collapse
|
2
|
Kapaon D, Riumallo-Herl C, Jennings E, Abrahams-Gessel S, Makofane K, Kabudula CW, Harling G. Social support receipt as a predictor of mortality: A cohort study in rural South Africa. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003683. [PMID: 39250457 PMCID: PMC11383236 DOI: 10.1371/journal.pgph.0003683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 08/13/2024] [Indexed: 09/11/2024]
Abstract
The mechanisms connecting various types of social support to mortality have been well-studied in high-income countries. However, less is known about how these relationships function in different socioeconomic contexts. We examined how four domains of social support-emotional, physical, financial, and informational-impact mortality within a sample of older adults living in a rural and resource-constrained setting. Using baseline survey and longitudinal mortality data from HAALSI, we assessed how social support affects mortality in a cohort of 5059 individuals aged 40 years or older in rural Mpumalanga, South Africa. Social support was captured as the self-reported frequency with which close social contacts offered emotional, physical, financial, and informational support to respondents, standardized across the sample to increase interpretability. We used Cox proportional hazard models to evaluate how each support type affected mortality controlling for potential confounders, and assessed potential effect-modification by age and sex. Each of the four support domains had small positive associations with mortality, ranging from a hazard ratio per standard deviation of support of 1.04 [95% CI: 0.95,1.13] for financial support to 1.09 [95% CI: 0.99,1.18] for informational support. Associations were often stronger for females and younger individuals. We find baseline social support to be positively associated with mortality in rural South Africa. Possible explanations include that insufficient social support is not a strong driver of mortality risk in this setting, or that social support does not reach some necessary threshold to buffer against mortality. Additionally, it is possible that the social support measure did not capture more relevant aspects of support, or that our social support measures captured prior morbidity that attracted support before the study began. We highlight approaches to evaluate some of these hypotheses in future research.
Collapse
Affiliation(s)
- David Kapaon
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Carlos Riumallo-Herl
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elyse Jennings
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Shafika Abrahams-Gessel
- Harvard Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Keletso Makofane
- FXB Center for Health and Human Rights, Harvard University, Boston, Massachusetts, United States of America
| | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Guy Harling
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Institute for Global Health, University College London, London, United Kingdom
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
- School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
3
|
Peng S, Li Z, Ji JS, Chen B, Yin X, Zhang W, Liu F, Shen H, Xiang H. Interaction between Extreme Temperature Events and Fine Particulate Matter on Cardiometabolic Multimorbidity: Evidence from Four National Cohort Studies. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:12379-12389. [PMID: 38961056 PMCID: PMC11256764 DOI: 10.1021/acs.est.4c02080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 07/05/2024]
Abstract
Accumulating evidence linked extreme temperature events (ETEs) and fine particulate matter (PM2.5) to cardiometabolic multimorbidity (CMM); however, it remained unknown if and how ETEs and PM2.5 interact to trigger CMM occurrence. Merging four Chinese national cohorts with 64,140 free-CMM adults, we provided strong evidence among ETEs, PM2.5 exposure, and CMM occurrence. Performing Cox hazards regression models along with additive interaction analyses, we found that the hazards ratio (HRs) of CMM occurrence associated with heatwave and cold spell were 1.006-1.019 and 1.063-1.091, respectively. Each 10 μg/m3 increment of PM2.5 concentration was associated with 17.9% (95% confidence interval: 13.9-22.0%) increased risk of CMM. Similar adverse effects were also found among PM2.5 constituents of nitrate, organic matter, sulfate, ammonium, and black carbon. We observed a synergetic interaction of heatwave and PM2.5 pollution on CMM occurrence with relative excess risk due to the interaction of 0.999 (0.663-1.334). Our study provides novel evidence that both ETEs and PM2.5 exposure were positively associated with CMM occurrence, and the heatwave interacts synergistically with PM2.5 to trigger CMM.
Collapse
Affiliation(s)
- Shouxin Peng
- Global
Health Department, School of Public Health, Wuhan University, Wuhan 430071, China
- Global
Health Institute, Wuhan University, Wuhan 430071, China
| | - Zhaoyuan Li
- Global
Health Department, School of Public Health, Wuhan University, Wuhan 430071, China
- Global
Health Institute, Wuhan University, Wuhan 430071, China
| | - John S. Ji
- Vanke
School of Public Health, Tsinghua University, Beijing 100084, China
| | - Bingbing Chen
- Global
Health Department, School of Public Health, Wuhan University, Wuhan 430071, China
| | - Xiaoyi Yin
- Global
Health Department, School of Public Health, Wuhan University, Wuhan 430071, China
| | - Wei Zhang
- Global
Health Department, School of Public Health, Wuhan University, Wuhan 430071, China
| | - Feifei Liu
- Global
Health Department, School of Public Health, Wuhan University, Wuhan 430071, China
- Global
Health Institute, Wuhan University, Wuhan 430071, China
| | - Huanfeng Shen
- School
of Resource and Environmental Sciences, Wuhan University, Wuhan 430079, China
| | - Hao Xiang
- Global
Health Department, School of Public Health, Wuhan University, Wuhan 430071, China
- Global
Health Institute, Wuhan University, Wuhan 430071, China
| |
Collapse
|
4
|
Jennings EA, Mall S, Bassil DT, Kahn K. Exposure to Adversity and its Impact on Later Life Cognitive, Mental, and Physical Health. Int J Public Health 2024; 69:1606499. [PMID: 38961855 PMCID: PMC11219567 DOI: 10.3389/ijph.2024.1606499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 05/29/2024] [Indexed: 07/05/2024] Open
Abstract
Objectives We aimed to assess later-life health responses to childhood and lifetime adversity in a cohort of rural, Black South African adults. Methods We performed ordinary least squares regression using two waves of data from Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) to estimate a decline in cognitive, mental, and physical health over approximately 3 years. Our analytic sample consisted of 1,993 women and 1,496 men. Results Associations between several types of adversity and health outcomes point to declines in health. At the same time, many adverse experiences are associated with improvements in cognitive, mental, and physical health in later life. The direction of the association varied by type of exposure, health outcome, and gender. Conclusion In populations exposed to many adversities during life, specific adverse experiences may sometimes be associated with greater improvements (and not just greater decline) in health in later life. Further research is needed to unpack the mechanisms at play in these populations.
Collapse
Affiliation(s)
- Elyse A. Jennings
- Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Sumaya Mall
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Darina T. Bassil
- Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
5
|
Zeng X, Liu X, Mahe J, Guo K, Wang L, Li L, Jing L. Sex Differences in the Relationship Between Emotional Support and Self-rated Health among Chinese Elderly. Am J Health Promot 2024; 38:219-227. [PMID: 37955208 DOI: 10.1177/08901171231212284] [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: 11/14/2023]
Abstract
PURPOSE This study aimed to explore sex differences in the association between emotional support and self-rated health among the elderly. DESIGN This was a cross-sectional survey based on the sub-project of China's National Basic Public Health Service Project-Health Management Services for the Elderly. SETTING Participants were recruited from ten rural townships in Jingyuan County, Gansu Province, Northwestern China. SUBJECTS 1405 subjects aged 60 or above. METHODS Emotional support (consisting of 5 items) and self-rated health (evaluated by EQ-VAS) were investigated in this study. Multiple linear regression was conducted to consider the potential relationship. RESULTS The frequency of children visit and the number of providers of emotional support were positively associated with self-rated health among older women (β = 1.13, 95%CI = 0.25-2.02; β = 1.80, 95%CI = 1.01-2.58), whereas the number of close friends had a positive association with self-rated health among older men (β = 1.11, 95%CI = 0.20-2.01). The number of close relatives and the frequency of seeking emotional support were not found to be associated with self-rated health among both older men and older women. CONCLUSION The study has found that the relationship between emotional support and self-rated health was differed by sex, calling attention to the need for sex-specific interventions.
Collapse
Affiliation(s)
- Xuejiao Zeng
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Xiaoming Liu
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jinli Mahe
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Kai Guo
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Lei Wang
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Liansheng Li
- Jing Yuan County Hospital of Traditional Chinese Medicine, Baiyin, China
| | - Lipeng Jing
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| |
Collapse
|
6
|
Jennings EA, Chinogurei C, Adams L. Marital experiences and depressive symptoms among older adults in rural South Africa. SSM - MENTAL HEALTH 2022; 2:100083. [PMID: 36277994 PMCID: PMC9581082 DOI: 10.1016/j.ssmmh.2022.100083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 02/23/2022] [Accepted: 02/26/2022] [Indexed: 01/21/2023] Open
Abstract
This paper advances the understanding of how marital transitions may influence mental health by investigating these associations among a population of rural, Black South Africans aged 40+ that was directly impacted by apartheid. Using two waves of data from 4,176 men and women in Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI), we investigated associations between marital experiences and depressive symptoms, by gender, and explored whether economic resources is a moderator of these associations. We found that experiencing a marital dissolution was associated with more depressive symptoms than remaining married for both men and women. We also found that men, but not women, report greater depressive symptoms if they remained separated/divorced, remained widowed, or remained never married between waves. We found no evidence that a decline in wealth moderated the impact of marital dissolution on depressive symptoms for women or men. These findings suggest that the documented benefits of marriage for mental health, and differences by gender in those benefits, may extend to older, rural South Africans, despite the unique experiences of this population.
Collapse
Affiliation(s)
- Elyse A. Jennings
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, USA
| | - Chido Chinogurei
- School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Leslie Adams
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
7
|
Jennings EA, Farrell M, Liu Y, Montana L. Associations between cognitive function and marital status in the U.S., South Africa, Mexico, and China. SSM Popul Health 2022; 20:101288. [DOI: 10.1016/j.ssmph.2022.101288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/11/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022] Open
|
8
|
Knight L, Schatz E. Social Support for Improved ART Adherence and Retention in Care among Older People Living with HIV in Urban South Africa: A Complex Balance between Disclosure and Stigma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11473. [PMID: 36141746 PMCID: PMC9517460 DOI: 10.3390/ijerph191811473] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
The number of older people living with HIV (OPLWH) (aged 50-plus) in South Africa is increasing as people age with HIV or are newly infected. OPLWH are potentially vulnerable because of the intersection of age-related and HIV stigmas, co-morbidities, and lack of social support. Evidence from younger populations suggests that social support can improve ART adherence and retention in care. Further, HIV status disclosure plays a role in mediating social support and may reduce stigma by facilitating access to social support. This paper draws on qualitative research with OPLWH to explore the complex associations between disclosure, social support, and HIV stigma among OPLWH in urban Western Cape. The findings demonstrate that OPLWH receive most of their support from their family and this support can facilitate adherence to ART and retention in care. However, social support is facilitated by participants' disclosure, thus, when perceived stigma limits disclosure, social support is less accessible. Gender, age, and pre-existing vulnerability also affect disclosure to and support from kin and community. Given that social support, particularly from family members, amplifies HIV care access and ART adherence, encouraging disclosure stimulating household HIV competency is likely to both address anticipated stigma and support improved OPLWH's health outcomes.
Collapse
Affiliation(s)
- Lucia Knight
- Division of Social & Behavioural Sciences, School of Public Health, University of Cape Town, Rondebosch, Cape Town 7701, South Africa
| | - Enid Schatz
- Department of Public Health, University of Missouri, Columbia, MO 65211, USA
| |
Collapse
|
9
|
Ralston M, Jennings E, Schatz E. Who is at Risk? Social Support, Relationship Dissolution, and Illness in a Rural Context. SOCIOLOGICAL INQUIRY 2022; 92:1053-1082. [PMID: 36059856 PMCID: PMC9436001 DOI: 10.1111/soin.12456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This study focuses on a cohort of adults (40-plus) in rural South Africa to unpack associations between physical health and receipt of social support, and the extent to which these associations were moderated by marital status. We use logistic regression to estimate the odds of having received emotional, physical, or financial support separately for men (N = 2247) and women (N = 2609). Our results suggest having an Activity of Daily Living (ADL) limitation or having at least one chronic condition was not significantly associated with social support receipt for women, but having an ADL limitation was associated with reduced odds of receiving financial support among men. Although marital status was strongly and significantly associated with receipt of social support for both men and women, marital status moderated the relationship between health indicators and social support receipt only for men. Our findings suggest that when men, but not women, experience a marital dissolution and are suffering from a disability or a chronic condition, their networks respond by providing needed social support.
Collapse
Affiliation(s)
| | | | - Enid Schatz
- University of Missouri; University of the Witwatersand
| |
Collapse
|
10
|
Guo Y, Ge T, Mei L, Wang L, Li J. Widowhood and Health Status Among Chinese Older Adults: The Mediation Effects of Different Types of Support. Front Public Health 2021; 9:745073. [PMID: 34869158 PMCID: PMC8637908 DOI: 10.3389/fpubh.2021.745073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/25/2021] [Indexed: 11/28/2022] Open
Abstract
Although many studies have suggested that widowhood is related to worse health conditions among older adults, few have examined the mediation effects of social support between widowhood and health. Employing mediation analysis to a sample of data from the 2014 wave of China Longitudinal Aging Social Survey (CLASS), this study examined the mediation effects of social support, including emotional support, instrumental support, and companionship, in the widowhood-health association among older adults. The results indicated that the negative effect of widowhood on older adults' health was in part attributable to decreased emotional support and companionship. Specifically, emotional support exerted a significant role in the widowhood-mental health association, and companionship exerted a significant role in widowhood-physical health and widowhood-mental health associations. In the subsample analysis, the mediation effects were only significant among female older adults, and among rural older adults. Our findings highlight the importance of emotional support and companionship in maintaining health among widowed older adults and strategies should pay more attention to female and rural widowed older adults.
Collapse
Affiliation(s)
- Yu Guo
- School of Public Policy and Administration, Institute for Population and Development Studies, Xi'an Jiaotong University, Xi'an, China
| | - Tingshuai Ge
- School of Public Policy and Administration, Institute for Population and Development Studies, Xi'an Jiaotong University, Xi'an, China
| | - Li Mei
- School of Public Policy and Administration, Institute for Population and Development Studies, Xi'an Jiaotong University, Xi'an, China
| | - Lina Wang
- School of Public Policy and Administration, Institute for Population and Development Studies, Xi'an Jiaotong University, Xi'an, China
| | - Jingbo Li
- School of Labor Economics, Capital University of Economics and Business, Beijing, China
| |
Collapse
|
11
|
Schatz E, Knight L, Mukumbang FC, Teti M, Myroniuk TW. 'You Have to Withstand That Because You Have Come for What You Have Come for': Barriers and facilitators to antiretroviral treatment access among older South Africans living with HIV. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:624-641. [PMID: 33682928 DOI: 10.1111/1467-9566.13243] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/09/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
Nationwide rollout of antiretroviral treatment (ART) is increasing the number of older persons living with HIV (OPLWH) in South Africa. Yet, little is known about how the sociological aspects of ageing - stigma, finances and family dynamics - impact access to ART. Qualitative interviews with 23 persons aged 50-plus living near Cape Town highlight the barriers and facilitators to the acceptability, affordability and availability of ART access among OPLWH. Key age-related barriers included perceived shame of sexuality and disclosing HIV status to others, perceived disrespect by clinical staff, affording transportation to clinics and pre-existing co-morbidities. Key age-related facilitators included family moral and financial support, particularly from children and grandchildren, and access to social grants. Importantly, many barriers and facilitators had feedback loops, for example social grants reduced transportation barriers to clinics when ageing and poor health limited mobility. As the population living with HIV ages, it is critical to assess the ways ageing, as a social process, impacts ART access and to address these to improve older persons' HIV care.
Collapse
Affiliation(s)
- Enid Schatz
- Department of Public Health, School of Health Professions, University of Missouri, Columbia, MO, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit(Agincourt, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lucia Knight
- Division of Social and Behavioural Sciences, Faculty of Health Sciences, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Faculty of Community and Health Sciences, School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Ferdinand C Mukumbang
- Department of Global Health, The Global Center for Integrated Health of Women, Adolescents, and Children (Global WACh, University of Washington, Seattle, WA, USA
| | - Michelle Teti
- Department of Public Health, School of Health Professions, University of Missouri, Columbia, MO, USA
| | - Tyler W Myroniuk
- Department of Public Health, School of Health Professions, University of Missouri, Columbia, MO, USA
| |
Collapse
|
12
|
Clark S, Cotton C, Margolis R, Kohler HP. The Psychological Benefits of Marriage and Children in Rural Malawi. Stud Fam Plann 2020; 51:251-272. [PMID: 32720321 PMCID: PMC7778373 DOI: 10.1111/sifp.12133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Despite an extensive literature on the psychological rewards of marriage and children in high-income countries, research on these relationships in low-income countries remains limited. This paper draws on data from 4,133 adult women and men interviewed in the Malawi Longitudinal Study of Families and Health to examine how marital status, categorized as never, formerly, monogamously, and polygynously married, and number of children are associated with psychological well-being. With respect to marital status, we find that women in polygynous unions fare worse than monogamously married women and this detrimental effect is stronger for women than for men. Formerly married men and women of reproductive age experience the worst psychological outcomes, although this association wanes with age. In contrast, the benefits of having children is only evident among older Malawian women. These findings offer novel insights into the patterns of nearly universal marriage and high fertility that characterize Malawi and much of sub-Saharan Africa.
Collapse
Affiliation(s)
- Shelley Clark
- Department of Sociology, McGill University, Montreal, Quebec, H3A 2T7, Canada
| | - Cassandra Cotton
- School of Social & Family Dynamics, Arizona State University, Tempe, AZ, 85287, USA
| | - Rachel Margolis
- Department of Sociology, Western University, London, Ontario, N6A 5C2, Canada
| | - Hans-Peter Kohler
- Department of Sociology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| |
Collapse
|