1. Coping and social support Death of a spouse Jennifer Tetzlaff EPI 6181 November 2006

2. Introduction  Loss of spouse one of most stressful life events in life course  Many accounts of ‘Widowhood effect’ Soon after death of a spouse, widows and widowers are at increased risk of 1 :  Morbidity - both physical and psychological  Mortality 1 e.g. Bowling A. Soc Sci Med. 1987; 24 (2): 117-24

3.  Period of greatest risk is within 30 days of a spouse entering hospital or dying Risk of death increases: ~ 62% for women, ~ 52% for men 2  Risk declines sharply after 3 months for women, 6 months for men, but  Risk remains high up to 2 years and then generally stabilizes at earlier physical and psychological levels Widowhood effect 2 Elwert F, Christakis NA. American Sociological Reviews 2006; 71 (1): 16

4. Possible Pathways  Loss of protective effect of marriage 3 Marriage promotes healthy behaviours and reduced risk taking Possibly substantiated by lower rates of death with remarriage: possibility of selection bias (healthier people are more likely to remarry rather than health being a result of marriage) 1  Shared noxious environmental influences that might affect health Some evidence to suggest that survivors are at increased risk of death or illness from same conditions as deceased  Lack of self-care skills New gender roles & responsibilities may be difficult for surviving spouse  Stress and/or depression Suppressed immune system - increased susceptibility to disease and mortality Response to stress with unhealthy behaviours (smoking, drinking, unhealthy eating) 3 e.g. Simon RW. American Journal of Sociology 2002; 107: 1064

5. Risk, Protective Factors and Coping  Closer spousal relationship: Initially – leads to more depression (risk) After 4 years – less depression (protective) 4  Higher SES: more depression Possible explanations:  E.g. More likely to own a home = More stress, more social isolation  More ‘personal independence’: better health outcome Greater resources to develop long-term coping strategies  Gender roles: more pronounced roles, worse health outcome 4 e.g. Carr D. Journal of Health and Social Behavior 2003; 44: 215-32.

6.  Perceived coping ability, self-esteem 5 Inversely related to stress at six months  Optimism versus Pessimism 6 Optimism may reduce health problems  Related to lower incidence of CAD Hostility theory? Antonovsky’s Sense of Coherence? 5 Johnson RJ, Lund DA, Diamond MF. Social Psychology Quarterly 1986; 49 (3): 273 6 Kivimaki M et al. Health Psychology 2005; 24 (4): 413-21 Risk, Protective Factors and Coping

7. Coping – Gender Differences  Coping abilities: Men often fare better with ‘Sudden Loss’ (quick, unexpected death) of spouse Women often fare better when death involves ‘Anticipatory Grief’ (period of warning)  Theorized to result from different existing social networks and social norms Men less likely to form social networks during long illness of spouse Men more likely to seek closeness only from their dying spouse Men more likely to remarry – ‘social adjustment’

8.  Evidence of ‘widowhood effect’ among white Americans - no evidence among black Americans 2 Protective effect of marriage present for both races  Suggested rationale: Elderly black Americans almost twice as likely to live with relatives Black Americans more active in religious organizations Blacks have stronger, more extensive social networks than elderly white Americans Again, coping and associated health effects proposed to be related to social networks 2 Elwert F, Christakis NA. American Sociological Reviews 2006; 71 (1): 16 Coping – Racial Differences

9. Social Support?  Extensive research with conflicting findings… the usual!  Miller et al. (2004) reviewed 19 studies of ‘adjustment’ in widows Results suggest that social support may be protective in the event of the loss of their spouse… …or it may be ineffective …or it may even be harmful 7 ?  This differential effect is postulated to be related to Perceived vs. Received social support: Perceived may have positive impact Received may have negative impact  Authors concluded that the results did not suggest social support improved adjustment 7 Miller NB, Smerglia VL, Bouchet N. J Women Aging 2004; 16:149-167.