Marital status, widowhood duration, gender and health outcomes: a cross-sectional study among older adults in India

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Abstract

Background

Previous research has demonstrated health benefits of marriage and the potential for worse outcomes during widowhood in some populations. However, few studies have assessed the relevance of widowhood and widowhood duration to a variety of health-related outcomes and chronic diseases among older adults in India, and even fewer have examined these relationships stratified by gender.

Methods

Using a cross-sectional representative sample of 9,615 adults aged 60 years or older from 7 states in diverse regions of India, we examine the relationship between widowhood and self-rated health, psychological distress, cognitive ability, and four chronic diseases before and after adjusting for demographic characteristics, socioeconomic status, living with children, and rural–urban location for men and women, separately. We then assess these associations when widowhood accounts for duration.

Results

Being widowed as opposed to married was associated with worse health outcomes for women after adjusting for other explanatory factors. Widowhood in general was not associated with any outcomes for men except for cognitive ability, though men who were widowed within 0–4 years were at greater risk for diabetes compared to married men. Moreover, recently widowed women and women who were widowed long-term were more likely to experience psychological distress, worse self-rated health, and hypertension, even after adjusting for other explanatory variables, whereas women widowed 5–9 years were not, compared to married women.

Conclusions

Gender, the duration of widowhood, and type of outcome are each relevant pieces of information when assessing the potential for widowhood to negatively impact health. Future research should explore how the mechanisms linking widowhood to health vary over the course of widowhood. Incorporating information about marital relationships into the design of intervention programs may help better target potential beneficiaries among older adults in India.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3682-9) contains supplementary material, which is available to authorized users.

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Most cited references 73

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Gender, marital status and the social control of health behavior.

D Umberson (1992)

Mortality rates are lower for married individuals than they are for unmarried individuals, and marriage seems to be even more beneficial to men than women in this regard. A theoretical model of social integration and social control is developed to explain why this may occur. Drawing from this model, I hypothesize that marriage may be beneficial to health because many spouses monitor and attempt to control their spouse's health behaviors. Furthermore, the provision, receipt, and consequences of these social control efforts may vary for men and women. These hypotheses are considered with analysis of a national panel survey conducted in 1986 (N = 3617) and 1989 (N = 2867). Results show that: (1) marriage is associated with receipt of substantially more efforts to control health for men than women, (2) those who attempt to control the health of others are more likely to be female than male, (3) there is some support for the social control and health behavior hypothesis among the married, and (4) the transition from married to unmarried status is associated with an increase in negative health behavior while the transition from unmarried to married status seems to have little effect on health behavior. A theoretical explanation is developed to explain these marital status differences.

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The times they are a changin': marital status and health differentials from 1972 to 2003.

Hui Liu, Debra J. Umberson (2008)

Although the meanings and rates of being married, divorced, separated, never-married, and widowed have changed significantly over the past several decades, we know very little about historical trends in the relationship between marital status and health. Our analysis of pooled data from the National Health Interview Survey from 1972 to 2003 shows that the self-rated health of the never-married has improved over the past three decades. Moreover, the gap between the married and the never married has steadily converged over time for men but not for women. In contrast, the self-rated health of the widowed, divorced, and separated worsened over time relative to the married, and the adverse effects of marital dissolution have increased more for women than for men. Our findings highlight the importance of social change in shaping the impact of marital status on self-reported health and challenge long-held assumptions about gender, marital status, and health.

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Widowhood and depression: explaining long-term gender differences in vulnerability.

R Kessler, Ryan Wortman, D Umberson (1992)

Results from a 1986 national survey (N = 3,614) show that having ever been widowed is associated with current levels of depression and that this association is greater for men than women. Some of this apparent gender difference occurs because men have been widowed for a shorter average period of time than women and the effects of widowhood appear to lessen over time. Widowhood also is associated with different types and amounts of life strain for men and women. The results suggest that the primary mechanism linking widowhood to depression among women is financial strain. Among men, the more critical mechanisms seem to be strains associated with household management. When specific strains occur, they appear to have different effects on respondents who have ever been widowed and those who have not. Taken together, these results suggest that what appears on the surface to be a gender difference in vulnerability to the same life event turns out upon closer examination to occur because widowhood does not affect men and women in the same way.

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Author and article information

Contributors

Jessica M. Perkins: jessica.perkins@post.harvard.edu

Hwa-young Lee: diana0224@gmail.com

K. S. James: james@isec.ac.in

Juhwan Oh: juhwan.oh328@gmail.com

Aditi Krishna: aditikrishna85@gmail.com

Jongho Heo: jjongho77@gmail.com

Jong-koo Lee: docmohw@snu.ac.kr

S. V. Subramanian: svsubram@hsph.harvard.edu

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 30 September 2016

Publication date PMC-release: 30 September 2016

Publication date Collection: 2016

Volume: 16

Electronic Location Identifier: 1032

Affiliations

[1 ]Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA USA

[2 ]Massachusetts Center for Global Health, Massachusetts General Hospital, Boston, MA USA

[3 ]JW LEE Center for Global Medicine, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul, 110-810 Korea

[4 ]Jawaharlal Nehru University, New Delhi, India

[5 ]Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA USA

[6 ]Public Health Joint Doctoral Program, San Diego State University & University of California, San Diego, CA USA

[7 ]Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea

Article

Publisher ID: 3682

DOI: 10.1186/s12889-016-3682-9

PMC ID: 5045657

PubMed ID: 27716203

SO-VID: 06b70b02-a5e7-4b8a-b509-33566fc49a82

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 22 December 2015

Date accepted : 19 September 2016

Custom metadata

ScienceOpen disciplines: Public health

Keywords: widowhood,aging,india,gender,self-rated health,chronic disease,cognition,psychological distress

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ScienceOpen disciplines: Public health

Keywords: widowhood, aging, india, gender, self-rated health, chronic disease, cognition, psychological distress

Marital status, widowhood duration, gender and health outcomes: a cross-sectional study among older adults in India

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Abstract

Background

Methods

Results

Conclusions

Electronic supplementary material

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Jiangsu Journal of Preventive Medicine

Most cited references 73

Gender, marital status and the social control of health behavior.

The times they are a changin': marital status and health differentials from 1972 to 2003.

Widowhood and depression: explaining long-term gender differences in vulnerability.

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