The enduring effects of marital status on subsequent depressive symptoms among women: investigating the roles of psychological, social and financial resources

Lópes

2016

JAHA

BackgroundStroke is among the leading causes of disability and death in the United States, and nearly 7 million adults are currently alive after experiencing a stroke. Although the risks associated with having a stroke are well established, we know surprisingly little about how marital status influences survival in adults with this condition. This study is the first prospective investigation of how marital history is related to survival after stroke in the United States.Methods and ResultsData from a nationally representative sample of older adults who experienced a stroke (n=2351) were used to examine whether and to what extent current marital status and past marital losses were associated with risks of dying after the onset of disease. Results showed that the risks of dying following a stroke were significantly higher among the never married (hazard ratio [HR], 1.55; 95% CI, 1.15–2.08), remarried (HR, 1.22; 95% CI, 1.05–1.43), divorced (HR, 1.22; 95% CI, 1.01–1.50), and widowed (HR, 1.32; 95% CI, 1.16–1.51) relative to those who remained continuously married. We also found that having multiple marital losses was especially detrimental to survival—regardless of current marital status and accounting for multiple socioeconomic, psychosocial, behavioral, and physiological risk factors.ConclusionsMarital history is significantly associated with survival after stroke. Additional studies are needed to further examine the mechanisms contributing to the associations and to better understand how this information can be used to personalize care and aggressively treat vulnerable segments of the population.

Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 99%

Marital History and Survival After Stroke

Lópes

2016

JAHA

“…The prevailing argument is that divorce has a negative impact on the economic, behavioral, and emotional well-being of individuals that reduces their ability to prevent, detect, and treat illness. 13,15,28-30,44 Contrary to expectations and existing literature, we found that losses of income and health insurance, 26,29 and increases in depressive symptoms, alcohol use, and smoking, 21,28,30 did not account for the excess risks attributable to a history of divorce in men and women. We suspect that the acute and chronic stress associated with divorce may have played an important role in our findings for both sexes.…”

Section: Discussioncontrasting

confidence: 99%

Association Between Divorce and Risks for Acute Myocardial Infarction

Circ: Cardiovascular Quality and Outcomes

George

Liu

et al. 2015

Background Divorce is a major life stressor that can have economic, emotional, and physical health consequences. However, the cumulative association between divorce and risks for acute myocardial infarction (AMI) is unknown. This study investigated the association between lifetime exposure to divorce and the incidence of AMI in U.S. adults. Methods and Results We used nationally representative data from a prospective cohort of ever-married adults aged 45 to 80 (n=15,827) who were followed biennially from 1992 to 2010. Approximately 14% of men and 19% of women were divorced at baseline and more than one-third of the cohort had at least one divorce in their lifetime. In 200,524 person-years of follow-up, 8% (n=1,211) of the cohort had an AMI and age-specific rates of AMI were consistently higher in those who were divorced relative to those who were continuously married (P<.05). Results from competing-risk hazard models showed that AMI risks were significantly higher in women who had 1 divorce (HR, 1.24; 95% CI, 1.01-1.55), 2 or more divorces (HR, 1.77; 95% CI, 1.30-2.41), and among the remarried (HR, 1.35; 95% CI, 1.07-1.70) compared with continuously married women after adjusting for multiple risk factors. Multivariable-adjusted risks were elevated only in men with a history of 2 or more divorces (HR, 1.30; 95%CI, 1.02-1.66) relative to continuously married men. Men who remarried had no significant risk for AMI. Interaction terms for sex were not statistically significant. Conclusions Divorce is a significant risk factor for AMI. The risks associated with multiple divorces are especially high in women and are not reduced with remarriage.

“…The prevailing argument is that marital dissolution has a negative impact on the economic, behavioral, and emotional well-being of individuals that reduces their ability to prevent, detect, and treat illness (LaPierre 2012; Lavelle and Smock 2012; O’Rand and Hamil-Luker 2005; Umberson 1992). The results of this study suggest that additional factors may be important to consider.…”

Section: Discussionmentioning

confidence: 99%

Race, Marital History, and Risks for Stroke in US Older Adults

2016

Social Forces

Stroke is among the leading causes of disability and death in the United States, and racial differences are greater for stroke than for all other major chronic diseases. Considering the equally sizeable racial disparities in marital life and associated risks across adulthood, the current study hypothesizes that black-white differences in marital history play an important role in the large racial inequalities in the incidence of stroke. The major objective are to (i) demonstrate how marital history is associated with the incidence of stroke, (ii) examine how marital factors mediate and/or moderate racial disparities in stroke, and (iii) examine the factors that may explain the associations. Using retrospective and prospective data from the Health and Retirement Study (n = 23,289), the results show that non-Hispanic (NH) blacks have significantly higher rates of marital instability, greater numbers of health-risk factors, and substantially higher rates of stroke compared with NH whites. Contrary to the cumulative disadvantage hypothesis, findings from discrete-time-hazard models show that the effects of marital history are more pronounced for NH whites than for NH blacks. Risks for stroke were significantly higher in NH whites who were currently divorced, remarried, and widowed, as well as in those with a history of divorce or widowhood, compared with NH whites who were continuously married. In NH blacks, risks for stroke were elevated only in those who had either never married or had been widowed—with no significant risks attributable to divorce. The potential mechanisms underlying the associations are assessed, and the implications of the findings are discussed.