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10/23/2017 Yuzu: Psychology of Gender: Fourth Edition

https://reader.yuzu.com/#/books/9781317345046/cfi/6/40!/4/2/162/2@0:2.22 1/2

EFFECT OF BEREAVEMENT ON HEALTH If marriage is good for health, presumably losing a spouse has negative effects on health. These negative effects could stem from the loss of resources that the deceased spouse provided as well as the general experience of bereavement. Determining the effects of bereavement on health is not easy. Two kinds of studies have been conducted to address this issue: cross-sectional and longitudinal. Cross-sectional studies evaluate people who are widowed at a single point in time. The advantage of this methodology is that large representative samples can be studied. There are three disadvantages. First, people are widowed for varying lengths of time, and the length of time since widowhood is bound to influence health. Second, the healthiest people are more likely to remarry after widowhood. Thus the people who remain widowed are not representative of all widowed people and may be more unhealthy than the widowed who have remarried. Third, causality cannot be inferred. In other words, we will not know if widowhood caused the decline in health or if unhealthy people were more likely to be widowed. At first glance, this latter possibility may seem unlikely. However, recall that people are attracted to similar others and marry people who are similar to themselves. One characteristic on which matching could occur is health. It is possible, then, that less healthy people are more likely to lose a spouse.

An important methodological issue to keep in mind when evaluating cross-sectional studies of the effect of widowhood on health is whether an appropriate comparison group of nonwidowed persons was used. This is especially important when evaluating sex differences in the effects of widowhood on health. Why? If widowed women and widowed men show equal health profiles, can we conclude that widowhood has the same effects on the health of women and men? No, because women and men who are not widowed differ in health. For example, married women are more depressed than married men. A study that shows no sex differences in depression among widowed women and men could imply that widowhood increased men’s distress levels to those of women or lowered women’s distress levels to those of men. In other words, widowhood could have very different effects on women’s and men’s distress. Let’s take another example. In general, men have higher suicide rates compared to women. A study that shows no sex differences in suicide rates among the widowed could imply that widowhood increased women’s suicide rates to those of men or decreased men’s suicide rates to those of women. The most appropriate comparison group to use in a study of widowhood is married women and men because both widowed and married people share the experience of having entered into marriage. It would not be appropriate to compare widowed persons to never-married persons because we know there are differences between the kinds of people who do and do not get married.

The second way to examine the effects of widowhood on health is to conduct a longitudinal study. Longitudinal studies typically examine people shortly after widowhood and then follow them over time to assess changes in their health. The disadvantage of this methodology is that we do not know people’s level of health before widowhood. The advantage, however, is that we know people’s initial health status immediately after widowhood so we can truly examine changes in health over time.

The ideal study of widowhood would use a prospective design in which people’s health is examined before and after widowhood. Imagine how difficult it would be to conduct such a study. One would have to enroll a large number of people into a study and then follow them for a long time so a sufficient number of people lose a spouse. Thus you can imagine there are few prospective studies on widowhood. One way in which a prospective study can be conducted is to follow couples in which a spouse is at high risk for death. However, the caregiver spouse’s health might already be impacted if a spouse is ill.

Evidence Widowhood seems to have a more negative effect on men’s health than women’s health (Stroebe, Schut, & Stroebe, 2007). A seven-year prospective study showed that widowed men had higher mortality rates compared to married people but widowed women did not (Molloy et al., 2009). Another study showed that men’s mortality was higher if widowed than married but women’s mortality was lower if widowed than married (Pizzetti & Manfredini, 2008). A study of stroke showed that widowed persons were at increased risk relative to married persons, but the risk was greater for men (Maselko et al., 2009).

Men also appear to be more distressed following widowhood compared to women. In a prospective study that followed couples before and after a spouse died from severe renal disease, men reported greater grief six months following the loss of their spouses than women (Pruchno, Cartwright, & Wilson-Genderson, 2009). A nationally representative survey showed that the transition to widowhood was associated with a decline in self- reported health for men but not women (Williams & Umberson, 2004). However, the negative effects were

10/23/2017 Yuzu: Psychology of Gender: Fourth Edition

https://reader.yuzu.com/#/books/9781317345046/cfi/6/40!/4/2/162/2@0:2.22 2/2

short-lived. Within three to five years, these men’s health had substantially improved. By contrast, another study showed that small sex differences in distress appeared among recently widowed persons, but large sex differences emerged among those who had been widowed for more than four years (van Grootheest et al., 1999). Finally, one study found that widowed women initially had worse mental health than married women (Wilcox et al., 2003), but with time, the mental health of widowed women improved and ended up exceeding that of the married women. Thus women may recover more easily from widowhood than men.

Explanations Strains. One explanation for sex differences in health following the loss of a spouse is that women and men face different strains or stressors from widowhood. Traditionally, women suffered financial strains, whereas men suffered strains from having to keep up with household chores. The strain of keeping up with household chores is an immediate strain and a daily strain, which may explain why men suffer more than women immediately following widowhood. Alternatively, caring for an ill spouse is a strain that is removed by widowhood. Because women are traditionally more involved in caregiving than men—whether the spouse is ill or not—one reason that women might not suffer as much as men following the loss of a spouse is that some of the burden associated with support provision has been removed. In an interview study with recently widowed men and women, women mentioned a freedom from having to look after someone as a deterrent to remarriage, whereas men did not express this concern (Davidson, 2001). Social Support. A major loss associated with widowhood is the loss of social support. Interpersonal protection theory has been used to explain why men suffer more than women