Widowhood effect

The widowhood effect is the increase in the probability of a person dying a relatively short time after their long-time spouse has died. This process of losing a spouse and dying shortly after has also been called “dying of a broken heart”. Responses of grief and bereavement due to the loss of a spouse increases vulnerability to psychological and physical illnesses (Ramadas & Kuttichira, 2013). Psychologically, losing a long-term spouse can cause symptoms such as depression, anxiety, and feelings of guilt. Physical illness may also occur as the body becomes more vulnerable to emotional and environmental stressors. There are many factors that may be affected when one becomes a widow. A widow (or widower if you are a male who lost a spouse) tends to have a decline in health regulation. This effect appears to be far more prevalent in older married couples than in younger married couples. As a result, studies that have been conducted in regards to this phenomenon since the early 2000s have revolved primarily around observations of older widows. Through the many studies that have been conducted over the years, it has been found that the widowhood effect affects the mortality rates of people with varying levels of severity depending on their genders and religions.^[1]It is far more frequent in more seasoned, long-term, elder couples than in recently married couples. Since the topic has only been recently studied within this last decade, and due to the prevalence of older couples being affected, most widows in similar studies are typically over the age of 50^[2] (Jegtvig, 2013). Through the numerous studies that have been directed throughout the years, it has been found that the widowhood impact influences the death rates of individuals with changing levels of stringencies relying upon their sexual orientations and religions. There are many theories as to what causes this to occur. There are many factors and theories about the widowhood effect but in a majority of studies, there becomes a 66% chance the second spouse will die within the first 3 months since the passing of the first spouse^[3] (Moon, et al., 2013)

Gender differences

The majority of peer-reviewed articles suggest that it is indeed men that are more frequently at risk of succumbing to the widowhood effect. A collaborative study by Gary R. Lee et al. (2001) surveyed 1686 married and widowed people age 65 or older using data from 1988 National Survey of Families and Households. The study took into account the psychological well-being of each person on a Center for Epidemiologic Studies— Depression scale (CES-D), and found that men were further depressed by the loss of their spouse than women were. Men were also more likely to die soon after the death of their spouse compared to their female counterparts . The researchers hypothesized that this was because older married men had a higher baseline happiness than their spouses, so they had more happiness to lose . Men in this study were also less likely to be avid church goers, despised chores, and were not as adept at helping their adult children. The lack of social behavior and general activity may contribute to the widowhood effect's influence on male mortality.^[4][5]

In a study done by Stahl and Shultz, they found that the death of a man’s spouse affected his physical activity (2014). Men’s physical activity increases immediately following the death of a spouse, and the authors note that this may perhaps be a coping mechanism to alleviate depressive symptoms (Stahl & Shultz, 2014). In the year following the death of a spouse, men are more likely to experience a fluctuation in physical activity during the transition into widowhood, if they did not die (Stahl & Shultz, 2014). Men in the youngest age group of this study (55- 65 years) were at the highest risk of mortality after the death of their spouse (Brenn & Ytterstad, 2016). Elwert and Christakis found that within the first month of bereavement after widowhood morality is largest and doesn’t decline sharply until the sixth month of widowhood for white males, compared to only the third month for white females (2006).

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Religious differences

A study, by Ernest L. Abel and Michael L. Kruger (2009), compared the likelihood of death for Catholic as compared to Jewish widows, based on the graves of Jewish and Catholic couples in the Midwest. The data suggested that the widowhood effect was stronger in Jewish than in Catholic couples. Catholic women lived 11 years after the death of their spouse while Jewish women lived 9.5 years after the deaths of their husbands. Similarly, the Jewish men lived 5 years after the death of the wives while the Catholic men lived about 8 years after the death of their wives.^[7]

Dietary health effects of widowhood

Research has found that surviving spouses tend to experience significant weight loss after the deaths of their mates. It has been theorized that these changes in weight are the result of differences in dietary intake before and after the death of a spouse. Danit R. Shahar et al. (2001) surveyed 116 older individuals in order to track their weight and eating habits over the course of their longitudinal study. Half of the participants were widowed and the other half were nonwidowed. The study found that the widowed subjects were more likely to eat meals alone than the married individuals. The diets of the widowed subjects consisted of more commercial foods than their counterparts, but they also lost a significant amount of weight compared to the married group. Danit R. Shahar et al. (2001) hypothesized that this weight loss was the result of the widowed participants not finding as much enjoyment in eating as the once did. This lack of fulfillment during meals was correlated to a lack of companionship while eating. Widowed subjects had less of an appetite and as a result lost weight over the course of the study.^[8]

Takotsubo and the Widowhood Effect

Recently, there has been a phenomenon discussed and researched dubbed the takotsubo condition, also referred to as the broken heart syndrome (Brenn & Ytterstad, 2016). Takotsubo has been discussed in contexts surrounding great physical and emotional stress, such as circumstance in which someone has been widowed, and “[e]motional stress has long been associated with myocardial infarction,” (Brenn & Ytterstad, 2016). In their research, Brenn and Ytterstad saw an increase in death of women 55-64 years old due to heart disease in the first week of widowhood than married women 55-64 years old (2016). Although takotsubo is not considered to be the direct cause of death at this time, it is an observed phenomenon (Brenn & Ytterstad, 2016.)

Effects of widowhood on social life

Elderly widows and widowers experience changes in their social lives prior to and following the deaths of their spouses. A study conducted by Rebecca L. Utz et al. (2002) revealed that elderly persons experiencing widowhood spent more time with family and friends than nonwidowed counterparts, based on the lifestyle changes that occur in elderly couples. Although widowed subjects were more likely to socialize with family and friends, they were no more likely to visit church or volunteer than the intact couples. This study also found that healthy spouses were reclusive while their significant other was on their deathbed, but due to a network of family and friends; the surviving spouse entered society being more social than had been prior to the death of their husband or wife. Elderly widows and widowers were more or less involved socially depending on the amount of support they had from family and friends.^[1] It has been noted that widows/widowers who have a close and supportive social network can counteract the effects of widowhood by remaining active in their social group.

Urban, rural and race variations

A study conducted by Rosato, O’Reilly and Wright (2015) revealed that there is a significant difference in urban-rural variation in the social environment as well as in health outcomes. There is evidence that social support from family and friends have better health outcomes on mortality rates. According to Rosato, O’Reilly and Wright (2015), investigations showed that the race of the partner influences widowhood effect; whites in endogamous marriages had greater mortality risks that were not obvious among blacks, which the authors concluded was due to a high level of family support for elderly among black families versuswhite families. Moreover, the study also found differences in urban and rural areas around the world. They found that elderly married couples in the US suffered significant mortality risks compared to those in Northern Ireland; in Northern Ireland older people living in more rural areas receive more social support from their families, and they live with their children, while in the US elderly people live in care homes. As a result, mortality rates are greater in urban areas and less in rural areas.

In a study done by Elwert and Christakis, they found that there was no widowhood effect found in endogamously married black men or women (2016). Deducing this finding, they proposed that this might be because blacks are able to extend their marital survival advantage into widowhood. This is likely because blacks are prone to have kin nearer to help take care of them, they may be more self-sufficient than their white counterparts, and there is greater religious participation in blacks that may help them with spiritual comfort (Elwert & Christakis, 2016). Whites married to whites were found to have “a large and enduring widowhood effect” because there is no reparation to make up for the survival advantages that marriage gave them, even if they have been widowed for years (Elwert & Christakis, 2008).

Deaths due to Suicide

The majority of elders who commit suicide in Denmark are widowers (Brenn & Ytterstad, 2016). In the USA, men under 50 who are widowed show “extremely high suicide rates (Brenn & Ytterstad, 2016). In Switzerland suicide risk increases in those who are widowed (Brenn & Ytterstad, 2016).

Possible causes

In the past, it was suggested that the widowhood effect was a mere coincidence resulting from the selection of mates with similar health risk . In a recent study by Paul J. Boyle, Feng, Z., & Raab, G. M. (2011), it was concluded that the increased mortality rate of widows is caused by the death of their spouse. Researchers in the study used data from the Scottish Longitudinal Study to compare the ratios of death in widowed males and females. The male and female subjects were categorized into different groups dependent on the manner in which their spouse died. The results provided evidence that suggest a causal relationship between mortality rate and widowhood.^[9]

In April 2016, the American Heart Association published an article regarding phenomenon referred to as "broken heart syndrome". This particular syndrome seems to occur when a person experiences an overwhelming amount of stress in their life in a short period of time. The cases mentioned involved both positive events like winning the lottery as well as negative events like experiencing the death of a spouse. Though broken heart syndrome has been misdiagnosed as a heart attack, the differences between the two phenomena are clear. Heart attacks are the result of a blockage of arteries, but broken heart syndrome is the result of a hormone induced enlargement of a portion of the heart. The enlarged region of the heart is less effective in regards to pumping blood, and the normal sized regions of the heart are forced to work harder as a result.^[4]

Notes

Bibliography

Elwert, F., & Christakis, N. A. (2008). The Effect of Widowhood on Mortality by the Causes of Death of Both Spouses. American Journal of Public Health, 98(11), 2092-2098. doi:10.2105/ajph.2007.114348

Wright, D. M., Rosato, M., & O’Reilly, D. (2015). Urban/rural variation in the influence of widowhood on mortality risk: A cohort study of almost 300,000 couples. Health & Place, 34, 67-73. doi:10.1016/j.healthplace.2015.04.003