Archive for August, 2016

Until Sickness Us Do Part

Wednesday, August 17th, 2016

Couples promise to stay together in sickness and in health, but a recent (and revised) study finds that the risk of divorce among older married couples rises when the wife – but not the husband — becomes seriously ill with heart trouble.

A previously widely reported finding that the risk of divorce increases when wives fall ill — but not when men do — is invalid, thanks to a short string of mistaken coding that negates the original conclusions, published in the March issue of the Journal of Health and Social Behavior. The paper, “In Sickness and in Health? Physical Illness as a Risk Factor for Marital Dissolution in Later Life,” garnered coverage in many news outlets, including The Washington Post, New York magazine’s The Science of Us blog, The Huffington Post, and the UK’s Daily Mail . However, an error in a line of the coding that analyzed the data means the conclusions in the paper — and all the news stories about those conclusions — are “more nuanced,” according to first author Amelia Karraker, an assistant professor at Iowa State University and a National Institute on Aging Postdoctoral Fellow at the ISR Population Studies Center.

The miscoding error happened because people who left the study were actually miscoded as getting divorced. Using the corrected code, Karraker and her co-author, Kenzie Latham of Indiana University-Purdue University Indianapolis, did the analysis again, and found the results stand only when wives develop heart problems, not other illnesses. “What we find in the corrected analysis is we still see evidence that when wives become sick marriages are at an elevated risk of divorce, whereas we don’t see any relationship between divorce and husbands’ illness. We see this in a very specific case, which is in the onset of heart problems. So basically it’s a more nuanced finding. The finding is not quite as strong,” said Karraker.

“Married women diagnosed with a serious health condition may find themselves struggling with the impact of their disease while also experiencing the stress of divorce,” says Karraker, a researcher at the University of Michigan Institute for Social Research (ISR).

For the study, she and Latham analyzed 20 years of data on 2,717 marriages from the Health and Retirement Study, conducted by ISR since 1992. At the time of the first interview, at least one of the partners was over the age of 50.

The researchers examined how the onset of four serious physical illnesses – cancer, heart problems, lung disease and stroke – affected marriages.

They found that overall 31 percent of the marriages ended in divorce over the period studied. The incidence of new chronic illness onset increased over time as well, with more husbands than wives developing serious health problems.
“We found that women are doubly vulnerable to marital dissolution in the face of illness,” says Karraker. “They are more likely to be widowed, and if they are the ones who become ill, they are more likely to get divorced.”

While the study did not assess why divorce is more likely when wives but not husbands become seriously ill, Karraker offers a few possible reasons.

“Gender norms and social expectations about care giving may make it more difficult for men to provide care to ill spouses,” Karraker speculates. “And because of the imbalance in marriage markets especially in older ages, divorced men have more choices among prospective partners than divorced women.
The study did not examine why a woman’s illness was more likely than a man’s to lead to divorce, but Karraker suggested that because women tend to be caregivers, it can cause extra strain when a man has to assume the role. By contrast, a study found a couple was no more likely to divorce if a husband got sick.

In fact, care giving can be such a strain that it can lead to illness or even death for the caregiver, Karraker said.

Dr. Jacob Ham, a clinical psychologist and Director of Mount Sinai Beth Israel’s HEARTS (Healing Emotions and Achieving Resilience to Traumatic Stress) Program, calls illness a “huge threat” to a person’s sense of attachment.

“Any time we feel threatened with trauma or loss, the desire to seek comfort and security from someone we love gets triggered. If the threat means you’re going to lose the person you turn to for that, it’s devastating,” Ham said.

“We did not have information on who initiated divorce in this study. But it’s important to keep in mind that in most cases, it’s women who do so. So it could be that when women become ill and their husbands are not doing a very good job caring for them, they would rather that he just go and they rely on friends and family who will take care of them.”

Increasing concern about healthcare costs for the aging population means policymakers should be aware of the relationship between disease and risk of divorce, Karraker believes. “Offering support services to spousal caregivers may reduce marital strain and prevent divorce at older ages,” she says. “But it’s also important to recognize that the impetus for divorce may be health-related and that sick ex-wives may need additional care and services to prevent worsening health and increased health expenditures.”