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How Marriage Affects Our Health

In Sickness And In Health

George H.W. Bush, Barbara Bush
In this May 3, 2006 photo, former President George H.W. Bush embraces former first lady Barbara Bush after she introduced him at the Genesis Women's Shelter Mother's Day Luncheon in Dallas. The Bushes had the longest marriage of any presidential couple in American history.
Tony Gutierrez/AP
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How Marriage Affects Our Health

George H.W. Bush was discharged from the hospital last week. The former president was hospitalized for a serious infection the day after the funeral for his wife, Barbara Bush. Many people wondered if the two events were somehow connected, if grief over the loss of his life partner somehow played a role in Bush’s illness.

The idea that marriage can affect your health, for good or bad, is probably as old as marriage itself, but in the 18th Century some mathematicians started to actually crunch the numbers, comparing life spans of married and unmarried people. They found the first evidence that your life partner dying increases your own risk of dying. It’s come to be known as the “Widowhood Effect.”

Dr. Nicholas Christakis runs the Human Nature Lab at Yale and co-authored some more recent studies that examined the widowhood effect in more detail. He says the widowhood effect, “fundamentally illustrates a very deep set of ideas regarding human social interaction, because look what it says: It says that when one person dies, it could contribute to or cause the death of another person.”

That’s why the widowhood effect has fascinated social scientists for hundreds of years and prompted additional study.

“What more profound an illustration of our connection to each other could there be than the fact that mortality might literally spread from person to person?” Christakis said.

About ten years ago, Dr. Christakis looked at how specific causes of death might affect the degree of risk for the survivor. Did it matter whether the spouse died from accident or disease, what type of disease, how sudden a death, and so on?

“The answer was, yes, it mattered what the previous spouse died of," Christakis said. "For instance, in the case of George H.W. Bush, it turns out that Barbara Bush died of chronic obstructive pulmonary disease and congestive heart failure. And those are two of the things that we found raise the risk of a widowhood effect the most in this paper that we published.”

And for the widow or widower, certain diseases are more likely to kill, like sepsis. “In fact, that's what George Bush was hospitalized for. So their case illustrates almost perfectly some of the analyses that we did that looked at the cause of death of the first person to die and the second person to die in this couple.”

Happily, former president Bush beat his infection and is now home recovering.

And that brings us to an important point: When we’re talking about the widowhood effect, we’re looking at statistics, not people. It’s not as if your spouse dies, and you’re suddenly at huge risk. We’re talking about small numbers of elderly people who die in any given year of their lives, and trends that aren’t really visible until they’re all added up. But Christakis says those larger trends are still instructive and should encourage practices that could nudge those statistics toward higher survival rates.

It starts with a different way of thinking about end of life care. Or, as Todd Rinehart puts it, “our care doesn't stop after the person dies. Our care continues.” Rinehart is the social work director for the division of Palliative Care and Geriatric Medicine at Mass General. He says their approach is not based specifically on the research on the widowhood effect, but they do integrate looking after the health of the survivors. “So we do follow people for the last 13 months after the death of their loved one,” he said.

Dr. Christakis’ research shows connecting with others diminishes the widowhood effect. A widower tends to be better off if they have other widowers to connect with. Rinehart says he’s seen a benefit himself in group therapy.

“I think that's the really the benefit of group work is that you're able to identify with others who are sharing the similar experience," Rinehart said. "They feel as though they've lost a part of themselves because they almost saw themselves as a unit. And so now one piece of that unit overnight is not there. And so if you're 70 or 80 how do you define yourself? Who are you now? Some people feel as though they've lost a limb they've lost a piece of them.”

But Rinehart says the reality is most people don’t opt for additional counseling, and everyone copes in different ways. Some people may already have the kind of support found in group counseling, and others may simply not need it. “They're trying to adjust to this new life — this new way of living that's unfamiliar.”

But the most profound finding regarding the widowhood effect involves considering the time before a loved one dies. Dr. Christakis says the widowhood effect is influenced not just by the cause of death; it’s also affected by the quality of care the dying spouse receives.

“If you take good care of people who are dying,” he says, “it reduces the risk of death of their beloved survivors.” He suggests that is something we should consider in providing quality hospice care for all: making sure our loved ones have a good death can reduce stress and contribute to our own health and longevity.

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