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Marital status, marital transitions, and health: a gendered life course perspective.

We work from a life course perspective to assess the impact of marital status and marital transitions on subsequent changes in the self-assessed physical health of men and women. Our results suggest three central conclusions regarding the association of marital status and marital transitions with self-assessed health. First, marital status differences in health appear to reflect the strains of marital dissolution more than they reflect any benefits of marriage. Second, the strains of marital dissolution undermine the self-assessed health of men but not women. Finally, life course stage is as important as gender in moderating the effects of marital status and marital transitions on health.

Adult↗

Marital status, marital satisfaction, and body image dissatisfaction.

OBJECTIVE: This study examined whether married individuals have comparable body image disturbance to nonmarried individuals and whether the quality of a marital relationship is significantly related to body image disturbance in a sample of dieters. METHOD: Measures of marital status, marital satisfaction, and body dissatisfaction were administered to a sample of 16,377 subjects who had tried to lose weight at least once within the previous 3 years. RESULTS: Marital status was not associated with increased body dissatisfaction. Marital satisfaction was significantly related to body dissatisfaction when controlling for age, body mass index, self-esteem, and gender. DISCUSSION: Body dissatisfaction occurs at comparable levels among married and single individuals and the study of marital functioning among eating-disordered individuals represents a large gap in the literature.

Adult↗

Socioeconomic status, marital status and hip fracture risk: a population-based case-control study.

Socioeconomic status and social support have been identified as important determinants of several diseases and overall mortality, but these factors have not been adequately examined in relation to hip fracture risk. The aim of this study was to determine the relationship of socioeconomic status and marital status to hip fracture risk. We used data from a population-based case-control study in postmenopausal women aged 50-81 years during 1993-1995 who resided in six counties in Sweden. The analysis was based on 1327 incident cases of hip fracture and 3262 randomly selected controls. Socioeconomic and marital status were obtained by record linkage with census data in 1960, 1970, 1980 and 1990. Information on other possible risk factors for hip fracture was collected by a mailed questionnaire. Women who were gainfully employed in 1990 had an odds ratio (OR) of 0.74 [95% confidence interval (CI) 0.56-0.96] compared with those not gainfully employed; those in the highest tertile of household income had an OR of 0.74 (95% CI 0.60-0.90) compared with those in the lowest tertile of income. Women who lived in a one-family house had an OR of 0.85 (95% CI 0.72-0.99) compared with those living in an apartment. Divorced, widowed or unmarried women had a higher risk of hip fracture than married or cohabiting women; the OR was 1.40 (95% CI 1.06-1.85). Married women who were both gainfully employed and were living in a one-family house had a substantially decreased risk of hip fracture compared with unemployed women living without a partner in an apartment (OR 0.39; 95% CI 0.22-0.71). Occupational affiliation among women ever employed, and educational level, were not associated with hip fracture risk. We conclude that employment, household income, type of housing and marital status seem to be risk indicators of hip fracture risk independent of known osteoporotic risk factors.

Aged↗

Marital status, marital quality, and atherosclerotic burden in postmenopausal women.

UNLABELLED: Marriage confers health benefits for men, but the evidence for women is less consistent. Inconsistent findings may be attributed, in part, to the confounding of marital status and marital quality. OBJECTIVES: The authors examined whether women in satisfying marriages evidence lesser atherosclerosis relative to women in low-satisfying marriages and relative to unmarried women. MATERIALS AND METHODS: Three hundred ninety-three women from the Healthy Women Study participated in this study. Marital status and quality were assessed at baseline when women were premenopausal. Cardiovascular risk factors were also assessed at baseline to determine potential mediators. Markers of atherosclerotic burden--B-Mode ultrasound measures of intima-media thickness and plaque in the carotid arteries and electron beam computed tomography assessments of calcification in the aorta and coronary arteries--were performed, on average, 11 years and 14 years later, respectively. A subset of women underwent a second ultrasound scan approximately 3 years after their first scan. RESULTS: Women in satisfying marriages had the least atherosclerosis in the carotid arteries and aorta, especially relative to those in low-satisfying marriages. Women in satisfying marriages also tended to show less rapid progression of carotid atherosclerosis relative to women in low-satisfying marriages. Women who did not have a partner had intermediate levels of atherosclerosis. Risk factors measured at baseline contributed to the differences between the satisfied and low-satisfied groups, but not those between the satisfied and unmarried groups. CONCLUSIONS: High-quality marriages may protect against cardiovascular disease for women. Studies concerning marriage and cardiovascular health in women should, therefore, concurrently examine marital quality and marital status.

Aged↗

Do socio-economic status, marital status and occupation influence the prevalence of Helicobacter pylori infection?

AIMS: To review the influence of three factors on the prevalence of Helicobacter pylori infection: socio-economic status, marital status and occupation. METHODS: MEDLINE searches were performed using the Medical Subject Headings: Helicobacter pylori and socio-economic status, couples, children, transmission and occupation. All relevant articles were reviewed and scrutinized for further references. CONCLUSIONS: Lower socio-economic status and/or a low level of education are associated with an increase in the prevalence of H. pylori infection. There is no evidence that H. pylori is sexually transmitted and cohabitation among adult individuals is not a risk factor for transmission. A few studies suggest that the presence of (young) children may be required for spread within families. Data on occupational risk of H. pylori infection are sparse. Gastroenterologists and other health care workers may be at increased risk but the data are not conclusive.

Adult↗

Does marital status and marital status change predict physical health in older adults?

BACKGROUND: Evidence for the effects of marital status and marital status change on physical health is equivocal. METHOD: Structural equation models examined whether marital status predicted physical health. Six groups were examined simultaneously: married (M); widowed (W); divorced (D); never married (NM); newly widowed (NW); and newly divorced (ND). There were four annual measures (T1-T4). Both NW and ND were married at T1, but had lost their partners by T2. Four physical health variables were examined: Problems, Limitations, Service use, and Self-rated health (SRH). Age and gender were included. RESULTS: Previous health predicted future for all measures and for all groups. However, the specific strengths and time-courses varied between marital status groups and between health measures. The most marked patterns were associated with marital status change. Service use was influenced most strongly by NW, whilst Limitations was influenced by ND. Problems distinguished NW and ND from stable marital status groups but also from each other. SRH was influenced by W and not by recent marital status change. The effects of age and gender were modest and restricted to specific health variables and specific marital statuses. CONCLUSIONS: The results demonstrate that marital status and marital status change, in particular, influence health longitudinally. The impact of a change to divorced or to widowed status is not the same. No two health variables responded in the same way, suggesting that marital status has a differential effect on health.

Aged↗

Contribution of job strain, job status and marital status to laboratory and ambulatory blood pressure in patients with mild hypertension.

The effects of job strain, occupational status, and marital status on blood pressure were evaluated in 99 men and women with mild hypertension. Blood pressure was measured during daily life at home and at work over 15 h of ambulatory blood pressure monitoring. On a separate day, blood pressure was measured in the laboratory during mental stress testing. As expected, during daily life, blood pressure was higher at work than at home. High job strain was associated with elevated systolic blood pressure among women, but not men. However, both men and women with high status occupations had significantly higher blood pressures during daily life and during laboratory mental stress testing. This was especially true for men, in that men with high job status had higher systolic blood pressures than low job status men. Marital status also was an important moderating variable, particularly for women, with married women having higher ambulatory blood pressures than single women. During mental stress testing, married persons had higher systolic blood pressures than unmarried individuals. These data suggest that occupational status and marital status may contribute even more than job strain to variations in blood pressure during daily life and laboratory testing.

Adult↗

Marital status, change in marital status, and mortality in middle-aged British men.

The effects of marital status and change in marital status on mortality among middle-aged British men were examined in a prospective cohort study, the British Regional Heart Study. This is a nationally representative cohort of men selected at random from general medical practices in 24 towns in England, Wales, and Scotland. It comprises 7,735 men aged 40-59 recruited in 1978-1980 and followed up for 11.5 years. Marital status and a wide range of biologic and lifestyle variables were measured at screening, and changes in marital status were assessed after 5 years. Single (never-married) men had an increased risk of cardiovascular disease mortality (relative risk (RR) = 1.5, 95% confidence interval (CI) 1.0-2.2) and noncancer, noncardiovascular mortality (RR = 1.8, 95% CI 1.1-3.3) after adjustment for potentially confounding variables: age, social class, smoking, recall of ischemic heart disease, recall of diabetes mellitus, use of antihypertensive drugs, body mass index, physical activity, alcohol intake, employment status, systolic blood pressure, blood cholesterol, and forced expiratory volume in 1 second. Divorced/separated men were not at increased risk of mortality, and widowed men were only at increased risk of other non-cardiovascular disease mortality (RR = 2.4, 95% CI 1.1-5.3). There was no effect of marital status on cancer mortality. Men who divorced during the follow-up period were at increased risk of both cardiovascular disease mortality (RR = 1.9, 95% CI 0.9-3.9) and other non-cardiovascular disease mortality (RR = 4.0, 95% CI 1.5-10.6), but men who became widowed during this time were not at increased risk. The excess mortality among single and recently divorced men was not explained by poor health or by exposure to a wide range of risk factors. It is unlikely that selection bias, chance, or artifact is responsible for the general relation between marital status and mortality. Variable and incomplete control for confounding by socioeconomic status and risk factors for common diseases may explain some of the inconsistencies observed between studies and between different categories of unmarried men (i.e., never-married, widowed, and divorced). It is possible that the social support offered by marriage exerts a protective effect for some men.

Adult↗

Smoking cessation by socioeconomic status and marital status: the contribution of smoking behavior and family background.

We studied socioeconomic status and marital status as predictors of smoking cessation, adjusting for previous smoking behavior and family background by using a large Finnish prospective twin dataset unselected for smoking behavior. The data were collected by postal surveys in 1981 and 1990, and the sample comprised 3,069 current smokers, of whom 20% had quit smoking by 1990. Logistic regression analyses of all twin individuals and conditional logistic regression analysis of discordant pairs were used to predict smoking cessation. High education predicted smoking cessation among both men (OR=2.32, 95% CI=1.31-4.10) and women (OR=3.98, 95% CI=1.85-8.51) as did high social class among women. Additionally, starting at a late age, smoking a small number of cigarettes per day, and a low level of nicotine per cigarette predicted cessation. Socioeconomic differences in cessation diminished only slightly when we adjusted for smoking behavior factors. Among the twin pairs who were discordant in terms of smoking cessation, the twin who continued smoking also smoked more on average at baseline (men: OR=.94, 95% CI=.89-.99; women: OR=.82, 95% CI=.71-.94). The male twins who continued smoking had a smaller probability of getting married during the follow-up than had the cotwin who had quit smoking (OR=3.91, 95% CI=1.02-15.02). Indicators of socioeconomic status were important predictors of smoking cessation even when we adjusted for previous smoking behavior. For men, marriage was associated with an increased probability of cessation

Adolescent↗

Consequences of depression during adolescence: marital status and marital functioning in early adulthood.

In previous studies, depression has been associated with both marital status and marital distress. Unfortunately, given the cross-sectional design of most of this research, the temporal nature of these associations is unclear. The authors examined the marital functioning of young adults as a function of whether they received psychiatric diagnoses of major depressive disorder or nonaffective psychiatric disorder during adolescence. Depression during adolescence was found to predict higher rates of marriage among younger women and subsequent marital dissatisfaction. This pattern of results appears to be specific to depression: The presence during adolescence of a nonaffective psychiatric disorder was unrelated to subsequent marital functioning. These findings highlight the potentially adverse consequences of depression in adolescence and underscore the importance of prevention and early treatment efforts.

Adolescent↗

Relationship of pain impact and significant other reinforcement of pain behaviors: the mediating role of gender, marital status and marital satisfaction.

The operant perspective of chronic pain emphasizes the important role of reinforcement contingencies in the maintenance of pain behaviors and the experience of pain. Patients' 'significant others' are viewed as primary reinforcing agents. The relationship between pain intensity, interference, and responses by significant others in maritally distressed, maritally satisfied, and unmarried samples of male and female pain patients and their significant others was examined in this study. Results revealed that only for married male patients significant other responses explained significant proportions of the variance in the impact of pain. Significant other responses failed to explain significant proportions of the variance for male patients living with non-married significant others. By way of contrast, for female patients pain impact and reinforcement variables were less highly associated in the married as compared to the unmarried patients. For both males and females, there were significantly higher correlations between significant other responses and pain impact levels for the maritally satisfied patients. These results provide qualified support for the operant formulation of the importance of reinforcement of pain behaviors by significant others, however, these responses appear to be dependent upon gender, marital status, and marital satisfaction. Thus, clinicians need to give greater attention to these variables when designing treatment plans.

Adult↗

Psychiatric illness, socioeconomic status, and marital status in people committing suicide: a matched case-sibling-control study.

STUDY OBJECTIVE: Suicides cluster in both families and persons with psychiatric disorders and socioeconomic disadvantages. This study compares these factors between suicide cases, their siblings, and population based controls in an attempt to evaluate both the familial and the individual element of these factors. DESIGN: Nested case-control study. Information on causes of death, psychiatric admission, marital status, children, and socioeconomic factors was obtained from routine registers. SETTING: Denmark. PARTICIPANTS: 985 suicide cases, 1104 sex-age (+/-3 years) matched siblings, and 16 619 controls. MAIN RESULTS: The suicide rate ratios obtained from the case-sibling and the case-control analysis, respectively, were of similar magnitude. For example, in the case-sibling analysis the adjusted suicide rate ratios associated with discharge from a psychiatric hospital within the previous 365 days, being unemployed the previous year, having a postgraduate degree and being single were 42.13 (95% CI 17.75 to 100.02), 1.78 (1.35 to 2.36), 0.51 (0.21 to 1.26), and 2.69 (1.91 to 3.79), respectively. The corresponding rate ratios obtained from the case-control analysis were 47.91 (35.41 to 64.83), 1.76 (1.49 to 2.08), 0.45 (0.26 to 0.76), and 2.39 (1.87 to 3.07). Moreover, the analogous ratios when comparing siblings and controls were 1.98 (1.08 to 3.63), 1.22 (1.06 to 1.41), 0.65 (0.44 to 0.95), and 0.89 (0.75 to 1.06). CONCLUSIONS: People who commit suicide deviate similarly from siblings and controls in exposure to hospitalised psychiatric disorders and socioeconomic disadvantages, although these factors contribute to the familial aggregation of suicides.

Adult↗

The U.S. fertility decline, 1961-1975: the contribution of changes in marital status and marital fertility.

Changes in marital fertility have accounted for 83 percent of the decline in total fertility since 1971; changes in marital status accounted for 19 percent, and changes in nonmarital fertility had only a negligible effect. Declines in the level of marital fertility account for a substantial part of the overall decrease; postponement of childbearing did not occur in any significant degree until the 1970s.

Adolescent↗

Aging Koreans' perceived conflicts in relationships with their offspring as a function of age, gender, cohabitation status, and marital status.

The Youn Scale was used to assess aging Koreans' perceived conflicts in relationships with their adult offspring. The sample consisted of 623 elderly Koreans between the ages of 55 and 84 years. Results indicated that aging Koreans experienced significantly more conflicts in their relationships as they grew older. There were also differences in the perceptions of problems in relationships with their offspring between those who lived together with their adult children and the those who did not, and also between those who were married and those who were single. The findings imply that aging Koreans want to have qualitatively better (i.e., warmer and closer) relationships with their offspring, regardless of their bereavement status and cohabitation status.

Age Factors↗

General and illness-specific adjustment to cancer: relationship to marital status and marital quality.

This study examined the relationship between psychological adjustment of adults with cancer and two marital variables: married versus unmarried and high versus low marital quality. Eighty-six married and 46 unmarried adults with cancer completed general and illness-specific measures of psychological adjustment. In general, men and subjects with low marital quality reported more depression and anxiety, a less positive health care orientation, and more illness-induced family difficulties than did women and subjects with high marital quality; unmarried subjects reported more dysphoric thoughts and feelings related to the their illness than did married subjects; and unmarried men reported more disruption in work activities and extended family relationships than did unmarried females or married subjects. Moreover, a greater percentage of unmarried subjects and subjects with low marital quality reported clinically elevated levels of symptomatology compared to those with high marital quality. The clinical implications of these findings are discussed.

Adult↗

Depression, socioeconomic status, age, and marital status in black women: a national study.

This study examined the relationship between an array of socioeconomic status (SES) indicators and depression among Black women; determined which SES indicator was most strongly associated with depression; and examined whether the relationship between SES and depression was the same across age and marital status. A sample of 1,407 Black women recruited through the National Black Women's Health Project completed a survey on psychological well-being. Independent variables included income, education, median income within zip codes, marital status, and age. The dependent variable was depression as measured by the CES-D. The average CES-D score among participants was 12.67 (SD = 10.54), and 31.9% screened positive for depression. An inverse relationship was found between income and education and depression. The higher the yearly household income and education level the lower the scores on the CES-D. Income was the SES indicator most strongly associated with depression. Younger women had higher scores on the CES-D. Never-married women exhibited significantly higher levels of depression compared to women who were married or living together with an intimate partner. There were no significant interactions between SES indicators, age, and marital status. These findings suggest that income, education level, marital status, and age may be important demographic variables to consider when designing interventions to address depression among Black women.

Adult↗

Differences in mortality by marital status in Finland from 1976 to 2000: analyses of changes in marital-status distributions, socio-demographic and household composition, and cause of death.

Being currently not married is more common today than 25 years ago. Over this period relative differences in mortality by marital status have increased in several countries, mainly as a result of a sharp decline in mortality among the married. Using Finnish census data linked with death certificates, we show that these increases are not explained by the non-married population becoming more marginalized in socio-economic status or household composition. However, the increases in marital-status differences in mortality from accidental, violent, and alcohol-related causes of death in the 30-64 age group indicate that changes in the health-related behaviour of the non-married population may play a role. The public-health burden associated with not being married has also grown. At the end of the 1990s about 15 per cent of all deaths above the age of 30 would not have occurred if the non-married population had had the same age-specific mortality rates as the married population.

Adult↗