This Article Abstract Full Text (PDF) Services Download to citation manager Citing Articles Citing Articles via HighWire PubMed PubMed Citation

Marital Quality and Psychological Adjustment to Widowhood Among Older Adults

A Longitudinal Analysis

^a Institute for Social Research, University of Michigan, Ann Arbor
^b Department of Health Care Policy, Harvard Medical School, Cambridge, MA
^c Department of Psychology, State University of New York, Stony Brook

Deborah Carr, Department of Sociology, University of Michigan, 500 S. State Street, Ann Arbor, MI 48109 E-mail: carrds{at}umich.edu.

	Abstract

TOP Abstract Theoretical Issues Marital Quality and Bereavement Other Influences on Marital... Methods Results Discussion References

 
Objectives. This study examined whether psychological adjustment to widowhood is affected by three aspects of marital quality—warmth, conflict, and instrumental dependence—assessed prior to the loss.

Methods. The Changing Lives of Older Couples (CLOC) is a prospective study of a two-stage area probability sample of 1,532 married individuals aged 65 and older. The CLOC includes baseline data on marital quality and mental health and data on grief, anxiety, and depression collected 6, 18, and 48 months after spousal loss.

Results. Widowhood was associated with elevated anxiety among those who were highly dependent on their spouses and lower levels of anxiety among those who were not dependent on their spouses. Levels of yearning were lower for widowed persons whose relationships were conflicted at baseline and higher for those reporting high levels of marital closeness and dependence on their spouses. Women who relied on their husbands for instrumental support had significantly higher levels of yearning than men who depended on their wives.

Discussion. The findings contradict the widespread belief that grief is more severe if the marriage was conflicted and suggest a more complex relationship between bereavement and characteristics of the marriage.

WIDOWHOOD is characterized as one of the most distressing of all life events (Holmes and Rahe 1967). Because the modern nuclear family is expected to be socially and economically autonomous, spouses may have few alternative sources of social, emotional, or instrumental support (Lopata 1973; Volkart and Michael 1957). Consequently, when a spouse dies, the survivor must not only adjust to the loss of a close relationship, but also manage the daily decisions and responsibilities that were once shared by both spouses (Carey 1979–80; Wortman, Kessler, and Umberson 1992). In this study we examined whether psychological adjustment to widowhood is affected by three dimensions of the marital relationship (warmth–closeness, conflict, and instrumental dependence, assessed at baseline) in a representative community sample of widows and matched controls. Using data from the Changing Lives of Older Couples (CLOC) survey, we addressed three questions: (a) Does the effect of widowhood on depression and anxiety differ as a function of the quality of the marriage? (b) How does marital quality before spousal death influence grief? and (c) Do the effects observed under (a) and (b) vary by gender?

	Theoretical Issues

TOP Abstract Theoretical Issues Marital Quality and Bereavement Other Influences on Marital... Methods Results Discussion References

 
Despite widespread belief that widowhood is the most stressful of all life events (Holmes and Rahe 1967), most studies concur that only 15–30% experience clinically significant depression in the year following their spouse's death (Jacobs, Hansen, Berkman, Kasl, and Ostfeld 1989; Lund et al. 1985–86; Stroebe, Stroebe, & Hanson, 1993; Wortman and Silver 1989; Zisook & Schucter, 1991). Three explanations are generally offered for the inconsistent link between widowhood and adjustment. First, the mental health effects of widowhood attenuate over time, and studies that focus on relatively long time horizons may underestimate the short-term emotional consequences (Bruce, Kim, Leaf, and Jacobs 1990; Ferraro 1984; Futterman, Gallagher, Thompson, Lovett, and Gilewski 1990; Lund, Caserta, Dimond, and Shapper 1989; Mendes de Leon, Kasl, and Jacobs 1994). Second, different aspects of mental health may follow different trajectories (Jacobs et al. 1987–88, p. 48), and analyses that focus only on a broad grief scale or a global measure of mental health, such as depression, may mask patterns among more specific symptoms such as anxiety (Prigerson et al. 1996; Zisook, Schucter, and Lyons 1987) or yearning, a preoccupation with and pining for the deceased (Archer 1999, p. 24; Bowlby 1980). To address these concerns, we focused on three indicators of psychological well being: depression, anxiety, and yearning, assessed 6 months after the loss.

A third explanation for the relatively weak relationship between widowhood and psychological adjustment is that emotional responses to loss vary widely on the basis of personal resources, contextual factors, and personality. Personal resources such as education (Lopata 1975), income (Arens 1982), good health (Norris and Murrell 1987), and social support (Krause 1986; Lepore, Silver, Wortman, and Wayment 1996; Norris and Murrell 1990) may protect against severe depression, anxiety, or grief. Contextual factors, such as the type or duration of illness experienced by spouse prior to death, may also account for variation in widowed adults' psychological adjustment (George and Gwyther 1984; Norris and Murrell 1987; Parkes and Weiss 1983; Vachon et al. 1982). Personality factors, such as an insecure attachment style or a tendency to ruminate, also may make some particularly vulnerable to grief (Fraley and Shaver 1999; Nolen-Hoeksema, Parker, and Larson 1994; Van Doorn, Kasl, Beery, Jacobs, & Priegerson, 1998).

A fourth factor—the quality and nature of one's marriage—also may influence psychological reactions to widowhood. The loss of marriages providing the highest levels of warmth and support may be most distressing to survivors. The link between relationship closeness and grief is a central theme of attachment theory (Bowlby 1980). Attachment theory holds that when a close emotional bond is severed—whether through death or separation—the grief process follows (Bowlby 1980). The grief process may involve feelings of sorrow or sadness and anxiety, as well as yearning for the deceased (Parkes 1985).

Bowlby 1980 formulation of the grief process has two important implications for the study of adjustment to widowhood. First, the model suggests that all losses should not be equally distressing; the dissolution of emotionally and socially significant ties may elicit the strongest psychological reactions. A second implication of attachment theory is that individuals display a series of diverse reactions to loss, including depression, anxiety (or "active distress"), or yearning for the deceased—an emotional reaction unique to loss. We examined whether three emotional responses to spousal death (depression, anxiety, and yearning) were influenced by three aspects of the marital relationship (closeness, conflict, and instrumental dependence).

	Marital Quality and Bereavement

TOP Abstract Theoretical Issues Marital Quality and Bereavement Other Influences on Marital... Methods Results Discussion References

 
The proposition that relationship quality is linked to different grief reactions can be traced back to psychoanalytic theory. Psychoanalytic theories of grief hold that the loss of a conflicted relationship is associated with prolonged or "pathological" grief (Abraham, 1924/Abraham 1927; Freud, 1917/Freud 1959). Survivors who had ambivalent or difficult relationships with their spouses are believed to have both anger toward and a strong attachment to the deceased. These conflicting feelings make it difficult for survivors to let go of their lost loved one, yet survivors simultaneously are angry at the deceased for abandoning them (Freud, 1917/Freud 1959). This argument is supported by Parkes and Weiss 1983, who obtained retrospective assessments of marital quality among a sample of bereaved adults. Widowed persons who reported high levels of marital conflict showed relatively little distress and higher levels of social participation 6 weeks after their spouse's death. Yet by 13 months after the death, those reporting highly conflicted marriages were significantly less likely to have returned to effective functioning and after 24–48 months had higher levels of anxiety, guilt, and depression than did the low-conflict group.

An important methodological issue weakens the conclusion of Parkes and Weiss 1983, however. Retrospective assessments of marital relationships were obtained after the spouse died and thus may be biased positively (Futterman et al. 1990) or negatively (Hirschfield et al. 1989). Widowed persons often display a bias toward selective positive recall when describing their deceased spouses and may "purify" the memory of the deceased (Lopata 1973; Parkes and Weiss 1983). Conversely, those who are most depressed after the loss may offer the most negative retrospective accounts of their marriages (Bonanno, Notarius, Gunzerath, Keltner, & Horowitz, 1998). Depressed individuals evaluate themselves and their relationships more negatively than do nondepressed persons (Abramson, Seligman, and Teasdale 1978; Beck 1967; Hirschfield et al. 1989) and are more likely to recall negative information about past experiences (Teasdale, Taylor, and Fogarty 1980).

An important longitudinal study of life transitions poses an alternative to the psychoanalytic theory of prolonged grief: Wheaton 1990 countered that exiting a stressful role may enhance well-being. Although traditional theories of stress posit that all life transitions (such as spousal deaths or job losses) are stressful (Holmes and Rahe 1967), Wheaton 1990 argued that the impact of an event varies according to the context in which the transition occurs. Specifically, in Wheaton 1990 analysis, bereaved spouses who reported marital problems at a baseline interview went on to experience significantly lower levels of distress at follow-up, compared with those reporting fewer marital problems. We have built upon the work of Wheaton 1990 in two ways; we had a larger sample of widowed adults and considered three distinct aspects of the marital relationship: closeness, conflict, and instrumental dependence (i.e., reliance on one's spouse for performing daily tasks). Although the loss of warm, nonconflictual relationships may be linked to elevated grief and depression, the loss of a marriage providing high levels of instrumental support may be linked to elevated anxiety among widowed persons. If families are arranged so that one's spouse is the primary—or only—helpmate, then the loss of this source of instrumental support may be distressing (Lopata 1973; Volkart and Michael 1957). Drawing from the research and theory discussed thus far, we proposed the following hypothesis regarding the mental health of widowed persons and matched controls:

H1: The effect of widowhood on both depression and anxiety will increase as levels of marital warmth and instrumental dependence increase and will decrease as levels of marital conflict increase. That is, the psychological toll of widowhood will be most severe for those who experienced low levels of conflict, high levels of warmth, and high levels of instrumental dependence in their marriages at baseline.

We posited the following hypothesis regarding variation in yearning, a core component of grief, among a sample of widowed persons only:

H2: Yearning (at 6-month follow-up) will be negatively associated with conflict and positively associated with warmth–closeness and instrumental dependence (at baseline).

We also explored whether these patterns differ for husbands and wives. The protective effects of marriage are stronger for men than for women (see Waite 1995, for a review). Wives are more likely than husbands to have alternate sources of emotional and social support (Antonucci 1990; Bock and Webber 1972; Fischer and Phillips 1982; Powers and Bultena 1976; Stroebe and Stroebe 1983; Stroebe, Stroebe, and Schut 1997). Women also provide more emotional support to their spouses than do men (Gove 1973; Lee 1988). Men who are in particularly warm and loving relationships may be more inclined to depend exclusively on their spouses for support, whereas men in conflicted relationships may be forced to seek other sources of emotional intimacy and social support. Thus, high levels of closeness and low levels of conflict may be stronger predictors of poor adjustment among widowers than among widows.

Instrumental dependence might also have different effects on widows' and widowers' adjustment. In current cohorts of older adults, men receive substantially more instrumental advantages from marriage than do women, generally in the form of household tasks (Hartman 1981; Miller and Garrison 1982). After his wife dies, a widower may be particularly ill equipped to handle the daily tasks of maintaining a household (Berardo 1970). Yet widowers also have two distinct advantages not typically available to widows: greater economic resources and a larger pool of potential spousal replacements (Lopata 1973). Over the life course, men earn substantially more than women and thus may have the resources to purchase homemaking services (see Bianchi 1995, for a review). Moreover, because of men's mortality disadvantage, women aged 65 and older outnumber men aged 65 and older by roughly 1.5 to 1 (U.S. Bureau of the Census 1996). Widowers may easily find companions to assist with the household tasks previously performed by their wives (Bengston, Rosenthal, and Burton 1990). Thus, we hypothesized that:

H3: Marital warmth–closeness will be a stronger positive predictor of yearning, anxiety, and depression among men (relative to women).

H4: Conflict will be a stronger negative predictor of yearning, anxiety, and depression among men (relative to women).

H5A: Instrumental dependence for male-typed tasks will be a stronger positive predictor of yearning, anxiety, and depression among women (relative to men).

H5B: Instrumental dependence for female-typed tasks will be a stronger positive predictor of yearning, anxiety, and depression among men (relative to women).

	Other Influences on Marital Quality and Adjustment to Spousal Loss

TOP Abstract Theoretical Issues Marital Quality and Bereavement Other Influences on Marital... Methods Results Discussion References

 
Our analysis included indicators of three other potential influences on bereavement. First, we controlled mental health prior to loss to help distinguish one's affective state before the death and change in affective state that occurred following the death (Jacobs 1993; Zisook & Schucter, 1991). Although most studies have examined prior depression as the sole indicator of prior mental health, we also considered anxiety at baseline. Second, the extent to which a presumed stressor, such as widowhood, affects the individual is linked to his or her other resources and vulnerabilities. Consequently, we included controls for socioeconomic status (education, income, and home ownership) at baseline. Finally, we controlled both spouse's and respondent's physical health at baseline, because physical health may influence marital quality at baseline and mental health at 6-month follow-up (Booth and Johnson 1994; Wickrama, Lorenz, and Conger 1997).

	Methods

TOP Abstract Theoretical Issues Marital Quality and Bereavement Other Influences on Marital... Methods Results Discussion References

 
Sample
The Changing Lives of Older Couples (CLOC) study is a prospective study of a two-stage area probability sample of 1,532 married individuals from the Detroit Standard Metropolitan Statistical Area (SMSA). To be eligible for the study, respondents had to be English-speaking members of a married couple in which the husband was aged 65 or older. All sample members were not institutionalized and were capable of participating in a 2-hour interview. Approximately 65% of those contacted for an interview participated, which is consistent with the response rate from other Detroit area studies. Baseline face-to-face interviews were conducted from June 1987 through April 1988.

CLOC researchers monitored spousal loss by reading the daily obituaries in three Detroit-area newspapers and by using monthly death record tapes provided by the State of Michigan. The National Death Index (NDI) was used to confirm deaths and obtain causes of death. Of the 319 respondents who lost a spouse during the study, 86% () participated in at least one of the three follow-up interviews, which were conducted 6 months (Wave 1), 18 months (Wave 2), and 48 months (Wave 3) after the death. The primary reasons for nonresponse were refusal to participate (38%) and ill health or death at follow-up (42%). Controls from the original sample of 1,545 were selected to match the widowed persons along the dimensions of age, race, and sex. The matched controls were reinterviewed at the three follow-up interviews at roughly the same time as their corresponding widowed persons.

We used two analytic samples in this study. The first included 290 persons (75 men and 215 women) who were interviewed at the 6-month follow-up and comprised 203 widowed persons and 87 matched controls. (Controls were not available for all bereaved subjects at the 6-month follow-up because funding for the control sample was cut from the proposed budget and was reinstated halfway through the data collection for the 6-month follow-up). The second sample included the 203 bereaved persons (53 men and 150 women) interviewed at the 6-month followup, or roughly 64% of the 319 respondents who lost a spouse.

Measures
Dependent variables.
In the first part of the analysis, which contrasted the widowed and matched controls, we focused on two dimensions of mental health at the 6-month follow-up: depression and anxiety. Depression () was assessed with a subset of 9 negative items from the 20-item Center for Epidemiologic Studies Depression (CES-D) scale (Radloff 1977). Respondents were asked to indicate how often they experienced each of nine symptoms in the week prior to interview. Response categories were "hardly ever," "some of the time," or "most of the time." The nine symptoms were (a) "I felt depressed"; (b) "I felt that everything I did was an effort"; (c) "My sleep was restless"; (d) "I felt lonely"; (e) "People were unfriendly"; (f) "I did not feel like eating. My appetite was poor"; (g) "I felt sad"; (h) "I felt that people disliked me"; and (i) "I could not ‘get going.’"

Anxiety () was assessed with 10 items from the Symptom Checklist 90 Revised (Derogatis and Cleary 1977). Respondents were asked to indicate how often they experienced each of 10 symptoms in the week prior to interview. Response categories were "not at all," "a little bit," "moderately," "quite a bit," and "extremely." Symptoms included (a) "nervousness or shakiness"; (b) "trembling"; (c) "feeling suddenly scared for no reason"; (d) "feeling fearful"; (e) "heart pounding or racing"; (f) "feeling tense and keyed up"; (g) "spells of terror and panic"; (h) "feeling so restless you couldn't sit still"; (i) "feeling that something bad is going to happen to you"; and (j) "thoughts and images of a frightening nature." For ease of interpretation, depression and anxiety scores were standardized and thus had a mean of 0 and a standard deviation of 1.

In the second part of the analysis we focused on widowed persons only and examined the correlates of yearning, considered a "core" symptom of grief (Bowlby 1980; Parkes 1985). Attachment theory holds that the essential dimension of grief that distinguishes bereavement from other forms of emotional distress is the act of pining for the lost person. Yearning reflects an intermittent, recurrent, and obtrusive wish or need to recover the person who has died. Yearning () was assessed with four questions: "In the last month (a) have you found yourself longing to have your spouse with you; (b) have you had painful waves of missing your spouse; (c) have you experienced feelings of intense pain or grief over the loss of your spouse; and (d) have you experienced feelings of grief, loneliness, or missing your spouse?" Response categories were "no, never"; "yes, but rarely"; "yes, sometimes"; and "yes, often." Items were drawn from widely used grief scales including the Bereavement Index (Jacobs, Kasl, and Ostfeld 1986), Present Feelings About Loss (Singh and Raphael 1981), and Texas Revised Inventory of Grief (Zisook, DeVaul, and Click 1982).

Independent variables.
Widowhood was a dummy variable set equal to 1 indicating those who were widowed between the baseline interview and the 6-month follow-up. Three dimensions of the marital relationship were considered: warmth–closeness, instrumental dependence (for both male- and female-typed tasks), and conflict. These three dimensions were chosen because they capture two of the most important functions of marriage for older adults: intimacy and interdependence (Atchley 1985). A fourth dimension, emotional dependence, was considered, but it was not significantly related to psychological adjustment in the multivariate analysis and was thus dropped from the study.

Questions assessing each of the marital domains were drawn from a modified version of the Dyadic Adjustment Scale (Spanier 1976). Respondents were asked to assess the frequency with which they experienced a given condition (response categories were "almost always," "often," sometimes," "rarely," and "never") or how true a given statement was in characterizing their marital relationship (response categories were "very true," "somewhat true," "a little true," and "not at all true"). Total scores equalled the scale-specific average (standardized) across items. Italicized items (see next paragraph) were reverse-coded.

Warmth–closeness () was assessed with a seven-item scale with the following questions: (a) "How much does your spouse make you feel loved and cared for"; (b) "How much is your spouse willing to listen when you need to talk about your worries and problems?"; (c) "There are some serious difficulties in our marriage"; (d) "Thinking about your marriage as a whole, how often do you feel happy about it?"; (e) "Taking all things together, how satisfied are you with your marriage?"; (f) "How often do you feel bothered or upset by your marriage?"; (g) "My spouse doesn't treat me as well as I deserve to be treated."

Conflict () was assessed with a two-item scale comprising the items (a) "How often would you say you and your spouse typically have unpleasant disagreements and conflicts?" and (b) "In some marriages there are times when you feel very close, but other times when you can get more upset with that person than with anyone else. How much does this sound like the relationship you have with your spouse?"

Instrumental dependence was measured with the following questions. "Husbands and wives often depend on one another to handle different responsibilities. At the present time, how much do you depend on your spouse to handle or help with: (a) home maintenance and minor repairs; (b) keeping up with checking and savings accounts and paying bills; (c) making major financial and legal decisions; and (d) preparing meals and doing general housework and laundry." Response categories were "a lot," "some," "a little," and "not at all." Factor analyses yielded one three-item subscale (), which tapped male-typed tasks (Items 1–3), and a single-item measure that tapped female-typed tasks (Item 4).

Confounding factors.
Spousal health at baseline was assessed with the question "Has your [spouse] had a serious illness, injury, surgery, or accident in the past 12 months?" Depression and anxiety at baseline were measured exactly the same way as the 6-month follow-up measures (Derogatis and Cleary 1977; Radloff 1977). Respondents' physical health at baseline was assessed with the question "How satisfied are you with your health?" Responses were "completely satisfied," "very satisfied," "somewhat satisfied," "not very satisfied," and "not at all satisfied." A dummy variable was set equal to 1 for those who said they were "not very satisfied" or "not at all satisfied" with their health.

Other potential predictors of psychological adjustment to loss, including race, marital duration, social support from friends, social support from relatives, religiosity, self-esteem, and provision of care to spouse prior to death, were included in preliminary analyses but were dropped because they were not significant predictors of the psychological adjustment ( p .05) and because inclusion of these variables did not alter the effects of marital quality on psychological adjustment.

Control variables.
Control variables included: age, sex (where ), home ownership at baseline (a dichotomous variable where ), total household income at baseline (natural log of income), and education (a continuous measure ranging from 3 to 17 years of completed schooling). The total household income variable was originally measured by asking respondents to indicate which of 10 income categories most accurately characterized their economic status. A continuous measure of income was derived by taking the midpoint of each of the 10 income categories. The natural log of income was used in this analysis because the respondents' income distribution was heavily skewed toward the lower income categories.

	Results

TOP Abstract Theoretical Issues Marital Quality and Bereavement Other Influences on Marital... Methods Results Discussion References

 
Sample Characteristics
Descriptive statistics and t tests comparing means for the widowed and matched controls are presented in Table 1 . Zero-order correlations among the dependent variables, marital quality indicators, and baseline mental health measures are displayed in Table 2 . Table 1 shows that widowed persons had significantly higher depression levels at the 6-month follow-up, yet they did not differ from matched controls in terms of anxiety. The spouses of widowed persons were significantly more likely to have had a serious illness at baseline, and widowed persons reported significantly lower levels of dependence on their spouses for male- and female-typed instrumental tasks at baseline. Widowed persons and controls did not differ significantly in terms of marital warmth or conflict. The widowed also had slightly lower incomes and were less likely to own their own homes. These differences likely reflect effects of the spouse's declining health before death.

Influence of Marital Quality on Mental Health of the Widowed and Nonwidowed
Our main objective in this analysis was to explore whether the mental health consequences of widowhood (i.e., depression and anxiety at a 6-month follow-up) were related to marital quality, assessed at baseline. Table 3 presents ordinary least squares (OLS) regression models for the total sample (i.e., both widows and matched controls). Model 1 showed the effect of widowhood on depression, and Model 2 estimated the effect of widowhood on anxiety, before controlling marital quality. Models 1 and 2 revealed that widowhood was associated with poorer psychological well being (net of demographic and contextual factors). Before marital quality was controlled, widowhood was associated with a .729 standard deviation increase in depression and a .116 standard deviation increase in anxiety scores. The effect of widowhood on depression did not change appreciably after marital quality variables were added to the model as moderators. However, the effect of widowhood on anxiety was no longer significant when instrumental dependence was incorporated into the analysis, suggesting that the anxiety may be due to the loss of practical assistance with daily demands.

View larger version (13K): [in this window] [in a new window]   Figure 1. Anxiety (Wave 1) among widows and controls by instrumental dependence for male-typed tasks. Note: All other independent variables controlled.

Influence of Marital Quality on Bereavement
Next, we assessed whether yearning for one's spouse (at the 6-month follow-up) was affected by the quality of one's marriage, assessed at baseline. Table 4 presents OLS regression models estimating the effects of marital quality on widowed persons' yearning. Model 1 was the baseline model, which included demographic, health, and control variables but no marital quality indicators. Model 2 incorporated marital warmth–closeness; Model 3 adjusted for marital conflict; Model 4 assessed the influence of instrumental dependence, and Model 5 included the baseline model plus all marital quality indicators. Marital quality played an important role in explaining variability in widowed persons' yearning. Although Model 1 accounted for only 3% of the variance in yearning, the inclusion of individual marital quality items increased the adjusted R² to anywhere from 6 to 8%, depending on the specific marital domain. The final model, which included the three measures of marital quality, explained 12% of the variance in yearning.

Interestingly, dependence on one's spouse for performing male-typed tasks increased yearning significantly (, p .01), yet reliance on one's spouse for performing female-typed tasks was not significantly linked to yearning. However, as might be expected, this pattern varied by gender. Model 4 was expanded to include interaction terms for both types of instrumental dependence by sex; the model adjusted R² increased from .064 to .089, and results showed that dependence on one's spouse for performing male-typed tasks influenced yearning differently for men and women. Each standard deviation increase in instrumental dependence for male-typed tasks was associated with a .214 decrease in men's yearning but a .385 increase in women's yearning. The interaction term (net of all other independent variables, with values of all independent variables set equal to sample mean) is plotted in Fig. 2. None of the other marital quality indicators interacted significantly with sex.

View larger version (13K): [in this window] [in a new window]   Figure 2. Yearning (Wave 1) by gender and instrumental dependence for male-typed tasks. Note: All other independent variables controlled.

Few other variables were significant predictors of yearning. Anxiety at baseline was associated with elevated levels of yearning at the 6-month follow-up, although baseline depression was unrelated to Wave 1 yearning. Interestingly, greater economic resources at baseline were positively associated with yearning. Those who owned their own home at baseline had significantly higher levels of yearning. Perhaps those who did not own a home experienced greater levels of social integration with neighbors in an apartment complex or retirement community. It is unlikely that homeowners at baseline experienced the loss of their home or relocation following their spouse's death; only 5% of homeowners at baseline were no longer homeowners at Wave 1. Moreover, household income at baseline was positively associated with yearning. This finding is surprising given the vast amount of research documenting an inverse relationship between socioeconomic status and diverse indicators of negative mental health (Dohrenwend, Levav, and Shrout 1992). It is possible that those with the lowest income at baseline experienced the smallest relative declines in their standard of living following the loss of their spouse (see Holden and Smock 1991, for a review), and thus may not have had to cope with the combined loss of both spouse and economic status simultaneously.

	Discussion

TOP Abstract Theoretical Issues Marital Quality and Bereavement Other Influences on Marital... Methods Results Discussion References

 
In this study we expanded upon prior research in four ways. First, we used prospective data to examine the effects of marital quality (at baseline) on mental health at a 6-month follow-up; thus, assessments of marital quality were not affected by positive (Futterman et al. 1990; Lopata 1975) or negative (Abramson et al. 1978; Hirschfield et al. 1989) recall bias. Second, we considered three conceptually and statistically distinct aspects of the marital relationship: closeness, conflict, and instrumental dependence. Third, we focused on both men and women and assessed whether the link between marital quality and psychological adjustment differed significantly for the two sexes. Finally, we included widowed persons and a control group to address an important issue previously neglected in studies of widowhood: Does the effect of widowhood on psychological adjustment vary on the basis of the nature of the marital relationship?

We found that widowhood is a significant predictor of depression and that this large and significant effect does not decline when marital quality indicators are incorporated into the analysis. In contrast, the effect of widowhood on anxiety is no longer statistically significant when levels of instrumental dependence are considered. This finding highlights the importance of considering the unique pathways through which loss influences both "passive depression" and "active distress." Although the loss of one's partner, regardless of relationship quality, may be associated with elevated sadness and depression, anxiety may instead be a reaction to the loss of a partner when accompanied by major changes in daily responsibilities and burdens.

Our analyses showed that the effect of widowhood on anxiety levels varies by how much one depended on one's spouse for performing male-typed tasks, such as home repair and financial management. Compared with the married controls, widowed persons who reported high levels of dependence on their spouse had significantly higher levels of anxiety at follow-up. This is not surprising; those who were not dependent on their spouses presumably are better able to care for themselves and maintain their households successfully following the loss of their spouse. In contrast, among married controls, lack of dependence on one's spouse may signify an uncooperative marriage. Because spouse's health at baseline is controlled, low levels of dependence on one's spouse are not attributable to poor spousal health.

Yearning, considered a core component of grief, is significantly and strongly affected by marital quality. Consistent with attachment theory (Bowlby 1980), our findings suggest that all losses are not equal; adjustment to widowhood is most difficult for those experiencing high levels of warmth and instrumental dependence and low levels of conflict in their marriages. Our findings support Wheaton 1990 assertion that role histories must be considered when researchers are examining life transitions. Although classic studies of stressful life events implicitly assume that all life events can overtax individuals' coping resources and leave them emotionally vulnerable (Holmes and Rahe 1967), our findings suggest that the impact of a stressor depends on the context surrounding the event.

Although studies of divorce demonstrate that those exiting troubled marriages are less susceptible to depression (Aseltine and Kessler 1993; Kitson and Sussman 1982), we know of no other prospective studies linking marital conflict to adjustment following widowhood. Moreover, preliminary analyses of the CLOC follow-up data reveal that this relationship holds when yearning is assessed at 18 and 48 months following the loss. Our findings do not support Freud's (1917/Freud 1959) claim that the loss of a conflicted relationship leads to delayed grief. However, our analyses did not focus on extreme levels of grief, nor on long-term horizons (beyond 4 years); further analyses are needed to understand linkages between marital conflict and delayed grief.

Although we expected to find that conflict and closeness would have larger effects on men's adjustment, given that marriage has greater protective effects for men (Waite 1995), we instead found no significant gender difference. We found support for our hypothesis that dependence on a spouse for male-typed tasks would be a stronger predictor of anxiety for women, although we did not find dependence on one's spouse for female-typed tasks to affect widows and widowers differently. In fact, dependence on one's spouse for performing homemaking tasks was not a significant predictor of yearning.

These findings tell an interesting story about gender, dependence, and socialization in current cohorts of older adults. Current cohorts of older widowers may not need the same amount of informal support as do widows, because of early socialization experiences (Stevens 1995). The development of personal attributes such as independence and self-reliance may have been imbued in young men, but not young women, of the CLOC cohort. Future generations of older women, who have higher levels of education, more years of work experience, and more egalitarian divisions of labor in their families (Bianchi 1995), may be less susceptible to dependence on their husbands for home repair and financial management tasks. Under such a scenario, gender differences in widows' and widowers' anxiety levels might be expected to decline among future cohorts of elderly.

Yet, at the same time, our findings suggest that adaptation to spousal loss may become more difficult in future cohorts. The members of the CLOC sample belong to a cohort who experienced relatively low levels of divorce and separation, given both the social stigma accompanying divorce and the dearth of opportunities for women to provide for themselves economically in earlier decades (Cherlin 1981; Holden and Smock 1991). Thus, men and women of this cohort may have remained in marriages that provided relatively low levels of warmth and relatively high levels of conflict. If current cohorts of married couples are more likely to dissolve dissatisfying marriages, then those who remain married until late life may have higher levels of marital satisfaction and thus may suffer more following the loss of these close relationships.

Future research on the linkages between marital quality and adjustment to loss should consider whether both spouses share similar assessments of the marriage at baseline and whether psychological adjustment to loss differs on the basis of whose report of the marriage is being considered. Preliminary analyses of the CLOC data reveal quite low correlations between respondents' and spouses' assessments of marital quality (most are less than .3), with the exception of marital conflict. Spouses' assessments of marital conflict are highly correlated (.473), and (the deceased) spouses' baseline reports of marital conflict are a significant negative predictor of their survivors' adjustment to loss. In contrast, survivors' psychological adjustment is not affected by their spouses' reports of dependence or warmth, suggesting that it is a person's own perceptions and feelings about his or her spouse that are related to bereavement.

Our findings are potentially important to the sociological study of life transitions. If all life transitions—especially highly anticipated ones such as widowhood in old age—are viewed as distressing (e.g., Holmes and Rahe 1967), then rigid normative expectations for the expression of emotion may be imposed on the individual (Averill 1968). Widowed persons' failure to comply with normative expressions of grief, such as yearning for a deceased spouse, are socially (and subtly) sanctioned: A denial of grief may "entail a rejection of the original assumption that the relationship was meaningful and close. The other alternative would be to consider the lack of response as a sign of actual or potential pathology" (Averill 1968, p. 732). By considering one's role history prior to spousal death, variations in bereavement may be better understood.

Our findings also have important implications for practitioners. Our data help identify a population at particularly high risk for anxiety—wives who were highly dependent on their spouses for performing instrumental tasks. The provision of instrumental assistance and practical support with daily activities and chores may help to alleviate their anxiety. Our results further suggest that not all bereaved persons experience similar levels of depression, anxiety, and yearning following the loss of a spouse. To the contrary, psychological adjustment to widowhood varies considerably on the basis of the nature of one's marriage. Because the grief process varies in timing, intensity, and difficulty from one person to the next, what helps one person cope with grief may not be helpful to another. Thus, interventions should be tailored to the bereaved person's circumstances and needs.

	Acknowledgments

 
The Changing Lives of Older Couples study was supported by grants from the Nancy Pritzer Research Network and the National Institute of Aging (P01-AG05561-01). Ronald Kessler's participation was supported by NIMH Research Scientist Award K05-MH00507.

Received for publication September 14, 1999. Accepted for publication December 23, 1999.

	References

TOP Abstract Theoretical Issues Marital Quality and Bereavement Other Influences on Marital... Methods Results Discussion References

 

• Abraham K., 1927(Original work published 1924). A short study of the development of the libido, viewed in the light of mental disorder. Selected papers of Karl Abraham 418-510. Hogarth. , London.
• Abramson L. Y., Seligman M. E. P., Teasdale J., 1978. Learned helplessness in humans: Critique and reformulation. Journal of Abnormal Psychology 87:49-79. [Medline]
• Antonucci T. C., 1990. Social supports and social relationships. Binstock R. H., George L. K., , ed.Handbook of aging and the social sciences 3rd ed. 205-226. Academic Press, San Diego, CA.
• Archer J., 1999. The nature of grief: The evolution and psychology of reactions to loss Routledge Press, London.
• Arens D. A., 1982. Widowhood and well-being: An examination of sex differences within a causal model. International Journal of Aging and Human Development 15:27-40. [Medline]
• Aseltine R. H., Jr. Kessler R. C., 1993. Marital disruption and depression in a community sample. Journal of Health and Social Behavior 34:237-251. [Medline]
• Atchley R., 1985. Social forces and aging 4th ed. Wadsworth, Belmont, CA.
• Averill J. R., 1968. Grief: Its nature and significance. Psychological Bulletin 70:721-748. [Medline]
• Beck A. T., 1967. Depression: Clinical, experimental, and theoretical aspects Harper & Row, New York.
• Bengston V. L., Rosenthal C., Burton L., 1990. Families and aging: Diversity and heterogeneity. Binstock R. H., George L. K., , ed.Handbook of aging and the social sciences 3rd ed. 263-287. Academic Press, San Diego, CA.
• Berardo F. M., 1970. Survivorship and social isolation: The case of the aged widower. Family Coordinator 19:11-25.
• Bianchi S., 1995. The changing economic roles of women and men. Farley R., , ed.State of our union: America in the 1990s 107-154. Russell Sage, New York.
• Bock E. W., Webber I. L., 1972. Suicide among the elderly: Isolating widowhood and mitigating alternatives. Journal of Marriage and the Family 34:24-31.
• Bonnano G. A., Norarius C. I., Gunzerath L., Keltner D., Horowitz M. J., 1998. Interpersonal ambivalence, perceived dyadic adjustment and conjugal loss. Journal of Consulting and Clinical Psychology 66:1012-1022. [Medline]
• Booth A., Johnson D. R., 1994. Declining health and marital quality. Journal of Marriage and the Family 56:218-223.
• Bowlby J., 1980. Attachment and loss: Vol. 3. Loss: Sadness and depression Basic Books, New York.
• Bruce M. L., Kim K., Leaf P. J., Jacobs S., 1990. Depressive episodes and dysphoria resulting from conjugal bereavement in a prospective community sample. American Journal of Psychiatry 147:608-611. [Abstract/Free Full Text]
• Carey R. G., 1979–80. Weathering widowhood: Problems and adjustment of the widowed during the first year. Omega 10:163-174.
• Cherlin A., 1981. Marriage, divorce and remarriage Harvard University Press, Cambridge, MA.
• Derogatis L. R., Cleary P. A., 1977. Confirmation of the dimensional structure of the SCL-90: A study in construct validation. Journal of Clinical Psychology 33:981-989.
• Dohrenwend B. P., Levav I., Shrout P. E., 1992. Socioeconomic status and psychiatric disorders: The causation-selection issue. Science 255:946-951. [Abstract/Free Full Text]
• Ferraro K. F., 1984. Widowhood and social participation in later life. Research on Aging 6:451-468. [Abstract]
• Fischer C. S., Phillips S. L., 1982. Who is alone: Social characteristics of people with small networks. Peplau L. A., Perlman D., , ed.Loneliness: A sourcebook of current theory, research and therapy 735-759. Wiley, New York.
• Fraley R. C., Shaver P. R., 1999. Loss and bereavement: Attachment theory and recent controversies concerning "grief work" and the nature of detachment. Cassady J., Shaver P. R., , ed.Handbook of attachment: Theory, research and clinical approaches 239-260. Guilford Press, New York.
• Freud, S. (1959). Mourning and melancholia. In J. Strachey (Ed and Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 14). London: Hogarth Press. (Original work published 1917).
• Futterman A., Gallagher D., Thompson L. W., Lovett S., Gilewski M., 1990. Retrospective assessment of marital adjustment and depression during the first two years of spousal bereavement. Psychology and Aging 5:277-283. [Medline]
• George L., Gwyther L., 1984. The dynamics of caregiving burden: Changes in caregiver well-being over time. The Gerontologist 26:253-259. [Medline]
• Gove W., 1973. Sex, marital status, and mortality. American Journal of Sociology 79:45-67.
• Hartman H. I., 1981. The family as the locus of gender, class and political struggle: The example of housework. Signs 6:366-369.
• Hirschfield R. M., Klerman G. L., Lavori P., Keller M. B., Griffith P., Coryell W., 1989. Premorbid personality assessments of first onset of major depression. Archives of General Psychiatry 46:345-350. [Abstract/Free Full Text]
• Holden K., Smock P. J., 1991. The economic costs of marital dissolution: Why do women bear a disproportionate cost?. Annual Review of Sociology 17:51-78. [Medline]
• Holmes J. H., Rahe R. H., 1967. The social readjustment scale. Journal of Psychosomatic Research 11:213-228. [Medline]
• Jacobs S., 1993. Pathologic grief: Maladaptation to loss American Psychiatric Press, Washington, DC.
• Jacobs S., Hansen F., Berkman L., Kasl S., Ostfeld A., 1989. Depressions of bereavement. Comprehensive Psychiatry 31:218-224.
• Jacobs S., Kasl S., Ostfeld A., 1986. The measurement of grief: Bereaved versus non-bereaved. The Hospice Journal 2:21-36. [Medline]
• Jacobs S., Kosten T., Kasl S., Ostfeld A., Berkman L., Charpentier P., 1987–88. Attachment theory and multiple dimensions of grief. Omega 88:41-52.
• Kitson G. C., Sussman M. B., 1982. Marital complaints, demographic characteristics and symptoms of mental distress in divorce. Journal of Marriage and the Family 44:87-101.
• Krause N., 1986. Social support, stress, and well-being among older adults. Journal of Gerontology 41:512-519. [Abstract/Free Full Text]
• Lee G. R., 1988. Marital intimacy among older persons: The spouse as confidant. Journal of Family Issues 10:273-284.
• Lepore S. J., Silver R. C., Wortman C. B., Wayment H. A., 1996. Social constraints, intrusive thoughts, and depressive symptoms among bereaved mothers. Journal of Personality and Social Psychology 70:271-282. [Medline]
• Lopata H. Z., 1973. Widowhood in an American city Schenkman, Cambridge, MA.
• Lopata H. Z., 1975. On widowhood: Griefwork and identity reconstruction. International Journal of Geriatric Psychiatry 8:41-53.
• Lund D. A., Dimond M. F., Caserta M. S., Johnson R. J., Poulton J. L., Connelly J. R., 1985–86. Identifying elderly with coping difficulties after two years of bereavement. Omega 16:213-224.
• Lund, D. A., Caserta, M. S., Dimond, M. F., & Shapper, S. D. (1989). Competencies, tasks of daily living and adjustments to spousal bereavement in later life. In D. A. Lund (Ed.), Older bereaved spouses. New York: Hemisphere.
• Mendes de Leon C. F., Kasl S. V., Jacobs S., 1994. A prospective study of widowhood and changes in symptoms of depression in a community sample of the elderly. Psychological Medicine 24:613-624. [Medline]
• Miller J., Garrison H. H., 1982. Sex roles: The division of labor at home and in the workplace. Annual Review of Sociology 8:237-262.
• Nolen-Hoeksema S., Parker L. E., Larson J., 1994. Ruminative coping with depressed mood following loss. Journal of Personality and Social Psychology 67:92-104. [Medline]
• Norris F. H., Murrell S. A., 1987. Older adult family stress and adaptation before and after bereavement. Journal of Gerontology 42:606-612. [Abstract/Free Full Text]
• Norris F. H., Murrell S. A., 1990. Social support, life events and stress as modifiers of adjustment to bereavement by older adults. Psychology and Aging 5:429-436. [Medline]
• Parkes C. M., 1985. Bereavement. British Journal of Psychiatry 146:11-17. [Free Full Text]
• Parkes C. M., Weiss R. S., 1983. Recovery from bereavement Basic Books, New York.
• Powers E. A., Bultena G. L., 1976. Sex differences in intimate friendships of old age. Journal of Marriage and the Family 38:739-747.
• Prigerson H. G., Bierhals A. J., Kasl S. V., Reynolds C. F., III Shear M. K., Newsom J. T., Jacobs S., 1996. Complicated grief as a disorder distinct from bereavement-related depression and anxiety: A replication study. American Journal of Psychiatry 153:1484-1486. [Abstract/Free Full Text]
• Radloff L., 1977. The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement 1:381-401.
• Singh B., Raphael B., 1981. Postdisaster morbidity of the bereaved: A possible role for preventive psychiatry?. The Journal of Nervous and Mental Disease 169:203-212. [Medline]
• Spanier G., 1976. Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and the Family 42:15-27.
• Stevens N., 1995. Gender and adaptation to widowhood in later life. Ageing and Society 15:37-58.
• Stroebe M., Stroebe W., 1983. Who suffers more? Sex differences in health risks of the widowed. Psychological Bulletin 93:297-301.
• Stroebe M., Stroebe W., Hansson R. O., , ed.Handbook of bereavement: Theory, research and intervention 1993Cambridge University Press, New York.
• Stroebe, M., Stroebe, W., & Schut, H. (1997). Sex differences in adjustment to bereavement: An empirical and theoretical review. Unpublished manuscript, University of Utrecht, The Netherlands.
• Teasdale J. D., Taylor R., Fogarty S. J., 1980. Effects of induced elation-depression on the accessibility of memories of happy and unhappy experiences. Behavior Research and Therapy 18:339-346. [Medline]
• U.S. Bureau of the Census1996. Statistical abstract of the United States: 1996 116th ed. U.S. Government Printing Office, Washington, DC.
• Vachon M. L. S., Rogers J., Lyall W. A., Lancee W. J., Sheldon A. R., Freeman S. J., 1982. Predictors and correlates of adaptation to conjugal bereavement. American Journal of Psychiatry 139:998-1002. [Abstract/Free Full Text]
• Van Doorn C., Kasl S., Beery L., Jacobs S., Prigerson H., 1998. The influence of marital quality and attachment styles on traumatic grief and depressive symptoms. Journal of Nervous and Mental Disease 186:566-573. [Medline]
• Volkart E. H., Michael S. T., 1957. Bereavement and mental health. Leighton A. H., Clausen J. A., Wilson N. A., , ed.Explorations in Social Psychiatry 281-307. Tavistock, London.
• Waite L., 1995. Does marriage matter?. Demography 32:483-504. [Medline]
• Wheaton B., 1990. Life transitions, role histories, and mental health. American Sociological Review 55:209-223.
• Wickrama K. A. S., Lorenz F. O., Conger R. D., 1997. Marital quality and physical illness: A latent growth curve analysis. Journal of Marriage and the Family 59:143-155.
• Wortman C. B., Kessler R. C., Umberson D., 1992. Widowhood and depression: Explaining long-term gender differences in vulnerability. Journal of Health and Social Behavior 33:10-24. [Medline]
• Wortman C. B., Silver R. C., 1989. The myths of coping with loss. Journal of Consulting and Clinical Psychology 57:349-357. [Medline]
• Zisook S., DeVaul R., Click M., 1982. Measuring symptoms of grief and bereavement. American Journal of Psychiatry 139:1590-1593. [Abstract/Free Full Text]
• Zisook S., Schuchter S. R., 1991. Early psychological reaction to the stress of widowhood. Psychiatry 54:320-332. [Medline]
• Zisook S., Schucter S. R., Lyons L. E., 1987. Adjustment to widowhood. Zisook S., , ed.Biopsychosocial aspects of bereavement 49-74. American Psychiatric Press, Washington, DC.

This article has been cited by other articles:

				R. J. Jacobs and B. Thomlison Self-Silencing and Age as Risk Factors for Sexually Acquired HIV in Midlife and Older Women J Aging Health, February 1, 2009; 21(1): 102 - 128. [Abstract] [PDF]

				D. S. Carr Black/White Differences in Psychological Adjustment to Spousal Loss Among Older Adults Research on Aging, November 1, 2004; 26(6): 591 - 622. [Abstract] [PDF]

				R. L. Utz, D. Carr, R. Nesse, and C. B. Wortman The Effect of Widowhood on Older Adults' Social Participation: An Evaluation of Activity, Disengagement, and Continuity Theories Gerontologist, August 1, 2002; 42(4): 522 - 533. [Abstract] [Full Text] [PDF]

				P. S. Fry Predictors of Health-Related Quality of Life Perspectives, Self-Esteem, and Life Satisfactions of Older Adults Following Spousal Loss: An 18-Month Follow-up Study of Widows and Widowers Gerontologist, December 1, 2001; 41(6): 787 - 798. [Abstract] [Full Text] [PDF]

				D. Carr, J. S. House, C. Wortman, R. Nesse, and R. C. Kessler Psychological Adjustment to Sudden and Anticipated Spousal Loss Among Older Widowed Persons J. Gerontol. B. Psychol. Sci. Soc. Sci., July 1, 2001; 56(4): S237 - 248. [Abstract] [Full Text] [PDF]

This Article Abstract Full Text (PDF) Services Download to citation manager Citing Articles Citing Articles via HighWire PubMed PubMed Citation