Marital status,health and mortality

Marital status and living arrangements, along with changes in these in mid-life and older ages, have implications for an individual's health and mortality. Literature on health and mortality by marital status has consistently identified that unmarried individuals generally report poorer health and have a higher mortality risk than their married counterparts, with men being particularly affected in this respect. With evidence of increasing changes in partnership and living arrangements in older ages, with rising divorce amongst younger cohorts offsetting the lower risk of widowhood, it is important to consider the implications of such changes for health in later life. Within research which has examined changes in marital status and living arrangements in later life a key distinction has been between work using cross-sectional data and that which has used longitudinal data. In this context, two key debates have been the focus of research; firstly, research pointing to a possible selection of less healthy individuals into singlehood, separation or divorce, while the second debate relates to the extent to which an individual's transitions earlier in the life course in terms of marital status and living arrangements have a differential impact on their health and mortality compared with transitions over shorter time periods. After reviewing the relevant literature, this paper argues that in order to fully account for changes in living arrangements as a determinant of health and mortality transitions, future research will increasingly need to consider a longer perspective and take into account transitions in living arrangements throughout an individual's life course rather than simply focussing at one stage of the life course.     

Informal care,health and mortality

Informal care provision is an activity in which individuals are increasingly likely to become involved across their life course, and particularly in later life, as a result of demographic changes such as increasing longevity and changes in co-residential living arrangements in later life. Academic research so far has highlighted the adverse impact of informal care provision on the financial position of the carer, however, the evidence on the impact of informal care provision on the carer's physical, mental and emotional health, and on their mortality, presents a more complex picture. This paper reviews research from the UK and beyond on the provision of informal care and its subsequent impact on health and mortality outcomes. Two key findings emerge from this review paper. Firstly, the cross-sectional analysis of data shows mixed associations between informal care provision and poor health outcomes for the carer. Such research highlights the importance of the demographic and socio-economic characteristics of the carer and the person cared for, and of the specific characteristics and nature of the care provided (e.g. duration, level). Secondly, longitudinal analysis, which typically benefits from a longer timeframe to follow up the impact of caring, shows that although informal care provision is not per se associated with adverse health and mortality outcomes, nevertheless particular types and durations of caring have shown negative outcomes.     

Effect of education and marital status on premature mortality among urban adults in Poland, 1988–1989

Mortality rates among adults 25–64 years of age (premature mortality) in 1988 and 1989 were compared by educational status (a four-level scale) and marital status (married vs. nonmarried) in three Polish cities situated in ecologically different regions of Poland. Each of the two social factors has a significant influence on mortality after the effect of the other is controlled statistically. The risk of premature death increases regularly with an individual's decreasing position on the educational scale; also, the risk is higher among nonmarried than among married persons. This is true in all three urban populations, at all age levels considered, and in both genders. However, the effects of education and of marital status on premature mortality are more dramatic in males than in females. At middle age, the condition of having no spouse and of being poorly educated each expose males to a greater risk of premature mortality than females. Am. J. Hum. Biol. 11:397–403, 1999. © 1999 Wiley-Liss, Inc.     

Presence of a Sibling as a Potential Buffer Following Parental Divorce: An Examination of Young Adolescents

Examined whether the presence of a sibling may buffer young adolescents from adverse influences of parental divorce. Subjects were 79 adolescents from intact families, 77 from divorced families, their mothers, and their social studies teachers. Independent variables included adolescent gender, parental marital status, and sibling group (i.e., no siblings, one older sibling only, or one younger sibling only). Dependent measures were externalizing behaviors as reported by the adolescent's teacher and internalizing behaviors as reported by the teacher and the adolescent. Results indicated a significant interaction between marital status and sibling group; specifically, adolescents with no siblings from divorced families were reported by teachers as demonstrating more externalizing problems than all other groups.     

Perceived family climate,psychological adjustment,and peer relationship of black adolescents: A function of parental marital status or perceived family conflict?

This study examined two contrasting views of divorce and its effect on the adjustment of children. The physical wholeness position maintains that divorce itself is the salient variable that adversely affects children via the physical dissolution of the family; while the psychological wholeness position maintains that conflict is the critical variable which influences adjustment and does so regardless of parental marital status. Results of analyses on a sample of black working lower class adolescents failed to support the physical wholeness position; adolescents' age at the time of parental divorce, gender, and parental marital status were not significantly related to perception of family climate, psychological adjustment, grade point average, or peer relationships. However, results did provide strong support for the psychological wholeness position since adolescents' perception of family climate, psychological adjustment, and peer relationships were all significantly related to level of perceived conflict in the family. Conceptualizing divorce as a crisis situation rather than as a uniformly and universally negative event appears more reasonable since adolescents in our sample adapted to, and coped with, divorce. Use of conflict identification and resolution interventions to reduce family conflict may prevent future problems in child development.     

Economic impact of divorce on children's development: Current findings and policy implications

Examined the economic impact of divorce on families' functioning and children's mental health. U.S. Bureau of the Census (1992b, 1993) data on rates of divorce and remarriage are reviewed, as well as data on economic aspects that both predispose to and result from marital dissolution (Hernandez, 1992). Research regarding the impact of economic stress and poverty on family functioning and child mental health problems is discussed. I make Jive recommendations for social policy that emphasize the need for attention to economic aspects of divorce and their impact on children's and parents' adjustment and well being. Particular attention is devoted to the need for continuity in families' economic standard following divorce, enforcement of child support laws, and new treatment approaches to help children cope with their parents' divorce.     

Childhood family relationships,marital and work conflict,and mental health distress in Mexican immigrants

The present study examined the associations among childhood family relationships, adult conflict in marriage and work relationships, and mental health distress in Mexican immigrants. The sample consisted of 135 married Mexican immigrants recruited from an ESL program in Southern California. Structural equation modeling was used to test theoretical hypotheses. The model revealed that dysfunctional childhood family relationships predicted dissatisfaction and conflict in marital and work relationships. Conflict in marital relationships directly contributed to mental health distress, whereas conflict in work relationships had an indirect effect on mental health by impacting negatively on immigrants' marital relationships. The model also indicated that immigrants' socioeconomic status in Mexico was linked to work relationships conflict in the United States, which, in turn, had a detrimental effect on marital relationships and mental health distress. Furthermore, a significant pathway was found linking recency of migration and immigrants' resident status (legal vs. illegal) to conflict in marital relationships and mental health distress. Finally, social status risk factors significantly predicted mental health distress. Mexican immigrants who were older, of lower status, and female experienced a high level of psychological distress. The findings were discussed in terms of attachment and migration stress theory, and Latino cultural patterns. © 1998 John Wiley & Sons, Inc.     

The physiology of marriage: pathways to health

Marriage is the central relationship for most adults and has beneficial effects for health. At the same time, troubled marriages have negative health consequences. This review outlines the physiological pathways through which marital relationships influence health based on a stress/social support model. In addition, we review recent findings suggesting that unhappy marriages are associated with morbidity and mortality. We then turn to studies of marital interaction that include assessment of physiological pathways through which marital functioning influences health: the cardiovascular, endocrine, and immune systems. Across these studies, negative and hostile behaviors during marital conflict discussions are related to elevations in cardiovascular activity, alterations in hormones related to stress, and dysregulation of immune function. Using recent conceptualizations of the physiological impact of chronic stress, we illustrate how physiological changes associated with marital functioning in these studies have long-term implications for health outcomes. Finally, we discuss future implications of current research for understanding the relationships among marital functioning, physiology, and health.     

Subjective health status as a determinant of mortality among African-American elders.

This study examines the efficacy of self-rated health as a determinant of 6-year survival among the 1209 African-American respondents in the Longitudinal Study on Aging (LSOA). The association between self-rated health and mortality risk has been established previously; however, this relationship has not been directly tested in a nonwhite sample. Findings indicate that self-rated health is a predictor of mortality that is independent of several control variables (income, sex, age, education, and marital status) and two objective health status indicators (bed days and doctor visits). However, it is not independent of limitations with activities of daily living. When all three objective health measures were included in a single model, self-rated health was not an independent predictor of mortality. However, when the full model was specified on sex-specific subsamples, the analysis found that self-rated health was an independent predictor of mortality for women, but not for men.     

A key informant needs assessment of an adult population: Application to consultation and prevention programs

Sixty-three key informants first identified the four most important problems confronting adults between the ages of 30 and 40 years and then responded to a series of open-ended questions in relation to the two most important problems identified. Respondents then rated a list of life events and problem areas as to their seriousness and prevalence and identified those they viewed as most important. Respondent-generated problems, in order of importance, were financial, employment, parenting, health/mental health, and marital. As examples of the qualitative outcomes of the open-ended questions, responses are summarized in this article for two problems: financial and parenting. The two most important problems identified from the rating scales were financial troubles and divorce, followed by a number of items pertaining to mental health, child-rearing, and marital problems. The discussion focuses on considerations of reliability and validity and on implications of the findings for the design of services.     

新疆和田地区667例60岁以上老人长寿影响因素分析

目的了解新疆和田地区老人的长寿影响因素,探讨遗传和环境因素与长寿之间的关系。方法采用分层整群抽样的方法,对新疆和田地区洛浦县、墨玉县和和田县的8个乡共667例老人进行长寿因素调查,包括问卷调查和体格检查。结果研究对象的平均每标准人日热能摄入量为2196.02kcal,占推荐摄入量（RNI）的115.58%。其主要营养素摄入量中,胆固醇、视黄醇、尼克酸、锌较低,分别占RNI的38.88%、36.71%、59.29%和53.80%,其它摄入量都已接近或超过RNI;单因素Logistic回归分析显示,婚次、婚姻状况、性生活、住房状况、家族长寿史、既往病史和碳水化合物有统计学意义（P〈0.05）;多因素逐步Logistic分析显示,婚姻状况、性生活、住房面积和家族长寿史是老人长寿的影响因素（P〈0.05）。结论长寿的父母有长寿的子女,已婚的老人比未婚、离婚、丧偶的老人长寿,有正常性生活的老人比无性生活的老人长寿;增加对老年人婚姻和性生活的关心,有利于提高老年人的生活质量。     

A life course approach to reproductive health: Theory and methods

Taking a life course approach to the study of reproductive health involves the investigation of factors across life and, also across generations, that influence the timing of menarche, fertility, pregnancy outcomes, gynaecological disorders, and age at menopause. It also recognises the important influence of reproductive health on chronic disease risk in later life. Published literature supports the use of an integrated life course approach to study reproductive health, which examines the whole life course, considers the continuity of reproductive health and the interrelationship between the different markers of this. This is in contrast to more traditional approaches that tend to focus only on contemporary risk factors and which consider each marker of reproductive health separately. For instance, we found evidence linking early life factors such as growth, socioeconomic conditions, and parental divorce with ages at menarche and menopause, although the nature of the relationship differs. We discuss the different theoretical models that are used within life course epidemiology and which postulate pathways linking exposures across the life course to health outcomes, using examples of relevance to the study of reproductive health. These highlight the importance of examining timing of exposures, such as during critical periods in early life, and the temporal order of exposures. How life course frameworks of reproductive health can be developed to help identify hypotheses to be tested is also demonstrated. This approach has implications for the development of effective health policy that moves beyond identifying not only the type of intervention but also the most appropriate time across life to intervene.     

城市居民生活满意感与心理健康的相关研究

目的探讨生活满意感对心理健康的影响。方法对286名宁波市民，采用自编的生活满意感量表、SCL-90症状自评量表进行问卷调查。结果①在不同群体总体生活满意感的比较中，不同职业状况、个人月收入、家庭月收入的群体闻存在极显著的差异，而不同性别、年龄、教育程度、婚姻状况的群体闻没有显著差异。②城市居民的总体满意感处在一般和较满意之间，在3个生活满意度因子中．满意度最高的是人际关系和健康状况因子。③社会物质生活条件和社会地位因子与SCL-90大部分因子的相关达到显著水平。④生活满意感水平高、低两组被试在SCL-90的绝大部分因子上的差异达到显著水平。结论个体的主观满意感水平能够影响个体的心理健康感。     

Effects of parental divorce and youth unemployment on adolescent health

The aim of this study is to gain more insight into the effects of two important events on adolescent health in the life course of youngsters, namely parental divorce and being unemployed. We made use of the dataset of the Utrecht Study of Adolescent Development, a longitudinal panel study, based on a representative sample of young people in the Netherlands (12–24 years old). We used the data of non-school-going youngsters who are at least 18 years old. Parental divorce does indeed have negative effects on adolescent health; however, this applies only for girls. Being unemployed or having been unemployed has negative effects on psychological health, especially for boys. But this experience does not have negative effects on physical health, either for boys or girls. Any conclusions on the consequences of parental divorce and youth unemployment for adolescent health have to be specified, at least for sex.     

How individual age-associated changes may influence human morbidity and mortality patterns

Patterns of human mortality share common traits in different populations. They include higher mortality in early childhood, lower mortality during the reproductive period, an accelerated increase of mortality near the end of the reproductive period, and deceleration in the mortality increase at oldest old ages. The deceleration of mortality rate is one of the most intriguing recent findings in longevity research. The role of differential selection in this phenomenon has been well studied. Possible contribution of individual aging in the shape of mortality curve is also recognized. However, this contribution has not been studied in details. In this paper, we specify most common patterns of age-associated changes in an individual organism and discuss their possible influence on morbidity and mortality in population. We subdivide individual age-associated changes into three components, having different influence on morbidity and mortality: (1) basal, (2) ontogenetic, and (3) time-dependent. Basal changes are connected with the universal decrease in the rate of living during an individual life. As a result, some phenotypic effects of aging may accumulate in an organism at a slower rate with age. Basal changes are likely to contribute to a plateau of morbidity often observed at old ages, and may partially be responsible for mortality deceleration at oldest old ages. Ontogenetic component is connected with change of the stages of ontogenesis (e.g., the growth, the reproductive period and the climacteric) during an individual life. The ontogenesis-related changes contribute to wave-like patterns of morbidity in population and may partially be responsible for mortality increase at middle ages and its deceleration at old ages. Time-dependent changes are connected with long-time exposure of an organism to different harmful factors. They are most likely to contribute to morbidity and mortality acceleration. We discuss how all three components of individual age-associated changes may interact in human organism and influence patterns of morbidity and mortality in population.     

Suicide, age and marital status

A new data set concerning suicide in relation to marital status for Scotland, 1973-83, is presented. The effects of age-standardization on marital status rates and of marital status standardization on age-specific rates are both elucidated. The difficulties of drawing conclusions from marital status rates for suicide are outlined. Nevertheless, the data suggest that the importance of the widowed state has been underestimated and that it appears that the relative risk for suicide associated with divorce has probably been decreasing among Scottish men over the study period.     

Stress: A Potential Disruptor of Parent Perceptions and Family Interactions

Reviews research on the relationship between extra familial stressors (e.g., unemployment, low socioeconomic status), interpersonal stressors (e.g., marital distress, divorce), and child stressors and parents' perceptions and family interactions in families with conduct-problem children. Various stressors appear to have the power to disrupt parenting practices seriously by causing some parents to be more irritable, critical, and punitive. Such parenting behaviors increase the likelihood that children develop conduct problems, setting in motion a cycle of negative parent-child interactions and further stress on the parents. This process appears to be mediated by patents' psychological well being, quality of social support or degree of isolation, sex and drug use.     

Social status,social support,and stress: a comparative review of the health consequences of social control factors

Abstract

The purpose of this review is to present evidence that two fundamental relationship dimensions, social status and social support, play significant roles in protecting individuals from stressors, stress responding, and related health problems. While there is a substantial literature on the link between social support and health, the role of social status has been largely overlooked in health psychology research. Research with humans and animals, in a variety of disciplines, demonstrates the effects of both status and support on acute stress responding and long-term health outcomes. Taken together, this research suggests that status and support serve to increase the individual's control over the social and physical environment, thus reducing the experience and effects of stress. The proposed social control model has implications for future research, including development of new measures, identification of health-relevant relationships, and generation of research questions to further illuminate our understanding of how social interactions affect health.     

The impact of a discrepancy between actual and preferred living arrangements on life satisfaction among the elderly in China

OBJECTIVES:

To explore the effects of a discrepancy between actual and preferred living arrangements on the relationship between living arrangements and life satisfaction among the elderly in China.

METHODS:

Secondary analysis of the 2005 dataset of the Chinese Longitudinal Healthy Longevity Survey was performed. A binary logistic regression model was used to analyze the relationship between life satisfaction and living arrangements.

RESULTS:

Among those with concordant actual and preferred living arrangements, living in a nursing home increased the likelihood of life satisfaction, whereas living alone and living with a spouse decreased the likelihood of life satisfaction compared to living with the next generation and a spouse. Among those with discordant living arrangements, there were no differences in life satisfaction between the various living arrangements, except that living with a spouse increased life satisfaction compared to living with the next generation and a spouse.

CONCLUSIONS:

A discrepancy between actual and preferred living arrangements modifies the relationship between life satisfaction and actual living arrangement. Living in a nursing home is a good option for Chinese elder care only if the older individual emotionally accepts it. Living alone or with a spouse is not a good arrangement for elder care, even though it is often preferred by the elderly. Those with discordant living arrangements are more satisfied living with their spouses.     

Vision and falls: A multidisciplinary review of the contributions of visual impairment to falls among older adults

Falls are a leading cause of mortality among older adults worldwide. With the increasing aging population, falls are rapidly becoming a public health concern. Numerous internal and external factors have been associated with an older adult's increased risk of falling. Most notably visual impairments are gaining recognition for their critical role in fall events, particularly related to trips, slips and falls due to environmental hazards. This review presents the issue of vision and falls from a multidisciplinary health professional perspective. Discussions include the influence of visual impairment on mobility and activities of daily living, the effects of medications on vision, visual cognitive factors on falls risk and visual training interventions. Finally, implications for multidisciplinary health professional practice and suggestions for future research are offered.