H G Prigerson1, P K Maciejewski, R A Rosenheck. 1. Mental Illness Research, Education and Clinical Center, Veterans Affairs Medical Center, West Haven, CT, USA. Holly.Prigerson@Yale.edu
Abstract
BACKGROUND: Little is known about the impact of marital dissolution and/or marital harmony on health service use. OBJECTIVES: To examine the ways in which marital dissolution and/or marital quality influence health and health service use. RESEARCH DESIGN: The Americans' Changing Lives (ACL) survey was designed to provide a longitudinal study of successful aging. The ACL contains a nationally representative sample of people over age 24, with an oversampling of individuals age 60 and above. SUBJECTS: Nine hundred and twenty seven female subjects who were married at baseline (1986); 101 (10.9%) of those were no longer married at follow up (1989). MEASURES: Health status and health service use at follow up. RESULTS: Marital dissolution, alone and together with marital quality, was associated with worsened mental and physical health and increased mental health service use. Marital harmony was associated with better sleep and fewer depressive symptoms and physician visits. Widowhood was associated with worsened health, but not with greater health service use. Separated women and women divorced from a discordant marriage were not more depressed but used more mental health services. Women separated from a marriage they had rated as harmonious increased their alcohol consumption. CONCLUSIONS: Marital dissolution increases the risk for mental and physical health problems, some of which emerge only among women who had harmonious marriages. Marital harmony appears protective against physician visits. Widows should be encouraged to seek help for their health difficulties. Separated women should be counseled that they are at heightened risk for increased alcohol consumption. Divorced and separated women appear to seek help for emotional problems, over and above depressive symptoms.
BACKGROUND: Little is known about the impact of marital dissolution and/or marital harmony on health service use. OBJECTIVES: To examine the ways in which marital dissolution and/or marital quality influence health and health service use. RESEARCH DESIGN: The Americans' Changing Lives (ACL) survey was designed to provide a longitudinal study of successful aging. The ACL contains a nationally representative sample of people over age 24, with an oversampling of individuals age 60 and above. SUBJECTS: Nine hundred and twenty seven female subjects who were married at baseline (1986); 101 (10.9%) of those were no longer married at follow up (1989). MEASURES: Health status and health service use at follow up. RESULTS: Marital dissolution, alone and together with marital quality, was associated with worsened mental and physical health and increased mental health service use. Marital harmony was associated with better sleep and fewer depressive symptoms and physician visits. Widowhood was associated with worsened health, but not with greater health service use. Separated women and women divorced from a discordant marriage were not more depressed but used more mental health services. Women separated from a marriage they had rated as harmonious increased their alcohol consumption. CONCLUSIONS: Marital dissolution increases the risk for mental and physical health problems, some of which emerge only among women who had harmonious marriages. Marital harmony appears protective against physician visits. Widows should be encouraged to seek help for their health difficulties. Separated women should be counseled that they are at heightened risk for increased alcohol consumption. Divorced and separated women appear to seek help for emotional problems, over and above depressive symptoms.