Does the "widowhood effect" precede spousal bereavement? Results from a nationally representative sample of older adults.

ABSTRACT

OBJECTIVE: Increased mortality risk following spousal bereavement (often called the "widowhood effect") is well documented, but little prior research has evaluated health deteriorations preceding spousal loss. DESIGN: Data are from the Health and Retirement Study, a nationally representative sample of Americans over 50 years old. METHOD: Individuals who were married in 2004 were considered for inclusion. Outcome data from 2006 on mobility (walking, climbing stairs), number of depressive symptoms, and instrumental activities of daily living (IADLs) were used. Exposure was characterized based on marital status at the time of outcome measurement "recent widows" (N=396) were bereaved between 2004 and 2006, before outcomes were assessed; "near widows" (N=380) were bereaved between 2006 and 2008, after outcomes were assessed; "married" individuals (N=7,330) remained married from 2004 to 2010, the follow-up period for this analysis. Linear regression models predicting standardized mobility, depressive symptoms, and IADLs, were adjusted for age, race, gender, birthplace, socio-economic status, and health at baseline. RESULTS: Compared to married individuals, recent widows had worse depressive symptoms (ß=0.71, 95% confidence interval (CI) [0.57, 0.85]). Near widows had worse depressive symptoms (ß=0.21, 95% CI [0.08, 0.34]), mobility (ß=0.14, 95%CI [0.01, 0.26]), and word recall (ß=-0.13, 95%CI [-0.23, -0.02]) compared to married individuals. CONCLUSIONS: Health declines before spousal death suggests some portion of the "widowhood effect" may be attributable to experiences that precede widowhood and interventions prior to bereavement might help preserve the health of the surviving spouse.