The widowhood effect is the increase in the probability of a person dying a relatively short amount of time after a long-time spouse has died. It can also be referred to as "dying of a broken heart". Being widowed increases the likelihood of developing severe mental disorders[1] along with psychological and other physical illnesses.[2]

Religious differences

A 2009 study by Abel and Kruger compared the likelihood of death between Catholic and Jewish widows, based on the graves of Jewish and Catholic couples in the Midwest. The data suggested that the widowhood effect was stronger in Jewish couples than in Catholic couples. Catholic women lived 11 years after the death of their spouse, while Jewish women lived nine and a half years after the deaths of their husbands. Similarly, the Jewish men lived five years after the death of their wives, while the Catholic men lived about eight years after the death of their wives.[3]

Health effects

Dietary

Research has found that surviving spouses tended to experience significant weight loss after the death of their partner. It was theorized that these changes in weight are the result of differences in dietary intake before and after the death of a spouse. Danit Shahar and colleagues surveyed 116 older individuals in order to track their weight and eating habits over the course of their longitudinal study. Half of the participants were widowed, and the other half were non-widowed. The study found that the widowed subjects were more likely to eat meals alone than the married individuals. The diets of the widowed subjects also consisted of more commercial foods than their counterparts. The authors hypothesized that this weight loss was the result of the widowed participants not finding as much enjoyment in eating as they did before their spouses death. Widowed subjects had less of an appetite and as a result, lost weight over the course of the study.[4]

Mental

The death of a spouse can have a major impact on one's mental health. Each individual may respond to their spouse's death differently. After the death of a spouse, many widows began to take more prescription medications for mental health issues.[5] The mental health effects differ between men and women. Men may become more depressed in widowhood compared to women. Married men also report a higher rate of happiness in their marriage which could be drastically altered after the partners death. Men and women both show greater rates of depression after the death of a spouse but the rates of depression in men tend to be higher than in women.[6][7]

A 2021 systematic review and meta-analysis by Singham, Bell, Saunders, and Stott reported that significant life stressors, such as the loss of a spouse, may be considered a risk factor in cognitive decline.[8]

Takotsubo

Takotsubo cardiomyopathy, also referred to as broken heart syndrome, has been discussed in contexts surrounding great physical and emotional stress, such as when someone has been widowed. In addition, emotional stress has long been associated with myocardial infarction.[9] In their research, Brenn and Ytterstad reported an increase in the death of women 55–64 years old due to heart disease in the first week of widowhood than married women 55–64 years old (2016). Although takotsubo is not considered to be the direct cause of death at this time, it is an observed phenomenon.[9]

Effects on social life

Elderly widows experience changes in their social lives prior to and following the deaths of their spouses. A study conducted by Utz and colleagues revealed that elderly persons experiencing widowhood spent more time with family and friends than non-widowed counterparts, based on the lifestyle changes that occur in elderly couples.[10] Although widowed subjects were more likely to socialize with family and friends, they were no more likely to visit church or volunteer than the intact couples. This study also found that healthy spouses were reclusive while their significant other was on their deathbed, but due to a network of family and friends; the surviving spouse entered society being more social than they had been prior to the death of their husband or wife. Elderly widows were more or less involved socially depending on the amount of support they had from family and friends.[10] It has been noted that widows who have a close and supportive social network can counteract the effects of widowhood by remaining active in their social group. Losing a spouse can have a profound impact on a person's overall well-being, affecting various aspects of their life. This can include their psychological, social, physical, practical, and economic well-being.[11] With all of these aspects of a widowed individual being affected maintaining a sense of normality is important to help avoid depression-like symptoms. Social support, as well as creating new lasting relationships through social interaction can help the process of bereavement go smoother for individuals who experience the widow effect.

Urban, rural, and race variations

A 2015 study conducted by Wright and colleagues revealed that there is a significant difference in urban-rural variation in the social environment as well as in health outcomes.[12] There is evidence that social support from family and friends has better health outcomes on mortality rates. Investigations showed that the race of the partner influences the widowhood effect; whites in endogamous marriages had greater mortality risks that were not obvious among blacks, which the authors concluded was due to a high level of family support for the elderly among black families versus white families. Moreover, the study also found differences in urban and rural areas around the world. They found that elderly married couples in the US suffered significant mortality risks compared to those in Ireland where older people living in more rural areas receive more social support from their families, and they live with their children, while in the US elderly people live in care homes. As a result, mortality rates are greater in urban areas and less in rural areas.

In a study done by Elwert and Christakis, they found that there was no widowhood effect found in endogamous marriages involving black men or women. Analyzing this finding, they proposed that this might be because black people are able to extend their marital survival advantage into widowhood. This is likely because black people are prone to have kin nearer to help take care of them, they may be more self-sufficient than their white counterparts, and there is greater religious participation in black people that may help them with spiritual comfort.[13] White people were found to have "a large and enduring widowhood effect" because there is no reparation to make up for the survival advantages that marriage gave them, even if they have been widowed for years.[14]

The widowhood effect appears to have a higher impact in rural and intermediate areas compared to urban areas. One factor may be that there are greater distances to primary care services in rural areas, and this increases mortality due to discouraged health checkups.[12] It is known that the size of family and social network coincides with physical functioning; the bigger the social group one belongs to the better they can physically function. Residential areas near green areas are associated with an increase in physical activity and lowered mortality.[12] Researchers measured peak flow to show the increases or decrease in physical functioning, and the results suggest that married subjects have a higher peak flow compared to those divorced or widowed.[15]

Possible causes

It was suggested that the widowhood effect was a mere coincidence resulting from the selection of partners with similar health risks. In a recent study by Boyle and colleagues, it was concluded that the increased mortality rate of widows is caused by the death of their spouse. Researchers in the study used data from the Scottish Longitudinal Study to compare the ratios of death in widowed males and females. The male and female subjects were categorized into different groups depending on the manner in which their spouse died. The results provided evidence that suggests a causal relationship between mortality rate and widowhood.[16]

In April 2016, the American Heart Association published an article regarding the phenomenon referred to as "broken heart syndrome". This particular syndrome seems to occur when a person experiences an overwhelming amount of stress in their life in a short period of time. The cases mentioned involved both positive events like winning the lottery as well as negative events like experiencing the death of a spouse. Though broken heart syndrome has been misdiagnosed as a heart attack, the differences between the two phenomena are clear. Heart attacks are the result of a blockage of arteries, but broken heart syndrome is the result of a hormone-induced enlargement of a portion of the heart. The enlarged region of the heart is less effective in regard to pumping blood, and the normal-sized regions of the heart are forced to work harder as a result.[17]

Notes

    1. ↑ Siflinger, Bettina (December 2017). "The Effect of Widowhood on Mental Health - an Analysis of Anticipation Patterns Surrounding the Death of a Spouse". Health Economics. 26 (12): 1505–1523. doi:10.1002/hec.3443. ISSN 1057-9230. PMID 27747997. S2CID 24179271.
    2. ↑ Ramadas, Smitha; Kuttichira, Praveenlal (April 2013). "Bereavement leading to death". Asian Journal of Psychiatry. 6 (2): 184–185. doi:10.1016/j.ajp.2012.09.002. PMID 23466120.
    3. ↑ Abel, Ernest L.; Kruger, Michael L. (2009). "The Widowhood Effect: A Comparison of Jews and Catholics". OMEGA: Journal of Death and Dying. 59 (4): 325–337. doi:10.2190/om.59.4.c. PMID 19927597. S2CID 32318445.
    4. ↑ Shahar, Danit R.; Schultz, Richard; Shahar, Avner; Wing, Rena R. (2001). "The Effect of Widowhood on Weight Change, Dietary Intake, and Eating Behavior in the Elderly Population". Journal of Aging and Health. 13 (2): 186–199. doi:10.1177/089826430101300202. PMID 11787511. S2CID 23064565.
    5. ↑ Avis, Nancy E.; Brambilla, Donald J.; Vass, Kerstin; McKinlay, John B. (January 1991). "The effect of widowhood on health: A prospective analysis from the Massachusetts women's health study". Social Science & Medicine. 33 (9): 1063–1070. doi:10.1016/0277-9536(91)90011-Z. PMID 1771433.
    6. ↑ Lee, G. R.; DeMaris, A.; Bavin, S.; Sullivan, R. (1 January 2001). "Gender Differences in the Depressive Effect of Widowhood in Later Life". The Journals of Gerontology Series B: Psychological Sciences and Social Sciences. 56 (1): S56–S61. doi:10.1093/geronb/56.1.s56. PMID 11192346.
    7. ↑ Stroebe, Wolfgang (1987). Bereavement and health: The psychological and physical consequences of partner loss. Cambridge, England: Cambridge University Press. ISBN 9780521287104.
    8. ↑ Singham, Timothy; Bell, Georgia; Saunders, Rob; Stott, Joshua (November 2021). "Widowhood and cognitive decline in adults aged 50 and over A systematic review and meta-analysis". Ageing Research Reviews. 71: 101461. doi:10.1016/j.arr.2021.101461. PMID 34534681. S2CID 237510106 – via PubMed.
    9. 1 2 Brenn, Tormod; Ytterstad, Elinor (August 2016). "Increased risk of death immediately after losing a spouse: Cause-specific mortality following widowhood in Norway". Preventive Medicine. 89: 251–256. doi:10.1016/j.ypmed.2016.06.019. PMID 27311340.
    10. 1 2 Utz, Rebecca L.; Carr, Deborah; Nesse, Randolph; Wortman, Camille B. (1 August 2002). "The Effect of Widowhood on Older Adults' Social Participation". The Gerontologist. 42 (4): 522–533. doi:10.1093/geront/42.4.522. PMID 12145380.
    11. ↑ Bennett, Kate Mary; Soulsby, Laura K. (16 November 2012). "Wellbeing in Bereavement and Widowhood". Illness, Crisis & Loss. 20 (4): 321–337. doi:10.2190/il.20.4.b. S2CID 12985640.
    12. 1 2 3 Wright, David M.; Rosato, Michael; O'Reilly, Dermot (July 2015). "Urban/rural variation in the influence of widowhood on mortality risk: A cohort study of almost 300,000 couples" (PDF). Health & Place. 34: 67–73. doi:10.1016/j.healthplace.2015.04.003. PMID 25957924. S2CID 20072289.
    13. ↑ Elwert, Felix; Christakis, Nicholas A. (February 1, 2006). "Widowhood and Race". American Sociological Review. 71 (1): 16–41. doi:10.1177/000312240607100102. S2CID 15340529.
    14. ↑ Elwert, Felix; Christakis, Nicholas A. (November 2008). "The Effect of Widowhood on Mortality by the Causes of Death of Both Spouses". American Journal of Public Health. 98 (11): 2092–2098. doi:10.2105/AJPH.2007.114348. PMC 2636447. PMID 18511733.
    15. ↑ Clouston, S. A.; Lawlor, A; Verdery, A. M. (2014). "The role of partnership status on late-life physical function". Canadian Journal on Aging. 33 (4): 413–25. doi:10.1017/S0714980814000282. PMC 4256949. PMID 25222477.
    16. ↑ Boyle, P. J.; Feng, Z.; Raab, G. M. (January 2011). "Does Widowhood Increase Mortality Risk? Testing for Selection Effects by Comparing Causes of Spousal Death". Epidemiology. 22 (1): 1–5. doi:10.1097/ede.0b013e3181fdcc0b. PMID 21052007. S2CID 27673114.
    17. ↑ "Is Broken Heart Syndrome Real?". Dallas: American Heart Association. April 18, 2016. Retrieved August 4, 2016.
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