Marital status, social support, and health transitions in chronic disease patients

Married persons tend to be healthier, both physically and mentally, than unmarried persons. We tested the hypothesis that being married results in better physical and mental health outcomes for chronic disease patients (N = 1,817) by increasing social support. We modeled health outcomes one year later, controlling for initial health status. Cross-validation studies of two random halves of the sample supported an indirect effect of marital status on mental health through social support, but did not support a relationship, direct or indirect, of either marital status or social support with physical health outcomes. In addition, specific types of functional support were not differentially predictive of mental health status.     

In Gesundheit und Krankheit?

This Study examines the relationship between health status and the risk of marital separation. The data base is the German Socio-Economic Panel, a representative longitudinal study of private households in Germany. Controlling for marital duration and other covariates, both poor health of one partner and poor health of both partners are associated with a higher risk of dissolution. The results suggest that the higher risk of dissolution is partly caused by financial burdens which are associated with illness. Further possible explanations??social expectations addressed to the healthy partner, an increasing dependence of the sick partner on his spouse, a reduction of alternatives and a deterioration of the marriage match??are of minor importance for the risk of separation. The results are also relevant for explaining health inequalities. They suggest that better health of married people compared to unmarried people not only depends on a protective effect of marriage on health, but is also due to the fact that healthier people are more likely to stay married.     

Postponement of health care by widowed,divorced, and never-married older men

This longitudinal research investigated the relationship between marital status and postponement of health care, reasons for postponement of treatment, factors associated with delaying care, and changes in health care behavior over a decade among 375 unmarried older men.Almost 30% of the men had not sought care when their health warranted it. Postponement of care was not associated with marital status although reasons for foregoing care were related to marital status. Discriminant analyses indicated the importance of financial distress to postponing care. The models were more effective in discriminating health care decisions of the formerly married than of the never married.Pat M. Keith is Professor of Sociology at Iowa State University. She earned her Ph.D. in Sociology at St. Louis University. Her current research interests are in the areas of gender roles in later life and rural-urban differences in the elderly.Address reprint requests to the author at Iowa State University, Department of Sociology, Ames, IA 50011.     

Has the future of marriage arrived? A contemporary examination of gender, marriage, and psychological well-being

A long tradition of research and theory on gender, marriage, and mental health suggests that marital status is more important to men's psychological well-being than women's while marital quality is more important to women's well-being than men's. These beliefs rest largely on a theoretical and empirical foundation established in the 1970s, but, despite changes in gender and family roles, they have rarely been questioned. The present analysis of three waves of a nationally representative survey indicates that, with few exceptions, the effects of marital status, marital transitions, and marital quality on psychological well-being are similar for men and women. Further, for men and women, occupying an unsatisfying marriage undermines psychological well-being to a similar extent--and, in some cases, to a greater extent--than exiting marriage or being continually unmarried.     

Status or Access? The Impact of Marriage on Lesbian,Gay, Bisexual,and Queer Community Change

Drawing on interview and survey research with 116 married and unmarried lesbian, gay, bisexual, and queer (LGBQ) individuals, this study offers the first systematic data on the relationship between legal marriage and LGBQ community life. The author distinguishes between marital status—being married—and marital access—gaining access to the institution of marriage—as distinct drivers of community change. In contrast to research with heterosexuals, the findings suggest that marital access plays a primary role in LGBQ community change. The different life course trajectories of LGBQ people and their prior experiences of social exclusion alter the relationship between marriage and community. The findings push family scholarship beyond a one‐model‐fits‐all approach to understanding the impact of marriage on community engagement. Taken together, they expand literature on marriage as greedy, the deinstitutionalization of marriage, and marriage and social inclusion as well as offer insights into how LGBQ people understand and enact marriage.     

Gatekeeper's response: A rejoinder

Gender, marital status, age, and race were considered in relation to the amount and assessment of social ties among 1,124 unmarried men and women aged 40 and over. When there were significant effects of marital status, widowed people tended to be advantaged in amount and supportiveness of their informal ties, although the influence of marital status was affected by age and race. Contrary to some literature, gender differences in social relationships favoring women were not consistently observed. The oldest never married may have the greatest potential needs for affective and instrumental support.     

The Role of Marital Status and Age on Men’s and Women’s Reactions to Touch from a Relational Partner

Prior research has consistently documented differences between men’s and women’s reactions to being touched by other people. One of the more interesting findings in this literature is the apparent role of marital status in dramatically altering these sex differences in reactions to intimate touch. Unmarried men tend to respond more favorably to intimate touch than unmarried women do, but this difference is reversed among married people. However, research that documented this effect has potentially confounded marital status with age. Participants in this investigation were 305 adults, ranging in age from 18–69. They completed an extensive survey of their reactions to touch to various body regions from a significant other. Results indicated that men had uniformly more positive reactions to intimate touch than women did. For non-intimate touch, the sexes were more comparable in their reactions. This investigation once again documented a disordinal sex by marital status interaction. Unmarried men had generally more positive reactions to touch than unmarried women did and this pattern was reversed among married participants. When statistically controlling for participants’ age, these interactions were still evident.     

Racial differences in depression trajectories among older women: socioeconomic, family, and health influences

Despite recent increases in life course research on mental illness, important questions remain about the social patterning of, and explanations for, depression trajectories among women in later life. The authors investigate competing theoretical frameworks for the age patterning of depressive symptoms and the physical health, socioeconomic, and family mechanisms differentiating black and white women. Using data from the National Longitudinal Survey of Mature Women, the authors use linear mixed (growth curve) models to estimate trajectories of distress for women aged 52 to 81 years (N = 3,182). The results demonstrate that: (1) there are persistently higher levels of depressive symptoms among black women relative to white women throughout later life; (2) physical health and socioeconomic status account for much of the racial gap in depressive symptoms; and (3) marital status moderates race differences in distress. The findings highlight the importance of physical health, family, and socioeconomic status in racial disparities in mental health.     

Clarifying the relationship between parenthood and depression

Unlike other major adult social roles in the United States, parenthood does not appear to confer a mental health advantage for individuals. However, while research has examined parental status differences in emotional well-being, relatively little is known about variations in emotional distress among parents. In this article, we clarify the relationship between parenthood and current symptoms of depression using data from the National Survey of Families and Households. The analyses provide support for our first hypothesis: Parenthood is not associated with enhanced mental health since there is no type of parent who reports less depression than nonparents. We also find support for our second hypothesis: Certain types of parenthood are associated with more depression than others. Additionally, although we find marital status differences in symptoms among parents, there are no gender differences in the association between parenthood and depression. We discuss the implications of our findings for ongoing theoretical debates about the advantages of social role involvement for mental health as well as the meaning of contemporary parenthood in the United States.     

Marital transitions and mental health

Most research identifies marital disruption as a precursor for poor mental health but is generally unable to discount the potential selection effect of poor mental health leading to marital disruption. We use data from nine annual waves of the British Household Panel Survey to examine social selection and social causation as competing explanations. Mental health is measured using the general health questionnaire. We examine mental health at multiple time points prior to and after a marital transition through separation or divorce and compare this process to those who experience widowhood. All groups transitioning out of marriage have a higher prevalence of poor mental health afterwards but for those separated or divorced, poor mental health also precedes marital disruption, lending support to both social-causation and social-selection processes. The processes both preceding and after the transition to widowhood differ, with increased prevalence of disorder centering around the time surrounding the death itself     

Interprofessional education for community mental health: Attitudes to community care and professional stereotypes

Social workers are considered key members of community mental health teams, yet difficulties in interprofessional collaboration between social workers and health care professionals, particularly psychiatrists and nurses, have been reported. This paper examines some sources of these difficulties in terms of perceived differences in models of mental illness, attitudes and values, including stereotyping, professional identification and role clarity. Interprofessional education (IPE) may diminish negative stereotypes and promote multidisciplinary teamwork. A theoretical framework is described and findings from the evaluation of a 1-year programme of interprofessional education for community mental health are presented. These findings suggest that attitudes and values concerning community care for people with mental health problems are largely shared by different professions, but they do confirm the existence of interprofessional stereotypes and of perceived status differences. In contrast to previous research, there was no evidence of changes in stereotypes. These findings are discussed in terms of the theoretical framework and the design of the programme.     

Mental health in young Australians: a longitudinal study

This article discusses patterns in mental health of young Australians from age 19 through 25 and explores changes in mental health over these years. Data are derived from five waves of the Australian Life Patterns longitudinal study. The outcome variable in focus was self-reported mental health. Analyses were conducted in two steps using linear mixed models with both fixed and random effects. The analysis shows a negative linear trend in mental health status. The mental health of women was worse than that of men though a negative trend was found in both men and women. Though high socio-economic status (SES) individuals reported best mental health compared to their mid and low-SES peers, a negative trend was identified for them as well as for mid-SES participants. There is weak support for a negative trend among those of low-SES backgrounds. The study adds to evidence that there is a negative trend in mental health in young Australians but that this trend is not uniform across all young people. In light of this we argue the need for further research that analyses patterns of poor mental health in relation to social systems and institutions.     

The prevalence, distribution, and mental health correlates of perceived discrimination in the United States.

The survey data presented here are on the national prevalences of major life-time perceived discrimination and day-to-day perceived discrimination; the associations between perceived discrimination and mental health; and the extent to which differential exposure and differential emotional reactivity to perceived discrimination account for the well-known associations between disadvantaged social status and mental health. Although more prevalent among people with disadvantaged social status, results show that perceived discrimination is common in the total population, with 33.5 percent of respondents in the total sample reporting exposure to major lifetime discrimination and 60.9 percent reporting exposure to day-to-day discrimination. The associations of perceived discrimination with mental health are comparable in magnitude to those of other more commonly studied stressors, and these associations do not vary consistently across subsamples defined on the basis of social status. Even though perceived discrimination explains only a small part of the observed associations between disadvantaged social status and mental health, given its high prevalence, wide distribution, and strong associations with mental health, perceived discrimination needs to be treated much more seriously than in the past in future studies of stress and mental health.     

Bachelor of Social Work Students and Mental Health Stigma: Understanding Student Attitudes

Bachelor-level social work students (n = 198) at a midsized Midwestern public university were surveyed to evaluate their attitudes toward those with mental health concerns. Additionally, students were surveyed regarding their willingness to seek treatment for their own mental health needs. Results of the analyses suggest that the majority of students do not hold stigmatizing attitudes toward mental illness. Students who believed mental health work is rewarding were less likely to be afraid or uncomfortable around people with mental illness. In addition, these students were more likely to report attitudes that acknowledge the capabilities of people with mental illness and were less concerned with others knowing their own mental health status. Implications for social work education and directions for future research are discussed.     

Marital status and psychiatric disorders among blacks and whites.

This paper examines the association between marital status and psychiatric disorder for Blacks and explores the extent to which these patterns differ from those for Whites. Widowed and separated/divorced Black males and females have higher rates of disorder than the married; never-married Blacks do not have an elevated risk of psychiatric illness. The association between marital status and disorder for White males is similar and stronger than that observed for Blacks. For White women, the separated/divorced have a higher risk of disorder than the married, and unmarried White females have higher rates of the substance abuse disorders, but lower rates of the anxiety disorder than the married. Across all marital status groups, Black males and White males have higher rates of disorder (except for depression), than females. A complex pattern emerges when gender differences in the relative rates of disorder for unmarried Blacks compared to married Blacks are considered. Separated/divorced Black men, widowed Black women, and never-married Black men are worse off than their respective peers. Except for the separated/divorced, opposite patterns are evident for Whites. Directions for further research are outlined.     

Untangling Inequalities: Gender,Race, and Socioeconomic Differences in Depression1

In their important paper, Link and Phelan (1995) argue that socioeconomic status is a fundamental cause of variation in well‐being and that the social resources associated with socioeconomic status constitute the fundamental cause of variation in well‐being. In this article, I elaborate on the fundamental cause perspective in three respects: by suggesting an expansion of the definition of resources, by examining how race and gender influence variation in the relationship between resources and mental health, and by developing a model of the relationship between social class, race, and gender that takes account of the potential asymmetry in the influence of resources across race and gender. Using the 2003 National Health Interview Survey and ordinary least squares regression, I find that black and white men are significantly less depressed than black and white women. However, women accrue greater mental health advantage from marriage, home ownership, and education. African‐American men experience less depression as a result of being unmarried and non‐Hispanic white women experience less benefit from full‐time employment, relative to African‐American women and men. Results are discussed in terms of implications for future research on race, class, and gender differences in health.     

Raising network resources while raising children? Access to social capital by parenthood status,gender, and marital status

Does raising non-adult children facilitate or restrict access to social capital as network resources? Using data from a national sample of adults in the United States, I do not find evidence for the direct effect of parenthood on the three dimensions of social capital (diversity, extensity, and quality), but instead I find evidence for its interaction effects on the quality of social capital. There is marginal evidence that parenthood status is associated with the quality of social capital positively for men but negatively for women. There is evidence that parenthood status is associated with the quality of social capital positively for the married but negatively for the unmarried. Also parenthood status is associated with the quality of social capital negatively for unmarried women but positively for the other three gender-marital groups, in particular unmarried men. These findings suggest the structural interplay of parenthood status with gender and marital status, and indicate the motherhood penalty, the fatherhood premium, the single-parenthood penalty, the married-parenthood premium, and the single-motherhood penalty in reaching higher-quality, rather than more diverse and extensive, social capital.     

Social Integration and Mental Well-Being Among Jail Inmates

Although social integration has consistently been linked to mental well-being among the general population, this relationship has not been explored for persons confined in total institutions. Jails, in particular, represent unique conditions that have the potential to alter the traditional relationship between social ties and mental health. Although previously unexamined, social ties maintained by jail inmates outside and inside of the institution are commonly presumed to weaken some of the adverse effects of a stressful environment and positively influence mental health. The current study explores the impact of social integration on mental well-being among 198 male and female inmates incarcerated in a large county jail. The impact of marital status, parental status, and social support (both inside and outside of the jail) on various dimensions of mental health was examined. The results indicate that rather than promoting mental well-being, social relationships inside and outside of the institution are associated with higher levels of distress. Specifically, married inmates report higher levels of depression and anxiety, and inmates with close social relationships inside of the jail report higher levels of hostility, although gender differences in these patterns are evident. The results of this study suggest that social integration may play a different role for persons incarcerated in total institutions than among the general population due to the unique conditions of social stigmatization and separation from support networks.     

‘A frog in a well’: the exclusion of disabled people from work in Cambodia

Based on ethnographic research conducted in north‐west Cambodia in 2000–2001, this paper examines why disabled people experience systematic marginalisation in the labour market. Although there are no official data on the relationship between disability and employment status in Cambodia, this research suggests that disabled people are more likely than their able‐bodied counterparts to be unemployed, in low status occupations, earn less or be out of the labour market altogether. Consequently, disabled people are more likely to live in poverty, experience social isolation and poor mental health. I argue that disabled people’s social status effectively shapes their work patterns through (mis)conceptions that associate ‘disability’ with ‘inability’ to work and to be employable. This paper illustrates how geographical processes fix disabled people in their socio‐spatial place, which together with ideological and structural inequalities distinguish and entrench their poverty from that of other social groups.     

Marital trajectories and mental health

This study expands the marital status and mental health literature by examining several dimensions of marital trajectories, including the number and type of prior marital losses and duration in current status. Data are drawn from the Piedmont Health Survey of the National Institute of Mental Health Epidemiologic Catchment Area Study, collected in 1982-83 (n = 2,158). Results indicate that number of prior losses moderates the health-enhancing effect of being currently married; higher order marriages are associated with worse mental health. Although results vary across the mental illnesses examined (depression, anxiety, and substance use), the negative effect of multiple loss also is observed for the currently divorced and widowed. There is less evidence that the type of prior loss (i.e., divorce or widowhood) moderates the effect of current marital status on mental health; however, some support is found among the presently widowed. The analyses of duration in current status suggest that the rate of decline in symptoms of anxiety following one's most recent loss varies by marital history among the currently widowed.