Friday March 6 2015
Illness can place a strain on a marriage
"Husbands more likely than wives to seek divorce when partner falls sick, says study," the Daily Mail reports after a US study tracked around 2,700 married older couples for 20 years to see how chronic illness impacted on their relationships.
Researchers specifically looked at the effects of one of four serious illnesses on the relationship: any type of cancer (except skin cancer), heart disease, lung disease or stroke.
Unsurprisingly, the onset of one of these illnesses in either spouse was associated with an increased risk of widowhood at a subsequent assessment.
However, the study also found the onset of serious illness in the wife was associated with a small increased risk (an estimated 6%) of divorce. This link wasn't found when the husband had the illness.
But this study cannot show a direct causative link. There are a wide variety of unmeasured factors that are likely to be influencing any association between illness and divorce.
That said, it would not be surprising that having to care for a person with a chronic illness could place a strain on some couples' relationships.
There is a wide range of support for people suddenly thrust into the role of caring for others. See our Care and support guide for more information.
And if you feel your relationship with your partner is having problems, whatever your respective health issues, you may benefit from couples therapy.
Where did the story come from?
The study was carried out by two researchers from Iowa State University and the University of Indianapolis in the US, and was funded by the US National Institute on Aging.
It was published in the peer-reviewed Journal of Health and Social Behaviour.
The Daily Mail's reporting of the study is broadly accurate, but it does not touch on the various limitations of the study.
The piece contains quotes from the lead author of the study, Dr Amelia Karraker, who speculates that some men may struggle to adapt to the role of caregiver, while some women may think that, "You're doing a bad job of caring for me or I wasn't happy with the relationship to begin with, and I'd rather be alone than in a bad marriage". Both notions seem plausible, at least for some couples, but have not been proven by the study in question.
What kind of research was this?
This study used data collected from a sample of married people taking part in the Health and Retirement study, an ongoing nationally representative cohort study of Americans over the age of 50 that has collected data every two years from 1992 onwards.
The researchers looked at the relationship between serious illness (cancer, heart or lung disease, or stroke) and the subsequent dissolution of the marriage, either through divorce or widowhood.
The authors discuss how the literature has often linked marital status to health and wellbeing, while divorce and widowhood can be followed by declines in physical and mental health.
Whether ill health may have a direct effect on marital status has not been studied as much, and this is what this study aimed to focus on. The researchers also wanted to see whether the relationship between the health of the spouse and divorce may vary by the nature of the illness or by gender.
The main limitation of a study like this is it can only find associations – it cannot prove cause and effect. There may be a wide variety of unmeasured factors involved in the link, especially when you are dealing with something as complex as human relationships.
What did the research involve?
The study used data collected in waves 1 to 10 of the Health and Retirement study between 1992 and 2010. The researchers looked at people who were married at the start of the study, and excluded marriages where either spouse already had serious physical illness, as they were specifically interested in the onset of illness as a risk factor for dissolution.
They also excluded those who had divorced or were widowed by the second wave of assessments in 1994, as it could not be known whether this had been preceded by illness as the cause. After exclusions, they therefore had a final sample of 2,701 marriages.
The main outcome of interest was whether marriage in wave 1 (1992) was followed by dissolution as the result of divorce or widowhood in a subsequent wave (beyond 1994).
They then wanted to see whether this was preceded by the onset of serious physical illness in either spouse. The researchers focused on four general categories of illness – cancer, heart disease, lung disease and stroke – as they say these form a lot of the chronic disease burden in the US.
In their analysis, they included the potential confounding factors (collected in wave 1) of age, education, ethnicity, socioeconomic status, marital duration, and initial marital satisfaction (assessed by the question, "Are you very satisfied, somewhat satisfied, about evenly satisfied and dissatisfied, somewhat dissatisfied, or very dissatisfied with your marriage?").
What were the basic results?
This 18-year study period in people above the age of 50 found marriages more often ended in divorce (33%) than widowhood (24%).
Unsurprisingly, increasing age was associated with an increased onset of physical diseases in both spouses, with husbands experiencing higher illness rates than wives.
The researchers' analysis found that the onset of illness in the husband was not associated with subsequent divorce. However, the onset of illness in the wife was associated with a 6% higher probability of being divorced in subsequent assessment. This represented a significant gender difference.
When looking at the relationship between illness and subsequent widowhood, there was no significant gender difference. Illness in the husband was associated with a 5% higher probability of the wife being a widow in a subsequent assessment. The respective figure for illness in a wife was 4%.
When the researchers carried out sub-analyses by illness, neither the husband's nor the wife's cancer or heart disease was associated with marital dissolution. There was some suggestion that a wife's lung disease and husband's stroke were associated with an increased risk of subsequent divorce, but these were not statistically significant.
How did the researchers interpret the results?
The researchers concluded that only the onset of illness in the wife is associated with an increased risk of divorce, but the onset of illness in either husband or wife is associated with an increased risk of widowhood.
They say their findings "suggest the importance of health as a determinant of marital dissolution in later life via both biological and gendered social pathways".
This US cohort study of older married couples (over the age of 50) finds links between the onset of serious illness in the wife and subsequent divorce, but the same link wasn't found with illness in the husband. Meanwhile, serious illness in either spouse was, rather unsurprisingly, associated with a higher risk of widowhood in a subsequent assessment.
This study has the strength of using a large, nationally representative dataset. However, it cannot prove direct causative links, and does not prove that wives are more likely to stick with their spouse during serious physical illness than husbands.
Though the study finds a link between illness onset and subsequent divorce, there are likely to be a wide variety of unmeasured factors involved in any link. For example, this could include:
- personality characteristics of both the husband and wife
- the nature of the illness – for example, the severity, prognosis, and impact on function and disability
- it may not necessarily be the "healthy spouse" who is the instigator of the end of the marriage – for example, the person who is ill may want to get out of an unhappy marriage to be able to cope with illness better
- mental health and other physical illnesses in the "ill spouse"
- physical and mental health of the "healthy spouse"
- lifestyle, activities, social and family connections, and external support
- the strength of the relationship between the couple
The only one of these factors that this research was able to partially take into account was the latter. Even in this case this involved a very crude assessment at the start of the study, asking only about the duration of the marriage and a broad question on marital satisfaction.
The research took into account a few other potential confounders (age, ethnicity, education and socioeconomic status), but as this study relied on data collected as part of a wider cohort study, it probably had limited capacity to assess any others.
Other limitations include the broad illness categories of cancer, heart disease, lung disease and stroke. As above, these categories could include a wide range of specific diseases, of varying severity and disability. It is also not known how accurate this information was.
Lastly, this study may not be applicable to other populations in non-US cultures, to younger married adults, or non-married people in committed relationships. So, all in all, this study does not prove that marriage only lasts in health but not in sickness.
Still, it does highlight the potential strain chronic conditions such as stroke can place on some relationships. People often make the mistake of assuming that supporting a partner or loved one with a chronic condition will come naturally, but this isn't always the case – it can often be hard, frustrating and upsetting work.
There is help available that can make that job easier. A good first practical step is to apply for a Carer's Assessment. This involves a discussion between you and a trained person, either from the council or another organisation that the council works with, to see what help and support, including financial support, you may be entitled to. Read more about carers' assessments.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.