Many researchers agree that widowhood has a significant role in the death of a spouse, especially for senior couples. Spousal bereavement has a direct causation effect on the death of the other partner. Elwert & Christakis, (2008) agrees that both women and men are affected by the death of a spouse in various ways. The death of a spouse from various mortality causes such as diseases or accident increases the all-cause mortality of the bereaved partner at different extent. The death of a spouse has been found to have a causation effect on the death of the widow or widower from cardiovascular, infection and life-threatening diseases such as cancer at varying degrees. Future research should assess and establish the different aspects of the widowhood effect to create health interventions that can be used to reduce the death of a bereaved spouse which has a causal effect on the death of the other spouse. However, the lack of specificity in research on how the death of a spouse increases the mortality of the remaining spouse hinders the ability to identify the specific opportunities which can be used to create health interventions to reduce the mortality rate of the surviving spouse.
Despite the fact that previous research lacks specificity and results in mixed results on the cause of increased mortality rate of a bereaved spouse research confirms that the increase of mortality rate or the widowhood effect is directly caused by the death of a spouse. Elwert & Christakis, (2008) agrees that mortality after widowhood increases for both wives and husbands. The bereavement of a wife increases the mortality rate of the surviving husband by 18% according to Elwert & Christakis, (2008) in an all-cause mortality assessment while the cause of death on wives due to bereavement increases by 16%. Martikainen & Valkonen, (1996) agrees that there is a strong correlation between the death of a spouse and increased mortality of the surviving partner. From research where the confounding factors such as accidents, lifestyle and socioeconomic environment were put in control Martikainen & Valkonen, (1996) notes that excess mortality rate increased for both men and women with men`s excess mortality being 17% and that for women was at 6%. The authors also noted that the mortality rate was higher in the shorter duration than in the long-term duration. This confirms that the death of a spouse has a causation effect on the overall increase in mortality of the surviving spouse but the causal effect is short-lived despite being a major stressful event in life.
The study on the widowhood effect is very important in the care of widowed people because it tries to establish the general health effects of spousal bereavement such as emotional stress and different healthcare interventions that can be put in place to reduce widow mortality rate after bereavement. The bias in this study can be traced back to the confounding factors such as accidents and shared a common environment. In accidents, one spouse may die at the spot while the other partner might survive with life-threatening injuries which ultimately leads to the death of the surviving spouse. On the other hand, the shared environment between the spouses means that the spouses share common environment which might be hazardous to their health such as unhealthy diet which would make their deaths correlated because their deaths have a common etiology. However, such deaths are correlated and do not have any causational relationship. Managing such confounding factors can be helpful in conducting a good widowhood effect analysis and will increase the legitimacy of the overall conclusions according to Martikainen & Valkonen, (1996).
The death of a spouse after bereavement is caused mainly by emotional stress, loss of material support that was previously available and the loss of social support which the spouses could have shared throughout their marriage. From Martikainen & Valkonen, (1996) study the excess mortality on bereaved men was high at 21%. However, the author's finds out that in the first week after bereavement in men it was 50% but gradually dropped afterward to around 20% after months of bereavement. On the other hand, amongst women, the mortality rate was 9% and 50% in early durations but levels down to 10% in the long term (Michael et al., 2009). This study is in agreement with Elwert & Christakis, (2008) research which finds a causation effect of widowhood to the excess mortality and also the varying excess mortality between men and women. Therefore, the grief of losing a spouse affects the surviving spouse both emotionally, mentally and also their physical health is affected. Studies show that the bereaved spouse has a high likelihood of developing health problems weeks and months after the death of the spouse. Amongst the problems that the bereaved spouse have a high likelihood of experiencing include heart attacks which are elevated in the first 30 days after bereavement due to emotional stress which causes the dysfunction of the sympathetic nervous system (Espinosa & Evans, 2008).
Increased Mortality Rate Due to the Death of a Spouse
The death of a spouse is a devastating occurrence that affects the surviving spouse both physically and psychologically. In most cases, the death of a spouse causes an intense shock to the surviving spouse which is manifested in the body through anxiety and depression. Depression and persistence physical suffering due to the loss of a spouse lowers the immune system strength which makes the spouse susceptible to diseases which increases the spouse mortality, especially in the first weeks following the spouse death. The widow effect refers to the tendency of increase mortality due to the physiological effects of losing a loved which affects the immune system. Widowhood and mortality have a causation relationship despite the existence of many confounding factors that are associated with the mortality of widows. The primary cause of widowhood effect is due to the decline of the overall social support that the spouses used to offer each other. Social support has a significant role in the overall wellness and life longevity of the couples (Sullivan & Fenelon, 2013).
Literature holds that the death of a spouse causes a chain reaction due to the lack of social support of the surviving spouse which creates a window for the opportunistic diseases and also increases the risk of cardiovascular diseases. Widowhood effect affects the long-standing companionship that was existing between a couple which leads financial, social and lifestyle adjustments which makes it difficult for the surviving spouse to maintain emotional and psychological wellbeing hence increasing their mortality due to other confounding factors. Adapting to the social and psychological changes after losing a spouse increases the chances of the widow or the widower to develop health problems (Zella, 2016). The widowhood effect can be divided into the new living conditions and the aftershock of losing companionship which causes an increase in mortality rate. Widowhood increases mortality by causing changes in the neuroendocrine changes that lead to the suppression of the immunity of the widow. Following the death of a spouse, research has found out that the survivors tend to engage in poor health behaviors such as smoking and drinking which are confounding factors that increase their mortality rate (Zheng & Thomas, 2013).
Married and Unmarried Mortality Rate
Berg & Gupta (2015) argues that the engagement in poor health activities is more common amongst males who have lost their spouse as they try to adjust their lifestyle and social support system. Due to the limited time available to create new social and emotional support the surviving spouse engages in unhealthy behavior such as over drinking and use of drugs which elevates their mortality rate. However, research has found a variation in mortality rate based on the nature of the spouse death. In the cases where the death of the spouse was expected the emotional damage, and neuroendocrine changes are low compared to the cases where the death of the spouse was sudden, and the surviving spouse was not prepared for the eventuality. Therefore, there is high mortality rate in spouses who were prepared for the death of a spouse compared to the ones where the death of the spouse was sudden (Sullivan & Fenelon, 2013).
Marital status has direct causation with increased mortality rate due to the direct cause of changes in the overall social arrangement and lifestyle changes which affect individual health. The report indicates that the unmarried people have poor health compared to the married people. Further, the report agrees with Elwert & Christakis, (2008) literature review that men are the most affected group due to the greater changes in partnership and living arrangements due to the death of a spouse (Liu, 2009). Marital status has a significant role in the overall health and also mortality outcomes with those that are unmarried being considered to have a high level of mortality rate compared to the married group due to the health behaviors and social support that marriage offers that the unmarried people cannot access. Further, the divorced people have a high risk of mortality due to their poor health outcomes. Single people especially have high mortality rates due to engagement in more health risk behaviors compared to the married people who have pressing responsibilities and support from the family (Robards et al., 2013).
Berg, G. J., & Gupta, S. (2015). The role of marriage in the causal pathway from economic conditions early in life to mortality. Journal of Health Economics, 40, 141-158. doi:10.1016/j.jhealeco.2014.02.004
Elwert, F., & Christakis, N. A. (2008). The effect of widowhood on mortality by the causes of death of both spouses. American journal of public health, 98(11), 2092-2098.
Espinosa, J., & Evans, W. N. (2008). Heightened mortality after the death of a spouse: Marriage protection or marriage selection? Journal of Health Economics, 27(5), 1326-1342. doi:10.1016/j.jhealeco.2008.04.001
Liu, H. (2009). Till Death Do Us Part: Marital Status and U.S. Mortality Trends, 1986 - 2000. Journal of Marriage & Family, 71(5), 1158-1173. doi:10.1111/j.1741-3737.2009.00661.x
Martikainen, P., & Valkonen, T. (1996). Mortality after the death of a spouse about duration of bereavement in Finland. Journal of Epidemiology & Community Health, 50(3), 264-268.
Michael, G., Anastasios, S., Helen, K., Catherine, K., & Christine, K. (2009). Gender differences in experiencing occupational stress: the role of age, education and marital status. Stress and Health, 25(5), 397-404.
Robards, J., Evandrou, M., Falkingham, J., & Vlachantoni, A. (2012). Marital status, health, and mortality. Maturitas, 73(4), 295-299.
Sullivan, A. R., & Fenelon, A. (2013). Patterns of widowhood mortality. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 69(1), 53-62.
Zella, S. (2016). Marital Status Transitions and Self-Reported Health among Canadians: A Life Course Perspective. Applied Research in Quality of Life, 12(2), 303-325. doi:10.1007/s11482-016-9462-y
Zheng, H., & Thomas, D. A. (2013). Marital Status, Self-Rated Health, and Mortality: Overestimation of Health or Diminishing Protection of Marriage. Journal of Health and Social Behavior, 54(1), 128-143. doi:10.1177/0022146512470564
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