Widowhood effect

The widowhood effect is the increase in the probability of a person dying during a relatively short period after their long-time spouse has died. The pattern indicates a sharp increase in the risk of death for the widower particularly, but not exclusively, in the three months after the death of their spouse. This process has also been called "dying of a broken heart". Being widowed leads to an increased likelihood of developing severe mental disorders. This can be partially attributed to the unanticipated decisions widows have to make with regard to the death of their spouse. Responses of grief and bereavement due to the loss of a spouse increase vulnerability to psychological and physical illnesses.

Gender differences

Men and women tend to respond differently to the death of a spouse. In general, men are more vulnerable to the widowhood effect. Women tend to maintain social relationships and friendships outside of marriage. When men are widowed, they tend to lose out on these social relationships and support groups and isolate themselves. Women maintain their friendships and relationships and rely on them for support after the death of a spouse.

The majority of peer-reviewed articles suggest that men are more frequently at risk of succumbing to the widowhood effect. A 2001 study by Gary Lee and colleagues surveyed 1686 married and widowed people aged 65 or older, using data from a 1988 National Survey of Families and Households. The study took into account the psychological well-being of each person on a Center for Epidemiologic Studies— Depression scale (CES-D) and found that men were further depressed by the loss of their spouse than women were. Men were also more likely to die soon after the death of their spouse, in comparison to their female counterparts. The researchers hypothesized that this was because older married men had higher baseline happiness than their spouses, so they had more happiness to lose. Men in this study were also less likely to be avid churchgoers, despise chores, and not as adept at helping their adult children. The lack of social behavior and general activity may contribute to the widowhood effect's influence on male mortality.

In a 2003 study, Wilcox and colleagues examined the overall health differences between married women and widows. Mental health alterations, including those of depression and socially extracting oneself, were the most common for women who have become widowed in the past year or so. Although some of these women were shown to extract themselves from social settings, the study also supported an alternate hypothesis that women experiencing the effects of widowhood were more likely to engage in coping mechanisms such as support groups, talking with fellow widows, and overall strong support systems such as close friends and family.

In a study done by Stahl and Schulz, they found that the death of a man's spouse affected his physical activity. Men's physical activity increases immediately following the death of a spouse, and the authors note that this may be a coping mechanism to alleviate depressive symptoms. In the year following the death of a spouse, men were more likely to experience a fluctuation in physical activity during the transition into widowhood, if they do not die. Men in the youngest age group of this study (55– 65 years) were at the highest risk of mortality after the death of their spouse. Additionally, Elwert and Christakis found that within the first month of bereavement after widowhood, mortality was the largest, and does not decline sharply until the sixth month of widowhood for white males, compared to only the third month for white females.

Christakis and Elwert analyzed nine years' worth of data gathered from 373,189 elderly married couples in the U.S. Their findings showed an 18% increase in "all-cause mortality" for men whose wives died first; for women, the risk is 16%. Although the percentage of males was higher than females, there was no significant difference to state that men were more affected than women. It is hard to say whether men or women suffer from the widowhood effect more, however, it is clear that it is higher in couples that are older.

Religious differences

A 2009 study by Abel and Kruger compared the likelihood of death for Catholic widows, as compared to 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 9.5 years after the deaths of their husbands. Similarly, the Jewish men lived 5 years after the death of the wives, while the Catholic men lived about 8 years after the death of their wives.

Health effects

Dietary

Experiencing the loss of a spouse often changes many components of the widow's life. The recently widowed individual is forced to change their everyday routine, which often puts immense stress on the recent widower/widow. Research has found that surviving spouses tend to experience significant weight loss after the death of their partner. It has been 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 consisted of more commercial foods than their counterparts, but they also lost a significant amount of weight compared to the married group. The authors hypothesized that this weight loss was the result of the widowed participants not finding as much enjoyment in eating as they once did. This lack of fulfillment during meals was correlated to a lack of companionship while eating. Widowed subjects had less of an appetite and as a result lost weight over the course of the study.

Mental

The death of a spouse can have a major impact on a person's mental health. Each individual may respond to their spouse's death differently. After the death of a spouse many widows begin to take more prescription medications for mental health issues. The mental health effects of men and women also differ. Men may become more depressed in widowhood compared to women because men may not have a strong enough support group. Married men also report a higher rate of happiness in their marriage and the death of their spouse could drastically alter this happiness. Men and women both show greater rates of depression after the death of a spouse but the rates of depression in men tends to be higher than in women.

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.

Takotsubo

Takotsubo cardiomyopathy, also referred to as the broken heart syndrome, has been discussed in contexts surrounding great physical and emotional stress, such as circumstance in which someone has been widowed. In addition, emotional stress has long been associated with myocardial infarction. In their research, Brenn and Ytterstad reported an increase in 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.

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. 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. 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. The loss of a spouse affects almost every domain of life, and as a consequence has a significant impact on wellbeing: psychological, social, physical, practical, and economic. With all of these aspects of a widowed individuals 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. There is evidence that social support from family and friends have better health outcomes on mortality rates. Investigations showed that the race of the partner influences 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 endogamously married black men or women. Deducing 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. 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.

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. 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. Researchers measured peak flow to show the increases or decreases in physical functioning, and the results suggest that married subjects have a higher peak flow compared to those divorced or widowed.

Possible causes

It was suggested that the widowhood effect was a mere coincidence resulting from the selection of partners with similar health risk. 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 dependent on the manner in which their spouse died. The results provided evidence that suggest a causal relationship between mortality rate and widowhood.

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.

Protective factors and treatment

There has been no definitive clinical way to treat the widowhood effect to lower the chances of the surviving spouse passing away close to when their spouse died. But it has been found that the level of anticipation that a person has of their spouse passing away can greatly impact their chance of passing away shortly after. It was found that anticipating the loss of their spouse eased to an extent the transition to widowhood. Those without a strong anticipation took longer to transition mentally to widowhood. Those that rated strongly for adaptation had lower death rates and had an easier transition to widowhood.

There is no universally accepted "proper" method or way to grieve or adjust to life after loss; it varies among individuals, influenced by their cultural and social practices, personality, and the circumstances surrounding the death. Even though grief processing varies, there are ways to reduce the effects of widowhood. Since a spouse is often one's primary source of social interactions, maintaining and establishing social bonds is a crucial aspect in determining the outcome of a widowed individual's bereavement. Social participation may be utilized "as an active coping strategy" as discovered in a study by Rebecca Utz and colleagues. Additionally, the loss of a spouse means the loss of a partner; the loss of a supportive presence with whom responsibility was shared amongst one another. Studies have shown that for couples who followed traditional gender roles, adjustment to life after their loss was often more difficult than for couples who did not. Undertaking the responsibilities previously considered the 'job' of one's deceased partner is often hard to handle on top of processing the loss; therefore, the utilization of organizations built to support, and help widowed individuals may also prove to be helpful in reducing grief. The Widowed Persons Service (WPS) and their parent organization, the American Association of Retired Persons (AARP), are two organizations which provide aid specifically to widowed individuals.