The complexities of ‘in sickness’

Yolanda Spencer is eternally grateful for the weekly visits from fellow members of the Bethel AME Church. Without them, she’s not sure how she would have survived the eight years since her husband, Vincent, now 62, fell off a ladder and became a quadriplegic.

An accident such as Vincent’s “is such a devastating thing to happen to a family,” Yolanda said. The Spencers’ relatives live far away, but, she said, members from the Jamaica Plain, Mass., church have been “really, really supportive.”

A pair of recent studies show just how detrimental the situation can be to a caregiving spouse’s health. They also shed light on how the risk can be offset by close social connections -- like the ones the Spencers, who are black, have with friends from church.

Although marriage is generally good for health, the stress of caring for a spouse with a disabling illness can shorten the caregiver’s life, according to a major study published late last month. And a separate large study, published a few weeks ago, found that how well one spouse fares after the other’s death hinges in large part on race.

Whites married to whites suffer a “large and enduring widowhood effect” when one spouse dies, but blacks married to blacks don’t, probably because of stronger social ties -- to church and to extended family -- that offset the trauma of the loss, said Dr. Nicholas Christakis, author of the studies and a Harvard Medical School physician and sociologist.

Actually, it’s the wife’s race that counts the most, according to the study of 410,272 older couples, published in the American Sociological Review. A black man married to a white woman suffers from being widowed just as much as if he were white, because her family might reject him after her death, Christakis said. But if a man, black or white, is married to a black woman, he is buffered from the widowhood effect because her black family accepts him as part of the family and continues to provide social and emotional support.

In other words, Christakis said, one of the many things a black wife does is connect her husband with her family, putting him in a “supportive context” that continues even after her death.

“When you marry someone, you really do marry their family,” said Gail Wyatt, a professor in the department of psychiatry at the David Geffen School of Medicine at UCLA who was not part of the study. “It’s marriage in the context of other people that is the protective thing.”

Many blacks and immigrant families are used to communal caregiving of the very old and the very young, Wyatt said. As immigrants adapt to American ways, however, they tend to “shift toward the white model.”

In general, research shows that marriage benefits a person’s health, especially that of males. Married men, on average, live seven years longer than single men, and married women live two years longer than their single sisters. Married people have better mental health than never-marrieds too, though, again, it’s men who benefit more from marriage.

But the emerging view of the link between marriage and health is more subtle than that -- that “marriage is good for you, except when it isn’t,” says Janice Kiecolt-Glaser, a professor of psychiatry at Ohio State University, only half in jest. In her own work, Kiecolt-Glaser has shown that wounds heal more slowly in caregivers of spouses with dementia, a sign that the stress of caregiving affects the immune system.

Researchers have long known that the death of one spouse raises, at least temporarily, the risk of death for the surviving spouse. Christakis’ team showed in another study that it’s not just being widowed that can ruin the health of the healthier spouse but the stress of caregiving as well. The causes of excess death in the caretaking spouse include accidents, suicide, heart attack, infection, lung disease and diabetes, according to the study of 518,240 couples 65 and older.

In the first 30 days after a spouse’s hospitalization -- a marker for the time of diagnosis -- the risk of death for the partner is almost as great as it would be if the spouse had died. After a husband’s hospitalization, a wife faces a 44% higher risk of death than if her husband were well, the study found. A husband faces a 35% increased risk.

Perhaps even more startling, a woman taking care of a husband with dementia or psychiatric illness is at greater risk of dying than if she were actually widowed. Taking care of a spouse with cancer, on the other hand, proved much less deleterious to the healthier spouse, probably, Christakis said, because cancer, though potentially lethal, is often not as disabling day-to-day.

Suzanne Mintz has been taking care of her husband for more than 30 years since he was diagnosed with multiple sclerosis. Over the years, she has suffered four bouts of serious depression, in part because of her husband’s illness, and the couple separated twice. They are now back together -- with more support, including home health aides. She said she co-founded the National Family Caregivers Assn. (nfcacares.org), a nonprofit advocacy organization in Kensington, Md., in part to help caregivers get the kind of support she needed.

The moral of the story is clear. If you can find someone to love, get -- and stay -- married.

Take good care of each other. If one of you gets sick or disabled, don’t try to manage alone.

Get help -- and social contact -- from as many sources as you can, including churches and community groups.

And if you do become widowed, try to maintain the family and community ties you had when you were married. It could be a matter of life or death.