title: Does the "widowhood effect" precede spousal bereavement? Results from a nationally representative sample of older adults.
abstract: OBJECTIVE
  Increased mortality risk following spousal bereavement (often called the "widowhood effect") is well documented, but little prior research has evaluated health deteriorations preceding spousal loss.
  
  
  METHODS
  Data are from the Health and Retirement Study, a nationally representative sample of Americans over 50 years old.
  
  
  METHODS
  Individuals who were married in 2004 were considered for inclusion. Outcome data from 2006 on mobility (walking, climbing stairs), number of depressive symptoms, and instrumental activities of daily living (IADLs) were used. Exposure was characterized based on marital status at the time of outcome measurement: "recent widows" (N=396) were bereaved between 2004 and 2006, before outcomes were assessed; "near widows" (N=380) were bereaved between 2006 and 2008, after outcomes were assessed; "married" individuals (N=7,330) remained married from 2004 to 2010, the follow-up period for this analysis. Linear regression models predicting standardized mobility, depressive symptoms, and IADLs, were adjusted for age, race, gender, birthplace, socio-economic status, and health at baseline.
  
  
  RESULTS
  Compared to married individuals, recent widows had worse depressive symptoms (β=0.71, 95% confidence interval (CI): [0.57, 0.85]). Near widows had worse depressive symptoms (β=0.21, 95% CI: [0.08, 0.34]), mobility (β=0.14, 95%CI: [0.01, 0.26]), and word recall (β=-0.13, 95%CI: [-0.23, -0.02]) compared to married individuals.
  
  
  CONCLUSIONS
  Health declines before spousal death suggests some portion of the "widowhood effect" may be attributable to experiences that precede widowhood and interventions prior to bereavement might help preserve the health of the surviving spouse.
authors: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA.
authors: Anusha M
authors: AM
authors: Vable
authors: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA.
authors: S V
authors: SV
authors: Subramanian
authors: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA; Department of Epidemiology, Harvard School of Public Health, Boston, MA; Division of Preventive Medicine, Department of Medicine, Brigham and Woman's Hospital, Harvard Medical School, Boston, MA.
authors: Pamela M
authors: PM
authors: Rist
authors: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA. Electronic address: mglymour@epi.ucsf.edu.
authors: M Maria
authors: MM
authors: Glymour
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001601:Bereavement; D003863:Depression / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D017533:Marital Status; D008603:Mental Health; D008875:Middle Aged; D018454:Spouses / Q000523:psychology*; D013997:Time Factors; D017805:Widowhood / Q000523:psychology*
keywords: Widowhood; cognitive functioning; depression; spousal bereavement; spousal loss