The aim of this study was to assess the association of widowhood and mortality among older Mexican Americans. The results suggest that widowhood puts men at higher risk for mortality, but it does not seem to have the same risk for women. Overall, our findings are consistent with other studies by finding increased risk of death for husbands. The primary difference with our finding is that the length of time that husbands are at risk of death is extended. Most studies find the risk of death levels out within 24 months, but our study of Mexican Americans revealed that the risk of death after losing a spouse levels out by 33 months which may suggest that Mexican American men have a longer risk of death related to widowhood than non-Hispanic whites. The longer trajectory of risk may also indicate that Mexican American men may take longer to adjust to the loss of a spouse.
Our study confirms the importance of a spouse for survival, at least for men. Marriage confers many health benefits over being single, divorced, or widowed such as lower depressive symptoms, better physical health, and higher life satisfaction (28
), but these advantages vary by gender with husbands benefiting more from marriage than women (32
). A recent study of twins found that survival is extended by having a spouse and close ties with friends and family (34
). Gender differences in the health benefits of social networks reveal that men tend to have few friends and rely primarily on their spouse for support, while women have broader social ties (35
). Therefore, one hypothetical explanation for the association of widowhood with increased mortality of the surviving spouse is the loss of potential health benefits of marriage. In part, this may explain why studies consistently find higher mortality risk related to widowhood for men because the marital relationship is more important to maintaining health for men than it is for women.
Most studies on Mexican American spouses have found that wives experience more burden related to their husbands’ health than husbands do related to their wives’ health (36
). The implication is that wives have more caregiving burden than husbands. Therefore, although the death of a husband may be depressing, it may act to lessen the caregiving burden for wives. Conversely, husbands consistently show little evidence of caregiving burden for their wives so their death may signal the beginning of self-care for which they may be ill-equipped.
Although one of the strengths of this study was inclusion of several time dependent indicators of health, health behaviors, social support, and financial strain, these measures did not completely explain the association of widowhood and mortality for men. Respondents died of other causes that could not be included in the analysis such as respiratory illness, accidents/suicide, digestive illness, and unknown causes of death. Future research that can control for a broader range of diseases may provide an explanation for the association of widowhood and mortality, especially because a majority of widows die shortly after their spouse. For example, clinical studies have found an association of loneliness with impaired cellular immunology, which in turn predicts vulnerability to infection (38
). It is also possible that the stress of widowhood worsens the severity and compromises the management of pre-existing chronic conditions. In that scenario, acute complications from these conditions could lead to greater mortality.
Recent research has indicated that distress due to widowhood is conditional on marital quality and differs substantially by gender with wives generally experiencing higher distress than husbands (39
). Therefore, these results should be interpreted with caution given that this database was not able to account for marital quality or spousal support. Absence of personality traits and other psychosocial characteristics is also a limitation of this study. An additional limitation is that incidence of widowhood was low throughout the seven year follow-up, which could affect the statistical significance. Finally, because of lack of blood data, we could not explore the potential link between increased blood stress markers with widowhood. In light of these limitations, future studies should examine change in health behavior markers after widowhood such as decreased physical activity, adherence to medical appointments, medication compliance, and flu vaccinations. Are there changes in the level of biomarkers for stress such as cortisol and interleukin-6? Is there a decrease in the level of social engagement? Providing answers to these questions in future studies will be key to the design, development, and testing of interventions to improve post-widowhood survival and health-related quality of life. An example of such interventions is discussion of hospice use with patients, particularly men, whose spouses face impending death. A recent study found that spouses who used hospice care before and after the loss of their spouse showed reduced mortality risk compared to widowed spouses who did not use hospice care (41
). In summary, our results provide an insight into a risk factor for death among older Mexican Americans, a fast growing segment of the elderly population in the United States.