Presentazione

da "www.nytimes.com" del 3.8.09

Published: August 3, 2009
Married people tend to be healthier than single people. But what happens when a marriage ends?

New research shows that when married people become single again, whether by divorce or a spouse’s death, they experience much more than an emotional loss. Often they suffer a decline in physical health from which they never fully recover, even if they remarry.

And in terms of health, it’s not better to have married and lost than never to have married at all. Middle-age people who never married have fewer chronic health problems than those who were divorced or widowed.

The findings, from a national study of 8,652 men and women in their 50s and early 60s, suggest that the physical stress of marital loss continues long after the emotional wounds have healed. While this does not mean that people should stay married at all costs, it does show that marital history is an important indicator of health, and that the newly single need to be especially vigilant about stress management and exercise, even if they remarry.

“When your spouse is getting sick and about to die or your marriage is getting bad and about to die, your stress levels go up,” said Linda Waite, a sociology professor at the University of Chicago and an author of the study, which appears in the September issue of The Journal of Health and Social Behavior. “You’re not sleeping well, your diet gets worse, you can’t exercise, you can’t see your friends. It’s a whole package of awful events.”

The health benefits of marriage, documented by a wealth of research, appear to stem from several factors. Married people tend to be better off financially and can share in a spouse’s employer health benefits. And wives, in particular, act as gatekeepers for a husband’s health, scheduling appointments and noticing changes that may signal a health problem. Spouses can offer logistical support, like taking care of children while a partner exercises or shuttling a partner to and from the doctor’s office.

But in the latest study, researchers sought to gauge the health effects of divorce, widowhood and remarriage in a large cohort of people over time.

Among the 8,652 people studied, more than half were still married to their first spouse. About 40 percent had been divorced or widowed; about half of that group were remarried by the time of the study. About 4 percent had never married.

Over all, men and women who had experienced divorce or the death of a spouse reported about 20 percent more chronic health problems like heart disease, diabetes and cancer, compared with those who had been continuously married. Previously married people were also more likely to have mobility problems, like difficulty climbing stairs or walking a meaningful distance.

While remarrying led to some improvement in health, the study showed that most married people who became single never fully recovered from the physical declines associated with marital loss. Compared with those who had been continuously married, people in second marriages had 12 percent more chronic health problems and 19 percent more mobility problems. A second marriage did appear to heal emotional wounds: remarried people had only slightly more depressive symptoms than those continuously married.

The study does not prove that the loss of a marriage causes health problems, only that the two are associated. It may be that people who don’t exercise, eat poorly and can’t manage stress are also more likely to divorce. Still, researchers note that because the effect is seen in both divorced and widowed people, the data strongly suggest a causal relationship.

One reason may be changes at the cellular level during times of high stress. In an Ohio State University study, scientists analyzed blood samples of people undergoing the stress of caring for a loved one with Alzheimer’s disease. The research focused on telomeres, which insulate and protect the ends of chromosomes; with aging, telomeres shorten and the activity of a related enzyme also declines.

Compared with a control group, the Alzheimer’s caregivers showed telomere patterns associated with a four- to eight-year shortening of life span. Dr. Waite said the stress of divorce or widowhood might take a similar toll, leading to chronic health and mobility problems.

None of this suggests that spouses should stay in a bad marriage for the sake of health. Marital troubles can lead to physical ones, too.

In a series of experiments, scientists at Ohio State studied the relationship between marital strife and immune response, as measured by the time it takes for a wound to heal. The researchers recruited married couples who submitted to a small suction device that left eight tiny blisters on the arm. The couples then engaged in different types of discussions — sometimes positive and supportive, at other times focused on a topic of conflict.

After a marital conflict, the wounds took a full day longer to heal. Among couples who exhibited high levels of hostility, the wound healing took two days longer than with those who showed less animosity.

“I would argue that if you can’t fix a marriage you’re better off out of it,” said Janice Kiecolt-Glaser, an Ohio State scientist who is an author of much of the research. “With a divorce you’re disrupting your life, but a long-term acrimonious marriage also is very bad.”