Is marital status associated with quality of life?

There was significant relationship between marital status and QOL, and this relationship appeared to differ by gender and age. Skiptomaincontent Advertisement SearchallBMCarticles Search Ismaritalstatusassociatedwithqualityoflife? DownloadPDF DownloadePub DownloadPDF DownloadePub Research OpenAccess Published:08August2014 Ismaritalstatusassociatedwithqualityoflife? Kyu-TaeHan1,2,Eun-CheolPark2,3,Jae-HyunKim1,2,SunJungKim1,2&…SoheePark2,4 Showauthors HealthandQualityofLifeOutcomes volume 12,Article number: 109(2014) Citethisarticle 15kAccesses 97Citations 8Altmetric Metricsdetails AbstractBackgroundThedivorceratehasbeenincreasingrapidlyinKorea;thesinglerateandtrendsindivorcearealsochangingrapidly.Thisstudyaimedtoexaminetherelationshipbetweenmaritalstatusandqualityoflife(QOL)inanattempttounderstandthesechanges.WealsoinvestigatedtherelationshipbetweenQOLandmaritalstatusbyagegroup.MethodsWeuseddatafromtheCommunityHealthSurvey(2008:n = 200,800;2009:n = 227,700;2010:n = 229,229)administeredbytheKoreanCentersforDiseaseControlandPrevention.Afterexcluding63,527participantswithincompleteinformationonQOLand/ormaritalstatus,thefinalanalysisinvolved594,202participants.Theanalysisusedt-testsandChi-squareteststocomparedemographicvariablesbetweenmenandwomen,andANOVAtocompareQOLscoresamongcomparisongroups.WealsoperformedamultilevelanalysisontherelationshipbetweenQOLandmaritalstatuswhileaccountingfortheprovincialdifferences.ResultsThemultilevelanalysisbymaritalstatusshowedthatsinglemenhadsignificantlyworseQOL(bothEQ-VASandEQ-5D)thanmarriedmen.Ontheotherhand,theQOLmeasuredbyEQ-VASwasbetterinsinglewomenthaninmarried,andseparatedordivorcedwomen.WhenQOLwasassessedusingEQ-5D,singleandseparatedordivorcedwomenhadworsescoresthanmarriedwomen.Intheanalysisbyagegroup,theQOLofmarriedmenundertheageof30 yearswaslowerthanthatofsinglemenormenwithmarriageproblemsasmeasuredbyEQ-VAS.However,among40–69-year-oldmen,marriedmenhadthehighestQOLvalues.Similarly,forwomenintheir30s,singlewomenhadthehighestEQ-VASvalues,butfor40–69-year-oldwomen,singlewomenhadlowerEQ-VASscoresthanmarriedwomen.ConclusionTherewassignificantrelationshipbetweenmaritalstatusandQOL,andthisrelationshipappearedtodifferbygenderandage. BackgroundLifeSatisfactionasmeasuredbytheBetterLifeIndexisanindicatorofqualityoflife(QOL)andiscalculatedbasedon11indicators.InareportissuedbytheOECDin2013,amongthe37countriesexamined,SouthKoreaheldalowposition,27thplace(Korea’sscore:6.0;OECDaverage:6.6/10).ItisapparentthatlifesatisfactionamongKoreansislow,evenincomparisonsusingotherindicators[1],nodefinitivefactorshavebeenidentifiedthatexplainwhylifesatisfactionorQOLissolow.PreviousstudiestoclarifyfactorsaffectingQOLhaveconsideredrelevantsocio-economicconditionsandsocioeconomicstatusgenerally.However,fewstudieshaveexaminedhowmarriagestatusimpactsQOL[2]–[4].Maritalstatushasbeenclassifiedassingle,married,andmarriageproblems(includingseparation,divorce,andbereavement).ThesituationforeachgroupinthisclassificationinSouthKoreaisasfollows.Accordingtothe2008OECDFamilyDatabase,thedivorcerateinKoreaisatahighlevelrelativetootherOECDcountries(Korea:2.6;OECDaverage:2.1of7),andthedivorcerateincreasedrapidlyfrom1970to2008(changefrom1970to2008:2.2/4totalpoints)[5].Moreover,accordingtothePopulationTrendsSurveyoftheKoreanNationalStatisticalOfficein2000–2012,thedivorcerateformenover40increasedfrom46.5%in2000to70.5%in2012,andthedivorcerateforwomenincreasedfrom54.2%to74.5%.Thesenumbersindicatethattrendsindivorceratesarechanging[6].AccordingtothePopulationandHousingCensusdepartmentofStatisticsKorea,thesinglerateamongmen25–39yearsoldrosefrom30.0%in1995to52.8%in2010.Similarly,thesinglerateamong25–39-year-oldwomenrosefrom13.2%to35.6%duringthesameperiod[7].Thus,giventhatthetrendsinmaritalstatusamongtheKoreansarechangingrapidly,astudyonwhethersuddenchangesinmaritalstatusinfluenceQOLisneeded.Ofcourse,therehavebeenpreviousstudiesofQOLrelatedtomaritalstatus.However,thosestudiesfocusedontopicssuchasthesocialroleofthespouseinmentalhealth,theimpactofmaritalstatusonaparticulardisease,ortheimpactofmaritalstatusinpreventingcertaindiseases[8]–[15].However,reportedresearchontheimpactoftherapidchangesinmaritalstatusandontherelationshipbetweenmaritalstatusandQOLineachagegroupislacking.Thus,inthisstudy,weanalyzedthedifferencesinQOLbymaritalstatusandexaminedtherelationshipofmaritalstatuswithQOLaccordingtosexandagegroup.MethodsStudypopulationThedatausedwerefromtheCommunityHealthSurveyadministeredbytheKoreanCentersforDiseaseControlandPrevention,whichwasdesignedtofacilitateinter-provincialcomparisons[16].TheCommunityHealthSurveywasadministeredbyinvestigatorswhoconductedone-on-onevisitsandinterviewstargetingadults19 yearsofageorolderin253healthcentersnationwidestartingin2008.Dataweregatheredfor200,800peoplein2008,227,700peoplein2009,and229,229peoplein2010.Thesewereintegratedandsamplingweightswereincorporatedfortheanalysis.Thefinalanalysisuseddatafrom594,202peoplefromthetotalof657,729afterexcluding63,527peopleforwhominformationonQOLand/ormaritalstatuswasincompleteandthereforecouldnotbeanalyzed.BecausetheCommunityHealthSurveydataisasecondarydatathatdonotcontainprivateinformationandisavailabletopublicdomain,ourstudydidnothavetoaddressethicalconcerns.VariablesTheoutcomevariableswerescoresontheEQ-VASandEQ-5DIndex.EQ-VASisaself-ratedhealthquestionnairepresentedasaverticalvisualanalogscale,wheretheendpointsarelabeled“best”and“worstimaginablehealthstate”.Participantscompletedthescalerangingfrom0to100onthestudyday.Responsestothisscalewereusedasaquantitativemeasureofparticipants’self-ratedhealth.TheEQ-5Disanindexoffivedimensionsofhealth-relatedQOL.Thefivedimensionsaremobility,self-care,usualactivities,pain/discomfort,andanxiety/depression.OriginalEQ-5Dindexhasvaluesrangingfrom0to1.Forthepurposeofcomparingthetwoindicators(EQ-VASandEQ-5D),theEQ-5DIndexwasmultipliedby100beforethedatawereanalyzed.Thevariableofmajorinterestinitsassociationwiththeoutcomevariableswasmaritalstatus.Maritalstatuswasdividedintomarried,single,andmarriageproblems(separation,divorce,bereavement).Otherindependentvariablesconsideredintheanalysiswerefrequentdepressionformorethan2 weeks,awarenessofstress,age,familyincome,educationlevel,perceivedhealthstatus,andsurveyyear.Stressawarenesswasdefinedastheendorsing“alot”or“verymuch”asdescriptiveofstressinone’sdailylife.Agewasclassifiedinto5-yearsintervals.Familyincomewasclassifiedintofourgroups.Educationlevelswereclassifiedas“lessthanhighschool”,“highschooleducation,”and“universityeducation.”Subjectivehealthstatuswasdefineddescribingone’ssubjectivehealthlevelas“good”or“verygood”.TheprovincialvariablesintheanalysisreflectedthecharacteristicsoftheCommunityHealthSurveydatausedintheanalysis.Provincialvariableswerebasedonthee-provincialindicatorsofthesurveyconductedbyStatisticsKoreabyyear,asfollows:residentpopulation,grossprovincialdomesticproduct(GRDP),crudedivorcerate,andmarriedcouple[17].Thee-provincialindicatorswerevariablesrepresentingthe16provinces.GRDPasvalue-addedontheproductionsidewasusedasanindicatortomeasurehowmuchvalueaddedtoeconomicactivitiesineachregion.StatisticalanalysisForcomparisonsrelatedtoQOL,weanalyzedmenandwomenseparately.FortheanalysisoftherelationshipbetweenQOLandmaritalstatus,thefollowingvariableswereadjusted:frequentdepressionformorethan2 weeks,stressawareness,age,familyincome,educationlevel,perceivedhealthstatus,surveyyear,andprovincialvariables.TocomparetherelationshipbetweenQOLandmaritalstatusbyagegroup,agewasdividedinto5-yearintervals.Wefirstexaminedthedistributionofeachvariabletoanalyzethegeneralcharacteristicsofeachgroup,andweperformedt-testsandχ2teststoexaminedifferencesineachvariableaccordingtogender.Next,tocomparetheaveragevaluesontheQOLindicesaccordingtotheindependentvariables,weperformedanalysesofvariance(ANOVAs).Finally,toanalyzetherelationshipbetweenQOLandmaritalstatus,consideringthecharacteristicsoftheCommunityHealthSurvey,weperformedamultilevelanalysis.AllanalyseswereperformedusingSASsoftware(ver.9.2).P-values<0.05wereconsideredtoindicatestatisticalsignificance.ResultsOfthe594,202participantsinthefinalsample,46.0%weremen,and54.0%werewomen.Ahigherproportionofmarriedpersonswereinmenthaninwomen.Womenwerealmosttwiceaslikelyaswerementoreportfrequentdepressionformorethan2 weeks,andawarenessofstresswashigherinwomenthanformen.Thesubjectivehealthstatusofmenwashigherthanthatofwomen.Regardingprovincialvariables,theresidentregistrationpopulationofmenwasslightlyhigherthanthatofwomen,andtheaverageofGRDPwashigherinmenthaninwomen(Table 1).Table1 Characteristicsofstudyparticipants(frequency,%) FullsizetableTheoverallANOVArevealedthattheaverageEQ-VASscorewashigherformenthanforwomen.IntermsoftherelationshipbetweenQOLandmaritalstatus,menandwomenhadsimilarresults.EQ-VASscoreswerehigherintheordersingle > married > marriageproblemsforbothmenandwomen.TheoverallQOL,measuredbytheEQ-5DIndex,washigherformenthanwomen.TheQOLmeasuredbytheEQ-5DIndexwashigherintheordersingle > married > themarriageproblemsinbothmenandwomen(Table 2).Table2 Relationshipsofqualityoflifewithdemographiccharacteristicsandhealthbehaviors[mean(SD)and p -values] FullsizetableAmultilevelanalysisoftheEQ-VASwasconductedtoinvestigatetherelationshipbetweenQOLandmaritalstatuswhileadjustingforpotentialconfoundingvariablessuchasage,depression,stress,andsocioeconomicstatus.Basedonmaritalstatus,menhadhigherEQ-VASvaluesintheordermarried > single > marriageproblems,andwomenhadhighervaluesintheordersingle > married > marriageproblems(malesingle:−0.567,separation/divorce/bereavement:−0.966;femalesingle:0.760,separation/divorce/bereavement:−0.544;p  marriageproblems > single.EQ-5Dvaluesforwomenwerehigherintheordermarried > single > marriageproblems(malesingle:−0.904,separation/divorce/bereavement:−0.707;femalesingle:-0.273,separation/divorce/bereavement:−0.822;p  0.05;age25–29,single:0.977,p  marriageproblemsandsingle.IntheanalysisoftheEQ-5D,therewasaslightlydifferenttendencyfromthatseenforEQ-VAS.Regardlessofage,inmen,QOLwasintheordermarried > marriageproblemsandsingle.EQ-VASscoresinwomenunder30 yearsshowedhigherQOLscoresintheordersingle > married > marriageproblems(age19–24,single:2.160,p  0.05).Inwomenaged40–49years,QOLscoreswereloweramongsinglethanamongmarriedwomen,andbetween45and54 years,marriageproblemswereassociatedwithpoorerQOLthanwasmarriedstatus(Figure 1).Figure1RegressioncoefficientestimatesforEQ-VASbymaritalstatusandage.A)DifferencesinEQ-VASaccordingtomaritalstatusbyagegroupinmen,B)DifferencesinEQ-VASaccordingtomaritalstatusbyagegroupinwomen;*P-value<0.05,P-valuesforresultsofmultilevelanalysis.Adjustedforfrequentdepressionformorethan2 weeks,stressawareness,age,familyincome,education,perceivedhealthstatus,yearofsurvey,provincialvariables.Whiskersineachbarrepresentstandarderrorestimatesofregressioncoefficients.Referencegroupis“Married”.FullsizeimageTheEQ-5Dscoresofwomenunder30 yearsshowedhigherQOLscoresintheordersingle > married > marriageproblems(age19–24,single:0.042,p > 0.05;separation/divorce/bereavement:−0.431,p > 0.05;age25–29,single:0.190,p  marriageproblems > single(Figure 2).Figure2RegressioncoefficientestimatesforEQ-5Dbymaritalstatusandage.A)DifferencesinEQ-5Daccordingtomaritalstatusbyagegroupinmen,B)DifferencesinEQ-5Daccordingtomaritalstatusbyagegroupinwomen;*P-value<0.05,P-valuesforresultsofmultilevelanalysis.Adjustedforfrequentdepressionformorethan2 weeks,stressawareness,age,familyincome,education,perceivedhealthstatus,yearofsurvey,provincialvariables.Whiskersineachbarrepresentstandarderrorestimatesofregressioncoefficients.Referencegroupis“Married”.FullsizeimageInanadditionalanalysisbydividingthemaritalstatusintofivegroups(single,separation,bereavement,divorcedandmarried),theoverallresultsbetweenmaritalstatusandQOLweresimilartothosewhen“separation,bereavementanddivorced”werecollapsedintheanalysis.EQ-VASscoreswerethelowestinmenandwomenwithmaritalstatusofseparation(single:−0.563,separation:−1.922,andbereavement:−1.152comparedwithmarriedinmen;single:0.763,separation:-1.205,bereavement:−0.507comparedwithmarriedinwomen;p 3.0.CO;2-NCAS  Article  PubMed  GoogleScholar  DownloadreferencesAuthorinformationAuthorsandAffiliationsDepartmentofPublicHealth,GraduateSchool,YonseiUniversity,Seoul,RepublicofKoreaKyu-TaeHan, Jae-HyunKim & SunJungKimInstituteofHealthServicesResearch,YonseiUniversityCollegeofMedicine,Seoul,RepublicofKoreaKyu-TaeHan, Eun-CheolPark, Jae-HyunKim, SunJungKim & SoheeParkDepartmentofPreventiveMedicine,YonseiUniversityCollegeofMedicine,Seoul,RepublicofKoreaEun-CheolParkDepartmentofBiostatistics,GraduateSchoolofPublicHealth,YonseiUniversity,50Yonsei-ro,Seodaemun-gu,Seoul,120-752,RepublicofKoreaSoheeParkAuthorsKyu-TaeHanViewauthorpublicationsYoucanalsosearchforthisauthorin PubMed GoogleScholarEun-CheolParkViewauthorpublicationsYoucanalsosearchforthisauthorin PubMed GoogleScholarJae-HyunKimViewauthorpublicationsYoucanalsosearchforthisauthorin PubMed GoogleScholarSunJungKimViewauthorpublicationsYoucanalsosearchforthisauthorin PubMed GoogleScholarSoheeParkViewauthorpublicationsYoucanalsosearchforthisauthorin PubMed GoogleScholarCorrespondingauthorCorrespondenceto SoheePark.AdditionalinformationCompetinginterestsTheauthorsdeclarethattheyhavenocompetinginterests.Authors’contributionsKTHandSPledthedesignandconceptionofthestudy,performedthedataanalysis,andwrotethemanuscript.ECPandJHKparticipatedinthestudydesign,andprovidedintellectualinputtothedevelopmentofthemanuscript.SJKassistedtodraftthismanuscript.Allauthorsreadandapprovedthefinalmanuscript.Authors’originalsubmittedfilesforimagesBelowarethelinkstotheauthors’originalsubmittedfilesforimages.Authors’originalfileforfigure1Authors’originalfileforfigure2Rightsandpermissions OpenAccess ThisarticleislicensedunderaCreativeCommonsAttribution4.0InternationalLicense,whichpermitsuse,sharing,adaptation,distributionandreproductioninanymediumorformat,aslongasyougiveappropriatecredittotheoriginalauthor(s)andthesource,providealinktotheCreativeCommonslicence,andindicateifchangesweremade. 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HealthQualLifeOutcomes12,109(2014).https://doi.org/10.1186/s12955-014-0109-0DownloadcitationReceived:07October2013Accepted:24June2014Published:08August2014DOI:https://doi.org/10.1186/s12955-014-0109-0SharethisarticleAnyoneyousharethefollowinglinkwithwillbeabletoreadthiscontent:GetshareablelinkSorry,ashareablelinkisnotcurrentlyavailableforthisarticle.Copytoclipboard ProvidedbytheSpringerNatureSharedItcontent-sharinginitiative KeywordsEQ-VASEQ-5DMaritalstatusQualityoflife DownloadPDF DownloadePub Advertisement HealthandQualityofLifeOutcomes ISSN:1477-7525 Contactus Submissionenquiries:[email protected] Generalenquiries:[email protected]