The Effects of Marriage on Health: A Synthesis of Recent ...

Marital status can both affect health outcomes and be affected by them. Healthier people may have a better chance of marrying and staying ... Skiptomaincontent The.govmeansit’sofficial. Federalgovernmentwebsitesoftenendin.govor.mil.Beforesharingsensitiveinformation,makesureyou’reonafederalgovernmentsite. Thesiteissecure. Thehttps://ensuresthatyouareconnectingtotheofficialwebsiteandthatanyinformationyouprovideisencryptedandtransmittedsecurely. TheEffectsofMarriageonHealth:ASynthesisofRecentResearchEvidence.ResearchBrief Breadcrumb ASPE Reports TheEffectsofMarriageonHealth:ASynthesisofRecentResearchEvidence.ResearchBrief PublicationDate Jun30,2007 AboutThisResearchBriefThisbriefwaspreparedbyRobertG.Wood,BrianGoesling,andSarahAvellarofMathematicaPolicyResearch,Inc.undercontracttoASPE. ThebriefsummarizesthefindingsofasynthesisoftheliteratureontheeffectsofmaritalstatusonhealthoutcomesintheU.S. ThefullreportisavailableonASPE'swebsite: http://aspe.hhs.gov/hsp/07/marriageonhealth/index.htmAreviewofinternationalstudies,"HowDoesMarriageAffectPhysicalandPsychologicalHealth? ASurveyoftheLongitudinalEvidence,"isavailableat: http://www2.warwick.ac.uk/fac/soc/economics/research/papers/twerp728.pdf JerryRegierPrincipalDeputy/AssistantSecretaryforPlanningandEvaluationMelissaPardueDeputyAssistantSecretaryforHumanServicesPolicyMarriagehasbecomeanincreasinglyimportanttopicinacademicandpolicyresearch. Aburgeoningliteraturesuggeststhatmarriagemayhaveawiderangeofbenefits,includingimprovementsinindividuals'economicwell-being,mentalandphysicalhealth,andthewell-beingoftheirchildren. Thisbrieffocusesonrecentresearchevidenceconcerningoneofthesepotentialbenefitsofmarriage —itseffectsonhealth. Thebriefprovidesanoverviewofwhatiscurrentlyknownabouttherelationshipbetweenmarriageandhealth;italsosuggestsdirectionsforfutureresearch.Marriedpeoplearegenerallyhealthierthanunmarriedpeople,asmeasuredbynumeroushealthoutcomes.(1) Toinvestigatethecomplexrelationshipbetweenmarriageandhealth,thisreviewscrutinizesrecentresearch,focusingonstudiesthatuserigorousstatisticalmethodstoexaminewhethermarriageisacauseofthesebetterhealthoutcomes.Afocusonthemostrigorousrecentevidencerevealsthatmarriagehaspositiveeffectsoncertainhealth-relatedoutcomes.Thesestudiesfind,forexample,thatmarriageimprovescertainmentalhealthoutcomes,reducestheuseofsomehigh-costhealthservices(suchasnursinghomecare),andincreasesthelikelihoodofhavinghealthinsurancecoverage.Inaddition,anemergingliteraturesuggeststhatgrowingupwithmarriedparentsisassociatedwithbetterhealthasanadult.Marriagehasmixedeffectsonhealthbehaviors —leadingtohealthierbehaviorsinsomecases(reducedheavydrinking)andlesshealthybehaviorsinothers(weightgain).Forotherkeyhealthoutcomes —inparticular,measuresofspecificphysicalhealthconditions-theeffectsofmarriageremainlargelyunaddressedbyrigorousresearch."UnderstandingtheMarriage-HealthConnectionTherelationshipbetweenmarriageandhealthiscomplex.Maritalstatuscanbothaffecthealthoutcomesandbeaffectedbythem.Healthierpeoplemayhaveabetterchanceofmarryingandstayingmarriedbecausetheymaybeviewedasmoredesirablemarriagepartnersbasedontheirphysicalattractiveness,earningspotential,mentalwell-being,degreeofself-sufficiency,orlikelylongevity.Socialscientistsdescribethispatternasthe“selection”ofhealthypeopleintomarriage.Ifthisistheonlyreasonforthecorrelationbetweenmarriageandhealth,thenmarriageisnotcausingbetterhealth.Instead,theobservedhealthdifferencesbetweenmarriedandunmarriedpeoplearetheresultofhealthierpeoplebeingmorelikelytomarry. Alternatively,theremaybeatruecausallinkbetweenmarriageandbetterhealth.Marriagecouldimprovehealthoutcomesinavarietyofways.Itmayresultintwoincomes,aswellaseconomiesofscale,improvingeconomicwell-being.(2) Havingmoreincomecould,inturn,improvehealthoutcomesbyenhancingaccesstohealthcareorloweringstress.Inaddition,aspousemayplayanimportantroleinmonitoringandencouraginghealthybehaviors(suchasgoodeatinghabitsandregularexercise),aswellasindiscouragingunhealthyones(suchassmokingorheavydrinking).(3) Marriagemayalsoprovideanemotionallyfulfilling,intimaterelationship,satisfyingtheneedforsocialconnection,whichcouldhaveimplicationsforbothphysicalandmentalhealth.(4) Mostresearchersconcludethattheassociationbetweenmarriageandhealthrepresentsacombinationoftheselectionofhealthierpeopleintomarriageandtruehealthbenefitsfrommarriage.(5,6,7) HealthOutcomesExamined Thisreviewhighlightstherecentliteratureontheeffectsofmarriageonhealth-relatedmeasuresfromfivebroadareas: HealthBehaviors. Thisreviewfocusesonbehaviorsthathavewell-documentedconnectionswithphysicalhealthoutcomes: alcoholanddruguse,smoking,bodyweight,andexercise. HealthCareAccess,Use,andCosts. Thisreviewexaminesthelinksbetweenmarriageandthreemainhealthcareoutcomes: (1)healthinsurancestatus;(2)healthcareuse(inparticular,hospitalandnursinghomecare);and(3)totalhealthcarecosts. MentalHealth. Thisreviewfocusesontheeffectsofmaritalstatusononecommonformofpsychologicaldistress: thepresenceofdepressivesymptoms. PhysicalHealthandLongevity. Thisreviewexaminestheeffectofmarriageonself-ratedhealthandlongevity,aswellasasmallsetofchronichealthconditions. IntergenerationalHealthEffects. Thisreviewfocusesonagrowingbodyofresearchlinkingachild'sparent'smaritalstatuswiththatchild'shealthoutcomesasanadult. MeasuringtheEffectsofMarriageBecausemarriageislikelytobebothacauseandaconsequenceofhealthoutcomes,researchmustdisentangletheinfluenceofselectionfromthetruecausalinfluenceofmarriage.Distinguishingbetweenthesetwofactorsrequirescarefulanalysisandadvancedstatisticalmethodsthathavebeenabsentfrommanystudies.Thisreviewfocusesonstudiesthatprovidethemostreliableevidenceonwhethermarriagehasacausalinfluenceonhealthoutcomes. Thestudiesprovidingthestrongestevidenceuselongitudinaldataandexaminetheassociationbetweenchangesinhealthoutcomesandtransitionsintoandoutofmarriage.Studiesofthistypeprovidemoreconvincingevidenceofacausalrelationshipbetweenmarriageandhealthbecausesamplemembersserveastheirowncontrolgroup,andtheeffectofmarriageismeasuredbycomparingtheiroutcomesbeforeandaftermarriage.Thismethodavoidscomparingtwogroupsthatmayhavedifferentbackgroundcharacteristics —inparticular,peoplewhomarryandpeoplewhodonot —whichmayleadtomisleadingandinaccurateresults. Somehealthoutcomesarenotwellsuitedforthistypeofanalysis,however.Forexample,manyphysicalhealthoutcomescannotbeexaminedinthisway,becausechangescanunfoldoveralongtimeandmaynotbeapparentimmediatelyafteramaritaltransition.Forthisreason,theevidenceontheeffectsofmarriageonphysicalhealthismorelimitedandsomewhatmorespeculativethanevidenceontheeffectsofmarriageonotherhealthoutcomesexaminedinthisreview. WhatIsCurrentlyKnown?EffectsonHealthBehaviors. Marriagemayinfluencehealththroughitseffectonbehaviorssuchasalcoholconsumption,druguse,cigarettesmoking,diet,andexercise.Recentresearchsuggeststhatmarriagehassignificanteffectsonthehealthbehaviorsofbothmenandwomen,butthepatternismixed —marriageisassociatedwithhealthierbehaviorsinsomecasesandlesshealthybehaviorsinothers.Studiesconsistentlyindicatethatmarriagereducesheavydrinkingandoverallalcoholconsumption,andthateffectsaresimilarforyoungmenandyoungwomen,andforbothAfricanAmericansandwhites.(8,9,10,11) Althoughtheresearchislessextensive,marriageisalsoassociatedwithreducedmarijuanauseforyoungmen,butlesssoforwomen.(8,11) Lessisknownabouttheeffectsofmarriageonthesubstanceuseofolderadults.Studiesofmarriageandsmokingrevealnoconsistentpatternofresults,suggestingthatmarriagemayhavelittleornoinfluenceonthisbehavior.(8,11,12,13) Incontrasttostudiesofalcoholanddruguse,studiesoftheeffectofmarriageonweightandphysicalactivitysuggestthatmarriagemayhavenegativeeffectsonhealthybehaviorsandmayencourageamoresedentarylifestyle.Severalrigorousstudiesfindthatmarriageleadstomodestweightincreasesforbothmenandwomen —typicallyaveraginglessthanfivepounds.(14,15,16,17,13,12) Theresearchontheeffectsofmarriageonphysicalactivityislessconclusivebecauseitisnotbasedonlongitudinalanalysisanddoesnotfullyadjustfordifferencesbetweenthosewhomarryandthosewhodonot.Theevidencethatisavailablesuggestsmarriagemayleadtoreductionsinphysicalactivity,particularlyformen.(18) Forcertainhealthbehaviors —inparticular,substanceuseamongyoungeradultsandweightgainamongalladults —theinfluenceofmarriagehasbeenwellstudiedandiswellunderstood.Forotherbehaviors,lessisknownandadditionalresearchisneededbeforestrongerconclusionscanbedrawn.Oneusefulareaforfutureresearchistoexaminetheeffectsofmarriageonthealcoholuseofolderadultstodeterminewhethertheeffectsobservedforyoungadultsexistinolderpopulations.Additionalresearchusinglongitudinaldataisalsoneededtoexaminetheeffectsofmarriageonphysicalactivitytodeterminewhethertherelationshipbetweenmarriageandphysicalactivityobservedincross-sectionalanalysesremainswhenmorerigorousestimationtechniquesareused. EffectsonHealthCareAccess,Use,andCosts. Marriagemayinfluencephysicalhealththroughitseffectsonhealthcareaccessanduse.Studiesofthelinkbetweenmarriageandhealthinsurancesuggestthat —byofferingaccesstocoveragethroughaspouse'spolicy —marriageincreasesthelikelihoodofhavinginsuranceandreducesthelikelihoodofbecominguninsuredafterajoblossorothermajorlifeevent.(19) Thiseffectislargerforwomen.Recentresearchalsofindsalinkbetweenmarriageandhealthcareuse.Marriageisassociatedwithshorteraveragehospitalstays,fewerdoctorvisits,andreducedriskofnursinghomeadmission.(20,21,22) Limitedevidencealsosuggeststhatmarriagemayincreasetheuseofpreventivecaresuchascancerscreenings.(12) Becauseofitseffectsonhealthcareuse,marriageisalsoassociatedwithlowerhealthcarecostsamongolderadults.Forexample,studiesshowthat,becausemarriagereducestheriskofnursinghomeadmission,marriagemayalsoleadtoreducednursinghomecosts.(22) Theeffectofmarriageinshorteninghospitalstaysmayalsoleadtoreductionsinhealthcarecosts.Researchindicatesthattheeffectofmarriageonhealthcarecostsexistsindependentoftheeffectofmarriageonphysicalhealth.(22) Specifically,manymarriedpeoplerelyontheirspousesforinformalcare,andthusrequirefewerlonghospitalstaysandnursinghomeadmissions,resultinginlowerhealthcarecosts —evenifmarriedandunmarriedolderadultsareequallylikelytogetsick.(20,21) Thesestudiesfindthatwivesareespeciallylikelytoprovideinformalcarefortheirhusbandsathome,sotheeffectofmarriageonhealthcarecostsmaybelargerformen. Thelinkbetweenmarriageandhealthcarecostsneedsfurtherstudy,becausemostpreviousresearchprovidesonlyindirectevidencebasedonexaminationofeffectsonhigh-costhealthservices,suchasnursinghomecare.Otheroutcomesripeforfutureresearchincludequalityofcare,useofprescriptionmedications,receiptofhigh-techexamsandtreatments,patientadherencetoprescribedtreatmentregimens,anduseofpreventivehealthservicesotherthancancerscreenings. EffectsonMentalHealth. Marriagemayaffectmanyaspectsofmentalhealth.Thisreviewfocusesontheprevalenceofdepressivesymptoms.Themostrecentrigorousresearchsuggeststhatmarriagereducesdepressivesymptomsforbothmenandwomen.(23,24,25,26) Inparticular,thesestudiesfindthatgettingmarrieddecreasesdepressivesymptoms,whilegettingdivorcedincreasesthem.Researchhasalsodocumentedthatincreasesindepressivesymptomsafterdivorcearelong-lastingandthattheprevalenceofthesesymptomsremainselevatedyearsafterthemaritalbreakup.(27,28) Inaddition,studiescomparingthementalhealthofstablymarriedadultstothosewhoremainunmarriedfindthatthosewhoarestablymarriedhavefewerdepressivesymptoms(andsmallerincreasesinthesesymptomsastheygrowolder),evenaftercontrollingforbaselinementalhealth.(23,25,26) Althoughresearchconsistentlyshowsthatbeingmarriedreducesdepression,theexistingevidencehaslimitationsthatfutureresearchshouldaddress.Inparticular,themostrigorousresearchtypicallyestimatestheeffectofmarriageandmaritaltransitionsbycomparingtheprevalenceofdepressivesymptomsintheperiodjustbeforeamaritaltransitiontotheprevalenceintheperiodjustafterthetransition.Thismethodadjustsforbackgrounddifferencesbetweenthosewhomarryandthosewhodonot.However,itmayintroduceothersourcesofbiasintotheestimates,andthedirectionofthisbiasisuncertain. Forexample,peoplemayexperiencefewerdepressivesymptomsintheperiodleadinguptomarriageinanticipationofthistransition.Similarly,peoplemayexperiencemoredepressivesymptomsintheperiodleadinguptoadivorce,asthequalityoftheirmarriagedeclines.Ifso,comparingsomeone'sdepressivesymptomsduringtheperiodjustbeforeamaritaltransitiontotheperiodimmediatelyaftermayunderestimatetheeffectofthistransition.Conversely,ifdepressivesymptomsarereducedforonlyashorttimeaftermarriageorareelevatedforonlyashorttimeafteramaritaldissolutionbeforereturningtotheirpre-transitionlevels,comparisonsofdepressivesymptomsjustbeforeandjustafterthetransitionwouldoverestimatethelong-termeffect.Toaddresstheselimitationsandtoobtainamorepreciseunderstandingoftherelationshipbetweenmarriageanddepression,longitudinaldatasetsareneededthatoffermoredetailedmentalhealthhistoriesandmoreinformationonchangesinmentalhealthstatusthanarecurrentlyavailable. EffectsonPhysicalHealthandLongevity. Manystudieshavedocumentedthatpeoplewhomarrylivelongerandenjoybetterphysicalhealththanthosewhodonotmarry.(29,30) However,methodologicalissuesrequirecautionininterpretingthispattern,becausemostoftheresearchinthisareareliesondescriptivemethodsthatdonotadequatelycontrolforthepossibleselectionofhealthierpeopleintomarriage.Althoughcentraltotheoverallassessmentofthelinkbetweenmarriageandhealth,rigorousresearchevidenceconcerningtheeffectofmarriageonspecificphysicalhealthoutcomesislimited,andfewsolidconclusionscanbedrawn. Therigorousresearchcurrentlyavailableprovideslimitedevidenceofaneffectofmarriageonphysicalhealth.Recentresearchfindsasignificantpositiveeffectofmarriageonhowmenratetheiroverallphysicalhealthstatus;however,itfindsnosucheffectforwomen.(30) Researchersfindapositiveeffectonwomen'sphysicalhealth,asmeasuredbytheprevalenceofspecifichealthconditionsandillnesses.(31) However,norecentrigorousstudiesbasedonU.S.sampleshaveexaminedwhetherasimilarmarriageeffectonthefrequencyofhealthconditionsorillnessesexistsamongmen.Similarly,littleevidenceexistsonthelinksbetweenmarriageandspecifichealthconditionsordiseases.Oneexceptionisarecentstudythatsuggestsapossiblelinkbetweenmarriageandtheriskofcardiovasculardiseaseforwomen;however,thestudyfindsnosucheffectformen.(32) Overall,theexistingresearchevidenceonthelinksbetweenmarriageandphysicalhealthislimitedtoanarrowrangeofhealthmeasuresanddoesnotofferacompletepictureoftheinfluenceofmarriageonphysicalhealth. Manystudieshavepointedtoastrongrelationshipbetweenmarriageandlongevity,(33,29,34) butthisresearchalsohaslimitations.Inparticular,thesestudiesaretypicallylimitedtosimpledescriptivecomparisonsofmarriedandunmarriedadultsthatdonotadequatelydistinguishtheeffectofmarriagefromthepossibleeffectsofhealthierpeopleselectingintomarriage.Asnoted,themostreliablestudiesoflinksbetweenmarriageandhealthexaminemeasuresdirectlybeforeandaftermaritaltransitions.However,becauselongevityisdeterminedonlyattheendoflife,itisnotpossibletoobservehowamaritaltransitionchangeslongevity.Someresearchershaveattemptedtoaddressselectionusingotherstatisticaltechniques,(5) butthesestudiesprovidelessconvincingevidencethandostudiesofmaritaltransitions.Forthisreason,thestrongestevidenceofapositiveeffectofmarriageonlongevitycomesmorefromtherobustnessofthisrelationshipacrossmanystudiesthanfromtheparticularstrengthsofanysinglestudy. Amoredefinitivetestoftheeffectofmarriageonphysicalhealthandlongevitywillrequireverylong-termlongitudinaldatathataffordtheopportunitytocontrolfordifferencesininitialhealthstatusmeasuredbeforesamplemembersbegintomarry.Withdataofthistype,researcherscanexaminehowdifferingmaritalhistoriesaffectphysicalhealth,controllingforanyinitialhealthdifferencesthatexistbetweenthosewhomarryandremainmarriedandthosewhodonot. IntergenerationalHealthEffects.Anemergingliteratureonthepossibleintergenerationalhealtheffectsofmarriagesuggeststhatmarriagealsohaspotentiallong-termconsequencesforthephysicalhealthofacouple'schildren.Inparticular,studiesshowthatgrowingupwithmarriedparentsisassociatedwithbetterphysicalhealthinadulthoodandincreasedlongevity.(35,36,37) ResearchsuggeststhatsuchintergenerationalhealtheffectsareespeciallystrongformenandoperateequallyforAfricanAmericanandwhitemen.(38,39,40) ThereislessevidenceexaminingpossibledifferencesinthisrelationshipforAfricanAmericanandwhitewomen. Therearemanypossiblereasonswhyparentalmaritalstatusmayhavelong-termhealthconsequencesforchildren.However,existingresearchprovideslimitedevidenceonthepathwaysbywhichchildhoodfamilystructureaffectsadultphysicalhealthandlongevity.Severalstudiessuggestthattheeffectsworkmostlythroughtheroleofchildhoodfamilystructureinshapingchildren'sfuturesocioeconomicattainment,andthroughadulthealthriskbehaviors,suchassmokingandheavydrinking.(35,39) Onaverage,childrenraisedintwo-parentfamiliesobtainmoreeducationandexhibithealthieradultbehaviorsthanchildrenfromothertypesoffamilies.Thesedifferences,inturn,haveconsequencesforadulthealthandlongevity. Researchonintergenerationalhealtheffectshasfocusedontrendsforpeopleborninthelate19thandearly20thcenturies,aperiodwhenpatternsofmarriage,divorce,andsingleparenthoodweremuchdifferentfromtoday.Itispossiblethattheapparentbenefitsofmarriageforchildren'shealthhaveweakenedassingleparenthoodanddivorcehavebecomemorecommonandlessstigmatizing.Inaddition,muchoftheresearchislimitedtodataforsmallnonrepresentativesamples.Theavailablenationallyrepresentativeevidenceisbasedondatasetsthatbegantrackingsamplemembersasadults,whichlimitstheabilitytocontrolfordifferencesinthebackgroundcharacteristicsofthosewhogrewupinatwo-parentfamilyandthosewhodidnot. Futureresearchisneededto Replicatetheresultsofexistingresearchwithnationallyrepresentativedatafollowingsamplemembersfromchildhoodintoadulthood, Distinguishmoreclearlytheeffectofparentalmaritalstatusfromtheeffectsofotherrelatedfamilycharacteristics, Identifymoreprecisemechanismsbywhichchildhoodfamilystructuremightinfluenceadultphysicalhealth,and Examinewhethertherelationshipsobservedinearliergenerationsalsoapplytoayoungercohortofchildrencomingofageinaperiodwhendivorceandsingleparenthoodareincreasinglycommon. Marriage,Health,andPolicyRecentresearchsuggeststhatmarriageimprovescertainhealthoutcomes.However,thepictureofmarriage'soveralleffectonhealthisnotyetcomplete.Futureresearchcouldmorefullyexploretheeffectsofmarriageonhealthcarecosts;thehealtheffectsofmarriagefordifferentracial,ethnic,andsocio-economicgroups;therolethatmaritalqualitymightplay;andtheintergenerationalhealtheffectsofmarriage.Moreover,littlerigorousresearchhasbeenconductedconcerningthecentralquestionofwhethermarriageaffectsphysicalhealth.Additionalresearchintheseandotherareascouldhelpclarifythebreadthofthehealtheffectsofmarriage.Betterinformationabouthowmarriageaffectshealthcancontributetodiscussionsabouttheroleandpurposesofpublicpolicyinsupportingmarriage —andpossiblygiveanewmeaningtothephrase“healthymarriage.” References1.Schoenborn,CharlotteA."MaritalStatusandHealth: UnitedStates,1999-2002."AdvanceData,no.351,December2004. 2.Lerman,Robert."MarriageandtheEconomicWell-BeingofFamilieswithChildren: AReviewoftheLiterature."Washington,DC:TheUrbanInstituteandAmericanUniversity,July2002. 3.Umberson,Debra."FamilyStatusandHealthBehaviors: SocialControlasaDimensionofSocialIntegration."JournalofHealthandSocialBehavior,vol.28,no.3,1987,pp.306-319. 4.HouseJ.S.,D.Umberson,andK.R.Landis."StructuresandProcessesofSocialSupport."AnnualReviewofSociology,vol.14,1988,pp.293-318. 5.Lillard,LeeA.,andConstantijnW.A.Panis."MaritalStatusandMortality: TheRoleofHealth."Demography,vol.33,no.3,August1996,pp.313-327. 6.Murray,JohnE."MaritalProtectionandMaritalSelection: EvidencefromaHistorical-ProspectiveSampleofAmericanMen."Demography,vol.37,no.4,November2000,pp.511-521. 7.Waite,LindaJ."DoesMarriageMatter?" Demography,vol.32,no.4,Nov.1995,pp.483-507. 8.Duncan,Greg,BessieWilkerson,andPaulaEngland."CleaningUpTheirAct: TheEffectsofMarriageandCohabitationonLicitandIllicitDrugUse."Demography,vol.43,no.4,Nov.2006,pp.691-710. 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Files Document rb.pdf(pdf,94.33KB) Topics Marriage&FamilyIssues ProductType ResearchBrief