Divorce and health: good data in need of better theory

Longitudinal evidence of the influence of early life circumstances, family characteristics, social ties and psychological distress on healthy behaviours of Brazilian adults: The Pro-Saude cohort study

BACKGROUND

This study examined the influence of early life circumstances, family characteristics, social ties and psychological distress in adulthood on adult's health-related behaviours.

METHODS

A cohort study (Pro-Saúde Study) involving technical and administrative civil servants at university campuses in Rio de Janeiro State, Brazil was conducted in Rio de Janeiro, Brazil. Data from 2155 adults were collected at baseline (1999) and after a 13-year period (2012-13). Family characteristics at 12 years of age were assessed retrospectively in 1999. Gender, marital status, living situation, social support, social networks of relatives and psychological distress were also measured in 1999. Data collection in 2012-13 included information about marital status, social networks of relatives, cigarette smoking, fruit and vegetable consumption and physical exercise. A conceptual model testing the relationships between variables was assessed through structural equation modelling.

RESULTS

Female gender (β = 0.043), better social networks of relatives in 1999 (β = 0.053) and 2012-13 (β = 0.069) and low psychological distress (β = -0.048) directly predicted less smoking. Better social networks of relatives in 2012-13 was directly linked to higher consumption of fruits (β = 0.045) and vegetables (β = 0.051) and being physically active (β = 0.070). Low psychological distress directly predicted higher fruit consumption (β = -0.040). Family characteristics at 12 years-old, marital status and living with other people were linked indirectly with health behaviours through social networks, social support and psychological distress.

CONCLUSIONS

Adults with better early life family and social circumstances, and those who were married reported positive health behaviours through indirect pathways. Stronger social ties and lower psychological distress represented the pathways by which early life circumstances and relationship status influenced positive health behaviours.

Interpersonal relationships, PNI, and health: Seeds in the 1980s, fruiting trees today

In this contribution to the Special Issue, I highlight how Janice Kiecolt-Glaser's research in the 1980s planted the seeds for two areas of social relationships and health research: loneliness and intimate/marital relationships. I review the foundational "seed" studies from the mid-to late-1980s, the research "saplings" that sprouted and grew during the subsequent twenty years, and the "mature trees" that have gone on to fruit and grow their respective areas of inquiry over the past twenty years. In addition to highlighting the mature trees that have borne rich empirical fruit, my other goal for this contribution is to draw attention to ideas and concepts from Kiecolt-Glaser's work and writing that merit further conceptual and empirical examination in the next generation of research on social relationships, psychoneuroendocrinology, psychoneuroimmunology, and health.

At the Intersection of Adverse Life Course Pathways: The Effects on Health by Migration Status

Adverse life events are major causes of declining health and well-being, but the effects vary across subpopulations. We analyze how the intersection of migration status and sex relates to two main adverse life events-job loss and divorce-thereby affecting individual health and well-being trajectories. Using data from the German Socio-Economic Panel (1984-2017), we apply descriptive techniques and individual fixed-effects regressions to analyze how job loss and divorce influence the health of immigrants and nonimmigrants. Our results support the hypothesis that immigrants suffer more from adverse life events than nonimmigrants in both the short and the long run. Relative to nonimmigrants, immigrants have a health advantage at younger ages, which becomes a disadvantage at older ages, and this faster decline at older ages is particularly steep among immigrants who experience adverse life events. These results help explain the vanishing health advantage of immigrants by showing that they are exposed to a double disadvantage over the life course: immigrants are more likely than nonimmigrants to suffer from adverse life events, such as job loss, and these events typically have a larger impact on their health. Our findings are the first to provide evidence regarding the consequences of different adverse life events and how they relate to the intersection of migration status and sex. Moreover, our results highlight the importance of intersectional analyses in research on immigrant health.

Marital transitions during earlier adulthood and subsequent health and well-being in mid- to late-life among female nurses: An outcome-wide analysis

Comparing outcomes for individuals remaining married to those for single or divorced individuals might overstate the positive effects of the decision to marry, since marriage carries an inherent risk of divorce and its associated negative outcomes. While a growing literature has examined marital transitions, confounding by past marital history remains a concern and only a limited set of outcomes have been examined. To address these issues, this study examined incident first-time marriage and incident divorce/separation in relation to multiple subsequent physical health, health behavior, psychological distress, and psychosocial well-being outcomes in a large sample of female nurses in the U.S.. Data from the Nurses' Health Study II were studied (1993 to 2015/2017 questionnaire wave, Nmarriage analyses = 11,830, Ndivorce/separation analyses = 73,018, interquartile range of baseline age = 35 to 42 years). A set of regression models were used to regress each outcome on marital transition status, adjusting for a wide range of initial health and wellbeing status in addition to other covariates. Bonferroni correction was performed to account for multiple testing. Among the initially never married, those who became married had lower mortality (RR = 0.65, 95%CI = 0.50, 0.84), lower risks of cardiovascular diseases (e.g., RRstroke = 0.64, 95%CI = 0.50, 0.82), greater psychological wellbeing and less psychological distress (e.g., ßdepressive symptoms = -0.10, 95%CI = -0.15, -0.06). Among the initially married, those who became divorced/separated had lower social integration (β = -0.15, 95%CI = -0.19, -0.11), greater psychosocial distress (e.g., RRdepression = 1.23, 95%CI = 1.10, 1.37), and possibly greater risks of mortality, cardiovascular diseases, and smoking. Future research could study similar questions using data from more recent cohorts, examine potential mechanisms and heterogeneity, and also examine alternative social relationship types.

Sleep Efficiency and Naturalistically-Observed Social Behavior Following Marital Separation: The Critical Role of Contact with an Ex-partner

Marital disruption is associated with increased risk for a range of poor health outcomes, including disturbed sleep. This report examines trajectories of actigraphy-assessed sleep efficiency following marital separation as well as the extent to which daily social behaviors and individual differences in attachment explain variability in these trajectories over time. One hundred twenty-two recently-separated adults (N = 122) were followed longitudinally for three assessment periods over five months. To objectively assess daily social behaviors and sleep efficiency, participants wore the Electronically Activated Recorder (EAR) during the day (for one weekend at each assessment period) and an actiwatch at night (for seven days at each assessment period). Greater time spent with an ex-partner, as assessed by the EAR, was associated with decreased sleep efficiency between participants (p = .003). Higher attachment anxiety was also associated with decreased sleep efficiency (p = .03), as was the EAR-observed measure of "television on." The latter effect operated both between (p = .004) and within participants (p = .005). Finally, study timepoint moderated the association between EAR-observed measure of "television on" and sleep efficiency (p = .007). The current findings deepen our understanding of sleep disturbances following marital separation and point to contact with an ex-partner and time spent with the television on as behavioral markers of risk.

The Divorce Process and Child Adaptation Trajectory Typology (DPCATT) Model: The Shaping Role of Predivorce and Postdivorce Interparental Conflict

Divorce has been conceptualized as a process. Research has extensively demonstrated that it is pre/postdivorce family environment factors that primarily account for the variability in children's adaptation over parental divorce process rather than the legal divorce per se. Amongst various factors, interparental conflict has been consistently identified as a prominent one. Surprisingly, a single source is still lacking that comprehensively synthesizes the extant findings. This review fills this gap by integrating the numerous findings across studies into a more coherent Divorce Process and Child Adaptation Trajectory Typology (DPCATT) Model to illustrate that pre/postdivorce interparental conflict plays crucial roles in shaping child adaptation trajectories across parental divorce process. This review also summarizes the mechanisms (e.g., child cognitive and emotional processes, coparenting, parent-child relations) via which pre/postdivorce interparental conflict determines these trajectories and the factors (e.g., child gender and age, child coping, grandparental support) that interact with pre/postdivorce interparental conflict to further complicate these trajectories. In addition, echoing the call of moving beyond the monolithic conceptualization of pre/postdivorce interparental conflict, we also review studies on the differential implications of different aspects (e.g., frequency versus intensity) and types (e.g., overt versus covert) of interparental conflict for child adjustment. Last, limitations of prior studies and avenues for future research are discussed. The proposed framework may serve as a common knowledge base for researchers to compare/interpret results, detect cutting edges of the fields, and design new studies. The specificity, complexity, nuance, and diversity inherent within our proposed model await to be more fully revealed.

Interactions between the κ opioid system, corticotropin-releasing hormone and oxytocin in partner loss

Selective adult social attachments, or ‘pair bonds’, represent central relationships for individuals in a number of social species, including humans. Loss of a pair mate has emotional consequences that may or may not diminish over time, and that often translate into impaired psychological and physical health. In this paper, we review the literature on the neuroendocrine mechanisms for the emotional consequences of partner loss, with a special focus on hypothesized interactions between oxytocin, corticotropin-releasing hormone and the κ opioid system.

This article is part of the theme issue ‘Interplays between oxytocin and other neuromodulators in shaping complex social behaviours’.

Divorce, health, and socioeconomic status: An agenda for psychological science

This brief review article discusses marital dissolution and health with a focus on two specific themes. First, we introduce and discuss the search for plausible causal pathways that link the end of marriage to distal health outcomes. Second, we suggest that the socioeconomic status disruptions that follow divorce represent a plausible causal pathway and emphasize the need for more psychological science in this area of study. Although there is substantial literature that demonstrates that divorced adults, especially divorced women, experience significant financial disruptions, the research in this area remains broad and largely the province of family sociology and demography. Research is needed to better understand adults' psychological and behavioral responses to changes in their financial situation after the end of marriage.

Intimate Relationships and Depression: Searching for Causation in the Sea of Association

This article provides a critical review of existing research on intimate (marriage or marriage-like) relationship distress and risk for depression. Using the meta-framework of research triangulation, we seek to synthesize research evidence across several different methodologies and study designs and to draw the most reliable conclusion regarding a potential causal association between relationship distress and depression. Focusing on existing correlational (i.e., observational), genetically informed, and intervention (i.e., experimental) research on the association between relationship distress and depression, we conclude that the existing body of research evidence supports the claim that relationship distress is a causal risk factor for depression. A secondary aim of the article is to highlight a variety of effective methods that, when viewed from the perspective of triangulation, enhance the pursuit of causal inference, including propensity score matching, target trial emulation, directed acyclic graph approach, and Mendelian randomization.

Smoking and Physical Activity Explain the Increased Mortality Risk Following Marital Separation and Divorce: Evidence From the English Longitudinal Study of Ageing

BACKGROUND

Marital separation and divorce are associated with an increased risk of early mortality, but the specific biobehavioral pathways that explain this association remain largely unknown.

PURPOSE

This study sought to identify the putative psychological, behavioral, and biomarker variables that can help explain the association of being separated or divorced and increased risk for early mortality.

METHODS

Using data from the English Longitudinal Study of Ageing, a representative community sample of aging adults (N = 5,786), we examined the association of marital status and life satisfaction, health behaviors measured 2 years later, biomarkers measured 4 years later, and mortality outcomes from the subsequent 4 years.

RESULTS

Consistent with prior literature, older adults who were separated/divorced evidenced greater risk of mortality relative to those in intact marriages over the study period, OR = 1.46, 95% CI [1.15, 1.86]. Marital status was associated with lower levels of life satisfaction, β = -0.22 [-0.25, -0.19] and greater likelihood of smoking 2 years later β = 0.17 [0.13, 0.21]. Lower life satisfaction predicted less frequent physical activity 2 years later, β = 0.07 [0.03, 0.10]. Smoking, but not physical activity, predicted poorer lung functioning 2 years later, β = -0.43 [-0.51, -0.35], and poorer lung function predicted increased likelihood of mortality over the following 4 years, β = -0.15 [-0.27, -0.03]. There was a significant total indirect effect of marital status on mortality through these psychological, behavioral, and biomarker variables, β = 0.03 [0.01, 0.05], which fully explained this mortality risk.

CONCLUSIONS

For separated/divorced adults, differences in life satisfaction predict health behaviors associated with poorer long-term lung function, and these intermediate variables help explain the association between marital dissolution and increased risk of earlier mortality.

DNA Methylation Across the Serotonin Transporter Gene Following Marital Separation: A Pilot Study

BACKGROUND

Marital separation and divorce are stressful life transitions associated with increased risk for a range of poor mental and physical health outcomes. A key task for research in this area is to identify individual differences that may index risk for these adverse outcomes.

PURPOSE

To examine the association between DNA methylation across the serotonin transporter gene (SLC6A4) and self-reported emotional distress following marital separation.

METHODS

Genomic DNA methylation (from buffy coat fractions of whole blood) was quantified in a sample of 47 adults following a recent marital separation; concurrent with the blood draw, participants completed questionnaires on their psychological adjustment to the separation experience.

RESULTS

Relatively greater methylation of SLC6A4 was associated with less subjective separation-related psychological distress, and this association held after accounting for participants' age, length of the relationship, time since the separation, and SLC6A4 genotype, b = -211.99, SE = 94.91, p = .03, 95% CI: -402.22, -25.21. Significantly stronger negative associations were observed between methylation and psychological adjustment among participants who had more recently separated from their former partner.

CONCLUSIONS

Although results derived from small samples must be considered preliminary and hypothesis generating, the current study raises new questions about the role of DNA methylation and psychosocial adaptation to stressful life events such as divorce, and the findings can inform future studies in this research area.

Objectively Measured Social Integration Is Associated With an Immune Risk Phenotype Following Marital Separation

Background

Close relationships play an integral role in human development, and robust evidence links marital separation and divorce to poor health outcomes. Social integration may play a key role in this association. In many ways, the study of marital separation and divorce provides an ideal model system for a more complete understanding of the association between life stress and physical health.

Purpose

The current study investigated associations among objectively measured social integration, psychological distress, and biomarkers of immune health in recently separated adults (N = 49).

Methods

We collected four measures of immune functioning-interleukin-6, C-reactive protein, and antibody titers to latent cytomegalovirus and Epstein-Barr virus-that were combined to yield a viral-Immune Risk Profile. To assess how variability in social integration is associated with immunological correlates following the end of a marriage, we incorporated observational ecological momentary assessment data using a novel methodology (the Electronically Activated Recorder).

Results

We found that objectively measured social behaviors are associated with concurrent viral-Immune Risk Profile scores over and above the effects of psychological distress and that psychological distress may be linked to biomarkers of immune health through social integration.

Conclusions

This research expands current knowledge of biomarkers of immune health after divorce and separation and includes a new methodology for objective measures of social engagement.

The impact of physical proximity and attachment working models on cardiovascular reactivity: Comparing mental activation and romantic partner presence

Close relationships, especially high-quality romantic relationships, are consistently associated with positive physical health outcomes. Attenuated cardiovascular reactivity is one physiological mechanism implicated in explaining these effects. Drawing on attachment and social baseline theories, this experimental study evaluated two potential affiliative cues as mechanisms through which romantic relationships may attenuate cardiovascular reactivity to a laboratory-based stressor. Prior to a cold pressor task, 102 participants were randomly assigned to either have their partner physically present, call upon a mental representation of their partner, or think about their day during the stressor. Consistent with our preregistered hypotheses, participants in both the partner present and mental activation conditions had significantly lower blood pressure (BP) reactivity during the cold pressor task compared to control participants for both systolic (d = -0.54) and diastolic BP (d = -0.53), but no significant differences emerged for heart rate or heart rate variability. Although participants in the partner present and mental activation conditions had similar BP reactivity to the cold pressor task, those in the partner present condition reported significantly less pain as a result of the task. The difference in BP reactivity by condition was moderated-BP reactivity was greater for people with lower self-reported relationship satisfaction. The results suggest that accessing the mental representation of a romantic partner and a partner's presence each buffer against exaggerated acute stress responses to a similar degree.

Association between Socioeconomic Status and 30-Day and One-Year All-Cause Mortality after Surgery in South Korea

Preoperative socioeconomic status (SES) is associated with outcomes after surgery, although the effect on mortality may vary according to region. This retrospective study evaluated patients who underwent elective surgery at a tertiary hospital from 2011 to 2015 in South Korea. Preoperative SES factors (education, religion, marital status, and occupation) were evaluated for their association with 30-day and one-year all-cause mortality. The final analysis included 80,969 patients who were ≥30 years old, with 30-day mortality detected in 339 cases (0.4%) and one-year mortality detected in 2687 cases (3.3%). As compared to never-married patients, those who were married or cohabitating (odds ratio (OR): 0.678, 95% confidence interval (CI): 0.462–0.995) and those divorced or separated (OR: 0.573, 95% CI: 0.359–0.917) had a lower risk of 30-day mortality after surgery. Similarly, the risk of one-year mortality after surgery was lower among married or cohabitating patients (OR: 0.857, 95% CI: 0.746–0.983) than it was for those who had never married. Moreover, as compared to nonreligious patients, Protestant patients had a decreased risk of 30-day mortality after surgery (OR: 0.642, 95% CI: 0.476–0.866). The present study revealed that marital status and religious affiliation are associated with risk of 30-day and one-year all-cause mortality after surgery.

Relationships and Health: The Critical Role of Affective Science

High-quality social relationships predict a range of positive health outcomes, but no broadly accepted theory can explain the mechanisms of action in this area. The central argument of this article is that affective science can provide keys for integrating the diverse array of theoretical models concerning relationships and health. From nine prominent theories, we cull four components of relational affect that link social resources to health-related outcomes. This component model holds promise for integrating research from the different theoretical perspectives and for generating new, mechanistic questions about the connection between relationships and health. The article closes by outlining three empirical study ideas that illustrate ways in which the different components can be studied together in the context of mechanism-focused research.

Preliminary evidence of attenuated blood pressure reactivity to acute stress in adults following a recent marital separation

OBJECTIVE

This study explores cardiovascular reactivity during an acute-stress task in a sample of recently separated adults.

DESIGN

In a cross-sectional design, we examined the association between adults' subjective separation-related distress and changes in heart rate and blood pressure across the acute-stress laboratory paradigm in a sample of 133 (n = 49 men) recently separated adults.

MAIN OUTCOME MEASURES

Heart rate (HR) and Blood pressure (BP) were recorded across a resting baseline period, a math stressor task, and a recovery period.

RESULTS

Multilevel analyses revealed that adults who reported greater separation-related distress exhibited higher initial BP and a slower linear increase in BP across the study period. In addition, adults reporting greater separation-related distress evidenced significantly slower declines in diastolic blood pressure (DBP) following the acute-stress task. HR reactivity was not moderated by separation-related distress.

CONCLUSIONS

In recently separated adults, preliminary evidence suggests that the context of the stressors may reveal differential patterns of problematic reactivity (exaggerated or blunted responding). Greater emotional intrusion and hyperactivity symptoms may index increased risk for blunted cardiovascular reactivity to general stressors. This pattern of reactivity is consistent with models of allostatic load that emphasise the deleterious effect of hyporesponsivity to environmental demands.

Impact of stressful death or divorce in people with HIV: A prospective examination and the buffering effects of religious coping and social support

This study examined the impact of a stressful death/divorce on psychological and immune outcomes in people with HIV. People with HIV with stressful death/divorce were examined from before the event to up to 12 months later (n = 45); controls were assessed at similar intervals (n = 112). Stressful deaths/divorces were associated with increased viral load and anxiety over time (ps ≤ .014), but not CD4+ or depression. Increased use of religious coping after the stressful death/divorce was associated with slower increases in viral load (p = .010). These data suggest people with HIV should consider the potentially elevated risk of transmission after such events and seek appropriate monitoring and care.