Chronic Illness and Mental Strain: The Moderating Role of Marital Status over the Disease Cycle
Jack Lam and Francisco Perales.
A consequence of an ageing population is that many people will eventually be diagnosed with a chronic condition. These conditions are associated with large monetary and social costs to individuals and their families over prolonged periods of time, and constitute a sizeable burden to the health care system. Compared to acute illnesses, chronic conditions are slow in their progression and often result in the emergence of new or increasingly pronounced functional limitations to which individuals must adjust. Undertaking large, recurrent and long-lasting life adjustments is a mentally straining process, and can have detrimental impacts on individuals’ mental wellbeing. Consistent with this, international research documents links between the experience of chronic conditions and poor mental health.
Given the socio-economic costs of poor mental health and the increasing prevalence of chronic conditions, we must improve our understanding of the factors that buffer the stress associated with living with chronic illness. Here, we consider the potential protective effect of partnerships. Partners can be an important source of support for individuals living with a chronic disease. They can provide both intangible types of support (e.g. emotional availability, aid managing medication use…) and more tangible ones (e.g. financial support to cover medication costs, help with housework…). Individuals with chronic conditions receiving either kind of support may make more successful life adjustments following the onset of chronic illness, and suffer less psychological strain as a result. However, the role of a spouse as a support source may change over time, e.g. if marital quality decreases with declines in spousal health, spouses who act as caregivers experience burnout, or individuals adjust to living with a health condition through self-care.
We test these premises using recent longitudinal survey data for Australia. We find that for both men and women chronic conditions are associated with poorer mental health and marriage is associated with a health premium relative to singlehood, divorce, separation and widowhood. Critically, the effects of having a chronic condition on mental health are smaller when individuals are married compared to unpartnered or in de facto relationships. There were however no differences when individuals were in de facto relationships and when individuals were unpartnered. We also find that this protective effect of marriage changes over time and in gendered ways.
We conclude that, while the observed mental health gains associated with being married are relatively small for single individuals, without intervention, their cumulative effects over the population may result in substantial societal costs.
January 16, 2017