Friday, March 2, 2018

#38 much on marriage: health effect (or not), spousal ratings of their own, who gets married





Good morning.

I guess it's commonly known among people who study such things, but I wasn't aware that "married people tend to be healthier than both the previously (bereaved, divorced, and separated) and never married."  Why this is so has been unclear, so "research has increasingly focused on how psychological stress experienced by unmarried versus married individuals may differentially impact physiological systems related to health."  The study appeared in a journal article in Psychoneuroendocrinology, The Official Journal of the International Society of Psychoneuroendocrinology, with a charming title that makes sense but sure wouldn't attract a lot of non-science readers:  "Marital status as a predictor of diurnal salivary cortisol levels and slopes in a community sample of healthy adults."  The background:

Compared to those who are married, numerous studies document higher rates of morbidity and mortality among previously and never married individuals.  Previously married individuals experience increased social isolation, a loss of social support, and stigma related to their separation.  Individuals who are never married also experience stigma and discrimination based on their non-normative marital status.  Recent interpretations of this literature suggest that the health benefits of marriage are partly or wholly attributable to better health in the happily married.  However, there are reasons that married people might be healthier irrespective of the quality of their relationships such as their access to health insurance, contact with a broader social network, and more regular routines.  Either way, this literature suggests that unmarried individuals are subject to experiencing multiple sources of stress that might put them at risk for disease and death.  [Citations omitted.]

A study by researchers from Carnegie Mellon University and the University of Pittsburgh found that stress may indeed be one reason why there is a difference.  What they learned, in a pretty decent study (methodologically speaking), was that married individuals have lower levels of cortisol than do the never-married or previously-married (divorced, separated, widowed) and that the rhythms of cortisol in the body vary by marital status (it drops off more rapidly during the day for married folks).  ("Married" includes couples living together in a marital-like relationship.)  Cortisol is a hormone produced by the body that is central to modulating stress.  "Increased cortisol production and disruption of cortisol's daily rhythm have been linked to poorer health outcomes."  (The quality of the marriage seems not to matter.)

The researchers note the limitations of their study.  It's observational (using saliva analyses), so they can't draw an inference about the causal direction (does marriage reduce cortisol levels or do people with lower cortisol levels marry at a higher rate?), although the proposition that cortisol levels affect who gets married seems implausible.  There's no evidence that there are behavioral effects from varying levels of cortisol.  They also used a relatively young sample (ages 21-55) and selected for good health, so "the current results may not be generalizable to older or less healthy populations."  It may also be that it's more socially acceptable to be unmarried at age 60 than at age 30.  Finally, they assume that "cortisol may be an important mediator of the association between marital status and health outcomes."  They do note, however, that "there is increasing evidence that elevated levels of cortisol and flatter cortisol rhythms may play a role in other important health outcomes including cardiovascular risk."

Interestingly, there was no difference in perceived stress between the married and the never married (but there was elevated perception of stress among the previously married).  The authors didn't expect that result; they observe that it may have been a function of the instrument they used to measure stress.  Seems to me it's also possible that the never married weren't as bothered—not missing something they didn't have and perhaps didn't want—while the previously married were, knowing what they missed and how they fare socially in comparison to when they were part of a couple.  Being a "one" in a world of "twos" is not always fun, especially if your social world is comprised primarily of "twos.".

They did not report results by sex.  I think that's unfortunate.  Given what seems to be the case for friendships, and that single women do better than single men at least psychologically and on tables of morbidity and mortality, it seems to me likely that women would have fewer stressors (and lower levels of cortisol) than men.  The lack of difference in perceived stress might also be accounted for by single women who aren't especially stressed by their status.  I wrote to one of the authors of the study, asking why they didn't control for sex.  He wrote back and said they did—and found no difference.

This research is hardly a brief for getting married if one is not otherwise inclined to do so.  The research also doesn't speak to those who are over 55 (as the authors explicitly point out).  One can imagine that the period when you're between 21 and 55 is the time you're most likely to be concerned about social and relationships status.  Are people of my vintage, over 60, less worried about such things?  Because in many cases they are largely settled?  (In my case, I was extremely alarmed at my status after the divorce, at age 55, but that was because I wanted to be married and liked being married, not a question of social stressors per se.) 

            I had to go look for myself and found that whoever wrote the Wikipedia article on "Marriage and Health" did a good job of reviewing the literature.  The summary statements (citations omitted) are clear: 

Marriage and health are closely related.  Married people experience lower morbidity and mortality across such diverse health threats as cancer, heart attacks, and surgery. . . .  The health-protective effect of marriage is stronger for men than women.  Marital status — the simple fact of being married — confers more health benefits to men than women.  Women's health is more strongly impacted than men's by marital conflict or satisfaction, such that unhappily married women do not enjoy better health relative to their single counterparts.  Laboratory studies indicate that women have stronger physiological reactions than men in response to marital conflict.

So looking at the research population by sex would have been enlightening.  I can only reconcile their findings of no difference by sex with other social science research about how single women fare better than single men by concluding it's the age limit in their study. 

            The findings on marriage and health are, incidentally, a subset of the general finding that "social relationships more broadly have a powerful impact on health. . . .  Those with stronger social relationships had a 50% lower risk of all-cause mortality.  Conversely, loneliness is associated with increased risk for cardiovascular disease, and all-cause mortality."  There hasn't been much research on health benefits of marriage vis-à-vis friendships or vis-à-vis cohabiting couples (or on same-sex marriages). 

However, there are several reasons why marriage may exert a greater health impact than other relationships, even other cohabiting relationships:  married couples spend time together during a wide variety of activities, such as eating, leisure, housekeeping, child-care and sleep.  Spouses also share resources and investments such as joint finances or home-ownership. Relative to other relationships, the increased interdependence of marriage serves as a source for more intense support.  Romantic couples who live together, but are unmarried, may represent a middle ground in health benefits between those who are married, and those who self-identify as single.

            One cannot conclude, however, that the health risks for single older (than 55, say) women are greater than those of their married counterparts.

* * *

            Now comes other research on marriage with conclusions that run in the opposite direction!  A professor of pediatrics at the Ohio State medical school published research this year suggesting that the health benefits of marriage have declined in recent decades to the point where it may not even exist.  Even though past research demonstrates that married people, on average, are healthier, and for a multitude of reasons, Dmitry Tumin reports that studies of the effects of marriage on health in the last decade or so have led to increased doubt about the existence of the effect.  (Even the research suggesting a health benefit finds that marriage brevity, and divorce, moderate it.  The research has also had to tease out the possibility that it is healthier people who tend to get married, so a marriage effect would be a spurious statistical relationship; it seems that isn't the case.)  One finding has remained reasonably robust:  long-term—but only long-term—marriages do provide a measurable health benefit for women.

            Assuming the decline exists, Dr. Tumin speculates on causes.  It may be that the role of marriage in society has changed; people in cohorts following the Baby Boomers are marrying at lower rates (especially people in lower socio-economic circumstances).  Maybe it's because getting married is simply a continuation of previous cohabitation (rather than a change from being single to being married), so there wouldn't be any marked change in health benefit.  There's also the possibility that causes of the marriage effect are being undermined by other social changes:  with the delayed marriage age, the social benefits of marriage (which affect health) are being derived in other ways, through family, friends, and unrelated roommates; younger people are also relying more on parental financial support (and reasonable financial security also contributes to better health).

            Other reasons, which seem to me plausible, is that being single (i.e., a "bachelor" or a "spinster") no longer carries the stigma that it may have in earlier decades, and that jobs can be had that provide a sufficient income for a single person to be financially secure.  (That one, however, may be true for those with jobs with salaries that are well above the minimum wage but not for those who are working for $7-8-9 per hour.  Elliott's an example; his job at the University immediately put him well ahead of a number of his friends/classmates when one takes into account both salary and fringe benefits.)

Other potential reasons for the decline in the health benefit is that there may be a decline in the quality of marriages because of the strain of expecting to have two incomes and the concomitant loss of time spent together; "against a backdrop of greater demands at home and at work, and less time spent together, today's married couples may indeed experience marriage more as a source of conflict and stress than as a resource that safeguards their health."  (I'm not so sure about this one; I know perfectly well that "for example" is no proof, but I know a large number of long-married couples where both worked and there were children involved.)

Dr. Tumin concludes: 

Among cohorts marrying between the 1980s and the 2000s, differences in general health between married and never-married adults were shown to decline, even before accounting for selection.  The marriage effect on within-person change in general health . . . also declined across successive cohorts of women, and was absent in all cohorts of men.  While these findings give further reason for skepticism about the capacity of marriage to enhance the public health, the rapid transformation of American marriage—including recent national legalization of same-sex marriage and increasing divergence in the likelihood of marriage between the socioeconomically advantaged and disadvantaged—requires ongoing monitoring of further changes in marital effects on health.

            So here are two studies that reach the opposite conclusions.  One of them is biological (measuring cortisol), the other is based on survey research.  Survey responses can be tricky to use and from which to obtain valid results; Dr. Tumin used the "Panel Study of Income Dynamics (PSID), a longitudinal survey of households. . . .  The main dependent variable is respondents' general health measured on a five-point scale (1 = excellent, 2 = very good, 3 = good, 4 = fair, and 5 = poor), and treated as a continuous variable in regression analyses.  This scale is widely used as a measure of general health that is highly predictive of later morbidity and mortality. . . .  The PSID asked heads of households to rate both their own and their spouse's health.  Spouse-rated health has been shown to predict mortality as well as self-rated health."

            My bet is that there's still a health benefit to marriage, one that's moderated in all sorts of ways, depending on the circumstances.  It's surprising to me that the second study reported finding no benefit at all for men (and citing other studies that reach the same conclusion), a finding that runs contrary to years of research.  I am highly skeptical.  I also like biology rather than surveys.

* * *

I didn't intend to dwell this much on marriage, but I was intrigued by an article in Social Psychology Quarterly titled "Do "His" and "Her" Marriages Influence One Another?  Contagion in Personal Assessments of Marital Quality among Older Spouses over a Four-Year Span" (as reported by Bloomberg).  Jeffrey Stokes, a sociologist at Illinois State University, looked at how the attitude of one spouse toward a marriage affects the attitude of the other.  Part of this is "well, duh" research (if I am positive about my marriage, and treat my wife with courtesy and affection/love and kindness, she's likely to reciprocate both in attitude and action).  But nobody had actually looked at the data.

What I found interesting—what I didn't know before—is that there has been research consistently showing that older men (that is, over 50) rate their marriages more highly than do their wives.  Stokes looked at survey responses on marriage quality from about 200 couples over age 50 (and the average length of marriage was 35 years, so clearly many of these couples were north of 50); on a 4-point scale, men scored their marriage 3.2 while women scored them 2.99.

Probably not surprisingly, the difference is less among young (hetero) couples (the data were gathered before same-sex marriage was legalized).  Of course, the gap could also widen as the couples get older.  What's also happened, perhaps reflective of these results, is that "about two-thirds of divorces are initiated by women, and the divorce rate for Americans over 50 has doubled in the past three decades.  One in four divorces now involve people older than 50."  Which, of course, can really screw up retirement plans for both of them.

The gist is that if you don't like your marriage, your view is going to affect your spouse's view.  If you like it, show it, and your spouse will likely come to like it, too (or, one hopes, grow more positive about it).

* * *

            Since I'm stuck on marriage for the moment, I can report (from Quartz) that there have been troubling data accumulating.  Two economists, Francine Blau and Anne Winkler, find that marriage is increasingly becoming a phenomenon of the upper and middle socio-economic-educational classes, not the lower ones, and particularly of college-educated women.

1960:  87% of 30- to 50-year-olds (men and women) were married
2015:  60%             "               "                      "            were married

The changes have not occurred evenly across groups.  One marked change:  it used to be that college-educated women were less likely to be married than women with less of an education.  Now college-educated women are more likely to be married than women with less education.  It isn't that the marriage rate for college-educated women increased (it declined from about 80% to 70%); what happened is that the marriage rate among less educated women plummeted (from about 87-88% to about 57/58%).  Similar changes occurred with men, but not to the same degree.

Other researchers, at the Brookings Institution, speculate that one reason for the change is that educated women have reframed marriage to be a more equitable and attractive bond.  Earlier, they could take a male-dominated relationship or have their independence—but not both.  Now they can have both, a stable marriage, raising children where they have them, and still have their independence.

            A parallel report, covered on the website MEL (which "covers sex, relationships, health, money and culture from a male point of view  even though we're not all male"), looked at marriage rates from the standpoint of income.  "While marriage rates are down across the board, the marriage rate for relatively poor, non-college-educated Americans has fallen more precipitously, meaning marriage is increasingly the province of the middle and upper classes."

            One would think marriage would be even more attractive to those with less money because of the advantages it provides (e.g., combining households, tax advantages).  But nope, it's the opposite.  During and after the most recent recession, in particular, there were a lot of "pissed-off" blue-collar workers, especially men.

            So these MEL authors spent time talking with a University of Minnesota law professor, June Carbone, who's written a book on families.  She maintains that divorce rates increased in the 1970s, as divorce laws became more liberal, but the divorce rate for college grads after 2000 returns to about what it was in the 1960s.  On the other hand, the rate increased for non-college-educated couples beginning in 1990.  Professor Carbone concludes that "lower-class relationships were becoming less stable."  She posits two kinds of stable marriages, as did the Brookings researchers:  patriarchal and egalitarian. 

Patriarchal:  The husband earns more, and he trades his income for custody rights to the children.  He's the head of the family; she takes care of the household.  If they divorce, she gets a share of his savings, while he gets custody.  They both see it as a good deal.

Egalitarian:  The second model is both spouses are in the workforce and both have a good income.  And both help out with the kids, taking them to doctor's appointments and dropping them off at soccer practice.

            What has happened is that the second model requires trust and stability—and many men in the lower economic-educational classes have neither:  they can't stay employed, so they're harder to trust because their economic status is so uncertain. 

            Another difference is the circumstances of pregnancy.  Before the advent of widely-available birth control, many marriages were born of pregnancy.  Once it became available, the age of marriage increased.  Conversely, the rate of pregnancy among college-educated women declined—but the average age of pregnancy for women who did not go to college stayed the same.  At the same time, those women became less likely to marry the father.  Why?  Because there was no financial incentive to do so (in terms of the father having a job).  The blue-collar guys are less likely to be employed and their incomes declined—so the possibility of a stable relationship declined as well.  Women now rely more on themselves; for one thing, they can more easily earn an income, unlike in the past. 

Now, blue-collar American women have to work.  They didn't have to in the 1950s. They don't have the option of not supporting themselves.  And it creates this unhappiness in blue-collar women that started in the '90s and accelerated afterward.

Men earn less but, in that socio-educational class, Professor Carbone says, expect women to do the housework.  Women, seeing men earning less, tend not to think that is a good idea.  So they don't get married.  "The farther down the economic ladder, the more traditional the marriage arrangement.  Both lower-class men and women think if they get married, she's going to do the bulk of the housework. But if they're single and just roommates, the responsibility doesn't fall to her."

            What's happened, Professor Carbone contends, is that "marriage is kind of a status symbol for the rich now.  There's this cultural shift among upper class, where high-status men want to marry high-status women.  Their ideal partner is a professional woman who's close to your equal (but who won't show you up)."  She notes that "the only group in American society for whom marriage rates have gone up are the top 10 percent of women in terms of income, mainly because ultra-rich men find them so desirable."

            One can make a good argument that this trend is not good for the nation.  It is unlikely good for the children.  It is not good for the health of the men (women do better on their own than men do).  It is not good for politics when there is a group of angry, unhappy citizens.  The data are also an excellent argument for job/retraining/educational programs.

Gary


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