HARVARD GAZETTE ARCHIVES

Jeanne and Fred Ide had to deal with the emotional as well as physical realities of a seriously ill spouse. A recent study by researchers at Harvard Medical School and the University of Pennsylvania shows that the impact of a spouse's illness on his or her partner's health can be as bad as or worse than it would be if the spouse had died. (Staff photo Justin Ide/Harvard News Office)

The study, by researchers at Harvard Medical School and the University of Pennsylvania, shows that the impact of a spouse's illness on his or her partner's health can be as bad as or worse than it would be if the spouse had died.

A man's hospitalization for a psychiatric disease had the worst impact on a wife's health, increasing her risk of dying during the study's nine-year course by 32 percent. His death, by contrast, only increased her risk of dying 17 percent.

A woman's hospitalization for dementia had the worst impact on a husband's health, increasing his risk of dying by 22 percent, similar to the increased risk from her death, 21 percent.

Nicholas Christakis, the study's lead author, said the findings highlight the extent to which we're all interrelated. They also point the way to new interventions to help caregivers handle the extra burden of an ill spouse or deal with the trauma of a spouse's death. (Staff photo Maggie Mastricola/ Harvard News Office)

Researchers said the increased risk for those and other conditions included in the study is likely due to the stress of providing care for someone incapable of caring for him- or herself. Researchers studied the impact of several diseases on a husband's or wife's risk of death. They found a decreasing risk for illnesses that require less care-giving - even those that are still potentially serious, such as colon cancer or lung cancer, neither of which had an effect on the spouse's risk of death.

The diseases with the worst impact on the husband or wife's health were dementia, psychiatric disease, hip or other serious fracture, chronic obstructive pulmonary disease, and congestive heart failure.

While the "caregiver burden," or the health effect on a partner when a spouse becomes ill, and the "widower effect" - the chances a survivor will die after a spouse's death - have each been studied separately, the new study is the first to examine them together.

Nicholas Christakis, the study's lead author, said the findings highlight the extent to which we're all interrelated. They also point the way to new interventions to help caregivers handle the extra burden of an ill spouse or deal with the trauma of a spouse's death.

Understanding the impact contracting a particular illness has on a person's spouse will allow the design of interventions aimed at keeping the spouse healthy, said Christakis, a professor of medical sociology at Harvard Medical School, and professor of sociology in the Faculty of Arts and Sciences.

"The treatment of disease and prevention of disease may reap more benefits than we have ever considered," he added.

The study, conducted by Christakis and Paul Allison of the University of Pennsylvania Sociology Department, was the largest on the subject to date. Christakis and Allison used Medicare records to track the health of 518,240 couples over age 65 for nine years, from 1993 to 2002. During that time, 383,480 husbands and 347,269 wives were hospitalized and 252,557 husbands and 156,004 wives died. The study, released Wednesday (Feb. 15), was published in the Feb. 16 New England Journal of Medicine.

The causes of the health declines for the "healthy" partner in the current study could come from many causes. The burden of giving care or stress from a spouse's death could cause a withdrawal from social networks and an increase in unhealthy behavior such as drinking, cessation of exercise, and eating unhealthy foods.

Christakis said the causes of death of the caregiving partner changed over time. Immediately after the spouse's diagnosis with a serious illness, the causes included heart attack, suicide, and accidents. Over longer periods, the causes tended to be related to underlying conditions, such as diabetes, which may be harder to manage alone or while caring for a spouse ill with another condition.

Age and poverty are also factors in the partner's health, the study showed. The negative effects of a spouse's illness on the partner's health increased as couples grew older, the study showed. Poverty also impacted a wife's health, increasing the risk of her dying after a husband's hospitalization.

Christakis said the work is part of a larger body of research on the health of people in social networks and on the nonbiological spread of disease. Such social effects can have a significant impact on a person's health, Christakis said. He offered the example of friends of a woman diagnosed with breast cancer all going out and getting mammograms, potentially discovering tumors earlier than they otherwise would have been found.

"These are a huge set of issues of fundamental social science interest that shed light on the workings of society," Christakis said.

In another example, Christakis said earlier research on the impact of a spouse's death on the survivor showed that giving a terminally ill spouse a "good death" - one that is pain-free, one in which the dying person knows what to expect, and one in which they don't burden their surviving loved ones - actually reduces the risk of death in the surviving spouse.