As married couples age and develop chronic health conditions, the daily demands of coping with their own health issues as well as those of their spouse may take a mental toll, according to a new study at the University of Michigan (U-M).
The study found that depression symptoms increased over time among married people who themselves had two or more chronic conditions requiring different types of self-care — such as a special diet and medications for heart disease along with pain-reducing therapy for arthritis.
When both the husband and wife had chronic health conditions, and needed different kinds of self-care from their partners, husbands fared worse. Their depression symptoms were significantly higher, but this effect was not found for wives.
For the study, the researchers used data from a long-term study of more than 1,110 older opposite-sex married couples from 2006 to 2014. They focused on conditions that have similar treatment goals focused on reducing cardiovascular risk — diabetes, heart disease, hypertension and stroke — and those with treatment goals and needs that are different from each of the other conditions — cancer, arthritis and lung disease.
While less than 10% of the women and less than 7% of the men in the study had levels of depression symptoms serious enough to suggest a need for treatment, lower-level depression is important for older people, clinicians, caregivers and adult children to understand, said Courtney Polenick, Ph.D., who led the study.
In both husbands and wives, the rise of depressive symptoms didn’t begin until a few years after the first assessment of their health and well-being.
“Our results suggest that there’s a window where, if one or both of you are managing complex conditions that don’t have similar self-management goals, it may be possible to intervene and prevent the development or worsening of depression,” said Polenick, who is part of the U-M Department of Psychiatry and Institute for Social Research.
“This might be the time for couples, and those who care for them, to emphasize broadly beneficial lifestyle behaviors that help to maintain both mental and physical health.”
For example, a woman coping with both high blood pressure and arthritis needs to make changes to her exercise routine, but her husband without such conditions could commit to making those changes along with her. Or a wife with diabetes who does most of the cooking and has a husband with prostate cancer could adopt a healthier menu for both of them.
“Research has focused on how individuals with multiple conditions, also called multimorbidity, manage their chronic health needs,” Polenick said. “But most people in later life are partnered, with similar health-related habits, and we need to understand how changing health affects the couple dynamic.”
The fact that both wives and husbands experienced significant increases in depressive symptoms as the years passed, when they were coping with differing conditions in themselves, is by itself important to understand, Polenick noted.
But the fact that wives whose husbands’ health needs differed from their own didn’t experience an even greater rise in depression is a bit surprising, she adds.
Meanwhile, husbands whose conditions had self-care needs that were different from their wives’ conditions did experience an additional rise in depression symptoms.
According to Polenick, among baby boomers or older, wives may be more used to taking the lead in caring for the health and emotional well-being of both themselves and their husbands.
But when husbands have wives who are coping with different health demands from their own, the husbands may experience less of this support than usual, worsening their stress and mental health.
“This is a reminder to step back and look at what your partner is coping with, to learn about their health conditions, to be conscious of it on a daily basis, and for grown children and clinicians to do the same,” she said. “Having that awareness, and helping one another manage health problems while watching for signs of depression, may help both members of a couple over time.”
The findings are published in Journals of Gerontology Series B: Psychological Sciences and Social Sciences.