On their wedding day they vowed to stand by each other for better or worse, for richer or poorer, in sickness and in health.
But recent research has found that as married couples get older and develop more chronic conditions the demands placed on them can lead to worsening mental health.
The study from the University of Michigan found that symptoms of depression increased over time for men and women who were married and who had two or more chronic conditions requiring different forms of care. When a married couple both have chronic conditions, each requiring different forms of care, husbands had significantly higher levels of depressive symptoms.
“We found that when wives and husbands had discordant conditions themselves, they reported significantly higher depressive symptoms over time. This increase didn’t begin until a few years after their first assessment, which suggests there may be a window where it is possible to prevent the development or worsening of depression. In addition, when husbands had one or more conditions with different self-management needs from their wives' self-management needs, husbands reported significantly higher depressive symptoms,” Courtney Polenick, PhD, lead author of the study, told Theravive.
In undertaking the research, Polenick and her team examined data from a study of over a thousand older heterosexual married couples between 2006 and 2014. The researchers focused on conditions with similar treatment goals that are centred around reducing cardiovascular risk, like heart disease, hypertension and stroke. They then focused on treatment goals or needs that differed from these like cancer, arthritis and lung disease.
“Most studies on managing multiple chronic conditions, also called multimorbidity, focus on how individuals manage their own conditions. But many older adults are married or living with a partner, so it is important to understand how multiple chronic conditions are managed and experienced within a couple,” Polenick said.
Husbands who had different health care needs than their wives were more likely to have depressive symptoms, but the same effect was not seen in wives. Polenick says this is surprising.
“In terms of couple dynamics, this study suggests that husbands may experience worse mental health when they have illness self-management needs that differ from those of their wives,” she said.
“Since wives typically provide more health-related support to their husbands than vice versa, it was somewhat surprising that wives did not report higher depressive symptoms when they had different self-management needs relative to their husbands' needs. This is a positive finding, however, in that it suggests that wives may generally show mental health resilience when they are helping partners who have different care needs from their own.”
Although less than 10 per cent of the women studied and less than seven per cent of the men studied displayed depressive symptoms serious enough to warrant treatment, Polenick says this low level of depression still needs to be recognised and addressed.
“This increase didn’t begin until a few years after their first assessment, which suggests there may be a window where it is possible to prevent the development or worsening of depression,” she said.
This might be an appropriate time for couples to engage in lifestyle behaviours than help maintain both their physical and mental health. As an example, a wife with high blood pressure who needs to change her exercise routine could have her husband who doesn’t need such changes commit to making them with her anyway. In a similar way, a wife who does the majority of the cooking and has diabetes could adapt meals to benefit both herself and her husband dealing with other health problems.
Polenick hopes to expand the research to look at a greater variety of chronic health conditions, and examine shorter time frames for conditions that could be managed by making lifestyle changes.
She argues as well as older couples, middle age couples could do more to understand what factors they can modify as they age and talk about how that could impact their emotional well-being.
“This study shows that chronic conditions with different self-management needs both within individuals and between spouses can have negative implications for mental health. These findings highlight the importance of learning about ways that older couples can best support one another in managing multiple chronic conditions, which we hope to consider in future research,” she said.
Elizabeth Pratt is a medical journalist and producer. Her work has appeared on Healthline, The Huffington Post, Fox News, The Australian Broadcasting Corporation, The Sydney Morning Herald, News.com.au, Escape, The Cusp and Skyscanner. You can read more of her articles here. Or learn more about Elizabeth and contact her via her LinkedIn and Twitter profiles.