Declining health and marital quality

Using a national sample of 1,298 married persons, we examined the effect of a change in health over a 3-year period on shifts in marital quality. The analysis suggests that decrements in health have an adverse influence on marital quality. Changes in financial circumstances, shifts in the division of household labor, declines in marital activities, and the problematic behavior of the afflicted individual account for much of the health-marital quality relationship. The increase in the number of disabled persons and chronically ill elderly in the United States, and subsequent primary care by the spouse, demonstrate the importance of understanding factors that may influence the quality of the care provided. One of those factors may be the extent to which declines in health affect marital quality. Studies of the possible relationships between declines in health and marital quality have conflicting results and leave a number of issues unresolved. Most research is disease-specific (e.g., Alzheimer's, cancer, low back pain, diabetes, head or spinal cord injury). While this approach provides patients with information that helps them to cope with their particular ailment (see Peyrot, McMurry, & Hedges, 1988, for an excellent example of such research), it limits our overall understanding of the way in which disease affects marital relations and the mechanisms by which it does so. The picture is complicated further by methodological problems of small sample sizes and lack of information about the quality of the marriage before the onset of disease, although a number of studies attempt to compensate for this by using a control group of healthy couples. This study addresses four questions: Does a decline in health affect the marital quality reported by the sick person? By the spouse? If so, by what mechanism do health declines affect the quality of the relationship? What factors moderate the effects of health declines on marital quality? Interviews with a national sample of 2,033 married persons in 1980 and 1983 are used here to address these questions. Unlike most studies on this topic (which are cross-sectional in design), the longitudinal data allow us to examine the impact of declines in health on changes in marital quality while taking into account preexisting factors that might contribute to the outcome. This topic should be a nonissue after the scores of studies on whether a decline in health is followed by a decline in marital quality. Several studies have shown improved or no change in marital relations (Hawley, Wolfe, Cathey, & Roberts, 1991; Johnson, 1985; Swensen & Fuller, 1992). While a larger number of studies indicate that health declines are associated with an erosion of marital quality (e.g., Peters, Stambrook, Moore, & Esses, 1990; Turk, Wach, & Derns, 1985; Wright 1991), the methodological weaknesses of this research make it problematic to advance a hypothesis on the relation between defines in health and marital quality. If marital quality does decline, four explanations are possible. First, declines in health typically involve some impairment in everyday functioning, meaning fewer hours of work and decreased income, or the diversion of income from normal household expenses to medical expenses. Declines in income and financial hardship are known to have adverse effects on marital quality. A second explanation entails a change in the division of labor in the household. The healthy individual might have to take on more of the cleaning, cooking, repairs and maintenance, and child care, while the afflicted individual performs fewer household tasks. The change in the division of labor, like most change, is in itself stressful and may be a source of marital unhappiness, especially if the healthy individual regards the new responsibilities as unfair. Third, a person in declining health may decrease shared activities that the couple finds rewarding. Shopping, visiting friends, household projects, and going out may decrease due to infirmities in the afflicted person or a decline in income. …