AJPH -- eLetters for Luoma and Pearson, 92 (9) 1518-1522

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RESEARCH AND PRACTICE:
Jason B. Luoma and Jane L. Pearson
Suicide and Marital Status in the United States, 1991–1996: Is Widowhood a Risk Factor?
Am J Public Health 2002; 92: 1518-1522 [Abstract] [Full text] [PDF]

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Marital Status and Risk of Death: Grace M Johnston (17 September 2002)

Marital Status and Risk of Death 17 September 2002

Grace M Johnston,
Associate Professor
Dalhousie University, Halifax, Nova Scotia, Canada
Send letter to journal:
Re: Marital Status and Risk of Death

Grace.Johnston{at}Dal.Ca Grace M Johnston

The Luoma and Pearson <1> article highlights the critical need to examine the association between marital status and death rates. In the 1980’s, I carried out a case-control study on this topic. However, I never submitted the findings from my doctoral dissertation <2> for publication. This letter is prompted by my assumption that it is never too late to share findings that shed light on questions that still require answers.
Figure 1 in the Luoma and Pearson article shows higher suicide rates for both widowed and divorced young men compared to their married and never married peers. The suicide rates are highest for widowed men, but their absolute numbers are relatively small. They recommend that spousal bereavement be a marker of potential risk of suicide and that interventions be considered in places such as funeral homes. They state that “Unfortunately, surveillance data are not available with which to examine whether people suffering losses other than spousal bereavement might also be at increased risk of suicide.” The patterns of increased suicide parallel the typically observed distribution of increased risk of death after the loss of a spouse.
In my longitudinal study of men 25 to 44 years in Alberta, the odds ratio of death was higher for marital status categories not typically available from cross sectional studies as well as for the widowed and divorced compared to married.
Spousal Status Odds Ratio P Value Had Temporary Separations 8.44 <.05 Widowed 5.06 ns* Divorced 2.38 <.001 Single 2.68 <.001 Remarried 1.69 <.10 Married 1.00 -- * As in the Luoma and Pearson study, the numbers of widowed men was very small (3 cases, and 1 control); hence the non significant finding.
The Alberta case-control study found an increased risk of death in the two years immediately after the loss of a spouse (OR=1.54), but also more than six years after the loss (OR=2.22), compared to 3-5 years after the loss. This rise in death rate some time after the loss of the spouse could be explained by selection into remarriage of the most healthy young men soon after the loss of a spouse.
Public health officials may wish to consider mortality prevention interventions for younger men with any spousal loss, and to be vigilant not only immediately after the loss, but also some years later particularly if remarriage has not occurred.
1 Luoma JB, Pearson JL. Suicide and marital status in the United States, 1991-1996: Is widowhood a risk factor? Am J Public Health. 2002:92:9
2 Johnston G. Increased risk of death after the loss of a spouse: Theory development and testing. Doctoral Dissertation. London, Ontario: University of Western Ontario, 1988, pp. 267, 310.