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I. M. A. JOUNG, K. STRONKS, & H. VAN DE MHEEN Erasmus University Rotterdam
F. W. A. VAN POPPEL Netherlands Interdisciplinary Demographic Institute*
J. B. W. VAN DER MEER AND J. P. MACKENBACH Erasmus University Rotterdam
The aim of this study is to estimate the relative contributions of psychosocial conditions, material circumstances, and health behaviors to differences in physical and mental health by marital status. Data on 3,510 Dutch persons who were part of the GLOBE study, aged 25-74 years, are used. Multiple logistic regression models show that never-married, divorced, and widowed men have higher morbidity rates than married men. For women, the health differences are almost solely due to excess morbidity among divorced women. We found that psychosocial conditions contributed most to the explanation of morbidity differences among men (25%-SO%), but material circumstances contributed most among women (50%-100%).
Key Words: health behaviors, marital status, material circumstances, psychosocial factors, self-reported health, social causation.
Mortality differences among marital status groups were first described in the previous century (Farr, 1858) and have been the focus of many studies since (Ben-Shlomo, Davey Smith, Shipley, & Marmot, 1993; Carter & Glick, 1976; Gove, 1973; Hu & Goldman, 1990; Rogers, 1995; Rosengren, Wedel, & Wilhelmsen, 1989; Trovato & Lauris, 1989). Morbidity differences among marital status groups also have been studied (Anson, 1989; Morgan, 1980; Verbrugge, 1979; Wyke & Ford, 1992). Results from these studies show that morbidity differentials largely have patterns similar to mortality differentials: Married persons have the lowest rates, divorced persons have the highest rates, and never-married and widowed persons have rates in between.
Several longitudinal studies have provided evidence that marital status is causally related to health outcomes (Ben-Shlomo et al., 1993; Ebrahim, Wannamethee, McCallum, Walker, & Shaper, 1995; Goldman, Korenman, & Weinstein, 1995; Jagger & Sutton, 1991; Martikainen & Valkonen, 1996; Schaefer, Quesenberry, & Wi, 1995; Tucker, Wingard, Friedman, & Schwartz, 1996). In these studies, researchers found that, after controlling for initial health status, married persons have a longer survival time and a lower incidence of health problems than unmarried persons. The effect of marital status on health generally is assumed to be mediated by psychosocial factors, material circumstances, and health behaviors (Gerstel, Riessman, & Rosenfield, 1985; Goldman et al., 1995; Lillard & Waite, 1995; Ross,...