Not every relationship can withstand the stress test of a serious illness of one of the partners. Studies show that if the woman receives a critical diagnosis, the probability of divorce is six times higher than for sick men.
Many studies have looked at the health effects of separation stress and divorce - but how does it look the other way round?
Even though the studies selected today are already a few years old, the magnitudes of differences between men and women were for me a new discovery that I wanted to share with you. Let us know in the comments what you think about it! Do you find it absurd or do you get similar impressions from your patients?
A prospective study (Source 1) published in the journal Cancer, conducted in 515 patients with CNS tumors, other solid tumors or multiple sclerosis who were married at the time of diagnosis did not show an overall increase in the divorce rate (12%), but the risk of divorce after diagnosis was more than 6 times higher if the woman was affected (21% versus 3%, p < 0.001).
Across all cohorts, "female gender" proved to be the strongest predictor of separation or divorce. The duration of marriage for disease correlated with separations in brain tumor patients (p = 0.0001). If separation or divorce occurred, this had a negative effect on the quality of life and treatment. Divorced or separated patients with cerebral tumors were hospitalized more frequently, participated less in clinical trials, received less multiple therapy regimens or whole brain radiation, and were less likely to die at home (p < 0.0001).
Larger work in 2015 (Sources 2, 3) evaluated data from the Health and Retirement Study (HRS), the largest publicly-accessible database on work, aging, and retirement in the USA. HRS is fascinating in itself. In the USA, it is regarded as the most comprehensive project in the field of behavioral and social sciences ever carried out. The longitudinal study began in 1992 and included over 43 thousand participants by 2010. By the end of 2017, almost 4,000 articles, dissertations, books or book chapters, and reports had been produced on the basis of the book.
On the basis of a sample of 2,701 marriages from the HRS, this study confirmed the results of the first study: a severe diagnosis (e.g. cancer, heart or lung disease, apoplexy) was accompanied by an increase in the divorce rate only for women affected. A large longitudinal cohort study in Denmark also found that cancer patients as a whole had no increased risk of divorce, but the same relationship existed again when differentiating between male and female patients (Source 4).
The above-mentioned studies come to similar conclusions: life-threatening diseases entail considerable stress, which has both physical and psychosocial effects. It can lead to marital conflict, separation or divorce, which in turn can adversely affect treatment, quality of life and survival (Sources 1).
Mental and social support from close relatives is one of the most important variables in coping with a critical illness. If it works well, it can even significantly improve outcomes. At the same time, it is particularly difficult if this support is lacking or the relationship becomes an additional source of stress. According to a meta-analysis, the extent of the impact of social relationships on mortality is comparable to the risk of tobacco and alcohol and greater than the risk of obesity and physical inactivity (Sources 5).
However, merely keeping the relationship together does not necessarily help. We know from numerous studies that quarreling in an existing marriage can have equally serious health consequences. Several examples of the relevance of supportive or tense relationships for health can be found in this article. So the question arises how many of the couples who were not counted among divorces in the studies still did not optimally support each other or needed outside help.
These things are surprisingly rarely discussed in clinical therapy settings. There is data suggesting that men are more stressed than women by caring for a sick spouse (Source 6). If the unaffected partner is overburdened, it would be better to seek professional help than to maneuver into a dead end that is burdensome for both. In addition to psychological support, domestic help or outpatient nursing services could also contribute to this. Social integration and psychological support of the sick partner could also have the effect that the unaffected partner is relieved and does not feel like the sole support.
Sources:
1. Glantz, M. J. et al. Gender disparity in the rate of partner abandonment in patients with serious medical illness. Cancer 115, 5237-5242 (2009).
2. Second Karraker, A. & Latham, K. In Sickness and in Health? Physical Illness as a Risk Factor for Marital Dissolution in Later Life. J Health Soc Behav 56, 420-435 (2015).
3. Sinclair, G. Men Are 6 Times More Likely To Leave Their Wives When Serious Illness Strikes, Studies Show. Awareness Act (2019). Available at: https://awarenessact.com/men-are-6-times-more-likely-to-leave-their-wives-when-serious-illness-strikes-studies-show/. (Accessed: 27th January 2019)
4. Carlsen, K., Dalton, S. O., Frederiksen, K., Diderichsen, F. & Johansen, C. Are cancer survivors at an increased risk for divorce? A Danish cohort study. Eur. J. Cancer 43, 2093-2099 (2007).
5 Green McDonald, P., O'Connell, M. & Lutgendorf, S. K. Psychoneuroimmunology, and cancer: A decade of discovery, paradigm shifts, and methodological innovations. Brain, Behavior, and Immunity 30, S1-S9 (2013).
6. England, P. Emerging Theories of Care Work. Annu. Rev. Sociol. 31, 381-399 (2005).