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Social support shields spouse from damage of caregiving

Yolanda Spencer will be eternally grateful for the weekly visits from fellow members of the Bethel AME Church in Jamaica Plain. Without them, she's not sure how she would have survived the last eight years since her husband, Vincent, now 62, fell off a ladder and became a quadriplegic.

An accident like Vincent's ''is such a devastating thing to happen to a family," said Yolanda, adding that both of their relatives live far away. Having church members nearby ''has been really really supportive."

A pair of recent studies shows just how detrimental such caregiving can be for the health of a spouse and how close social connections -- like the ones the Spencers, who are black, have with friends from church -- can offset some of this risk.

Although marriage is generally good for health, the stress of caring for a spouse with a disabling illness can shorten the life of a caregiving spouse, Dr. Nicholas Christakis, a Harvard Medical School physician and sociologist, showed in a major study published late last month. How well one spouse fares after the death of the other hinges in large part on race, Christakis found in a separate large study, also published a few weeks ago.

While whites married to whites suffer a ''large and enduring widowhood effect" when one spouse dies, blacks married to blacks don't, probably because they have stronger social ties -- to church and to extended family -- that offset the trauma of losing a spouse, Christakis said.

Actually, it's the wife's race that really counts, according to the study, of 410,272 older couples, published in the American Sociological Review. A black man married to a white woman suffers from being widowed just as much as if he were white, because her kin might reject him after her death, Christakis suggested. But if a man, black or white, is married to a black woman, he is buffered from the widowhood effect because her black kin accept him as part of the family and continue to provide social and emotional support.

In other words, Christakis said, one of the many things a black wife does is connect her husband with her kin, putting him in a ''supportive context" that continues even after her death.

''When you marry someone, you really do marry their family," said Gail Wyatt, a professor in the department of psychiatry at the David Geffen School of Medicine at UCLA who was not part of the study. ''It's marriage in the context of other people that is the protective thing."

Many blacks and immigrant families are used to communal caregiving of the very old and the very young, Wyatt said. As immigrants adapt to American ways, however, they tend to ''shift toward the white model."

In general, research shows that marriage benefits a person's health, especially if that person is male. Married men, on average, live seven years longer than single guys, and married women, two years longer than their single sisters. Married people have better mental health than never-marrieds, too, though, again, it's men who benefit more from marriage.

But the emerging view of the link between marriage and health is more subtle than that. As Janice Kiecolt-Glaser, a professor of psychiatry at Ohio State University, put it, only half in jest, ''Marriage is good for you, except when it isn't."

In her own work, Kiecolt-Glaser has shown that wounds heal more slowly than normal in caregivers of spouses with dementia, a sign that the stress of caregiving impacts the immune system.

Researchers have long known that the death of a spouse raises, at least temporarily, the risk of death for the surviving spouse. What Christakis's team showed in the other new study was that it's not just being widowed that can ruin the health of the healthier spouse; it's the stress of caregiving as well. The causes of excess death in the caretaking spouse include accidents, suicides, heart attacks, infections, lung disease, and diabetes, according to the study of 518,240 couples aged 65 and older.

In the first 30 days after a spouse's hospitalization -- a marker for the time of diagnosis -- the risk of death for the partner was almost as great as it would be if the spouse had died. After a husband's hospitalization, a wife faces a 44 percent higher risk of death than if her husband were well, the study found. A husband faces a 35 percent increased risk.

Perhaps even more startling, a woman taking care of a husband with dementia or psychiatric illness was at greater risk of dying than if she were actually widowed. Taking care of a spouse with cancer, on the other hand, was much less deleterious to the healthier spouse, probably, Christakis said, because cancer, while potentially lethal, is often not as disabling day to day.

Suzanne Mintz has been taking care of her husband for 30-plus years, since he was diagnosed with multiple sclerosis. Over the years she has suffered four bouts of serious depression, in part because of her husband's illness, and the couple separated twice. They are now back together -- with more support, including home health aides. She said she cofounded the National Family Caregivers Association (nfcacares.org), a nonprofit advocacy organization in Kensington, Md., in part to help caregivers get the kind of support she needed.

The moral of the story is clear. Get -- and stay -- married if you can find someone to love.

Take good care of each other. If one of you gets sick or disabled, don't try to manage alone.

Get help -- and social contact -- from as many sources as you can, including churches, community groups, and social service agencies.

And if you do become widowed, try to maintain the family and community ties you had when you were married. It could be a matter of life or death.

Judy Foreman is a freelance columnist who can be contacted at foreman@globe.com.

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