The Receipt of Care, Spousal Health, and Depressive Symptoms in Later Life

Background and Purpose: Those who have spouses with depressive symptoms or declines in their physical health are at increased risk of becoming depressed. Older adults who rely on daily living help from spouse, may be more likely to be influenced by their spouses’ physical and mental health than those who do not need care from their spouses. This may be because care-receiving older adults grow concerned about their caregivers and perceive themselves as burdens on their caregivers as the health of their caregivers declines. However, little research has investigated the role of care-receiving in the effects of spousal health on the other partner. Using social contextual models of depression (Coyne, 1976, 1984; Tower & Kasl, 1996) as a theoretical framework, the present study examines how the physical and mental health of spouses differentially affects depressive symptoms among partners according to care-receiving status.

Methods: The sample consists of older adults within the United States, aged 51 and over, from the six waves of the Health and Retirement Study (HRS) between 2000 and 2010 (n=15,044). Spousal physical health was measured on the basis of functional impairment, number of health problems, and self-rated health. Spousal mental health was measured using the CES-D scale. Respondents’ depressive symptoms were assessed by the CES-D scale. Control variables included respondents’ age, race, educational attainment, and health characteristics (functional impairment, number of health problems, and self-rated health). A Linear Mixed Model with random intercept was used to test an analytic model that focused on the moderating effects of the receipt of care. Multiple imputation was used to address issues related to missing data.

Results: The results indicate that spousal physical and mental health is significantly associated with the depressive symptoms of wives and husbands. For wives, their husbands’ functional impairment and depressive symptoms were significantly associated with the wives’ depressive symptoms (β=0.04, p<0.001; β=0.13, p<0.001 respectively). However, the receipt of care from husbands did not moderate the effects of spousal physical and mental health on the depressive symptoms of wives. For husbands, wives’ functional impairment, self-rated health, and depressive symptoms were significantly related to higher levels of depressive symptoms for husbands (β=0.02, p<0.01; β=0.02, p<0.05; β=0.08, p<0.001 respectively). In addition, the receipt of care moderated the effects of wives’ mental health on husbands’ depressive symptoms (β=0.06, p<0.001). That is, deterioration in wives’ mental health is associated with greater increases in depressive symptoms for husbands who receive care from their wives than for those who do not.

Conclusions and Implications: This study found gender differences in reference to responding to changes in spousal mental health when older adults receive care from their partners. If husbands receive care from their wives, they are more sensitive to changes in their wives’ depressive moods than those who do not receive care from wives. The findings support the understanding that the marital relationship is an important social context for the development of depressive symptoms in later life. Implications for future research and practice will be discussed.