Scottish Longitudinal Study
Development & Support Unit

Current Projects

Project Title:

Does the widowhood effect start before spouse bereavement?

Project Number:



Zhiqiang Feng (University of St Andrews)
Chris Dibben (University of Edinburgh)
Gillian Raab (University of Edinburgh)
Dawn Everington (University of St Andrews)

Start Date:

12 February 2015



Previous literature has consistently found elevated mortality among surviving spouses following the death of a spouse, or the ‘widowhood effect’. Death of a spouse significantly raises a person’s risk of death and poor health. Loss of spouse is not only a stressful event but also leads to loss of social and material support, and role change. The risk of death varies by gender and the widowhood effect is especially pronounced in men instead of women (Martikainen & Walkonen, 1996). There has been debate on whether the widowhood effect is causal for the higher mortality risk may be due to the fact that couples share similar characteristics. We have used the SLS examining risk of mortality for widows/widowers to address this issue. We examined separately mortality risks by spousal cause of death. Our rationale was that the risk should vary by spousal cause of death if there is a selection effect. Our findings support that the widowhood effect is causal because we found no significant variation of mortality risks among surviving partners whose spouse died from different causes (Boyle et al 2011). The effect of widowhood on surviving spouse may happen before the death of a spouse. This is due to the fact that care of the spouse may generate considerable burden for a person, so called “caregiver burden”, which may lead to deterioration of health prior to the bereavement. However, so far little research has examined health effects on spouses before the widowhood event. One exception has uncovered that higher levels of self-reported depression and anxiety, and worse self-reported general health for spouse nearing bereavement (Williams et al 2008). No research has been carried out using objective measures from patient records. In this study we will follow the SLS members who were married in 2001 and link to ISD data to identify poor mental and physical health risks for those who suffer spousal loss in the follow-up period. Especially we will examine whether the surviving spouse suffers poor mental health before the bereavement event, and whether the negative effect varies with time to the bereavement event. We will also investigate whether living alone, living with children have any effects on risks of poor health for the spouses before the bereavement. Furthermore we will examine whether the widowhood effect varies with geographical areas such as urban rural types.


To test whether poor physical and mental health is more common among men or women who are widowed and whether the effect occurs before bereavement.

Specific research questions:

  • Are people who lost their partners at higher risk of death, poor physical health and mental health?
  • Are effects in terms of depression/anxiety occuring before the death of partners?
  • Do effects in terms of depression/anxiety vary with the time to the death event and time after the event?
  • Do effects vary over geographies such as urban rural types?
  • To what extent illness before the death of partner is predictive of early mortality of survivor?


Boyle, P J. Feng, Z and Raab, G.M (2011) Does Widowhood Increase Mortality Risk? Testing for Selection Effects by Comparing Causes of Spousal Death. Epidemiology, 22, 1-5

Manor O, and Eisenbach Z. 2003, Mortality after spousal loss: are there socio-demographic differences? Social Science and Medicine. 56 405-13

Manzoli L, Villari, P. Pirone, G. M. & Boccia, A, Marital status and mortality in the elderly: a systematic review and meta-analysis, Social Science & Medicine, 64. 77-94

Mineau, GP, Smith, KR, Bean, LL, 2002 Historical trends of survival among widows and widowers, Social Science and Medicine, 54, 245-254

Pizzetti P. & Manfredini, M, “The shock of widowhood”? evidence from an Italian population (Parma, 1989-2000), Soc Indic Res. 85 499-513

Williams BR, Sawyer P, Roseman JM, et al. Marital status and health: exploring pre-widowhood. J Palliat Med. 2008;11(6):848–856.

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