"That will be us someday!" It's the sweet wish of a young couples when they spy older couples on the street, in restaurants, on the dance floor who still seem to be in love.
But the other side of that wish is this: love may have no expiration date, but all people do. Death of a partner is most likely to happen in old age, more likely to happen to older women, and is often considered to be one of the most traumatic events a person can experience. This sort of loss, or bereavement, is often related to Major Depressive Disorder (clinical depression). The most recent version of the Diagnostic and Statistical Manual (DSM-V) removed the "bereavement exclusion": thus a grieving person who exhibits the symptoms of depression may receive that diagnosis even though these symptoms are a normative response to loss of a loved one. Fried, Bockting, Arjadi, Borsboom, Amshoff, Cramer, Epskamp, Tuerlinckx, Carr, and Streoebe (2015) note that we often assume bereavement causes a person to have depression, and depression produces symptoms. This is called the "Common Cause Hypothesis" because all symptoms are thought to come from one situation: depression. However, the authors caution us that this hypothesis may not be appropriate because there are thousands of symptoms that depressed people may have, these may contradict each other (e.g.; some depressed people eat too much while other depressed people don't feel like eating at all), and risk factors, such as suicide, may vary depending on the constellation of symptoms that an individual exhibits. Instead, Fried et al. (2015) encourage us to consider a Network model. From this view, bereavement would cause symptoms, and these symptoms would create situations, such as depression. These symptoms could also interact with (influence) each other to produce such situations. To test these two viewpoints, the authors used data on depression symptoms from the Changing Lives of Older Couples (CLOC) study. First, they compared the scores on a depression test from 241 widowed seniors (from Follow-Up 1) to 274, age- and gender-matched, married seniors (from Follow-Ups 1-3). The majority of the participants were female and senior citizens. When these individuals joined the CLOC study there was no difference in their reported depression symptoms, but in the follow-up interviews, six months after the death of a spouse the bereaved seniors demonstrated slightly more of these symptoms compared to the seniors who were still married. In fact, 84 of the widowed seniors exceeded the criteria for Major Depressive Disorder by endorsing at least six symptoms. The most commons symptoms were: feeling lonely; feeling sad; feeling depressed; having trouble motivating themselves; problems sleeping; problems eating. Then Fried et al. (2015) applied complicated statistical models to see if the Common Cause or the Network frameworks would best explain the relationship between bereavement, depression, and depression symptoms. For the Common Cause model to be supported these six symptoms should be better predicted by Depression; instead four of these symptoms were better predicted by loss itself (bereavement) lending support to the Network model. Further investigation revealed that bereavement was especially linked to one symptom, feeling lonely. These results caution us to think more broadly about depression and spousal loss in older age, especially for older women. Instead of assuming that bereavement causes depression, it may be that bereavement causes a set of symptoms including loneliness. In turn, it could be that this loneliness is what eventually leads a person to experience Major Depressive Disorder. As this week's meme suggests, true love may last forever: into old age and even when the person we love is gone. With love still in our hearts but now suddenly on our own, it is easy to see how loneliness could set in. And that is a depressing thought.
You never thought this would happen. As a teenager it was drilled into your head that having sex without using birth control would surely result in a pregnancy. Now you are an adult, you want to have a baby, and it is not happening. So what do you do? You probably talk with a doctor and maybe she suggests some infertility treatments. One of the cheaper interventions is Artificial Insemination: injecting sperm into the uterus during ovulation. This costs on average $865, although the price can vary considerably. Other interventions like In Vitro Fertilization (embryos are created from sperm and egg and then inserted into the uterus) cost an average of $8,158, with additional expenses up to $5,000 for the medication used to increase egg production prior to each treatment. Because there is no guarantee of pregnancy, these procedures may need to be repeated many times before it occurs, if it occurs at all. With yearly college tuition costing $9,000 - $30,000 it is possible to spend more trying to create your child than to educate your child.
Insurance lightens this burden for some but not everyone has health insurance or insurance policies that cover infertility treatments. As of 2016 only 15 states in the U.S. require that infertility treatments are covered by private insurance; and even in those states there are exceptions based on a woman's place of employment and the specific insurance plans offered through that workplace. In some states insurance companies' definitions of infertility (failure to conceive after a year of unprotected heterosexual sexual intercourse) also unfairly deny lesbian women coverage. Blanchfield and Patterson (2015) raised further concerns about access to infertility help and insurance coverage. They evaluated data from thousands of women who participated in the 2002, then in the 2006-2013 waves of the National Survey of Family Growth (NSFG) to determine if racial minority women (non-White) and sexual minority women (lesbian women and women who report sexual attractions that are not exclusively heterosexual) have the same access to "fertility assistance" and insurance coverage as women in related majority groups. From 2002 to the most recent wave in 2013, about twice as many White women compared to racial minority women reported getting medical assistance for pregnancy. Heterosexual women were also more likely to receive this help compared to sexual minority women. However, regardless of race or sexual orientation, women who received help reported getting the same forms of assistance, including advice, testing, fertility drugs, and Artificial Insemination. Private health insurance coverage varied by race and sexual orientation with White heterosexual women being most likely to have this financial help. In 2002, this comparative lack of insurance and related lower income failed to explain racial and sexual minority women's lower rate of medical assistance for pregnancy: even when these women could pay for these services they were less likely to receive them. However, from 2006-2013, lack of insurance coverage was enough to completely explain the persistent lower level of medical assistance for sexual minority women's infertility. In other words, if sexual minority women can pay for the treatments they are now just as likely to receive them as heterosexual women. On the other hand, even from 2006-2013 lower income and lack of insurance could only account for part of the persistent lower level of medical assistance for racial minority women's infertility. This means that even when non-White women have the means to pay they do not always get these interventions. This is particularly disturbing as White, Black, and Hispanic women have approximately the same rate of infertility (11%) and these groups represented more than 90% of the women surveyed in the NSFG. Thus with equal means to pay, these groups should have reported equal experience with medical assistance. Blanchfield and Patterson (2015) offer three possible explanations for this racial discrepancy. First, racial minority women may not have the "social support" that White women have when they are faced with infertility: if your friends and family don't suggest talking to a doctor then you are less likely to do so. Second, for Black women in particular, our nation's history of abusing Black citizens for medical testing (see for example: U.S. Military in WWII; the Tuskegee Study; Henrietta Lacks) may make them more cautious about involving the medical community in their personal lives. Finally, although it is unethical and illegal, stereotypes and prejudices about racial minority fertility may bias doctors away from discussing infertility with women from these groups. This is something that we must try to change. Along with the emotional and financial devastation that often accompanies infertility, a woman should not have to fear or be denied the chance to talk with her doctor about this condition. FURTHER READING: You can access the Blanchfield and Patterson (2015) article online or through your local college library. Resolve: The National Infertility Association offers facts and information about support groups for individuals and couples coping with infertility. The Broken Brown Egg is a blog about Black women and infertility; it also includes links to useful resources.
