Love Hurts

"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.

FURTHER READING:

The Fried et al. (2015) Journal of Abnormal Psychology article can be accessed through your local college library.

Advice from the American Association of Retired Persons (AARP) on ways to survive bereavement.

WebMD's suggestions to "Help Yourself Out of Depression." If loneliness or depression are causing you to have suicidal thoughts, it is very important that you get help. In the U.S. you can call the National Suicide Prevention Lifeline is 1-800-273-8255.

BONUS!

A TEDx talk by Dr. John Cacioppo on "The Lethality of Loneliness."

Now I Can Get Fat

At first glance this week's meme made me groan because joking about women and weight is really only funny anymore if delivered by Amy Schumer with a critical jab toward our culture.

However, as a life-span developmental psychologist, I began to wonder...do women and men gain weight after they say "I do"?  Apparently the answer is yes - although the amount is debated.  Some studies, regardless of other factors that influence weight, find a gain of about 5 lbs (2.28 kg) amongst young adult newlyweds and others estimate the gain to be up to 20 lbs (9 kg) if we follow those married young adults through midlife.

Meltzer, Novak, McNulty, Butler, and Karney (2013) devised a study to evaluate this weight gain against two competing theories to explain this trend.  The first theory is the Health Regulation Model: the argument here is that marriage encourages us to take care of each other.  If our marriage going well, we would be more likely to go to the doctor, floss, eat well, and by extension maintain a healthy weight.  Because marital satisfaction tends to decline within the first few years, that health maintenance would also decline leading to skipping the doctor, forgetting to floss, eating junk food, and by extension gaining weight.

The alternate theory is featured in our meme:  it is supposed to be funny because the bride has snagged her man and no longer has to worry about looking a certain way to attract a mate.  This is the premise of the Mating Market Model: if our marriage is going well we may gain weight because we are not interested in finding a new mate; if our marriage is going poorly we may lose weight because we are gearing up to attract a new partner within a culture that values thinness.

Meltzer et al. tracked more than 100 heterosexual young adult couples (average age 24 - which is younger than the average age of first marriage in the U.S.) for four years after their marriages.  These participants were asked to complete questionnaires about their marital satisfaction and to self-report their heights and weights to calculate their Body Mass Indexes (BMIs).  After controlling for pregnancy and childbirth, the trend of weight gain after marriage was confirmed: both men and women gained some weight after marriage, but weight gain was not in the unhealthy range.  So our meme may be correct about weight gain but incorrect to imply that only women may experience this after marriage.

Lending strength to the Mating Market Model and to our meme, the authors also found that participants who reported greater marital satisfaction were more likely to report weight gain.  If our bride (and groom) match the demographics of the Meltzer et al. study, perhaps they have the right to be smug: if they are happy with their marriage they may gain some weight and not care a bit.  The Mating Market Model was further supported by another trend in their data: when participants reported that they were "thinking of divorce" they also tended to report a lower BMI than usual.

Interestingly, unlike thoughts of divorce, levels of overall marital stress did not correlate with changes in BMI.  Using the Health Regulations Model we would have expected the couples who reported less marital stress to have steady or lower BMIs, but no such relationship was found.  The authors note this as further evidence on the side of the Mating Market Model.

However, is marriage a leading correlate of weight gain?  Currently about 51% of American adults are married (happily and otherwise) while 69% of American adults are overweight.  Thus, there must be other factors involved.  Also, if the majority of American heterosexual adults get married at some point and the majority of American adults are overweight, it also stands to reason that you don't have to be thin to get married in the first place.  If you find happiness with another person just count your lucky stars instead of counting the numbers on the scale.

Further Reading:

The Meltzer et al. (2013) study can be accessed through your local college library or as a free pdf via Research Gate.

A piece by NPR that casts a critical view on the use of BMI as an accurate assessment of weight and health.

Information about body image from the National Eating Disorder Association.  Their website has links to lots of excellent resources including this one about Size Diversity.

Find good information about health, food, and fitness from the Academy of Nutrition and Dietetics.
A post by Samantha Joel on the Science of Relationships blog:  What makes a good spouse based on psychological research.  See if you and your partner have what it takes.