Journal of Women & Aging

ISSN: 0895-2841 (Print) 1540-7322 (Online) Journal homepage: https://www.tandfonline.com/loi/wjwa20

Depressive symptoms among elderly men

and women who transition to widowhood:
comparisons with long term married and long
term widowed over a 10-year period

Jiao Yu, Eva Kahana, Boaz Kahana & Chengming Han

To cite this article: Jiao Yu, Eva Kahana, Boaz Kahana & Chengming Han (2019): Depressive
symptoms among elderly men and women who transition to widowhood: comparisons with long
term married and long term widowed over a 10-year period, Journal of Women & Aging, DOI:
10.1080/08952841.2019.1685855

To link to this article: https://doi.org/10.1080/08952841.2019.1685855

Published online: 31 Oct 2019.

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JOURNAL OF WOMEN & AGING
https://doi.org/10.1080/08952841.2019.1685855

Depressive symptoms among elderly men and women

who transition to widowhood: comparisons with long term
married and long term widowed over a 10-year period
a
Jiao Yu , Eva Kahanaa, Boaz Kahanab, and Chengming Hana
a
Sociology Department, Case Western Reserve University, Cleveland, Ohio, USA; bPsychology
Department, Cleveland State University, Cleveland, Ohio, USA

ABSTRACT KEYWORDS
This study explores gender differences in mental health sequelae Depressive; symptoms;
of transition to widowhood among old-old retirement community gender; differences;
dwellers. Data are based on a prospective panel survey of 748 older widowhood
adults (mean age = 78) with follow-ups over a 10-year period.
Mixed-effects models suggest that elderly widows and widowers
experienced sharp increases of depressive symptoms subsequent
to spousal loss. Men showed stable increases of depressive symp-
toms after widowhood whereas an inverted U-shape curve of
depressive symptoms was prominent for older women. Findings
indicate that women are more resilient and are better able to cope
with spousal loss than are their male counterparts.

Introduction
The focus of our study is on gender differences in depressive symptoms after
transition to widowhood in a sample who were close to age 80 at baseline. We
obtained data during a 10-year period of annual follow-ups. We were interested in
learning about the experience of widowhood in late life for older adults who live
dispersed from their families after retiring to the Sunbelt. These elders are called
upon to deal with the aftermath of bereavement in an age-segregated setting where
social supports must come from peers rather than family. There is very limited
longitudinal literature that would chart the impact of losing one’s spouse over
a longer period of time among old-old individuals (over age 85 at final follow-up).
We obtained data during a 10-year period of annual follow-ups thereby filling an
important research gap.
The stressful nature of bereavement in general and loss of a spouse in
particular have been well-recognized in the sociological literature (Lee,
DeMaris, Bavin, & Sullivan, 2001; Lopata, 1996). Indeed, widowhood has long
been acknowledged as one of the most stressful life events (Holmes & Rahe,
1967). As a consequence of the psychological upheaval brought about by
widowhood, studies have consistently demonstrated increased levels of

CONTACT Jiao Yu jiao.yu@case.edu Department of Sociology, Case Western Reserve University, 10900
Euclid Avenue, Cleveland, OH 44106
© 2019 Taylor & Francis
2 J. YU ET AL.

depressive symptoms among those individuals who experienced loss of their

spouse (Carnelley, Wortman, & Kessler, 1999; Das, 2013).
While the literature on the impact of widowhood has been largely cross-
sectional (Balkwell, 1981; Earle, Smith, Harris, & Longino, 1997; Spahni,
Morselli, Perrig-Chiello, & Bennett, 2015), there have been a number of short-
term longitudinal studies that explore the mental health consequences of experi-
encing widowhood (e.g. Carr, House, Wortman, Nesse, & Kessler, 2001; Lee &
DeMaris, 2007). Longitudinal research on the subject is particularly important
since widowed individuals are likely to differ in many ways from their long-term
married counterparts who are typically used as the comparison group in cross-
sectional studies. Furthermore, the trajectories of depressive symptoms can only
be studied by using the long-term longitudinal follow-ups.
Based on longitudinal research it has been established that dramatic increases
in depression typically appear in the aftermath of losing a spouse (Van Der
Houwen, Shut, van den Bout, Stroebe, & Stroebe, 2010). These increases have
been found to be sustained during the first year subsequent to bereavement. The
adverse effects of bereavement on mental health appear to be attenuated as time
goes on. (Utz, Carr, Nesse, & Wortman, 2002). In order to observe changes in
depressive symptoms, it is important to follow participants for an extended time
period. Utilizing longitudinal data allows us to capture the within-person tra-
jectories of depressive symptoms that take place in a longer period of time. It is
also valuable to compare the between-person differences of depression trajec-
tories between those who transition into widowhood with those who do not,
since generally a positive association between aging and depression has been
documented in previous studies (Mirowsky & Ross, 1992; Yang, 2007). Such
comparison allows us to distinguish whether the observed increment of depres-
sion is due to aging or due to the stressful nature of widowhood.
The loss of one’s spouse not only implies a dramatic re-organization in the
social world of the bereaved person but also results in the loss of familiar and
meaningful social roles (Utz et al., 2002). Men and women may experience
different alterations of their life patterns subsequent to widowhood. The literature
on gender differences appears inconsistent. Some studies attribute much greater
ill effects subsequent to widowhood for women (Lopata, 1996), while others find
greater vulnerability among male survivors (Lee & DeMaris, 2007; Lee et al., 2001;
Umberson, Wortman, & Kessler, 1992). Furthermore, some recent studies have
reported similarities between the responses of men and women to the widowhood
experience (Sasson & Umberson, 2013). A possible reason for the discrepancy is
that studies that employed a cross-sectional design were unable to estimate the
long-term effects of widowhood on mental health. Widowhood might be devas-
tating for most people in the short run, but its effects may attenuate with time.
Since women may recover more rapidly than men (Van Grootheest, Beekman,
van Groenou, & Deeg, 1999), cross-sectional studies may only capture the
temporal association between gender and elevated levels of depression.
 JOURNAL OF WOMEN & AGING 3

Most prospective longitudinal studies of widowhood on mental health out-

comes have relied on limited waves of data and followed the participants for
several months to two or three years (Carr, 2004; Chou & Chi, 2000; Lee &
DeMaris, 2007). One exception is the study by Sasson and Umberson (2013),
which explored the long-term impact of widowhood on surviving spouses to
understand the trajectories of depressive symptoms among widows and
widowers. That study used eight waves of the Health and Retirement Study
(HRS) and followed respondents biennially during a 14-year period starting in
1994. The age range of respondents was 53–63 at baseline. Based on their midlife
to young–old sample, these researchers found no gender differences of bereave-
ment effects on depressive symptoms. Respondents in younger age groups may
experience higher rates of re-marriage than those at older ages. This may lead to
an under-estimation of the widowhood effects on their mental health.
The benefits of longitudinal data allow us to depict depression trajectories of
various marital status groups. They also permit examination of changes in depres-
sion proximate to occurrence of widowhood. In this study, we divided the sample
into those who remained continuously married during the study period, those
who were widowed at the outset of the study and continued in their widow status
and finally considered a third group who transitioned to widowhood during the
study. Benefits of using the current dataset include annual follow-ups with a highly
committed cohort of study participants that yielded very little loss to follow-up.
Given the drawbacks of cross-sectional design, this study employs prospec-
tive panel data to examine the relationship between widowhood and depressive
symptoms. Our study aims to take into account previously documented gender
differences in depressive symptoms that are independent of widowhood and are
observed cross-culturally (Hopcroft & Bradley, 2007). We examine the relation-
ship between widowhood and the trajectories of depressive symptoms of old-
old community dwelling adults over a 10-year span through comparing those
who remained married, long-term widowed and those who experienced spousal
loss. We also explore gender differences in mental health sequelae of transition
to widowhood among older adults to address the gender patterns in depressive
symptoms of the older Sunbelt retirees.

Methods
Sample
Data for this study draw from a longitudinal study of successful aging conducted
by the Elderly Care Research Center (Kahana, Kelley-Moore, & Kahana, 2012;
Lee, Kahana, & Kahana, 2017). This is a panel study of racially homogeneous
community dwelling older adults interviewed annually over the span of 20 years.
The large retirement community from which our sample was obtained is
situated on the West Coast of Florida. This community was designed to attract
4 J. YU ET AL.

healthy and independent older adults. Residents of the retirement community

are mostly working class, non-Hispanic white retirees from Midwestern states
who purchased modest condominiums after selling their homes up North. This
homogeneous group with similar racial and social economic background is
especially suitable for this study, allowing us to tease out the potential influences
of unobserved confounders of widowhood and depression.
At the first wave of the study, 1000 older adults were randomly selected from
residential listings of the retirement community to complete an in-home, face-to-
face interview by trained interviewers after obtaining informed consent. The
structured interview was of 60–90 minutes duration to assess respondents’ demo-
graphic, psychosocial, behavioral and health status. The response rate at baseline
was 77.3%. Death was the primary source of attrition for this sample. Loss to
follow-up for other reasons (e.g. moving with no forwarding address or loss of
interest in study participation) accounted for only 7% of annual attrition. This
study utilized the first 10 waves of the data. As for our analytic sample, we
excluded single and divorced respondents. We further limited our sample to
participants who were followed for at least three study waves to maintain statistical
power. Among our baseline sample (N = 748), 112 remained married across 10
waves (long-term married). 158 were widowed at the baseline and remained so
continuously thereafter (long-term widowed). There were 487 participants who
transitioned to widowhood within the 10-year study period. There were only five
participants in this sample who remarried after widowhood. We included those
participants as part of the transition to widowhood group.

Measures
Outcomes
Depressive symptoms. The outcome variable in this study was depressive
symptoms measured with a 10-item version of the Center for Epidemiologic
Studies Depression (CES-D-10) scale. The CES-D-10 (Andersen, Vestergaard,
Riis, & Lauritzen, 1994) is a brief version of the 20-item CES-D scale assessing
depressive symptoms over the past week. Participants were rated themselves on
a 5-point scale from 0 (rarely) to 5 (all of the time) about their feelings on the
following items in the last week: (1) cannot shake off the blues; (2) had crying
spells; (3) felt just couldn’t get going; (4) had trouble keeping your mind on what
you were doing; (5) felt lonely; (6) felt depressed; (7) felt sad (8) felt hopeful
about the future; (9) felt happy; (10) enjoyed life. We reverse scored the positive
items (8, 9 and 10) and then calculated the mean scores of all items together to
assess participants’ depressive symptoms. The final measure of depression
ranged from 1 to 5, with a higher score indicating a higher level of depressive
symptoms. Studies have found that the CES-D-10 scale has strong predictive
accuracy, validity and high correlations with the original 20-item version
(Björgvinsson, Kertz, Bigda-Peyton, McCoy, & Aderka, 2013).
 JOURNAL OF WOMEN & AGING 5

Predictors
The primary predictor in this study was marital status. The marital status of
participants was recorded at each wave, allowing us to construct a typology
of marital trajectory for respondents. In line with previous research (Sasson &
Umberson, 2013), we categorized these trajectories into three groups: The long-
term married (married for all waves), the long-term widowed (widowed at base-
line and continued across all waves), and the transition to widowhood group
(married at baseline and transitioned to widowhood during follow-ups). For the
participants who experienced bereavement in this panel, we marked the occur-
rence of widowhood for the specific wave as 1 and 0 otherwise. We also created
a widowhood duration variable (in years) to indicate the duration of widowhood.
We used gender as another primary predictor (0 = men, 1 = women). We were
particularly interested in assessing gender differences in the development of
depressive symptoms for the transition to widowhood groups.

Control variables
We controlled for several potential confounders, including physical health,
socioeconomic status and demographic characteristics. Physical health was
measured with baseline self-rated health and comorbidity. Participants were
asked to rate their health over last year on a scale of 1 (very poor) to 5 (very
good). Since less than 5% of our participants rated their health as “very poor”
and “poor”, we combined these two categories with “fair” health, resulting in
a 3-category variable, i.e. 1 (fair), 2 (good) and 3 (very good). Comorbidity was
measured through the chronic conditions subscale of the Older Americans
Resources Study (George & Fillenbaum, 1985). Respondents were asked whether
they had been diagnosed by a physician in the past year as having one or more of
14 chronic illnesses . These conditions include: arthritis; asthma; emphysema or
chronic bronchitis; osteoporosis; high blood pressure; heart problems; diabetes;
digestive disease; liver disease; kidney disorders; urinary tract problems; cancer;
stroke and Parkinson’s disease. We counted the number of chronic conditions at
baseline to indicate the comorbidity of participants.
Two indicators were used to assess socioeconomic status: baseline house-
hold income and years of education. Household income was measured
through a 14-category indicator ranging from under $2,500; $2,500 to
$4,999; $5,000 to $7,499; and up to $50,000 or more. Participants were
asked to select one bracket corresponding to their income level. Although
the household income is an ordinal variable, we used it as a continuous
variable in our study so that higher scores indicated higher income levels. We
also included study waves, study waves (squared) and age (in years) in our
study. For ease of interpretation and the efficiency of estimation, we centered
age at the baseline mean age (Yang & Land, 2013). Since our sample was
6 J. YU ET AL.

drawn from a racially homogeneous community, race was not included in

our analysis.

Analysis plan
The analyses were organized in three parts. First, we reported descriptive statistics
of study variables for the three marital groups. We tested for statistical differences
between long-term married, long-term widowed and the transition to widowhood
groups using χ2 test or F test as appropriate. Second, the trajectories of depressive
symptoms were estimated through mixed effects modeling analysis. This model is
especially useful to estimate both within-person trajectories and between-person
differences. We incorporated time-invariant covariates (gender, health status,
socioeconomic status and martial groups) and time-varying covariates (study
waves and age) into the analyses and specified a 2-level model. The level 1
model is a repeated observational model that estimates each individual’s trajectory
in CES-D scores as a function of waves and age. In the level 2 model, we
incorporated marital status and other time-invariant covariates.
In our analyses, we first included gender and control variables in model 1 to
assess the gender differences in the trajectories of depressive symptoms after
adjusting for demographic characteristics, health status and socioeconomic
status. Model 2 included marital groups to compare the average changes of
depressive symptoms among the three marital groups. We also added the
interactive effects of marital status and study waves to compare the rates of
change in depressive symptoms among the three martial groups. Third, to
investigate gender differences of the transition to widowhood group, we esti-
mated the mixed effects models for widows and widowers in this group,
respectively. We included widowhood occurrence (the wave when widowhood
occurred) and widowhood duration (years widowhood lasted for) along with all
covariates in the model. We were interested in examining gender differences on
the changes of CES-D scores with extended duration of widowhood.

Results
Table 1 presents the descriptive statistics of baseline CES-D and all covariates for
the long-term married, the long-term widowed and the transition to widowhood
groups. We used χ2 test for categorical variables and F test for continuous
variables to compare group differences. Women were more likely to be selected
into widowhood. Women accounted for 87% of all long-term widows. Women
also accounted for 65% in the transition to widowhood group. In contrast, in the
long-term married group, 62.5% of respondents were men. The mean ages at
baseline were also different for the three marital groups. The long-term married
group was slightly younger than the other two groups. The long-term married
group also reported higher household income than the other two groups. As for
 JOURNAL OF WOMEN & AGING 7

health status, the transition to widowhood group was most disadvantaged with
20.7% of the participants in this group reporting fair self-rated health (reflecting
relatively poor health) compared with lower frequencies of fair health reported
by the other two groups (8% and 9%, respectively). The baseline comorbidity
and education did not differ for the three groups.
In terms of depressive symptoms (shown in Table 1), the long-term married
group had the lowest levels of CES-D with the mean score of 1.5 (ranging from 1
to 5), while the long-term widowed group was the most disadvantaged group
with a mean level of 1.8 CES-D score. The transition to widowhood group fell in
between at the baseline. Figure 1 demonstrates depressive symptom trajectories
of the three marital groups. Generally, all three groups experienced increases in
their CES-D scores over time. The long-term married group was the most
advantaged at the onset of the panel and showed lower increases of depression
across 10 waves. The long-term widowed group started with the highest levels of
CES-D and remained stable with a slight increase in the last few waves. The
transition to widowhood group started at midpoint relative to the other two
groups and experienced an increase in the middle waves and slightly declined
afterward, ending with similar levels of CES-D as the long-term widowed group.
Next, we conducted mixed-effects modeling analyses to estimate the overall
effects of marital status on the trajectories of depressive symptoms and the gender-
specific effects of widowhood on the development of depression. Table 2 displays
the findings from the mixed effects regression. In model 1, we included gender
and covariates to examine the gender differences of CES-D after adjusting for
demographic characteristics, health and socioeconomic status. Compared with
elderly men, older women, on average, had 0.16 (s .e. = 0.03, p < .001) higher levels
of CES-D. Study wave was positively associated with elevated CES-D for all
participants. Each year was associated with 0.03 (s,e. = 0.01, p < .01) increases of

Table 1. Descriptive statistics of study variables for marital groups at baseline.

Long-term Long-term Transition to Group
married widowed widowhood Differences
CES-D 1.50(0.40) 1.80(0.53) 1.72 (0.50) ***
Gender
Male 70(62.5%) 21(13.29%) 168(35.15%) ***
Female 42(37.5%) 137(86.71%) 310(64.85%)
Age (in years) 76.48(3.15) 78.26(4.17) 79.85(4.79) ***
Years of education 13.67(2.58) 13.78(2.42) 13.56(2.52) n/s
Income 9.53(2.32) 7.85(2.77) 8.60(2.81) ***
Comorbidity 1.58(1.23) 1.58(1.23) 1.83(1.42) n/s
Self-rated health
Fair 9 (8.04%) 14(8.86%) 99(20.71%)
Good 63(56.35%) 85(53.80%) 247(51.67%) ***
Very good 40(35.71%) 59(37.34%) 132(27.62%)
N 112 158 478 –
n = 748. Frequencies with percentages for categorical variables and means with standard deviations for
continuous variables are reported. Group differences tested using χ2 test (for categorical variables) and
F test (for interval variables).
* p < .05, ** p < .01, *** p < .001, n/s = not significant.
8 J. YU ET AL.

Figure 1. The trajectories of CES-D scores (mean) of three groups.

mean CES-D scores in our sample. An additional year of age contributed to a 0.01
(s,e. = 0.003, p < .01) increases in mean CES-D score in model 1. Higher levels of
household income and better health were associated with lower levels of CES-D.
In model 2, we compared the CES-D of marital groups after adjusting for
gender, age, study time, health and SES. Compared with the transition to widow-
hood group, the long-term married group had significantly lower levels of CES-D
scores. The long-term married group, on average, scored 0.14 (s.e. = 0.05, p < .01)
lower than the transition to widowhood group. No significant difference was
found between the long-term widowed group and the transition to widowhood
group. The interaction terms of martial groups and wave represent the rates of
change in mean CES-D. The long-term married and long-term widowed group
showed significantly lower rates of increases in mean CES-D compared to the
transition to widowhood group. This means that the slope of depression for the
transition to widowhood group was steeper than the other two groups. Older
adults who experienced bereavement, rapidly developed higher levels of depres-
sion compared with their long-term married or long-term widowed counterparts.
We also noticed that the gender differences in CES-D scores diminished by 20%
[(0.156–0.125)/0.156] but were still significant after controlling for marital status
in the model.
As we noted earlier, gender may influence the effects of widowhood on the
development of depressive symptoms. To explore gender differences, we split
the transition to widowhood sample into gender groups and tested the gender
differences of widowhood on the trajectories of depression. Model 1 in Table 3
displays the mixed modeling results of the older men after adjusting for
 JOURNAL OF WOMEN & AGING 9

Table 2. Mixed-effects modeling of CES-D scores over 10 waves.

Model 1 Model 2
b (SE) b (SE)
Fixed effects
Women 0.156*** 0.125***
(0.032) (0.033)
Study waves 0.026** 0.034***
(0.009) (0.009)
Study wave2 0.001 0.001
(0.001) (0.001)
Age 0.009** 0.005
(0.003) (0.003)
Education (in years) −0.007 −0.008
(0.006) (0.006)
Household Income −0.019*** −0.017**
(0.006) (0.006)
Self-rated health (Fair as reference)
Good −0.144*** −0.135**
(0.043) (0.043)
Very good −0.306*** −0.290***
(0.049) (0.049)
Comorbidity 0.059*** 0.058***
(0.012) (0.012)
Marital status
(Transition to widowhood as reference)
Long-term married – −0.136**
(0.047)
Long-term widowed – 0.049
(0.041)
Rates of change
(Transition to widowhood as reference)
Long-term married*wave −0.016*
(0.007)
Long-term widowed*wave −0.023***
(0.007)
Intercept 1.980*** 1.987***
(0.102) (0.101)
Random effects
Level 1 Variance 0.352*** 0.351***
(0.004) (0.004)
Level 2 Intercept 0.337*** 0.331***
(0.012) (0.027)
Level 2 Slope 0.044*** 0.044***
(0.003) (0.003)
n = 748. Coefficients with Standard errors in parentheses are reported. Age is centered
at the baseline mean age.
* p < .05, ** p < .01, *** p < .001

covariates and widowhood characteristics. We found a booster effect of widow-

hood occurrence on the CES-D scores among older men. The CES-D scores of
older men increased by 0.64 (s.e. = 0.07, p < .001) at the year of bereavement. The
duration of widowhood was not significantly associated with their CES-D. As for
older women, both widowhood occurrence and widowhood duration were
significant predictors of depressive symptoms. Similar to older men, older
women experienced sharp increases in their CES-D scores subsequent to
10 J. YU ET AL.

Table 3. Gender differences of CES-D scores over 10 waves.

Model 1 Model 2
CES-D of Men CES-D of Women
Fixed effects
Wave 0.026 0.055**
(0.021) (0.017)
Wave2 0.002 −0.000
(0.002) (0.002)
Age 0.004 0.009
(0.006) (0.005)
Education (in years) 0.000 −0.014
(0.010) (0.011)
Household Income −0.027* −0.021*
(0.011) (0.009)
Self-rated health (Fair as reference)
Good −0.305*** −0.100
(0.076) (0.066)
Very good −0.480*** −0.269***
(0.093) (0.077)
Comorbidity 0.027 0.073***
(0.024) (0.018)
Widowhood occurrence 0.642*** 0.409***
(0.072) (0.045)
Widowhood duration −0.003 −0.039*
(0.025) (0.015)
Intercept 2.164*** 2.123***
(0.176) (0.164)
Random effects
Level 1 Variance 0.341*** 0.380***
(0.010) (0.008)
Level 2 Intercept 0.286*** 0.356***
(0.027) (0.020)
Level 2 Slope 0.051*** 0.041***
(0.010) (0.006)
Log likelihood −496.818 −1080.361
N 168 310
n = 748. Coefficients with Standard errors in parentheses are reported. Age is centered at
the baseline mean age.
* p < .05, ** p < .01, *** p < .001

bereavement (b = 0.41, s.e. = 0.05, p < .001). Unlike older men, widowhood
duration was negatively associated with CES-D scores among women (b = −0.04,
s.e. = 0.02, p < .05) and this effect was statistically significant. The finding
implied that older women adapted to spousal loss over time with decreased
CES-D scores over the period of widowhood.
Figure 2 illustrates gender differences of depression trajectories in the transi-
tion to widowhood group. It is clear that the CES-D levels of older men
continued to increase across all 10 waves and the rates of change were stable
compared to older women. In contrast, older women had higher levels of CES-D
at the baseline. They experienced increases in their CES-D scores at the begin-
ning and maintained this trend. Their CES-D scores slightly declined at the last
few waves. The CES-D scores displayed a general upward trend for both men
and women participants as they aged. However, an inverted U-shape curve of
 JOURNAL OF WOMEN & AGING 11

Figure 2. Gender differences of predicted CES-D scores for the transition to widowhood group.

depression over time was prominent for older women in contrast to the stable
increases of depression among the older men.
In longitudinal studies, attrition can be a potential factor that biases estima-
tion. In our sample we only included participants who had been interviewed for
at least three waves. This may potentially exclude the unhealthiest older adults.
We conducted sensitivity analyses and rerun all models with the original sample
including all participants. We didn’t identify any significant differences between
the results from the whole sample and the subsample we used in this study. We
also conducted the variance inflation factor test to rule out multicollinearity in
our model and all variables have vif values smaller than 10, which indicated that
multicollinearity is not likely to be a major problem in our model.

Discussion
The purpose of this study was to examine gender differences in depressive
symptoms as a function of experiencing widowhood among old-old commu-
nity-dwelling adults. Relying on 10-wave prospective panel data, we assessed
how timing and duration of widowhood were associated with the long-term
development of depressive symptoms among older participants. We compared
both the within-person depression trajectories and between-group differences.
Consistent with previous research (Sasson & Umberson, 2013), we found that
the long-term married group was the most advantaged. Long-term married
respondents enjoyed higher incomes and better subjective rated health than
did their widowed counterparts. Compared with long-term widows or
12 J. YU ET AL.

widowers, long-term married respondents reported lower CES-D scores at

baseline. They also demonstrated lower rates of increases in CES-D across the
panel. Our results indicate that long-term marriage is likely to confer benefits for
the mental health of older participants. Stability in partner relationship along
with the relative absence of negative life events and ill health were associated
with the lowest depressive symptoms in this group. These advantages may play
an important role in accounting for lower increases of depressive symptoms
reported by these elders.
It is notable that at baseline those destined to transition to widowhood in
the course of the study already exhibited much higher depressive symptoms
than did the long term married group. Indeed, they were close to scores of
the long term widowed. This is likely to be a function of ill health of the
spouse who subsequently died and the caregiving burden that may have
triggered the subsequent depression (Carr et al., 2001).
In terms of the impact of widowhood on those who recently transitioned to
this status, our findings confirm prior research (Carnelley, Wortman, Bolger, &
Burke, 2006) by documenting a steep increase in depressive symptoms among
the newly widowed. These increments appear to be attenuated over time, as has
been observed in prior research with younger samples (Minton, Hertzog,
Barron, French, & Reiter-Palmon, 2009). Accordingly, it appears that even at
very old ages (mean age of the transition to widowhood group in our sample was
79.85), people have the resilience to bounce back after the traumatic event of
widowhood (Bonanno, Westphal, & Mancini, 2011).
Social integration is likely to be an important factor in maintaining
resilience and relieving depressive symptoms for these older adults. There
is evidence from prior research that increased post widowhood support from
children and relatives as well as increased social participation may help
ameliorate adverse mental health effects of bereavement (Utz et al., 2002).
Indeed, the ill effects of loneliness in both physical and mental health have
been increasingly documented (Golden et al., 2009).
Our data are relevant to understanding the widowhood experience among
increasing numbers of older adults who relocate to the Sunbelt and live
dispersed from their families, who could provide traditional sources of social
support after bereavement. Our findings indicate that these elders manage on
their own and face limited prospects for remarriage. Given that they are
living in age-segregated retirement communities, they may rely on friends
and “fictive kin” for social supports.
Recognizing the well-established pattern of women exhibiting more depres-
sive symptoms than men across cultures and national boundaries (Hopcroft &
Bradley, 2007), we accounted for these gender differences in our analyses.
Among longitudinal studies with younger age groups, some have not observed
gender differences in depressive symptoms (Lee, Lee, Chun, & Park, 2017).
However, our findings in an older age group indicate that men appear to have
 JOURNAL OF WOMEN & AGING 13

experienced dramatic increases of depressive symptoms after the occurrence of

widowhood. Older women in our study were better able to adapt bereavement
and showed greater resilience over time than did their male counterparts.
A series of explanations have been offered for greater incidence of post
widowhood depression among men (Lee et al., 2001). These relate to traditional
gender roles prevalent among older cohorts where men fulfill the role of
breadwinner and women deal with domestic tasks, while the couple depend
on the husband’s income (Zuo & Tang, 2000). In these situations, men are likely
to derive greater emotional as well as instrumental benefits from marriage than
do women. Indeed, data based on the same sample as the current study revealed
that men are more likely to refer to their wife as the source of greatest meaning in
their lives, while women refer to family in general (Ermoshkina, Kahana, &
Kahana, 2019). Hence, men may be likely to sustain greater losses after the death
of their spouse (Umberson et al., 1992). Another explanation relates to the need
for men to assume household responsibilities after widowhood to which those in
older cohorts they are not accustomed (Lopata, 1996). Men may thus have
poorer nutrition and fewer desirable health habits after widowhood, increasing
their risk of physical illness (Bengtson, Rosenthal, & Burton, 1990). Ill health
would serve as a major contributing factor to depressive symptoms.
As for the women, after they reach retirement age, they are less likely to depend
on their husbands. Public programs such as social security provide a safety net for
older women. Even as they confront the distressing loss of a spouse, in our study
they exhibited a great deal of resilience. Accordingly, they portrayed a stable
decline of their depressive symptoms subsequent to widowhood. Even though
we found that men exhibited worsened mental health after widowhood, it is also
important to recognize that the effect sizes pointing to greater depression among
widowed men are not large. This has also been noted by previous research (Lee &
DeMaris, 2007). Even as we attempt to explain gender differences observed in this
study, it is important to recognize that gender roles have been undergoing major
shifts (Cotter, Hermsen, & Vanneman, 2011) and the present findings may not
apply to future cohorts of old-old adults.
We also note some limitations of this study. First, our study was based on
a homogenous older cohort of retirement community dwelling elderly. Our
findings may not be generalized to more diverse population. Second, a selection
mechanism might be involved in the relationship between depression and
bereavement. Men are more likely to select out of widowhood through mortality,
which can also lead to an over-representation of women in the transition to
widowhood group. The imbalanced gender distribution can be a factor that
confounds the statistical association between gender and the development of
depressive symptoms.
In conclusion, gender differences in depressive symptoms subsequent to
bereavement have long been debated in studies of late-life mental health. We
employed a 10-wave longitudinal follow-ups of a very old cohort to explore this
14 J. YU ET AL.

issue. Our findings suggest that subsequent to widowhood, there is a dramatic

decline in psychological health. Older adults who experienced spousal loss suffer
from steep increases of depression, albeit the increments appear to be attenuated
over time. Long-term marriage and stable relationship are likely to benefit the
psychological well-being of the very old adults. Second, we identify gender
differences in adjustment to widowhood indicating that men suffer greater incre-
ments of depressive symptoms subsequent to bereavement whereas women are
more likely to recover from this stressful event and return to their previous level of
mental health. Our findings underscore that women are not always exhibiting
greater vulnerability than men in response to late life stressors (Gibson, 1996).
Future longitudinal studies are needed to explore gender differences in more
diverse samples and to consider interventions that could help eliminate gender
disparities when elderly persons involuntarily exit from marriage.

Disclosure statement
No potential conflict of interest was reported by any of the authors.

ORCID
Jiao Yu http://orcid.org/0000-0001-9876-7928

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