Mind Your Body: Sick with Sadness

Two years ago, Susie Katz's husband of 47 years died. "He was a total partner in everything," she says. One of the things the 74-year-old missed the most was the ability to share little German expressions they both understood. Life without him "felt empty and lonely." But she continued to volunteer at her synagogue, started walking with a friend, and set up a game table at her Los Angeles-area home, where she teaches four mahjong classes a week.

The fact that Katz is so active—or even alive—is not to be taken for granted. The death of a partner increases one's own risk of death by 10 to 40 percent over the next few years. This "widowhood effect" is even greater in the first six months and can linger for 10 years or longer.

Yet some survivors, such as Katz, seem to remain healthy, prompting psychologists to ask whether certain people are more vulnerable than others, and whether we can diagnose and reduce such vulnerability. Now a new study reported in Brain, Behavior, and Immunity offers an important clue: Some people are genetically inclined to suffer increased inflammation in response to bereavement, while others are not.

Research has shown that acute stressors such as public speaking and mental arithmetic, as well as chronic stressors like marital problems and a history of child abuse, both heighten inflammation. This immune response, which attacks invading pathogens but can damage the body's own tissues, is thought to get a jump start when the body senses imminent danger. That's handy when a predator or enemy is about to attack and cause injury and possible infection, but a chronic state of fight-or-flight prolongs inflammation beyond its usefulness, and the body starts to destroy itself. Inflammation raises the risk of such ailments as heart disease, cancer, and rheumatoid arthritis.

Given that bereavement causes stress, stress causes inflammation, and inflammation causes disease and death, a team of researchers suspected that inflammation might partially explain the impact of widowhood on life expectancy. And they wondered if they could tell, based on genetic makeup, who would be most susceptible to the effect.

The researchers looked at 64 adults age 61 to 83, about half of whom were widowed (for two years, on average). They measured the blood levels of several inflammation-inducing molecules, including one called interleukin-6, or IL-6. The researchers also looked for different variations of a gene responsible for producing IL-6. In widows who had a low-producing variation, IL-6 concentration was no different from that in nonwidowed controls. But for those with the high-producing variation (about half the subjects), bereavement doubled the level of IL-6. The upshot? The combination of genetics and widowhood increased inflammation, even years after a partner's death.

This is the first study showing genetic susceptibility to bereavement stress, says lead author Mary-Frances O'Connor, a psychologist at the University of Arizona. Practically, actual IL-6 levels (which your doctor can easily measure) are more important than genotype for predicting health outcomes, she adds, but if we find a drug targeting the IL-6 gene, genetic testing could someday be critical.

Widowhood can also increase the risk of death by altering living arrangements and behavior. For women, loss of a spouse through death or divorce often means a loss of income, which can affect housing, health care, nutrition, and overall stress levels. A man, on the other hand, can often no longer rely on a partner who may have cooked, cleaned, looked after him, and maintained his social calendar. "In a way he's losing his primary health care provider," says Felix Elwert, a sociologist at the University of Wisconsin-Madison who studies spousal loss. (Of course, all couples are different, but the widowhood effect is generally stronger for men.)

The initial spike in mortality after a partner's death indicates that it's not just a loss of benefits but how a person adjusts to widowhood that affects health. Research shows that becoming socially isolated increases both blood pressure and inflammation, while a strong community—friends, support groups, a church—can make grieving less hard on a widow or widower.

Aside from reaching out or moving closer to loved ones, widowed individuals can take a number of steps to try to extend their lives. Studies have found that cognitive behavioral therapy, aerobic exercise, meditation, T'ai Chi Chih, and a Mediterranean diet all reduce the IL-6 level in the blood. In one study, subjects who practiced compassion meditation for six weeks felt decreased anxiety and produced fewer inflammation biomarkers when placed in a stressful situation.

Still, O'Connor's top piece of advice after losing anyone you're close to is to visit the family doctor. A checkup will pick up on signs of inflammation, as well as other health issues (widowhood increases the risk of heart disease, cancer, diabetes, and alcoholism). Medical attention is particularly urgent if you've been neglecting your own wellness while taking care of a dying partner, O'Connor notes. "It's a really critical time to think about your physical health as well as your emotional health."