The embodiment of parental death in early life through accelerated epigenetic aging: Implications for understanding how parental death before 18 shapes age-related health risk among older adults.

Parental death in early life has been linked to various adverse health outcomes in older adulthood. This study extends prior research to evaluate how parental death in early life is tied to accelerated epigenetic aging, a potentially important biological mechanism from which social and environmental exposures impact age-related health. We used data from the 2016 Venous Blood Study (VBS), a component of the Health and Retirement Study (HRS), to examine the association between parental death in early life and accelerated epigenetic aging as measured by three widely used epigenetic clocks (PCPhenoAge, PCGrimAge, and DunedinPACE). We also assessed whether some of the association is explained by differences in educational attainment, depressive symptoms, and smoking behavior. Methods included a series of linear regression models and formal mediation analysis. Findings indicated that parental death in early life is associated with accelerated epigenetic aging for PCPhenoAge and DunedinPACE. The inclusion of educational attainment, depressive symptoms, and smoking behavior attenuated this association, with formal mediation analysis providing additional support for these observations. Parental death in early life may be one of the most difficult experiences an individual may face. The elevated biological risk associated with parental death in early life may operate through immediate changes but also through more downstream risk factors. This study highlights how early life adversity can set in motion biological changes that have lifelong consequences.

Social Isolation: An Unequally Distributed Health Hazard.

Social isolation is a potent predictor of poor health, mortality, and dementia risk. A great deal of research across national contexts provides causal evidence for these linkages and identifies key explanatory mechanisms through which isolation affects health. Research on social isolation recognizes that some people are more likely than others to be isolated, but over the past several decades, researchers have focused primarily on the consequences of isolation for health rather than a systematic assessment of the social conditions that foster isolation over the life course. In this article, we review the available evidence on inequities in social isolation and develop a conceptual framework to guide future research on structural systems that fuel social isolation over the life course. Future work in this area has the potential to identify root causes of inequality in social isolation, as well as targeted policy levers to reduce isolation in vulnerable populations.

Parental Death Across the Life Course, Social Isolation, and Health in Later Life: Racial/Ethnic Disadvantage in the U.S.

Bereavement is a risk factor for poor health, yet prior research has not considered how exposure to parental death across the life course may contribute to lasting social isolation and, in turn, poor health among older adults. Moreover, prior research often fails to consider the racial context of bereavement in the United States wherein Black and Hispanic Americans are much more likely than White Americans to experience parental death earlier in life. The present study uses longitudinal data from the Health and Retirement Study (HRS; 1998-2016) to consider linkages of parental death, social isolation, and health (self-rated health, functional limitations) for Black, Hispanic, and White older adults. Findings suggest that exposure to parental death is associated with higher levels of isolation, greater odds of fair/poor self-rated health, and greater odds of functional limitations in later life. Moreover, social isolation partially explains associations between parental bereavement and later-life health. These patterns persist net of psychological distress-an additional psychosocial response to bereavement. Racial inequities in bereavement are central to disadvantage: Black and Hispanic adults are more likely to experience a parent's death earlier in the life course, and this differential exposure to parental death in childhood or young adulthood has implications for racial and ethnic inequities in social isolation and health throughout life.

Exposure to Family Member Deaths Across the Life Course for Hispanic Individuals.

The present study documents differences in exposure to family member deaths among foreign-born and U.S.-born Hispanic individuals compared with non-Hispanic Black and non-Hispanic White individuals. We use data from the Health and Retirement Study (HRS; 1992-2016, ages 51+; N = 23,228) and the National Longitudinal Study of Adolescent to Adult Health (Add Health; Waves I-V, ages 12-43; N = 11,088) to estimate the risk of exposure to the death of a mother, father, spouse, sibling, and child across the life course. HRS results show more inequities in exposure to family deaths compared with Add Health results, suggesting differences by age or birth cohort. Compared with non-Hispanic Whites, U.S.-born Hispanic individuals in the HRS have a higher risk of experiencing a child's death throughout adulthood and a sibling's death in later life; the latter is explained by larger sibship size, indicating a greater lifetime risk of bereavement experiences. The higher risk of parental death during childhood for U.S.-born and foreign-born Hispanic individuals is explained by covariates (e.g., lower levels of educational attainment). Hispanic individuals generally have a lower risk of family deaths than non-Hispanic Black individuals, but at times a higher risk of exposure relative to non-Hispanic White individuals.

Sleep quality moderates the association between family bereavement and heart rate variability.

Two separate bodies of literature point to the link between family bereavement and cardiovascular health and between sleep quality and cardiovascular outcomes. However, less is known about the joint influence of family bereavement and sleep quality on cardiovascular functioning. The aims of this study were to examine the relationships between experiencing the death of a family member and heart rate variability (HRV) and to further explore whether these associations differ by sleep quality. Using data from the Midlife in the United States (MIDUS) Biomarker Project, the sample for this study included respondents who experienced the death of an immediate family member - father, mother, spouse, sibling, or child - within a year before the Biomarker project and those who did not experience any deaths (N = 962). We used two measures of HRV and sleep quality was measured using the Pittsburgh Sleep Quality Index. Results showed that experiencing the death of a family member was associated with worse HRV only among those with poor sleep quality and not for those with good sleep quality. These results suggest that poor sleep quality may indicate psychophysiological vulnerability for those who experienced the death of a family member. Interventions to improve sleep quality could be effective in enhancing cardiovascular health of bereaved individuals.

Sexual Motives, Stress, and Depressive Symptoms Among Midlife Different-Sex and Same-Sex Couples.

BACKGROUND AND OBJECTIVES: Within relationships, sexual motives and stress are independent determinants of psychological health, with notable gendered patterns. However, previous research largely focuses on young adults and different-sex couples. Both sexual motives and levels of stress may be uniquely important to psychological health in midlife, and in potentially different ways for same-sex and different-sex couples. This study examined how the associations between sexual motives, stress, and depressive symptoms differ for midlife men and women in same-sex and different-sex marriages. RESEARCH DESIGN AND METHODS: Using dyadic data from same-sex and different-sex midlife married couples (N = 830 individuals; 415 couples), we examined the associations of intrinsic (e.g., sex for enjoyment and pleasure) and extrinsic (e.g., sex to please one's spouse) motives for having sex with depressive symptoms and tested whether these associations differed by levels of stress for same-sex and different-sex spouses. RESULTS: Intrinsic sexual motives were associated with fewer depressive symptoms only for same-sex married couples under high stress. Extrinsic sexual motives were related to greater depressive symptoms for women in low-stress conditions and men in high-stress conditions, and this did not differ for same-sex compared to different-sex marriages. DISCUSSION AND IMPLICATIONS: Results show that the interplay between sexual motives and stress varies for men and women in same-sex and different-sex marriages. These findings underscore the importance of considering both gender and sexuality in studying sexual motives in midlife and suggest sexual motives as a useful treatment focus for protecting the psychological health of midlife married couples.

Multiple Family Member Deaths and Cardiometabolic Health among Black and White Older Adults.

Although the bereavement literature is voluminous, we know very little about how exposure to multiple family member deaths across the life course shapes health trajectories as people age and whether unequal exposure to bereavement contributes to racial inequities in cardiometabolic health. We use longitudinal data from the Health and Retirement Study (1992-2016) to consider how multiple family member deaths before midlife shape trajectories of cardiometabolic health after age 50 for Black and white adults (n = 22,974). Results show that multiple family member deaths prior to age 50 are associated with more cardiometabolic conditions at age 50 and a faster increase in conditions with advancing age. Moreover, Black adults are significantly disadvantaged by a greater risk of bereavement and more cardiometabolic conditions regardless of bereavement status. The life course trauma of exposure to multiple family member deaths uniquely contributes to the cardiometabolic risk of Black Americans.

Gender and Social Isolation across the Life Course.

Social isolation has robust adverse effects on health, well-being, dementia risk, and longevity. Although most studies suggest similar effects of isolation on the health of men and women, there has been much less attention to gendered patterns of social isolation over the life course-despite decades of research suggesting gender differences in social ties. We build on theoretical frames of constrained choice and gender-as-relational to argue that gender differences in isolation are apparent but depend on timing in the life course and marital/partnership history. Results indicate that boys/men are more isolated than girls/women through most of the life course, and this gender difference is much greater for the never married and those with disrupted relationship histories. Strikingly, levels of social isolation steadily increase from adolescence through later life for both men and women.

Parental Death and Cognitive Impairment: An Examination by Gender and Race-Ethnicity.

OBJECTIVES: We provide the first nationally representative longitudinal study of cognitive impairment in relation to parental death from childhood through early adulthood, midlife, and later adulthood, with attention to heterogeneity in the experience of parental death. METHODS: We analyzed data from the Health and Retirement Study (2000-2016). The sample included 13,392 respondents, contributing 72,860 person-periods. Cognitive impairment was assessed using the modified version of the Telephone Interview for Cognitive Status. Discrete-time hazard regression models were estimated to predict the odds of cognitive impairment. RESULTS: Both exposure and timing of parental death were related to the risk of cognitive impairment in late life and associations vary by gender. The detrimental effect of a father's death was comparable for daughters and sons although exposure to a mother's death had stronger effects on daughter's than son's risk of cognitive impairment. Father's death at younger ages had the strongest effect on sons' late-life risk of cognitive impairment, whereas mother's death in middle adulthood had the strongest effect on daughters' risk. We found no significant racial-ethnic variation in the association between parental death and cognitive impairment. DISCUSSION: It is important to explore the gender-specific pathways through which parental death leads to increased risk of cognitive impairment so that effective interventions can be implemented to reduce risk.

Sibling Deaths, Racial/Ethnic Disadvantage, and Dementia in Later Life.

OBJECTIVES: Sibling loss is understudied in the bereavement and health literature. The present study considers whether experiencing the death of siblings in mid-to-late life is associated with subsequent dementia risk and how differential exposure to sibling losses by race/ethnicity may contribute to racial/ethnic disparities in dementia risk. METHODS: We use discrete-time hazard regression models, a formal mediation test, and a counterfactual simulation to reveal how sibling loss in mid-to-late life affects dementia incidence and whether unequal exposures by race/ethnicity mediate the racial/ethnic disparities in dementia. We analyze data from the Health and Retirement Study (2000-2016). The sample includes 13,589 respondents (10,670 non-Hispanic White, 1,761 non-Hispanic Black, and 1,158 Hispanic adults) aged 65 years and older in 2000 who show no evidence of dementia at baseline. RESULTS: Discrete-time hazard regression results show that sibling loss in mid-to-late life is associated with up to 54% higher risk for dementia. Sibling loss contributes to Black-White disparities in dementia risk. In addition, a simulation analysis shows that dementia rates would be 14% lower for Black adults if they experienced the lower rates of sibling loss experienced by White adults. This pattern was not observed among Hispanic adults. DISCUSSION: The death of a sibling in mid-to-late life is a stressor that is associated with increased dementia risk. Black adults are disadvantaged in that they are more likely than Whites to experience the death of siblings, and such losses contribute to the already substantial racial/ethnic disadvantage in dementia.

The Death of a Child and Parents' Psychological Distress in Mid to Later Life: Racial/Ethnic Differences in Exposure and Vulnerability.

OBJECTIVES: This study considered whether experiencing the death of a child is associated with subsequent psychological distress in older populations, as well as variation in both exposure and vulnerability to the death of a child among Black, Hispanic, and White older parents. METHODS: We used multilevel models to link the death of a child with subsequent distress for 9,763 non-Hispanic White, 2,496 non-Hispanic Black, 1,014 foreign-born Hispanic, and 712 U.S.-born Hispanic parents from the Health and Retirement Study, 2006-2016. RESULTS: The death of a child is associated with increased psychological distress in mid to later life for Black, White, and Hispanic parents, with greater vulnerability for foreign-born Hispanic parents. Notably, Black and U.S.-born Hispanic parents are disadvantaged because of the additive effects of their greater exposure to bereavement and their higher distress levels regardless of bereavement status. These effects persist net of additional stressors associated with race/ethnicity. DISCUSSION: The death of a child is a traumatic life course event associated with lasting psychological distress for aging parents. Black and U.S.-born Hispanic parents are disadvantaged in that they are more likely than White parents to experience the death of a child, and foreign-born Hispanic parents may be disadvantaged by greater vulnerability to distress following child death.

Support in Response to a Spouse's Distress: Comparing Women and Men in Same-sex and Different-sex Marriages.

Support for a spouse with psychological distress can be expressed in many different ways. Previous research indicates that support expression is shaped by gender, but we do not know much about how support within marriage is provided in response to a spouse's distress outside of a different-sex couple context. In this study, we analyze dyadic data from 378 midlife married couples (35-65 years; N = 756 individuals) within the U.S. to examine how men and women in same- and different-sex relationships provide support when they perceive that their spouse is experiencing distress. We find women in different-sex couples are less likely to report taking care of their distressed spouse's tasks or giving their distressed spouse more personal time and space compared to women in same-sex couples and men. We also find that men in different-sex couples are less likely to report encouraging their spouse to talk compared to men in same-sex couples and women. Being personally stressed by a spouse's distress is positively associated with providing support to that spouse, whereas feeling that a spouse's distress is stressful for the marriage is negatively associated with providing support. This study advances understanding of gendered provisions of support in response to psychological distress in marriage, moving beyond a framing of women as fundamentally more supportive than men to a consideration of how these dynamics may be different or similar in same- and different-sex marital contexts.

Psychological distress in North America during COVID-19: The role of pandemic-related stressors.

RATIONALE: The COVID-19 pandemic has wreaked havoc on lives around the globe. In addition to the primary threat of infection, widespread secondary stressors associated with the pandemic have included social isolation, financial insecurity, resource scarcity, and occupational difficulties. OBJECTIVE: The current study examined the impact of these disruptions on psychological distress during the initial adjustment phase to the pandemic in North America. METHOD: A sample of 2463 residents of the US and Canada completed both baseline and follow-up surveys across several weeks between March and May 2020. RESULTS: Those participants perceiving stress related to higher levels of personal threat to health and to the well-being of family members at baseline reported higher levels of depressive symptoms at follow-up, even after controlling for baseline depressive symptoms. In addition, pandemic-related secondary stressors (social isolation, financial insecurity, occupational difficulty, and resource scarcity) were all independently associated with depressive symptoms at follow-up, controlling for both baseline depression and perceived health threats. The results were robust and held up after controlling for demographic factors. Women, young adults, and those who reported lower income were all at higher risk for subsequent depressive symptoms. CONCLUSION: Findings from the present study can help to identify key groups at risk for mental health problems during the pandemic, and indicate actionable areas for targeted intervention.

Racial Differences in Early Parental Death, Midlife Life Problems, and Relationship Strain With Adult Children.

OBJECTIVES: Black Americans typically experience the death of a parent earlier in the life course than do non-Hispanic Whites, and early parental death is known to hinder subsequent relationship outcomes. Whether early parental death may contribute to racial differences in midlife family relationships and the role midlife adults' current life problems play remain unexplored. METHOD: Using multilevel modeling, we examined how timing of parental death is associated with relationship strain with adult children and whether the association differs by midlife adults' life problems in Black (n = 166) and non-Hispanic White (n = 467) families from the Family Exchanges Study. RESULTS: Losing a parent in childhood was associated with more relationship strain with adult children for Black midlife adults, but not for their non-Hispanic White counterparts. Among the bereaved, earlier timing of parental death was associated with more relationship strain with adult children only for Black midlife adults. In both bereaved and nonbereaved sample, participants' recent physical-emotional problems exacerbated the link between timing of parental death and relationship strain with adult children for Black midlife adults. DISCUSSION: Experiencing the death of a parent in the early life course can be an added structural disadvantage that imposes unique challenges for Black Americans in midlife. Policies and programs aimed at supporting bereaved children may benefit relationships with their own children later in life, and addressing physical-emotional problems in midlife may be a viable intervention point for those midlife adults who experienced the death of a parent in the early life course.

The Gender-as-Relational Approach for Theorizing About Romantic Relationships of Sexual and Gender Minority Mid- to Later-Life Adults.

We deploy the "gender-as-relational" (GAR) approach to enhance the study of the long-term romantic relationships of sexual and gender minority mid- to later-life adults. The GAR approach states that gender within relationships is shaped by three key factors: own gender, partner's gender, and the gendered relational context. This approach highlights that the relationship dynamics of men, women, and gender nonconforming people are highly diverse, reflecting that gender is a social construct formed within interactions and institutions. We explicate how GAR can reorganize the study of sexual and gender diversity in three research areas related to aging and relationships-caregiving, marital health benefits, and intimacy-and discuss theory-driven methods appropriate for a GAR research agenda. A GAR framework reorients research by complicating taken-for-granted assumptions about how gender operates within mid- to later-life romantic relationships and queering understandings of aging and romantic relationships to include experiences outside of heteronormative and cisnormative categories.

"Go See Somebody": How Spouses Promote Mental Health Care.

This study considers when, whether, and how spouses encourage professional mental health care by analyzing qualitative data from 90 in-depth interviews with gay, lesbian, and heterosexual spouses. Findings show that a majority of spouses are engaged in promoting each other's mental health care but that the strategies used to promote care vary by gender and the gender composition of the couple. The majority of gay men and lesbian women promote care by framing mental health problems as largely biochemical, fixable only with professional care or medicine, and work to destigmatize this care. Lesbian women uniquely emphasize the influence of a spouse's symptoms on marital quality as a reason to pursue care. Some heterosexual women and men also report seeing their spouse's mental health care as something for them to deal with on their own and thus do not encourage care. This study has important implications for researchers looking to understand why some individuals seek mental health care and others do not and provides policymakers insight into mental health interventions via spouses.

Differences in how spouses influence each other's alcohol use in same- and different-sex marriages: A daily diary study.

RATIONALE: Different-sex spouses influence each other's alcohol consumption, with women having more influence on their spouses than men. Because women drink less than men, this long-term influence partly explains why married men and women consume less alcohol than their unmarried peers. However, much less is known about possible gender differences in the ways spouses influence each other's alcohol use on a day-to-day basis in same-compared to different-sex marriages. Because sexual minority people are at higher risk for alcohol use disorders compared to their heterosexual counterparts, such knowledge could shed light on ways to reduce this risk and alcohol use disparities between sexual minority and heterosexual people. METHOD: We use 10 days of diary data collected in 2014-2015 in the United States from 157 female same-sex, 106 male same-sex, and 115 different-sex married couples in midlife (ages 35-65) to examine how one spouse's drinking influences how much the other spouse drinks on the following day. RESULTS: Men reported higher levels of daily drinking than women; after including covariates, men in different-sex marriages reported drinking at the highest levels. Results from actor-partner interdependence models show that men in same- and different-sex marriages drink more, and women in different-sex marriages drink less when their spouse drinks more the previous day. Female same-sex spouses did not change their drinking behaviors in response to their spouse's drinking. CONCLUSIONS: Overall higher rates of drinking among men in same-sex marriages suggest an accumulation effect of drinking that may contribute to sexual minority health disparities. Women and men in different-sex marriages may be engaging in social control or navigating masculinity norms. Women in same-sex marriages may not feel the need to adjust to low levels of drinking by their spouses. Findings suggest that spousal influence over alcohol consumption unfolds differently in same-sex compared to different-sex marriages.

Widowhood and mortality: gender, race/ethnicity, and the role of economic resources.

PURPOSE: We examine widowhood effects on mortality across gender and race-ethnicity, with attention to variation in the mediating role of economic resources. METHODS: Data were drawn from the Health and Retirement Study (1992-2016). The analytic sample included 34,777 respondents aged 51 years and older who contributed 208,470 person-period records. Discrete-time hazard models were estimated to predict the odds of death among white men, black men, Hispanic men, white women, black women, and Hispanic women separately. The Karlson-Holm-Breen analysis was conducted to examine the mediating role of economic resources across groups. RESULTS: Across all gender and racial-ethnic subgroups, widowhood effects on mortality were largest for Hispanic men. Black women and Hispanic women also suffered stronger effects of widowhood on mortality than white women. For both men and women, economic resources were an important pathway through which widowhood increased mortality risk for whites and blacks but not for Hispanics. CONCLUSIONS: Findings highlight that gender and race-ethnicity intersect with widowhood status to disadvantage some groups more than others. It is important to explore the complex pathways that contribute to the higher mortality risk of racial-ethnic minorities, especially Hispanic men, after widowhood so that effective interventions can be implemented to reduce those risks.

Race, death of a child, and mortality risk among aging parents in the United States.

The death of a child is a stressful and traumatic life event that has been linked to increased mortality risk among parents. Tragically, black parents are significantly more likely than white parents to lose a child in the United States; however, prior research has not addressed this racial disadvantage in relation to parents' mortality risk. In this study, we focus on the racial context of the United States to suggest that black parents already face higher mortality rates compared to white parents, and the unequal burden of child death adds to their mortality risk. Using discrete-time event history models, we consider whether the death of a child by midlife is associated with increased mortality risk for black parents and for white parents in mid- to later-life using longitudinal data from the Health and Retirement Study (HRS; 1996-2016). Descriptive results show that by midlife, black parents, especially black mothers, experience substantially higher child mortality compared with white parents. At the same time, we find that losing a child prior to midlife is associated with heightened mortality risk for aging black mothers and white mothers. Controlling for educational attainment explains the association between child death and parental mortality risk among white mothers, whereas heightened biopsychosocial and behavioral risk factors explain the association for black mothers. Overall, the death of a child is associated with increased mortality risk for black mothers and for white mothers, but the processes linking child death to parental mortality seem to differ for black and white parents. These findings have implications for policies and interventions that address increased mortality risk for parents following the death of a child.