Association between poor self-reported health and unmarried status among adults: examining the hypothesis of marriage protection and marriage selection in the Indian context

Abstract

Background The link between marital status and health differences has long been a topic of debate. The substantial research on marriage and health has been conducted under two important hypotheses: marital protection and marriage selection. While the majority of evidence on the marriage-health relationship using these hypotheses comes from developed countries, there is a lack of evidence from Asia, particularly from India. Objectives The current study examines theoretical frameworks of marriage i.e., marital protection and marriage selection in the Indian setting concurrently, bringing substantial empirical evidence to explore the link between marriage and health, considering this subject in the context of self-reported health (SRH). Secondly, this study will aid in investigating age and gender differences in marriage and health. Methods Using the Study on Global AGEing and Adult Health (SAGE), a cohort study of individuals aged 50 years and older with a small section of individuals aged 18 to 49 for comparative reasons, the present study population was 25 years and above individuals with complete marital information. Logistic regressions were employed to explore the connection between marital status and self-reported health. In the marriage protection hypothesis, the follow-up poor SRH was the dependent variable, whereas the initial unmarried status was the independent variable. For the marriage selection effects, initial poor SRH as the independent variable and follow-up unmarried status as the dependent variable had considered. Results Examining the marital protection hypothesis, the initial unmarried status (OR: 2.14; CI at 95%: 1.17, 3.92) was associated with the followed-up SRH transition from good to poor between 2007 and 2015 for young men, while initial unmarried status was linked with a lower likelihood of stable good SRH and a higher likelihood of stable poor SRH status across all age categories among women. Focusing on the marriage selection hypothesis, among young men, a significant association exists between the initial poor SRH and departure in marital status from married to unmarried. Young women with initial poor SRH (OR: 0.68; CI at 95%: 0.40, 1.00) had lower odds of stable married. In comparison, women with initially poor SRH, irrespective of age, were more likely to have higher odds of being stably unmarried. Conclusion Marriage indeed protects health. There are also shreds of evidence on health-selected marital status in India. Taken together, the aspect of marital protection or marriage selection is gender and age-specific in India. The findings contribute to a more comprehensive understanding of the relationship between marriage and health, which may have significant implications for health-related public policies aimed at unmarried women.

Rural urban differences in self-rated health among older adults: examining the role of marital status and living arrangements

“…Regarding marital status, the likelihood of poor SRH was significantly higher among the currently unmarried people than their counterparts in India. The result is similar to many previous studies in India and elsewhere [ 18 , 38 ]. The theory of marriage protection and selection explains the linkage between marital status and health outcomes, which supports our study findings.…”

“…Existing literature suggests that marital status and living arrangements are significant social determinants of self-rated health in later life in India and other countries [ 17 ]. Many previous studies found a significant association between marital status and health outcomes among older people in India and elsewhere [ 18 ]. The positive and negative association varies with the geriatric population's space, place, and background characteristics [ 19 ].…”

“…Third, marital status is considered important social status in many societies, positively reflecting individuals' mental health and social well-being [ 21 ]. Similarly, older who are living alone were found to be more vulnerable regarding health and socioeconomic well-being in India and elsewhere [ 18 ]. Further, physical and subjective health status also differs with individuals' socioeconomic and psycho-physical health backgrounds.…”

The relationship between marital status and cognitive impairment in Chinese older adults: the multiple mediating effects of social support and depression

“…This finding is consistent with previous studies [ 7 , 12 ], with those having a spouse exhibiting higher cognitive functioning. The ‘marriage protection effect’ highlights that being married can affect the health level and longevity of individuals by providing emotional support and related social support from their spouses and promoting a healthy lifestyle [ 47 ], indicating that marital status enhances cognitive functioning in older people. This finding also supports the marriage resource model, which proposes that marriage offers multiple forms of resources for individuals with a spouse [ 48 ].…”

Body image and hopelessness in older adults: The intervening roles of aging self‐stereotypes and marital status

“…Previous studies have found that marital status has an impact on both mental and physical health of older adults (e.g., Pettee et al, 2006; Sjöberg et al, 2020; Zhang & Li, 2011). In accordance with the marital protection hypothesis, older adults receive better attention and care within a marriage, and even protection from physical limitations (Hossain & James, 2022). Furthermore, marital relationships provide internal stability and support for individuals during later life, a time that can include many external changes, declines and losses (Bontinen, 2001).…”