Consistency and Timing of Marital Transitions and Survival During Midlife: the Role of Personality and Health Risk Behaviors



Marital status is associated with survival.


The aims of this study are to evaluate marital history and timing on mortality during midlife, test the role of pre-marital personality, and quantify the role of health risk behaviors.


Cox proportional hazard models were run with varying classifications of marital history and sets of covariates.


In fully adjusted models compared to the currently married, lifetime marital history predicts premature mortality with never married at 2.33 times risk of death and ever married at 1.64 risk of death. Midlife marital history shows that not having a partner during midlife (hazard ratio (HR) = 3.10 formerly married; HR = 2.59 remaining single) has the highest risk of death. Controlling for personality and health risk behaviors reduces but does not eliminate the impact of marital status.


Consistency of marital status during midlife suggests that lack of a partner is associated with midlife mortality.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. 1.

    Internal Revenue Service. Publication 590. Table 1. Single Life Expectancy. 2009: P. 90.

  2. 2.

    Heron M, Hoyert DL, Murphy SL, Xu J, Kochanek KD, Tejada-Vera BS. Deaths: Final data for 2006. Natl Vital Stat Rep. 2009;57(14):11-12. Available at Accessibility verified October 10, 2011.

    Google Scholar 

  3. 3.

    Ben-Shlomo Y, Smith GD, Shipley M, Marmot MG. Magnitude and causes of mortality differences between married and unmarried men. J Epidemiol Commun Health. 1993;47:200-205.

    Article  CAS  Google Scholar 

  4. 4.

    Tucker JS, Friedman HS, Wingard DL, Schwartz JE. Marital history at midlife as a predictor of longevity: Alternative explanations of the protective effect of marriage. Health Psychol. 1996;15:94-101.

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Johnson NJ, Backlund E, Sorlie PD, Loveless CA. Marital status and mortality: The National Longitudinal Mortality Study. Ann Epidemiol. 2000;10:224-238.

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Lund R, Holstein BE, Osler M. Marital history from age 15 to 40 years and subsequent 10-year mortality: A longitudinal study of Danish males born in 1953. Int J Epidemiol. 2003;33:389-397.

    Article  Google Scholar 

  7. 7.

    Dupre ME, Beck AN, Meadows SO. Marital trajectories and mortality among US adults. Am J Epidemiol. 2009;170:546-555.

    PubMed  Article  Google Scholar 

  8. 8.

    Carstensen LL, Hartel CR, eds. When I’m 64. Washington DC: National Academy Press; 2006.

    Google Scholar 

  9. 9.

    Pruchno R. Not your mother’s old age: Baby Boomers at age 65. Gerontologist. 2012;52:149-52.

    PubMed  Article  Google Scholar 

  10. 10.

    Schaie KW. Developmental influences on adult intelligence: The Seattle Longitudinal Study. New York: Oxford University Press; 2005.

    Google Scholar 

  11. 11.

    Rosow I. What is a cohort and why? Hum Dev. 1978;21:65-75.

    Article  Google Scholar 

  12. 12.

    Williams RB. Psychological factors, health and disease: The impact of aging and the lifecycle. In: Manuck SB, Jennings R, Rabin BS, Baum A, eds. Behavior, health and aging. Mahwah: Lawrence Erlbaum Associates; 2000:135-151.

    Google Scholar 

  13. 13.

    Siegler IC, Peterson BL, Barefoot JC, et al. Using college alumni populations in epidemiologic research: The UNC Alumni Heart Study. J Clin Epidemiol. 1992;45:1243-1250.

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Siegler IC, Costa PT, Brummett BH, et al. Patterns of change in hostility from college to midlife in the UNC Alumni Heart Study predict high-risk status. Psychosom Med. 2003;65:738-745.

    PubMed  Article  Google Scholar 

  15. 15.

    Hooker K, Hoppmann C, Siegler IC. Personality: Life span compass for health. In: Whitfield KE, ed. Annual review of gerontology and geriatrics: Focus on behavioral prospective on health in later life. New York: Springer; 2010:201-232.

    Google Scholar 

  16. 16.

    Siegler IC, Peterson BL, Barefoot JC, Williams RB. Hostility during late adolescence predicts coronary risk factors at midlife. Am J Epidemiol. 1992;136:146-154.

    PubMed  CAS  Google Scholar 

  17. 17.

    Siegler IC, Feaganes JR, Rimer BK. Predictors of adoption of mammography in women under the age of 50. Health Psychol. 1995;14:274-78.

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Hathaway SR, McKinley JC. Booklet for the Minnesota Multiphasic Personality Inventory. Minneapolis: University of Minnesota Press; 1943.

    Google Scholar 

  19. 19.

    Dahlstrom WG, Welsh GS, Dahlstrom LE. An MMPI handbook: Research applications. Minneapolis: University of Minnesota Press; 1975.

    Google Scholar 

  20. 20.

    Cook WW, Medley DM. Proposed hostility and pharisaic-virtue scales for the MMPI. J Appl Psychol. 1954;38:414-418.

    Article  Google Scholar 

  21. 21.

    Colligan RC, Offord KP, Malinchoc M, Schulman P, Seligman ME. CAVEing the MMPI for an optimism-pessimism scale: Seligman’s attributional model and the assessment of explanatory style. J Clin Psychol. 1994;50:71-95.

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Malinchoc M, Offord KP, Colligan RC. PSM-R: Revised optimism-pessimism scale for the MMPI2 and the MMPI. J Clin Psychol. 1995;51:205-214.

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Maruta T, Colligan RC, Malinchoc M, Offord KP. Optimists vs. pessimists: Survival rate among medical patients over a 30-year period. Mayo Clin Proc. 2002;75:140-143.

    Google Scholar 

  24. 24.

    Brummett BH, Helms MJ, Dahlstrom WG, Siegler IC. Prediction of all-cause mortality by the Minnesota Multiphasic Personality Inventory Optimism-Pessimism Scale scores: Study of a college sample during a 40-year follow-up period. Mayo Clin Proc. 2006;81:1541-1544.

    PubMed  Article  Google Scholar 

  25. 25.

    Tindle HA, Chang YF, Kuller LH, et al. Optimism, cynical hostility and incident coronary heart disease and mortality in the women’s health initiative. Circulation. 2009;120:656-662.

    PubMed  Article  Google Scholar 

  26. 26.

    Siegler IC, Zonderman AB, Barefoot JC, Williams RB, Costa PT, McCrae RR. Predicting personality in adulthood from College MMPI Scores: Implications for follow-up studies in psychosomatic medicine. Psychosom Med. 1990;52:644-652.

    PubMed  CAS  Google Scholar 

  27. 27.

    Henretta JC. Lifetime marital history and mortality after age 50. J Aging Health. 2010;22:1198-1212.

    PubMed  Article  Google Scholar 

  28. 28.

    Mortensen LH, Siegler IC, Barefoot JC, Gronbaek M, Sorensen TIA. Prospective associations between sedentary lifestyle and BMI in midlife. Obesity. 2006;14:1462-1471.

    PubMed  Article  Google Scholar 

  29. 29.

    Brummett BH, Babyak MA, Williams RB, Barefoot JC, Costa PT, Siegler IC. NEO personality domains and gender predict levels and trends in Body Mass Index over 14 years during midlife. J Res Pers. 2006;40:222-236.

    Article  Google Scholar 

  30. 30.

    SAS v. 9.1. SAS Institute, Cary NC.

  31. 31.

    Hughes ME, Waite LJ. Marital biography and health at midlife. J Health Soc Beh. 2009;50:344-358.

    Article  Google Scholar 

  32. 32.

    Joung IMA, van de Mheen HD, Stronks K, van Poppel FWA, Mackenbach JP. A longitudinal study of health selection in marital transitions. Soc Sci Med. 1998;46:425-435.

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    U. S. Census. Selected characteristics of Baby Boomers 42–60 years old in 2006. Available at Accessibility verified November 10, 2010.

  34. 34.

    Merrill SS, Verbrugge LM. Health and disease at midlife. In: Willis SL, Reid JD, eds. Life in the Middle. San Diego: Academic; 1999:78-103.

    Google Scholar 

  35. 35.

    Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: A meta-analytic review. PLoS Med. 2010;7:1-20.

    Article  Google Scholar 

  36. 36.

    Krieger N, Rehkopf DH, Chen JT, et al. The fall and rise of US inequities in premature mortality: 1960–2002. PLoS Med. 2008;5:0227-0241.

    Article  Google Scholar 

  37. 37.

    Von Dras DD, Williams RB, Kaplan BH, Siegler IC. Correlates of perceived social support and equality of interpersonal relationships at midlife. Int J Aging Hum Dev. 1996;43:199-217.

    Article  Google Scholar 

  38. 38.

    Brodhead WE, Kaplan BH, James SA, et al. The epidemiologic evidence for a relationship between social support and health. Am J Epidemiol. 1983;117:521-537.

    Google Scholar 

  39. 39.

    Kiecolt-Glaser JK, Newton TL. Marriage and health: His and hers. Psychol Bull. 2001;127:472-503.

    PubMed  Article  CAS  Google Scholar 

  40. 40.

    Croezen S, Havenman-Nies A, Picavet HSJ, et al. Positive and negative experiences of social support and long-term mortality among middle aged Dutch people. Am J Epidemiol. 2010; 173–179.

  41. 41.

    Miller G. Why Loneliness is hazardous to your health. Science. 2011;331:138-140.

    PubMed  Article  CAS  Google Scholar 

  42. 42.

    Hawkley LW, Cacioppo JT. Loneliness matters: A theoretical and empirical review of consequences and mechanisms. Ann Behav Med. 2010;40:218-227.

    PubMed  Article  Google Scholar 

  43. 43.

    Roelfs DJ, Shor E, Yogev T. The rising relative risk of mortality for singles: Meta-analysis and meta-regression. Am J Epidemiol. 2011;174:379-389.

    PubMed  Article  Google Scholar 

Download references


This study has been funded by Marchionne Foundation, R01-HL55356 from the National Heart Lung and Blood Institute with co-funding from the National Institute on Aging, R01 AG12458 from the National Institute on Aging, P01 HL36587 from National Heart, Lung and Blood Institute and from the Duke Behavioral Medicine Research Center. We would like to thank Christin Ogle for her comments on this manuscript.

Conflict of Interest

The authors have no conflict of interest to disclose.

Author information



Corresponding author

Correspondence to Ilene C. Siegler Ph.D., M.P.H..

About this article

Cite this article

Siegler, I.C., Brummett, B.H., Martin, P. et al. Consistency and Timing of Marital Transitions and Survival During Midlife: the Role of Personality and Health Risk Behaviors. ann. behav. med. 45, 338–347 (2013).

Download citation


  • Marital history
  • Midlife mortality
  • Longitudinal study
  • UNC Alumni Heart Study