Stress Proliferation and Disability over the Life Course

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For decades, life course and stress process scholars have documented that negative, stressful experiences have consequences for health across the life course. However, less attention has been paid to hearing impairment, a highly prevalent functional limitation that has significant implications for the quality of life of older adults. Hearing impairment is common at older ages (reported by 27.3% of those aged 65-74 and 45.1% of those aged 75 and older) and has negative consequences for the quality of life not only of the focal individual but also for those close to them (CDC 2017, Ciorba et al. 2012, Dalton et al. 2003, Wallhagen et al. 2004). The aim of this dissertation is to apply a life course and stress process framework to the experience of hearing impairment via two studies that each use nationally representative, longitudinal data from the Health and Retirement Study (HRS). My findings contribute to our understanding of marriage, family, gender, and health by moving beyond the traditional approach that focuses on individuals with disabilities to explore the impacts of disability on spouses.

In Chapter 2, I build on the stress process framework by conceptualizing hearing impairment as a chronic stressor that impacts mental health and examining the role of social support in this relationship. Using fixed-effects regression models applied to three waves of HRS data (2006, 2010, 2014), I found that worse self-rated hearing is associated with a significant increase in depressive symptoms, and that social support interacted with hearing impairment: low levels of social support were associated with more depressive symptoms but only among people with poor self-rated hearing. Moreover, high levels of social support reduced depressive symptoms for those with poor hearing. These findings suggest that hearing impairment is a chronic stressor in individuals' lives, and that responses to this stressor vary by the availability of social resources.

Chapter 3 examines stress proliferation among married couples. While decades of research show the health benefits of marriage, stress proliferation suggests that chronic stressors such as disability may undermine social relations, thus limiting their role as a coping resource. For this study, I matched couples by household identification number over ten waves of the HRS (1998-2016). Fixed-effects regression models revealed that wives’ hearing impairment is associated with an increase in husbands’ depressive symptoms, but that husbands’ hearing impairment is not associated with wives’ depressive symptoms. This could be because women in heterosexual marriages have traditionally been expected to monitor their husbands’ health, but not vice versa. Since men are less used to serving as caregivers, they may find their wives’ hearing impairment distressing. Also, wives usually find social support outside of the marriage, while husbands traditionally rely on their wives for companionship. This would provide wives, but not husbands, with external resources to cope with their spouses’ hearing impairment. These findings reveal that the stress of hearing impairment does spill over from one spouse to another, depending on gender.

Overall, this dissertation demonstrates that hearing impairment is a chronic stressor that has major implications for individuals’ mental health. Moreover, the mental health consequences of hearing impairment are not only limited to individuals but can also spill over to impact spouses. Further research is needed to extend our understanding of how disability, in general, and hearing impairment, specifically, shapes health across the life course for individuals and those close to them.






West, Jessica Sayles (2021). Stress Proliferation and Disability over the Life Course. Dissertation, Duke University. Retrieved from


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