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Angelo Merendino, who documented his wife’s struggle with breast cancer, showed that caring for your spouse can be a transformative experience.Angelo Merendino

For married couples, serious illness is supposed to unfold like the story of Angelo Merendino, the New York photographer who stayed by his wife Jen's side from the minute she was diagnosed with breast cancer – just five months after their wedding day – through four years of gruelling cancer treatments. Released last year and shared on social-media sites far and wide, his photographic series of her battle with cancer is proof that true love knows no bounds.

Serious illness does not always bring out the best in people, however. Some studies have shown that men in particular may have trouble keeping a promise to stay together in sickness as in health.

The newest study, presented Thursday at the annual meeting of the Population Association of America in Boston, found an increased risk of divorce in older couples when the wife – but not the husband – became seriously ill.

The researchers looked at how the onset of cancer, heart problems, lung disease or stroke affected the outcomes of 2,717 marriages, using data from a 20-year study on health and retirement conducted since 1992.

At the time of the first interview, both spouses were healthy and at least one was over age 50. By the end of a 20-year period, men were more likely to have developed a serious illness, but a woman's illness was more strongly associated with divorce, the researchers found.

Co-author Dr. Amelia Karraker, a researcher at the University of Michigan Institute for Social Research, attributed the findings to differences in gender roles.

The participants were drawn from a generation in which men were not typically socialized to provide caregiving, she said. When a wife gets sick later in life, the husband's lack of experience "may make the caregiving role especially stressful for them," she said.

Karraker's findings confirm the results of a study published in 2009 in the journal Cancer. Dr. Marc Chamberlain, a neuro-oncologist at the Seattle Cancer Care Alliance, initiated this study after noticing that his female patients seemed more likely to end up separated or divorced after receiving a brain-cancer diagnosis than his male patients.

Chamberlain and colleagues found that when the husband received a diagnosis, only 3 per cent experienced marital separation or divorce within 14 months. Among the female patients, however, about 21 per cent ended up alone.

Like Karraker, Chamberlain pointed out that the nurturing role is not the cultural norm for men, "so therefore caring for a sick person is perhaps a role that men are not adequately equipped to deal with," he said.

But Chamberlain dismissed the notion that men's lack of experience with caregiving is limited to older generations. "I think that theory is a bit weak," he said, noting that the patients in his study were of all ages. The picture may sound bleak for women who get ill. Nevertheless, other research suggests that the negative impact of traditional gender roles may work both ways.

Men who develop a serious illness during their prime working years are at greater risk of marital disruption than women in the same circumstances, according to a 2010 study by sociologist Dr. Jay Teachman at Western Washington University.

He noted that poor health can upset the economic, social and emotional balance of a marriage. "That this shock results only in divorce as a result of the reduced health of husbands is a testament to the continued gendered nature of marriages," he wrote.

Dr. Deborah McLeod, a spokesperson for the Canadian Association of Psychosocial Oncology, cautioned against instilling fear in women that they will be abandoned after a cancer diagnosis. She pointed out that studies of gender differences in marriage dissolution linked to illness have not documented who initiated the divorce.

Patients in a cancer crisis tend to re-evaluate their lives, including their marriages, she explained. "It's not uncommon [for patients] to divorce in the middle of a cancer diagnosis and treatment."

She added that the findings of the Seattle study may not apply to all cancers. Brain-cancer patients require an unusually high level of caregiving. Many may undergo personality changes as a result of tumours in their frontal lobes, she said.

Chamberlain emphasized that the purpose of studying gender differences in divorce after a serious illness is to help doctors flag patients who may be at increased risk of marriage dissolution during a health crisis. With early intervention, counsellors, social workers and religious leaders could provide support for the caregiving spouse, he said.

Partners may discover that caregiving is not a thankless role. Angelo Merendino, the photographer, described caring for his wife, who died of breast cancer in 2011, as a transformative experience. "With each challenge we grew closer," he wrote at "I've never been as happy as I was during this time."

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