Unpaid care, time taken off work and healthcare costs before and after partner bereavement among same-gender and different-gender partners: A national population-based study

Katherine Bristowe; Peter May; Alexandra Pitman; Jingjing Jiang; Liadh Timmins; Michael King; Debbie Braybrook; Steve Marshall; Elizabeth Day; Paul Clift; Ruth Rose; Katherine Johnson; Kathryn Almack; Richard Harding

doi:10.1177/02692163251355796

Unpaid care, time taken off work and healthcare costs before and after partner bereavement among same-gender and different-gender partners: A national population-based study

Katherine Bristowe, Peter May, Alexandra Pitman, Jingjing Jiang, Liadh Timmins, Michael King, Debbie Braybrook, Steve Marshall, Elizabeth Day, Paul Clift, Ruth Rose, Katherine Johnson, Kathryn Almack, Richard Harding

University of Hertfordshire

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Recent research has demonstrated higher levels of psychological distress for bereaved same-gender partners compared to different-gender partners. Economic outcomes have not yet been examined.

AIM: To examine whether there are differences between same- and different-gender civil partners or spouses (hereafter 'partners') in the amount of unpaid care provided in the 3 months pre-bereavement, and time taken off work and formal healthcare used in the 3 months pre- or post-bereavement.

DESIGN: A population-based cross-sectional survey of bereaved partners from England/Wales was conducted including three economic outcomes of interest: unpaid care, time taken off work, and formal healthcare used. We estimated formal healthcare costs using reference costs. We balanced groups on sociodemographic characteristics using propensity score weights and estimated average marginal difference in outcomes between groups using multivariable regressions.

SETTING/PARTICIPANTS: There were 542 complete cases for primary analysis (220 same-gender partners, 322 different-gender partners).

RESULTS: Same- and different-gender partners provided very high levels of unpaid care pre-bereavement (mean 122 h/week). Of those in paid employment, 85% missed some work pre- and post-bereavement. Same-gender partners had higher formal healthcare costs post-bereavement (+£79, 95% CI: +2 to +156). There were no other significant differences between groups.

CONCLUSION: The economic burdens of bereavement are substantial. Same-gender partners were associated with more formal healthcare use than different-gender partners post-bereavement, possibly connected to higher levels of psychological distress. Future research should consider longer-term impacts of partner bereavement on health outcomes, explore whether care services are experienced as inclusive, and target ethnically diverse and gender diverse communities.

Original language	English
Pages (from-to)	2692163251355796
Journal	Palliative Medicine
DOIs	https://doi.org/10.1177/02692163251355796
Publication status	E-pub ahead of print - 16 Aug 2025

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Bristowe, K., May, P., Pitman, A., Jiang, J., Timmins, L., King, M., Braybrook, D., Marshall, S., Day, E., Clift, P., Rose, R., Johnson, K., Almack, K., & Harding, R. (2025). Unpaid care, time taken off work and healthcare costs before and after partner bereavement among same-gender and different-gender partners: A national population-based study. Palliative Medicine, 2692163251355796. Advance online publication. https://doi.org/10.1177/02692163251355796

@article{d223d8a0ec97419f9c1e705537dddfb6,

title = "Unpaid care, time taken off work and healthcare costs before and after partner bereavement among same-gender and different-gender partners: A national population-based study",

abstract = "BACKGROUND: Recent research has demonstrated higher levels of psychological distress for bereaved same-gender partners compared to different-gender partners. Economic outcomes have not yet been examined.AIM: To examine whether there are differences between same- and different-gender civil partners or spouses (hereafter 'partners') in the amount of unpaid care provided in the 3 months pre-bereavement, and time taken off work and formal healthcare used in the 3 months pre- or post-bereavement.DESIGN: A population-based cross-sectional survey of bereaved partners from England/Wales was conducted including three economic outcomes of interest: unpaid care, time taken off work, and formal healthcare used. We estimated formal healthcare costs using reference costs. We balanced groups on sociodemographic characteristics using propensity score weights and estimated average marginal difference in outcomes between groups using multivariable regressions.SETTING/PARTICIPANTS: There were 542 complete cases for primary analysis (220 same-gender partners, 322 different-gender partners).RESULTS: Same- and different-gender partners provided very high levels of unpaid care pre-bereavement (mean 122 h/week). Of those in paid employment, 85\% missed some work pre- and post-bereavement. Same-gender partners had higher formal healthcare costs post-bereavement (+£79, 95\% CI: +2 to +156). There were no other significant differences between groups.CONCLUSION: The economic burdens of bereavement are substantial. Same-gender partners were associated with more formal healthcare use than different-gender partners post-bereavement, possibly connected to higher levels of psychological distress. Future research should consider longer-term impacts of partner bereavement on health outcomes, explore whether care services are experienced as inclusive, and target ethnically diverse and gender diverse communities.",

author = "Katherine Bristowe and Peter May and Alexandra Pitman and Jingjing Jiang and Liadh Timmins and Michael King and Debbie Braybrook and Steve Marshall and Elizabeth Day and Paul Clift and Ruth Rose and Katherine Johnson and Kathryn Almack and Richard Harding",

year = "2025",

month = aug,

day = "16",

doi = "10.1177/02692163251355796",

language = "English",

pages = "2692163251355796",

journal = "Palliative Medicine",

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Bristowe, K, May, P, Pitman, A, Jiang, J, Timmins, L, King, M, Braybrook, D, Marshall, S, Day, E, Clift, P, Rose, R, Johnson, K, Almack, K & Harding, R 2025, 'Unpaid care, time taken off work and healthcare costs before and after partner bereavement among same-gender and different-gender partners: A national population-based study', Palliative Medicine, pp. 2692163251355796. https://doi.org/10.1177/02692163251355796

TY - JOUR

T1 - Unpaid care, time taken off work and healthcare costs before and after partner bereavement among same-gender and different-gender partners

T2 - A national population-based study

AU - Bristowe, Katherine

AU - May, Peter

AU - Pitman, Alexandra

AU - Jiang, Jingjing

AU - Timmins, Liadh

AU - King, Michael

AU - Braybrook, Debbie

AU - Marshall, Steve

AU - Day, Elizabeth

AU - Clift, Paul

AU - Rose, Ruth

AU - Johnson, Katherine

AU - Almack, Kathryn

AU - Harding, Richard

PY - 2025/8/16

Y1 - 2025/8/16

N2 - BACKGROUND: Recent research has demonstrated higher levels of psychological distress for bereaved same-gender partners compared to different-gender partners. Economic outcomes have not yet been examined.AIM: To examine whether there are differences between same- and different-gender civil partners or spouses (hereafter 'partners') in the amount of unpaid care provided in the 3 months pre-bereavement, and time taken off work and formal healthcare used in the 3 months pre- or post-bereavement.DESIGN: A population-based cross-sectional survey of bereaved partners from England/Wales was conducted including three economic outcomes of interest: unpaid care, time taken off work, and formal healthcare used. We estimated formal healthcare costs using reference costs. We balanced groups on sociodemographic characteristics using propensity score weights and estimated average marginal difference in outcomes between groups using multivariable regressions.SETTING/PARTICIPANTS: There were 542 complete cases for primary analysis (220 same-gender partners, 322 different-gender partners).RESULTS: Same- and different-gender partners provided very high levels of unpaid care pre-bereavement (mean 122 h/week). Of those in paid employment, 85% missed some work pre- and post-bereavement. Same-gender partners had higher formal healthcare costs post-bereavement (+£79, 95% CI: +2 to +156). There were no other significant differences between groups.CONCLUSION: The economic burdens of bereavement are substantial. Same-gender partners were associated with more formal healthcare use than different-gender partners post-bereavement, possibly connected to higher levels of psychological distress. Future research should consider longer-term impacts of partner bereavement on health outcomes, explore whether care services are experienced as inclusive, and target ethnically diverse and gender diverse communities.

AB - BACKGROUND: Recent research has demonstrated higher levels of psychological distress for bereaved same-gender partners compared to different-gender partners. Economic outcomes have not yet been examined.AIM: To examine whether there are differences between same- and different-gender civil partners or spouses (hereafter 'partners') in the amount of unpaid care provided in the 3 months pre-bereavement, and time taken off work and formal healthcare used in the 3 months pre- or post-bereavement.DESIGN: A population-based cross-sectional survey of bereaved partners from England/Wales was conducted including three economic outcomes of interest: unpaid care, time taken off work, and formal healthcare used. We estimated formal healthcare costs using reference costs. We balanced groups on sociodemographic characteristics using propensity score weights and estimated average marginal difference in outcomes between groups using multivariable regressions.SETTING/PARTICIPANTS: There were 542 complete cases for primary analysis (220 same-gender partners, 322 different-gender partners).RESULTS: Same- and different-gender partners provided very high levels of unpaid care pre-bereavement (mean 122 h/week). Of those in paid employment, 85% missed some work pre- and post-bereavement. Same-gender partners had higher formal healthcare costs post-bereavement (+£79, 95% CI: +2 to +156). There were no other significant differences between groups.CONCLUSION: The economic burdens of bereavement are substantial. Same-gender partners were associated with more formal healthcare use than different-gender partners post-bereavement, possibly connected to higher levels of psychological distress. Future research should consider longer-term impacts of partner bereavement on health outcomes, explore whether care services are experienced as inclusive, and target ethnically diverse and gender diverse communities.

U2 - 10.1177/02692163251355796

DO - 10.1177/02692163251355796

M3 - Article

C2 - 40818047

SN - 0269-2163

SP - 2692163251355796

JO - Palliative Medicine

JF - Palliative Medicine

ER -

Unpaid care, time taken off work and healthcare costs before and after partner bereavement among same-gender and different-gender partners: A national population-based study

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