Psychological adjustment to sudden and anticipated spousal loss among older widowed persons.

OBJECTIVES This study examined if older adults' psychological adjustment to widowhood varies based on whether the death was sudden or anticipated and if these effects are mediated by death context characteristics (e.g., predeath caregiving, nursing home use, spouse's age at death, and couple's communication about the death). METHODS The effects of forewarning on multiple indicators of mental health and grief were examined in a sample of 210 widowed persons who participated in the Changing Lives of Older Couples (CLOC) study. The CLOC is a probability sample of 1,532 married individuals aged 65 and older for whom baseline information was collected in 1987-88, with widowed persons reinterviewed 6, 18, and 48 months after spousal loss. RESULTS Forewarning did not affect depression, anger, shock, or overall grief 6 or 18 months after the loss. Prolonged forewarning was associated with elevated anxiety both 6 and 18 months after the death. Sudden spousal death elevated survivors' intrusive thoughts at the 6-month follow-up only. Sudden death was associated with slightly higher levels of yearning among women but significantly lower yearning among men both 6 and 18 months after the loss. DISCUSSION The findings call into question the widespread belief that grief is more severe if death is sudden and suggest a more complex relationship between bereavement and circumstances of spousal death.

[1]  S. Jacobs.  Pathologic grief: Maladaptation to loss. , 1993 .

[2]  I. Fooken.  OLD AND FEMALE: PSYCHOSOCIAL CONCOMITANTS OF THE AGING PROCESS IN A GROUP OF OLDER WOMEN , 1985 .

[3]  L. Pearlin.  The social contexts of stress. , 1993 .

[4]  L. A. Despelder,et al.  The Last Dance: Encountering Death and Dying , 1983 .

[5]  M. Gilewski,et al.  Changes in grief and mental health of bereaved spouses of older suicides. , 1992, Journal of gerontology.

[6]  R. Weiss,et al.  Recovery from bereavement , 1983 .

[7]  A. Bowling,et al.  Life After a Death: A Study of the Elderly Widowed , 1982 .

[8]  V. Wilson.  The consequences of elderly wives caring for disabled husbands: implications for practice. , 1990, Social work.

[9]  E. Robins,et al.  The Depression of Widowhood after Thirteen Months , 1972, British Journal of Psychiatry.

[10]  L. Berkman,et al.  The measurement of grief: bereaved versus non-bereaved. , 1986, The Hospice journal.

[11]  C. M. Parkes.  The First Year of Bereavement , 1974 .

[12]  I. Shannon.  The Caregiving Dilemma: Work in an American Nursing Home , 1994 .

[13]  Symptomatology and management of acute grief , 1944 .

[14]  C. L. Johnson,et al.  A longitudinal study of family supports to impaired elderly. , 1983, The Gerontologist.

[15]  C. M. Parkes.  The first year of bereavement. A longitudinal study of the reaction of London widows to the death of their husbands. , 1970, Psychiatry.

[16]  T. H. Holmes,et al.  The Social Readjustment Rating Scale. , 1967, Journal of psychosomatic research.

[17]  P. Thoits,et al.  2 – Dimensions of Life Events That Influence Psychological Distress: An Evaluation and Synthesis of the Literature , 1983 .

[18]  D. Kramer.  How Women Relate to Terminally Ill Husbands and their Subsequent Adjustment to Bereavement , 1997 .

[19]  M. Roach,et al.  Adjustment to Widowhood and Divorce , 1989 .

[20]  L. Gwyther,et al.  Caregiver well-being: a multidimensional examination of family caregivers of demented adults. , 1986, The Gerontologist.

[21]  L. Calhoun,et al.  Social Reactions to the Survivor of a Suicide in the Family: A Review of the Literature , 1991 .

[22]  R. Carey.  Weathering Widowhood: Problems and Adjustment of the Widowed during the First Year , 1980, The Final Transition.

[23]  Robert G. Dunn,et al.  The Psychological and Social Experience of Suicide Survivors , 1988 .

[24]  S. Zisook,et al.  Measuring symptoms of grief and bereavement. , 1982, The American journal of psychiatry.

[25]  B. Raphael,et al.  Postdisaster Morbidity of the Bereaved: A Possible Role for Preventive Psychiatry? , 1981, The Journal of nervous and mental disease.

[26]  S. Zisook,et al.  Early psychological reaction to the stress of widowhood. , 1991, Psychiatry.

[27]  D. Lund.  Older bereaved spouses : research with practical applications , 1989 .

[28]  D. Maddison,et al.  Factors Affecting the Outcome of Conjugal Bereavement , 1967, British Journal of Psychiatry.

[29]  Robert Blauner.  Death and Social Structure , 1992 .

[30]  L. Wright,et al.  The impact of Alzheimer's disease on the marital relationship. , 1991, The Gerontologist.

[31]  D. M. Bernstein.  Bitter, Bitter Tears: Nineteenth-Century Diarists and Twentieth-Century Grief Theories , 1984 .

[32]  K. Bennett,et al.  Narratives of death: a qualitative study of widowhood in later life , 2000, Ageing and Society.

[33]  S. O'Bryant,et al.  The Psychological Well-Being of Older, Recent Widows , 1988 .

[34]  L. Thompson,et al.  The role of anticipatory bereavement in older women's adjustment to widowhood. , 1988, The Gerontologist.

[35]  J. F. Ball.  Widow's Grief: The Impact of Age and Mode of Death , 1977 .

[36]  M. Moss.  Widowhood in an American City , 1975 .

[37]  R. Fulton,et al.  A Psychosocial Aspect of Terminal Care: Anticipatory Grief , 1971 .

[38]  C Hinds,et al.  The needs of families who care for patients with cancer at home: are we meeting them? , 1985, Journal of advanced nursing.

[39]  M. Vachon.  Stress Reactions to Bereavement. , 1976 .

[40]  E. Rynearson.  Bereavement after homicide: a descriptive study. , 1984, The American journal of psychiatry.

[41]  R. Kessler,et al.  The impact of widowhood on depression: findings from a prospective survey , 1999, Psychological Medicine.

[42]  R. Kalish.  Death, grief, and caring relationships , 1981 .

[43]  L. George.  Sociological Perspectives on Life Transitions , 1993 .

[44]  H. Sudak.  Handbook of Aging and Mental Health: An Integrative Approach , 2000 .

[45]  M. Reed,et al.  Predicting grief symptomatology among the suddenly bereaved. , 1998, Suicide & life-threatening behavior.

[46]  E M Pattison,et al.  The experience of dying. , 1967, American journal of psychotherapy.

[47]  W. Lancee,et al.  Predictors and correlates of adaptation to conjugal bereavement. , 1982, The American journal of psychiatry.

[48]  T. Lundin.  Morbidity following Sudden and Unexpected Bereavement , 1984, British Journal of Psychiatry.

[49]  A. P. Fengler,et al.  Wives of elderly disabled men: the hidden patients. , 1979, The Gerontologist.

[50]  E. Rynearson,et al.  Bereavement after homicide: a synergism of trauma and loss. , 1993, The American journal of psychiatry.

[51]  W. Stroebe,et al.  Who suffers more? Sex differences in health risks of the widowed. , 1983, Psychological bulletin.

[52]  S. O'Bryant,et al.  Contributions of the care-giving role to women's development , 1990 .

[53]  M. Skaff,et al.  Perspectives on the Family and Stress in Late Life , 1998 .

[54]  C. M. Parkes.  Bereavement , 1971, British Journal of Psychiatry.

[55]  R. J. Brown,et al.  Health After Bereavement: A Controlled Study of Young Boston Widows and Widowers , 1972, Psychosomatic medicine.

[56]  F. Norris,et al.  Older adult family stress and adaptation before and after bereavement. , 1987, Journal of gerontology.

[57]  Age and the Life Course , 2022, Aging, Society, and the Life Course.

[58]  J. House,et al.  Marital quality and psychological adjustment to widowhood among older adults: a longitudinal analysis. , 2000, The journals of gerontology. Series B, Psychological sciences and social sciences.

[59]  J. Goodwin,et al.  A prospective study of response to stressful life events in initially healthy elders. , 1987, Journal of gerontology.

[60]  S. O'Bryant.  Forewarning of a Husband's Death: Does it Make a Difference for Older Widows? , 1991 .

[61]  P. Clayton,et al.  Anticipatory Grief and Widowhood , 1973, British Journal of Psychiatry.

[62]  Michael Smilowitz,et al.  Relational Conclusion through Interaction with the Dying , 1985 .

[63]  R. Rusalem,et al.  Anticipatory grief and aged widows and widowers. , 1975, Journal of gerontology.

[64]  P. Dawson,et al.  Spousal caregiving following institutionalization: the experience of elderly wives. , 1993, Journal of advanced nursing.

[65]  G. Hinrichsen,et al.  Difficulties and rewards in family care of the depressed older adult. , 1992, The Gerontologist.

[66]  R. Kessler,et al.  Widowhood and depression: explaining long-term gender differences in vulnerability. , 1992, Journal of health and social behavior.

[67]  G. Winokur,et al.  A study of normal bereavement. , 1968, The American journal of psychiatry.

[68]  S. Olshansky,et al.  The fourth stage of the epidemiologic transition: the age of delayed degenerative diseases. , 1986, The Milbank quarterly.

[69]  C. Sanders.  Effects of Sudden vs. Chronic Illness Death on Bereavement Outcome , 1983 .

[70]  J. Wal,et al.  The Aftermath of Suicide: A Review of Empirical Evidence , 1990 .

[71]  L. Radloff.  The CES-D Scale , 1977 .

[72]  M. Gilhooly,et al.  Anticipatory grief: a review. , 1990, Social science & medicine.

[73]  D. Commerce.  Statistical abstract of the United States , 1978 .

[74]  S. Zisook,et al.  PTSD Following Bereavement , 1998, Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists.

[75]  R. Turner,et al.  Stressful life events and depressive symptoms: disaggregating the effects of acute stressors and chronic strains. , 1988, Journal of health and social behavior.

[76]  L. Derogatis,et al.  Confirmation of the dimensional structure of the scl‐90: A study in construct validation , 1977 .

[77]  C. M. Parkes.  The First Year of Bereavement †. , 1974, Psychiatry.

[78]  John Birtchnell,et al.  The Nature of Grief: The Evolution and Psychology of Reactions to Loss , 2001, British Journal of Psychiatry.

[79]  H. Kendig,et al.  Health and well-being of spouse caregivers and the widowed. , 1997, The Gerontologist.