Attachment orientations and loss adjustment among bereaved spouses

Trajectories of depressive symptoms early in the course of bereavement: Patterns, psychosocial factors and risk of prolonged grief

In the context of bereavement, little is known about the mechanisms that differentiate normative adjustment patterns from those that may indicate potential psychopathology. This study aimed to replicate and extend previous work by (1) characterizing the trajectories of depressive symptoms from 3 to 12 months after the loss of a spouse, (2) examining whether (a) childhood maltreatment and attachment style predicted distinct depression trajectories, and (b) different depression trajectories were associated with the risk of prolonged grief at 12 months post-loss. Recently bereaved individuals (N = 175) completed self-report assessments at 3, 4, 6, and 12-months post-loss. Trajectories of depressive symptoms were estimated using group-based trajectory modelling. Four distinct trajectories of depressive symptoms were identified: (1) resilience (minimal/no depression across time points; 45%), (2) moderate depression-improved (alleviated to 'mild' by 12 months; 31%), (3) severe depression-improved (alleviated to 'moderate' by 12 months; 15%), and (4) chronic depression ('severe' symptoms across time points; 9%). Higher childhood maltreatment predicted a greater likelihood of belonging to the 'severe depression-improved' and 'chronic depression' groups than the 'resilient' and 'moderate depression-improved' groups. Widow(er)s with higher attachment anxiety were more likely to belong to the 'severe depression-improved' and 'chronic depression' groups than the 'resilient' group. The trajectory groups with persistent levels of depressive symptoms up until 6 months were more likely to exhibit prolonged grief at 12 months post-loss. Changes from pre-loss functioning cannot be estimated. Our findings provide insight into the early identification of post-loss prolonged grief.

Factors Contributing to Well-Being in Japanese Community-Dwelling Older Adults Who Experienced Spousal Bereavement

PURPOSE

Providing support for older adults after spousal bereavement is crucial for psychological recovery through the grieving process and for promoting a healthy and happy remainder of life. The current study aimed to understand factors influencing well-being among Japanese community-dwelling older adults who experienced spousal bereavement by evaluating how their roles and activities affected their psychological well-being following the loss.

METHOD

We conducted a cross-sectional, anonymous, self-administered questionnaire survey of 332 older adults who had experienced death of a spouse in later adulthood.

RESULTS

Identified factors that affected well-being after spousal loss were sex, ability to go out without assistance from others, long duration since spousal loss, having a hobby, and adopting a life-oriented approach to cope with bereavement. Well-being following spousal loss was influenced by participants' activities and roles.

CONCLUSION

Findings of the current study provide potentially valuable suggestions for surviving spouses and their supporters when coping with grief following spousal loss. [Research in Gerontological Nursing, 17(3), 121-130.].

Do insecure attachment styles predict prolonged grief symptoms? Significant null findings

Insecure attachment is proposed to be a risk factor in the development and persistence of severe grief. Although prior research demonstrates positive cross-sectional and longitudinal correlations between attachment styles and prolonged grief symptoms, controlled longitudinal analyses yield fewer convincing results. Therefore, we sought to further clarify the concurrent and longitudinal associations between these constructs. A sample of 225 bereaved Dutch adults (87% women; Mean age: 48.86 years) participated in a three-wave longitudinal survey including measures of attachment anxiety and attachment avoidance at baseline and prolonged grief symptoms at baseline and 6- and 12-month follow-up. Attachment anxiety and attachment avoidance were significantly positively correlated with prolonged grief symptoms at all time-points. However, multiple regressions, controlling for baseline symptoms, showed that attachment anxiety, attachment avoidance, and their interaction did not predict residual change in prolonged grief symptoms. These findings cast doubt on the proposed role of insecure attachment styles in prolonged grief.

Prevalence of Prolonged Grief Disorder and Related Clinical Factors Among Turkish Psychiatric Outpatients During the COVID-19 Pandemic

Prolonged grief disorder (PGD), a new diagnosis in some classification systems, has gained prominence due to the high mortality rates observed during the Covid-19 pandemic. Herein, the prevalence of PGD (diagnosed with structured clinical interviews), death-related features, and associated clinical factors were investigated among outpatient psychiatric patients who lost a first-degree relative within the past 12-24 months. PGD was diagnosed in 30/68 patients (44.1%). PGD development did not differ based on cause of death (Covid-19-related vs. other causes) but was associated with higher age of the bereaved, younger age of the deceased, and degree of kinship. Higher rates of depression, insomnia, and anxious attachment were also observed in PGD patients. Finally, the unexpectedness of death predicted the development of PGD. Due to the high prevalence of PGD among psychiatric patients, clinicians should be aware of the disorder, monitor grief processes in high-risk patients, and consider PGD in treatment planning.

Spousal caregiving, widowhood, and cognition: A systematic review and a biopsychosocial framework for understanding the relationship between interpersonal losses and dementia risk in older adulthood

Accumulating research suggests that stressful life events, especially those that threaten close intimate bonds, are associated with an increased risk of dementia. Grieving the loss of a spouse, whether in the form of caregiving or after the death, ranks among 'life's most significant stressors', evoking intense psychological and physiological distress. Despite numerous studies reporting elevated dementia risk or poorer cognition among spousal caregivers and widow(er)s compared to controls, no review has summarized findings across cognitive outcomes (i.e., dementia incidence, cognitive impairment rates, cognitive performance) or proposed a theoretical model for understanding the links between partner loss and abnormal cognitive decline. The current systematic review summarizes findings across 64 empirical studies. Overall, both cross-sectional and longitudinal studies revealed an adverse association between partner loss and cognitive outcomes. In turn, we propose a biopsychosocial model of cognitive decline that explains how caregiving and bereavement may position some to develop cognitive impairment or Alzheimer's disease and related dementias. More longitudinal studies that focus on the biopsychosocial context of caregivers and widow(er)s are needed.

Contributing factors to heterogeneity in the timing of the onset of major depressive episode: Results from a national study

INTRODUCTION

It remains unclear whether specific clinical factors contribute to heterogeneity in the timing of the onset of major depression.

METHODS

Using a nationally representative US adult sample, the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions, we compared the characteristics of 5 different groups of patients defined by their age at onset: (i) before 18 years, (ii) between 18 and 34 years, (iii) between 35 and 44 years, (iv) between 45 and 59 years, and (v) 60 years or older. Specifically, we examined parental history of psychiatric disorders, history of childhood maltreatment experiences, sociodemographic characteristics, lifetime psychiatric disorders, and psychiatric disorders that occurred before the first major depressive episode (MDE).

RESULTS

Compared with first MDE occurring between 18 and 34 years, first MDE before 18 years was more strongly associated with childhood maltreatment and family history of psychiatric disorders, and less strongly linked to prior lifetime psychiatric disorders, whereas first MDE occurring at 60 years and older was more strongly associated with widowhood and a prior lifetime history of generalized anxiety disorder.

LIMITATIONS

Associations found cannot be interpzreted as causal relationships due to study design and the risk of recall bias.

CONCLUSION

Our results suggest substantial age differences in risk factors for first MDE. Improving early detection and treatment of major depression and other psychiatric disorders, and preventing childhood maltreatment may have broad benefits to reduce the burden of MDE at all ages.

An attachment perspective on loss and grief

Attachment theory provides a useful framework for understanding emotional reactions to separation and loss and the process of adapting to these painful events. In this article, we review adult attachment studies that have examined emotional reactions and adjustment to separation and loss in romantic and marital relationships. We begin with a brief account of attachment theory. Next, we review studies examining the emotional consequences of losing a relationship partner and the coping responses that can help a person adjust to this loss. Throughout the article, we also summarize research documenting attachment-related individual differences in responses to separation and loss. (99 words).

We're Not That Choosy: Emerging Evidence of a Progression Bias in Romantic Relationships

Dating is widely thought of as a test phase for romantic relationships, during which new romantic partners carefully evaluate each other for long-term fit. However, this cultural narrative assumes that people are well equipped to reject poorly suited partners. In this article, we argue that humans are biased toward pro-relationship decisions-decisions that favor the initiation, advancement, and maintenance of romantic relationships. We first review evidence for a progression bias in the context of relationship initiation, investment, and breakup decisions. We next consider possible theoretical underpinnings-both evolutionary and cultural-that may explain why getting into a relationship is often easier than getting out of one, and why being in a less desirable relationship is often preferred over being in no relationship at all. We discuss potential boundary conditions that the phenomenon may have, as well as its implications for existing theoretical models of mate selection and relationship development.

Matters of the heart: Grief, morbidity, and mortality

Spousal bereavement is associated with an elevated risk of morbidity and mortality. Several well-regarded multidisciplinary research teams have sought to understand the biopsychosocial processes underlying why widow(er)s are at elevated physical health risk. In this paper, we review research from multiple investigatory teams, including our own, showing that, on average, widow(er)s exhibit maladaptive patterns of autonomic, neuroendocrine, and immune activity compared to matched comparisons. Widow(er)s also exhibit poorer health behaviors than they did before their spouse's death. There is considerable variation in post-loss psychological adjustment trajectories among widow(er)s, which likely corresponds to physical health risk trajectories. Yet, there is little biobehavioral research on patterns of change in physical health risk after the death of a spouse. We summarize recently published work demonstrating the utility of attachment theory to characterize and predict individual differences in physical health biomarkers; we highlight the need for a biopsychosocial approach to understand and characterize post-loss trajectory patterns. We conclude by discussing the possibility that this line of inquiry could help researchers, and ultimately providers, identify adjustment trajectories earlier and thus deliver appropriate interventions when they are most needed.