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Pollak C, Verghese J, Blumen HM. Loneliness predicts decreased physical activity in widowed but not married or unmarried individuals. Front Public Health 2024; 12:1295128. [PMID: 38756882 PMCID: PMC11096491 DOI: 10.3389/fpubh.2024.1295128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 04/09/2024] [Indexed: 05/18/2024] Open
Abstract
Background Physical activity is associated with improved health and function in older adults, yet most older adults are sedentary. Loneliness is associated with decreased physical activity at the cross-section, but longitudinal studies are scarce. We examined longitudinal associations between loneliness and physical activity-and whether they were modified by marital status and network size (the number of children, relatives, and friends a person interacts with at least once a month). Methods We analyzed data from 1,931 older adults without dementia at baseline from the Rush Memory and Aging Project with a mean follow-up of 4.8 years (mean age 79.6 ± 7.7, 74.9% women). Loneliness was assessed using the de Jong Gierveld Loneliness Scale. Physical activity was assessed as the frequency with which participants engaged in five categories of activities (e.g., walking, gardening, calisthenics, bicycling, and swimming). Linear mixed effects models examined associations between baseline loneliness and change in physical activity over time after adjusting for demographics, depressive symptoms, global cognition, disability, network size, marital status, social support, and social and cognitive activities. We assessed for effect modification by marital status and network size. Results Associations between loneliness and physical activity differed by marital status. In widowed individuals, baseline loneliness was associated with a 0.06 h/week greater decrease in physical activity per year compared to those who were not lonely (p = 0.005, CI -0.1, 0.02)-which equaled a 150% decrease in physical activity per year. Loneliness did not predict a statistically significant decrease in physical activity in married or unmarried individuals. Discussion Loneliness is associated with decreased physical activity in widowed older adults and should be considered in the design of interventions to prevent or slow the decline in physical activity and promote healthy aging.
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Affiliation(s)
- Chava Pollak
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Joe Verghese
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Helena M. Blumen
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
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Lamba N, Longkoi KT. Journey Towards a Meaningful Life: Adaptation and Resilience in the Lives of Young Hindu Widows. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241235428. [PMID: 38389184 DOI: 10.1177/00302228241235428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Spousal death is a life-altering and traumatic life event in married life, compelling the surviving partner to transition and make substantial adjustments to their new life situation. Losing a spouse can affect individuals differently based on gender, impacting their psychological, social, and economic well-being. This article describes adaptation to a new life condition as widows strive to reconcile their roles, status, and identity while binding their resilience to direct their lives. This study explored the lives of 17 young Hindu widows in rural and semi-urban areas of Haryana, India. Using personal face-to-face interviews and purposive sampling, it captured their unique life stories. After losing their spouses, participants showed impressive resilience, reshaping their lives and identities. They navigated challenges firmly, emphasising personal commitment over social support for effective adaptation. It highlights a need for better support systems for widows, offering potential pathways to enhance their post-loss well-being.
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Affiliation(s)
- Narendra Lamba
- Department of Arts, St Xavier's College Jaipur, Jaipur, India
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Katsiferis A, Bhatt S, Mortensen LH, Mishra S, Westendorp RGJ. Sex differences in health care expenditures and mortality after spousal bereavement: A register-based Danish cohort study. PLoS One 2023; 18:e0282892. [PMID: 36947502 PMCID: PMC10032540 DOI: 10.1371/journal.pone.0282892] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/26/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Spousal bereavement is a life event that affects older people differently. We investigated the impact of spousal bereavement on medical expenditures and mortality in the general population, emphasizing on age and sex. METHODS Data are from a population-based, retrospective cohort study following 924,958 Danish citizens over the age of 65 years, within 2011-2016. Changes in health care expenditures in those who suffer bereavement were compared with time matched changes among those who did not. Mortality hazards were analysed with time to event analysis. RESULTS A total of 77,722 (~8.4%) individuals experienced bereavement, 65.8% being females. Among males, bereavement was associated with increase of expenditures the year after, that was 42 Euros per week (95% CI, 36 to 48) larger than the non-bereaved group. The corresponding increase for females was 35 Euros per week (95% CI, 30 to 40). The increase of mortality hazards was highest in the first year after bereavement, higher in males than females, in young old and almost absent in the oldest old. Compared with the reference, mortality the year after spousal loss was 70% higher (HR 1.70 [95% CI 1.40 to 2.08]) for males aged 65-69 years and remained elevated for a period of six years. Mortality for females aged 65-69 years was 27% higher in the first year (HR 1.27, [1.07 to 1.52]), normalizing thereafter. CONCLUSION Bereavement affects older people differently with younger males being most frail with limited recovery potential.
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Affiliation(s)
- Alexandros Katsiferis
- Section for Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Statistics Denmark, Copenhagen, Denmark
| | - Samir Bhatt
- Section for Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Laust Hvas Mortensen
- Section for Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Statistics Denmark, Copenhagen, Denmark
| | - Swapnil Mishra
- Section for Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Rudi G J Westendorp
- Section for Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Statistics Denmark, Copenhagen, Denmark
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Östergren O, Fors S, Rehnberg J. Excess Mortality by Individual and Spousal Education for Recent and Long-Term Widowed. J Gerontol B Psychol Sci Soc Sci 2022; 77:946-955. [PMID: 34878543 PMCID: PMC9071383 DOI: 10.1093/geronb/gbab227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES The loss of a spouse is followed by a dramatic but short-lived increase in the mortality risk of the survivor. Contrary to expectations, several studies have found this increase to be larger among those with high education. Having a spouse with high education is associated with lower mortality, which suggests that losing a spouse with high education means the loss of a stronger protective factor than losing a spouse with low education. This may disproportionately affect the high educated because of educational homogamy. METHODS We use Swedish total population registers to construct an open cohort of 1,842,487 married individuals aged 60-89 during 2007-2016, observing 239,276 transitions into widowhood and 277,946 deaths. We use Poisson regression to estimate relative and absolute mortality risks by own and spousal education among the married and recent and long-term widows. RESULTS We find an absolute increase in mortality risk, concentrated to the first 6 months of widowhood across all educational strata. The relative increase in mortality risk is larger in higher educational strata. Losing a spouse with high education is associated with higher excess mortality, which attenuates this difference. DISCUSSION When considering the timing and the absolute level of excess mortality, we find that the overall patterns of excess mortality are similar across educational strata. We argue that widowhood has a dramatic impact on health, regardless of education.
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Affiliation(s)
- Olof Östergren
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Stefan Fors
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Johan Rehnberg
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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Dynamical indicators in time series of healthcare expenditures predict mortality risk of older adults following spousal bereavement. BMC Geriatr 2022; 22:301. [PMID: 35395751 PMCID: PMC8991510 DOI: 10.1186/s12877-022-02992-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The process of aging renders older people susceptible for adverse outcomes upon stress. Various indicators derived from complex systems theory have been proposed for quantifying resilience in living organisms, including humans. We investigated the ability of system-based indicators in capturing the dynamics of resilience in humans who suffer the adversity of spousal bereavement and tested their predictive power in mortality as a finite health transition. METHODS Using longitudinal register data on weekly healthcare consumption of all Danish citizens over the age of 65 from January 1st, 2011, throughout December 31st, 2016, we performed statistical comparisons of the indicators 'average', 'slope', 'mean squared error', and 'lag-1 autocorrelation' one year before and after spousal bereavement, stratified for age and sex. The relation between levels of these indicators before bereavement and mortality hazards thereafter was determined by time to event analysis. We assessed the added value for mortality prediction via the time dependent area (AUC) under the receiver operating characteristic curve. RESULTS The study included 934,003 citizens of whom 51,890 experienced spousal bereavement and 2862 died in the first year thereafter. Healthcare consumption is increased, more volatile and accelerating with aging and in men compared to women (all p-values < 0.001). All dynamic indicators before bereavement were positively related with mortality hazards thereafter (all p-values < 0.001). The average discriminative performance for the 1-year mortality risk of the model with only age as a predictor (AUC: 68.9% and 70.2%) was significantly increased with the addition of dynamical indicators (78.5% and 82.4%) for males and females, respectively. CONCLUSIONS Dynamic indicators in time series of health care expenditures are strong predictors of mortality risk and could be part of predictive models for prognosis after life stressors, such as bereavement.
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Krstic Joksimovic K. Gender as a moderator of the relationship between coping strategies and indicators of recovery from the loss. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-02973-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Peña-Longobardo LM, Rodríguez-Sánchez B, Oliva-Moreno J. The impact of widowhood on wellbeing, health, and care use: A longitudinal analysis across Europe. ECONOMICS AND HUMAN BIOLOGY 2021; 43:101049. [PMID: 34371339 DOI: 10.1016/j.ehb.2021.101049] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To estimate whether becoming widowed had a significant effect on individual's health status as well as on healthcare and non-healthcare resources use, compared to people who remained in a couple in Europe. DATA AND METHOD It was used the Survey of Health, Aging and Retirement in Europe from 2004 to 2015. The statistical technique used was genetic matching which analysed the differences in wellbeing, mental health, health status, risk of death, health care resources and long-term care utilization of people who have become widowed, comparing with people who remained married or with a partner. We considered shortterm and medium-term effects. RESULTS In the short term, those who became widowed had a worse wellbeing and mental health, in addition to a greater probability of receiving formal care and informal care from outside the household. There seems to be a significant effect in the use of formal and informal care from outside the household in the medium term. CONCLUSIONS The results might help to concentrate a major effort of any policy or strategy, not only in the field of health but also in the provision of long-term care, immediately after the negative shock occurs.
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Bidulka P, Vestergaard SV, Hlupeni A, Kjærsgaard A, Wong AYS, Langan SM, Schmidt SAJ, Lyon S, Christiansen CF, Nitsch D. Adverse outcomes after partner bereavement in people with reduced kidney function: Parallel cohort studies in England and Denmark. PLoS One 2021; 16:e0257255. [PMID: 34555018 PMCID: PMC8460004 DOI: 10.1371/journal.pone.0257255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/26/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To investigate whether partner bereavement is associated with adverse cardiovascular and kidney-related events in people with reduced kidney function. DESIGN Two parallel matched cohort studies using linked routinely collected health data. SETTING England (general practices and hospitals using linked Clinical Practice Research Datalink, Hospital Episode Statistics, and Office of National Statistics) and Denmark (hospitals and community pharmacies using the Danish National Patient, Prescription and Education Registries and the Civil Registration System). PARTICIPANTS Bereaved people with reduced kidney function (estimated glomerular filtration rate (eGFR) <60mL/min/1.73m2 (England) or hospital-coded chronic kidney disease (Denmark)) and non-bereaved people with reduced kidney function similarly defined, matched on age, sex, general practice (England), and county of residence (Denmark) and followed-up from the bereavement date of the exposed person. MAIN OUTCOME MEASURES Cardiovascular disease (CVD) or acute kidney injury (AKI) hospitalization, or death. RESULTS In people with reduced kidney function, we identified 19,820 (England) and 5,408 (Denmark) bereaved individuals and matched them with 134,828 (England) and 35,741 (Denmark) non-bereaved individuals. Among the bereaved, the rates of hospitalizations (per 1000 person-years) with CVD were 31.7 (95%-CI: 30.5-32.9) in England and 78.8 (95%-CI: 74.9-82.9) in Denmark; the rates of hospitalizations with AKI were 13.2 (95%-CI: 12.5-14.0) in England and 11.2 (95%-CI: 9.9-12.7) in Denmark; and the rates of death were 70.2 (95%-CI: 68.5-72.0) in England and 126.4 (95%-CI: 121.8-131.1) in Denmark. After adjusting for confounders, we found increased rates of CVD (England, HR 1.06 [95%-CI: 1.01-1.12]; Denmark, HR 1.10 [95%-CI: 1.04-1.17]), of AKI (England, HR 1.20 [95%-CI: 1.10-1.31]; Denmark HR 1.36 [95%-CI: 1.17-1.58]), and of death (England, HR 1.10 [95%-CI: 1.05-1.14]; Denmark HR 1.20 [95%-CI: 1.15-1.25]) in bereaved compared with non-bereaved people. CONCLUSIONS Partner bereavement is associated with an increased rate of CVD and AKI hospitalization, and death in people with reduced kidney function. Additional supportive care for this at-risk population may help prevent serious adverse events.
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Affiliation(s)
- Patrick Bidulka
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | | | - Admire Hlupeni
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anders Kjærsgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Angel Y. S. Wong
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sinéad M. Langan
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sigrun Alba Johannesdottir Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Susan Lyon
- Kidney Transplant Recipient, and Widow of Kidney Transplant Recipient, London, United Kingdom
| | | | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Jiao K, Chow AYM, Chen C. Dyadic Relationships between a Surviving Parent and Children in Widowed Families: A Systematic Scoping Review. FAMILY PROCESS 2021; 60:888-903. [PMID: 33118179 DOI: 10.1111/famp.12610] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The death of a family member affects not only individual family members but also their relationships and interactions. Grief has been studied mostly as an intrapersonal experience. Adopting the family perspective, this systematic scoping review focused on parent-child relationships in widowed families so as to identify what is already known on this topic and the research gaps for future study. The review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Four databases (Web of Science, Psycinfo, PubMed, and CINAHL Plus) were searched. Search terms were combinations of two concepts: (1) loss of a parent (20 terms) and (2) parent-child (eight terms). 5,419 studies were identified during the search, of which 36 studies were included in the review following two rounds of screening. Four research themes emerged, and the aggregated findings were identified: (a) The surviving parent and children are likely to become closer following the loss of a parent, while other relevant factors need to be taken into account; (b) Better parent-child relationships play a protective role in children's adjustment to loss; (c) The surviving parent and children's adjustment to loss are interdependent; (d) Through parenting, communication style, coping strategy, and other attributes, the surviving parent can influence their children's adjustment. Gender and age differences were identified in parent-child relationships. The findings further justify the importance of a family perspective when conducting research and practice on bereavement. Several research gaps were identified. Existing studies paid insufficient attention to children's agency and bidirectional relationships, and the interaction process and its role underlying parent-child bidirectional causality. A conceptual framework of parent-child relationships in widowed families is proposed based on these findings.
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Affiliation(s)
- Keyuan Jiao
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Amy Y M Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Chuqian Chen
- Department of Medical Humanities, School of Humanities, Southeast University, Nanjing, China
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Yang F, Gu D. Widowhood, widowhood duration, and loneliness among older adults in China. Soc Sci Med 2021; 283:114179. [PMID: 34225038 DOI: 10.1016/j.socscimed.2021.114179] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 06/07/2021] [Accepted: 06/24/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Widowhood is a distressful life event that is associated with loneliness in older adults. However, widowhood is not a binary event, and little is known about the role of widowhood duration in loneliness and about the relationship between widowhood duration and loneliness in different age and sex groups. Given the increases in aging population and in widowed older adults in China, we examined whether and how widowhood and widowhood duration were associated with loneliness in different age and sex groups among Chinese older adults. METHODS Five waves of Chinese Longitudinal Healthy Longevity Survey 2002-2014 were used. The analysis included 34,440 sampled individuals aged 65 and above. Random intercept ordered logistic models were used to examine relations between widowhood, its duration and loneliness in the entire sample and by age and sex groups. RESULTS Results show that with a wide set of covariates controlled for, widowhood was a significant correlate of loneliness in older adults (OR = 2.34, p < .001); and those who were remarried after widowhood were less likely to be lonely compared to their not-remarried counterparts (OR = 0.47, p < .001). In addition, widowhood was associated with more than twice greater odds of loneliness in the first couple of years following bereavement of spouse (OR = 3.09, p < .001) compared to the currently married older adults. The increased odds ratio of loneliness slightly decreased with the length of widowhood, but it was still significant, even after 40 years of bereavement (OR = 1.96, p < .001). CONCLUSIONS These findings are mostly consistent across age and sex groups. In conclusion, this study sheds light on the relationship between widowhood duration and loneliness and the role of remarriage in widowed older adults' loneliness based on a nationwide survey in China. Widowhood has an acute and long-lasting effect on loneliness in older adults. Remarriage after widowhood could largely reduce or offset the risk of loneliness.
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Affiliation(s)
- Fang Yang
- Department of Social Work, School of Sociology and Political Science, Shanghai University, China. Building 2, #231, Nanchen Road 333, Baoshan District, Shanghai, PR China.
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Huang FY, Hsu AL, Chao YP, Shang CMH, Tsai JS, Wu CW. Mindfulness-based cognitive therapy on bereavement grief: Alterations of resting-state network connectivity associate with changes of anxiety and mindfulness. Hum Brain Mapp 2020; 42:510-520. [PMID: 33068043 PMCID: PMC7775995 DOI: 10.1002/hbm.25240] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/20/2020] [Accepted: 09/29/2020] [Indexed: 12/12/2022] Open
Abstract
Bereavement, the experience of losing a loved one, is one of the most catastrophic but inevitable events in life. It causes grief and intense depression‐like sadness. Recent studies have revealed the effectiveness and proficiency of mindfulness‐based cognitive therapy (MBCT) in emotional regulation among bereavement populations. MBCT improves the well‐being of the bereaved by enhancing cognitive performances. Regarding the neural correlates of bereavement grief, previous studies focused on the alleviation of emotion–cognition interferences at specific brain regions. Here, we hypothesized that the bereavement grief fundamentally triggers global alterations in the resting‐state brain networks and part of the internetwork connectivity could be reformed after MBCT intervention. We recruited 19 bereaved individuals who participated the 8‐week MBCT program. We evaluated (a) the large‐scale changes in brain connectivity affected by the MBCT program; as well as (b) the association between connectivity changes and self‐rated questionnaire. First, after MBCT, the bereaved individuals showed the reduction of the internetwork connectivity in the salience, default‐mode and fronto‐parietal networks in the resting state but not under emotional arousal, implying the alleviated attention to spontaneous mind wandering after MBCT. Second, the alterations of functional connectivity between subcortical (e.g., caudate) and cortical networks (e.g., cingulo‐opercular/sensorimotor) were associated with the changes of the mindfulness scale, the anxiety and the emotion regulation ability. In summary, MBCT could enhance spontaneous emotion regulation among the bereaved individuals through the internetwork reorganizations in the resting state.
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Affiliation(s)
- Feng-Ying Huang
- Department of Education, National Taipei University of Education, Taipei, Taiwan
| | - Ai-Ling Hsu
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yi-Ping Chao
- Graduate Institute of Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | | | - Jaw-Shiun Tsai
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan.,Center for Complementary and Integrated Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Changwei W Wu
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan.,Brain and Consciousness Research Center, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan
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LeRoy AS, Petit WE, Brown RL, Murdock KW, Garcini LM, Stowe RP, Fagundes CP. Relationship satisfaction determines the association between Epstein-Barr virus latency and somatic symptoms after the loss of a spouse. PERSONAL RELATIONSHIPS 2020; 27:652-673. [PMID: 36685314 PMCID: PMC9854169 DOI: 10.1111/pere.12336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The loss of a spouse is associated with a host of negative health outcomes. While bereaved individuals commonly report somatic symptoms, no investigations exist of the association between reactivation of latent Epstein-Barr virus (EBV) and somatic symptoms among this population. Further, how an individual perceives the quality of their lost relationship in retrospect may impact loss outcomes. Among 99 bereaved spouses, elevated EBV antibody titers were associated with somatic symptoms for those who retrospectively reported high or mean levels of relationship satisfaction (RS), but not among those less satisfied. Further, higher RS was associated with greater grief symptoms. This study identifies higher retrospective RS as a possible risk factor for negative physical and mental health outcomes during bereavement.
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Affiliation(s)
- Angie S. LeRoy
- Department of Psychological Sciences, Rice University, Houston, Texas
| | | | - Ryan L. Brown
- Department of Psychological Sciences, Rice University, Houston, Texas
| | - Kyle W. Murdock
- Department of Biobehavioral Health, The Pennsylvania State University, State College, PA
| | - Luz M. Garcini
- Department of Psychological Sciences, Rice University, Houston, Texas
| | | | - Chris P. Fagundes
- Department of Psychological Sciences, Rice University, Houston, Texas
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Psychiatry, Baylor College of Medicine, Houston, TX
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Einiö E, Metsä-Simola N, Saarioja S, Martikainen P, Korhonen K. Is impending or actual death of a spouse with dementia bad for mental health? Antidepressant use surrounding widowhood. Eur J Public Health 2020; 30:953-957. [DOI: 10.1093/eurpub/ckaa099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Previous studies have shown that the risk of death is elevated after the death of a spouse. Limited evidence is available on changes in mental health before and after bereavement among individuals whose spouse dies of dementia.
Methods
We analyzed changes in the 3-month prevalence of antidepressant use for 5 years before and 3 years after widowhood for individuals whose spouses died of either dementia or other causes. The study used data of 41 855 widowed individuals and repeated-measures logistic regression analyses. Antidepressant use was based on the prescription register of Finland in 1995–2007.
Results
Five years before widowhood, the 3-month prevalence for antidepressant use was 4% among widowing men and 6–7% among widowing women, regardless of whether the spouse died of dementia or other causes. Further changes in antidepressant use depended on a spouse’s cause of death. Women whose spouses died of dementia experienced large increase in antidepressant use starting from 3 to 4 years prior to widowhood, whereas other widows did not experience large increase until after widowhood. The trajectories for men were similar. Antidepressant use following the death of a spouse with dementia stayed at a new heightened level after widowhood.
Conclusions
The trajectories of antidepressant use indicate that the process of losing a spouse to dementia is bad for mental health, already a few years prior to widowhood. There are no clear improvements in mental health after the death of a spouse with dementia. Support services for individuals whose spouses’ dementia progresses are needed.
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Affiliation(s)
- Elina Einiö
- Population Research Unit, Department of Social Research, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Niina Metsä-Simola
- Population Research Unit, Department of Social Research, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Saska Saarioja
- Population Research Unit, Department of Social Research, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Department of Social Research, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Laboratory of Population Health, Max Planck Institute for Demographic Research, Rostock, Germany
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Kaarina Korhonen
- Population Research Unit, Department of Social Research, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
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Liu H, Umberson D, Xu M. Widowhood and mortality: gender, race/ethnicity, and the role of economic resources. Ann Epidemiol 2020; 45:69-75.e1. [PMID: 32336656 PMCID: PMC7304506 DOI: 10.1016/j.annepidem.2020.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/19/2020] [Accepted: 02/29/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE We examine widowhood effects on mortality across gender and race-ethnicity, with attention to variation in the mediating role of economic resources. METHODS Data were drawn from the Health and Retirement Study (1992-2016). The analytic sample included 34,777 respondents aged 51 years and older who contributed 208,470 person-period records. Discrete-time hazard models were estimated to predict the odds of death among white men, black men, Hispanic men, white women, black women, and Hispanic women separately. The Karlson-Holm-Breen analysis was conducted to examine the mediating role of economic resources across groups. RESULTS Across all gender and racial-ethnic subgroups, widowhood effects on mortality were largest for Hispanic men. Black women and Hispanic women also suffered stronger effects of widowhood on mortality than white women. For both men and women, economic resources were an important pathway through which widowhood increased mortality risk for whites and blacks but not for Hispanics. CONCLUSIONS Findings highlight that gender and race-ethnicity intersect with widowhood status to disadvantage some groups more than others. It is important to explore the complex pathways that contribute to the higher mortality risk of racial-ethnic minorities, especially Hispanic men, after widowhood so that effective interventions can be implemented to reduce those risks.
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Affiliation(s)
- Hui Liu
- Department of Sociology, Michigan State University, East Lansing.
| | - Debra Umberson
- Department of Sociology and Population Research Center, The University of Texas at Austin, Austin
| | - Minle Xu
- Population Research Center, The University of Texas at Austin, Austin
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15
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Health in widowhood: The roles of social capital and economic resources. Soc Sci Med 2020; 253:112965. [PMID: 32259724 DOI: 10.1016/j.socscimed.2020.112965] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 03/14/2020] [Accepted: 03/24/2020] [Indexed: 11/23/2022]
Abstract
A sizeable literature has demonstrated strong negative associations between widowhood and health, but longitudinal evidence on moderating factors has been mixed. This study assesses the roles of pre-existing social capital and wealth in moderating changes in health in the event of spousal death. Samples of widowed individuals (n = 796) and matched married controls (n = 8233) are employed from 17 consecutive waves of the Household, Income and Labour Dynamics in Australia Survey (2001-2017). Individual-level fixed-effects models are used to estimate changes in physical and mental health before and after spousal death, in reference to one's own health more than two years before widowhood. Results show a temporary physical health improvement in the year of spousal death, and a decline in mental health beginning up to two years before spousal death, lasting up to two years after spousal death. Using social capital-from children, club membership or volunteering status, and social connections-observed earlier than two years before spousal death, this study finds that widowed individuals with higher social capital show poorer mental health than those with less capital. This negative moderating role is more marked among widowed males than females. In contrast, greater wealth, particularly from non-financial assets, is associated with earlier psychological adjustment among males. For females, mental health in widowhood shows little difference by wealth. These findings suggest that social capital may not be sufficient to protect deteriorations in mental health among widowed individuals, and that the pursuit of alternative avenues may be especially important among the less wealthy.
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16
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Guevara JE, Gilbert S, Murdock KW, Stowe RP, Fagundes CP. Sex differences in executive functioning and latent herpesvirus reactivation among bereaved and non-bereaved individuals. Stress Health 2019; 35:396-406. [PMID: 30977590 PMCID: PMC6790147 DOI: 10.1002/smi.2867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 04/02/2019] [Accepted: 04/07/2019] [Indexed: 01/24/2023]
Abstract
The death of a spouse is a highly stressful event. Better executive functioning has been shown to benefit men to a greater degree than women during stress. We evaluated potential sex differences in stress and immune dysregulation among control and bereaved participants who completed a self-report measure of perceived stress, neuropsychological measures of inhibition and updating/monitoring of information in working memory, and a blood draw to measure Epstein-Barr virus (EBV) antibody titres. Moderation analyses were conducted to test the hypothesis that better inhibition would be associated with less stress and immune dysregulation among male bereaved participants compared with female bereaved participants. Bereaved females demonstrated greater EBV antibody titres than bereaved males. Male bereaved participants benefited from better inhibition, as evidenced by fewer EBV antibody titres, whereas bereaved female participants did not. In the control group, males with high inhibition reported lower stress than males with low inhibition. Present study results are an important step towards identifying those at greatest risk of stress and poor health.
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Affiliation(s)
- Jasmin E. Guevara
- Department of Biobehavioral Health, The Pennsylvania State University
| | - Sarah Gilbert
- Department of Biobehavioral Health, The Pennsylvania State University
| | - Kyle W. Murdock
- Department of Biobehavioral Health, The Pennsylvania State University
| | | | - Christopher P. Fagundes
- Department of Psychology, Rice University,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center,Department of Psychiatry, Baylor College of Medicine
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17
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Widowhood and mortality risk of older people in rural China: do gender and living arrangement make a difference? AGEING & SOCIETY 2019. [DOI: 10.1017/s0144686x19000436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIncreased mortality after spousal bereavement has been observed in many populations. Few studies have investigated the widowhood effect in a traditional culture where the economy is underdeveloped. The reasons for the widowhood effect and its gender dynamic are not well understood. In this study, we assessed whether the widowhood-associated excess mortality exists and differs by gender and living arrangement in rural China. We used a six-wave panel of data derived from rural people over 60 years old in the Chaohu region of China. Cox regression analyses suggest that there was a positive effect of spousal loss on mortality for older rural Chinese and this effect was gender different. Our findings also suggest that living with adult children after spousal loss played a protective role in reducing the risk of older men's death, though it tended to increase older men's mortality risk in general.
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18
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Jang H, Tang F, Gonzales E, Lee YS, Morrow-Howell N. Formal volunteering as a protector of health in the context of social losses. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2018; 61:834-848. [PMID: 29843571 DOI: 10.1080/01634372.2018.1476945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study aims to examine the effect of the death of a family member or friend on psychological well-being, specifically the moderating effects of first-time volunteering and social network. With the sample of 354 volunteers from the Experience Corps® (EC) programs, Analysis of covariance (ANCOVA) estimated the differences in psychological well-being. Among volunteers who had experienced the death of a family member or friend, new volunteers showed significant improvement in positive affect compared to experienced volunteers. EC members gained additional social contacts through volunteering. Formal volunteering has a salutatory effect on older adults' health after the loss of family members.
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Affiliation(s)
- Heejung Jang
- a School of Social Work, University of Pittsburgh , Pittsburgh , Pennsylvania, USA
| | - Fengyan Tang
- a School of Social Work, University of Pittsburgh , Pittsburgh , Pennsylvania, USA
| | - Ernest Gonzales
- b School of Social Work, Boston University , Boston , Massachusetts, USA
| | - Yung Soo Lee
- c Department of Social Welfare , Incheon National University , Incheon , Korea
| | - Nancy Morrow-Howell
- d Brown School of Social Work , Washington University in St. Louis , St. Louis, Missouri, USA
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19
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Franke S, Kulu H. Mortality Differences by Partnership Status in England and Wales: The Effect of Living Arrangements or Health Selection? EUROPEAN JOURNAL OF POPULATION = REVUE EUROPEENNE DE DEMOGRAPHIE 2018; 34:87-118. [PMID: 30976244 PMCID: PMC6241022 DOI: 10.1007/s10680-017-9423-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 03/08/2017] [Indexed: 10/19/2022]
Abstract
This article investigates the relationship between partnership status and mortality in England and Wales. Using data from the Office for National Statistics Longitudinal Study for the period between 2001 and 2011, we examine whether married people have lower mortality levels than unmarried individuals; whether individuals who cohabit have mortality levels similar to those of married or single persons; and how much the fact that married couples live with someone rather than alone explains their low mortality. Our analysis shows first that married individuals have lower mortality than unmarried persons. Second, men and women in premarital unions exhibit mortality levels similar to those of married men and women, whereas mortality levels are elevated for post-marital cohabitants. Third, controlling for household size and the presence of children reduces mortality differences between married and unmarried non-partnered individuals, but significant differences persist. The study supports both protection and selection theory. The increase in mortality differences by age between never-married cohabitants and married couples is likely a sign of the long-term accumulation of health and wealth benefits of marriage. Similar mortality levels of cohabiting and married couples at younger ages suggest that healthier individuals are more likely to find a partner.
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Affiliation(s)
- Sebastian Franke
- Department of Geography and Planning, School of Environmental Sciences, University of Liverpool, Roxby Building, Liverpool, L69 7ZT UK
| | - Hill Kulu
- School of Geography and Sustainable Development, University of St Andrews, Irvine Building, North Street, St Andrews, KY16 9AL UK
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20
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Tseng FM, Petrie D, Leon-Gonzalez R. The impact of spousal bereavement on subjective wellbeing: Evidence from the Taiwanese elderly population. ECONOMICS AND HUMAN BIOLOGY 2017; 26:1-12. [PMID: 28142088 DOI: 10.1016/j.ehb.2017.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 01/12/2017] [Accepted: 01/13/2017] [Indexed: 06/06/2023]
Abstract
Bereavement is an inevitable event in our life. This paper employs the Taiwanese panel Survey of Health and Living Status of the Elderly (SHLSE) to evaluate the impact of losing a spouse on self-assessed health and subjective well-being measured by depression and life satisfaction. Propensity score matching methods are used to generate a hypothetical bereavement date and a weight for the non-bereaved to create a comparable non-bereaved cohort and a difference-in-differences (DiD) approach is used to estimate the impact of spousal bereavement. The results show that spousal bereavement increases depression scale by 1.81 points but this increment decreases by 0.43 points every year after bereavement. It takes approximate 4 years to restore to the level prior to bereavement. We also examine the demographic and socioeconomic differences in the spousal bereavement impact and find that the spousal bereavement impact is greater on the bereaved in the higher income group in terms of self-assessed health and depression. Our results only represent a lower boundary of the possible impact of spousal bereavement on self-assessed health and subjective wellbeing due to data restrictions.
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Affiliation(s)
- Fu-Min Tseng
- Department of Economics, National Chung Cheng University, Taiwan.
| | - Dennis Petrie
- Centre for Health Economics, Monash University, Australia
| | - Roberto Leon-Gonzalez
- National Graduate Institute for Policy Studies, Tokyo, Japan; Rimini Centre for Economic Analysis, Italy
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21
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Guldin M, Ina Siegismund Kjaersgaard M, Fenger‐Grøn M, Thorlund Parner E, Li J, Prior A, Vestergaard M. Risk of suicide, deliberate self-harm and psychiatric illness after the loss of a close relative: A nationwide cohort study. World Psychiatry 2017; 16:193-199. [PMID: 28498584 PMCID: PMC5428185 DOI: 10.1002/wps.20422] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The loss of a close relative is a common event, yet it is associated with increased risk of serious mental health conditions. No large-scale study has explored up to now the importance of the bereaved person's relation to the deceased while accounting for gender and age. We performed a nationwide Danish cohort study using register information from 1995 through 2013 on four sub-cohorts including all persons aged ≥18 years exposed to the loss of a child, spouse, sibling or parent. We identified 1,445,378 bereaved persons, and each was matched by gender, age and family composition to five non-bereaved persons. Cumulative incidence proportions were calculated to estimate absolute differences in suicide, deliberate self-harm and psychiatric illness. Cox proportional hazard regression was used to calculate hazard ratios while adjusting for potential confounders. Results revealed that the risk of suicide, deliberate self-harm and psychiatric illness was increased in the bereaved cohorts for at least 10 years after the loss, particularly during the first year. During that year, the risk difference was 18.9 events in 1,000 persons after loss of a child (95% CI: 17.6-20.1) and 16.0 events in 1,000 persons after loss of the spouse (95% CI: 15.4-16.6). Hazard ratios were generally highest after loss of a child, in younger persons, and after sudden loss by suicide, homicide or accident. One in three persons with a previous psychiatric diagnosis experienced suicide, deliberate self-harm or psychiatric illness within the first year of bereavement. In conclusion, this study shows that the risk of suicide, deliberate self-harm and psychiatric illness is high after the loss of a close relative, especially in susceptible subgroups. This suggests the need for early identification of high-risk persons displaying adjustment problems after loss of a close family member, in order to reduce the risk of serious mental health outcomes.
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Affiliation(s)
- Mai‐Britt Guldin
- Research Unit for General Practice, Aarhus UniversityAarhusDenmark
| | | | | | | | - Jiong Li
- Department of Public HealthAarhus UniversityAarhusDenmark
| | - Anders Prior
- Research Unit for General Practice, Aarhus UniversityAarhusDenmark,Department of Public HealthAarhus UniversityAarhusDenmark
| | - Mogens Vestergaard
- Research Unit for General Practice, Aarhus UniversityAarhusDenmark,Department of Public HealthAarhus UniversityAarhusDenmark
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22
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Vignes B. Crisis or Chronic Strain?: Gender and Age Differences in Sickness Absence following Early Spousal Loss. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2017; 58:54-69. [PMID: 28661767 DOI: 10.1177/0022146516688243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This population-based study ( N = 908,468) examines the effects of spousal loss on being absent from work due to illness or injury (sickness absence) among employed individuals in Norway. Fixed-effects models capturing antecedent and short- and long-term effects of spousal loss over a 15-year period were estimated to explore gender and age differences in the impact of widowhood. The crisis model, the social-role model, and the life course perspective are discussed. Furthermore, the study calls into question whether parenthood explains the gendered age gradient of the widowhood effect. The results show that the theoretical relevance of the crisis and social-role models is best understood in dialogue with a gendered life course approach. The results show that the crisis response is especially high among young widowers, whereas the recovery period is markedly prolonged among young widows. Parenthood at the time of widowhood explains much of the age difference among widowers and widows.
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Affiliation(s)
- Bo Vignes
- 1 University of Bergen, Bergen, Norway
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23
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Einiö E, Moustgaard H, Martikainen P, Leinonen T. Does the risk of hospitalisation for ischaemic heart disease rise alreadybeforewidowhood? J Epidemiol Community Health 2017; 71:599-605. [DOI: 10.1136/jech-2016-207987] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 12/15/2016] [Accepted: 02/10/2017] [Indexed: 12/26/2022]
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24
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Perkins JM, Lee HY, James KS, Oh J, Krishna A, Heo J, Lee JK, Subramanian SV. Marital status, widowhood duration, gender and health outcomes: a cross-sectional study among older adults in India. BMC Public Health 2016; 16:1032. [PMID: 27716203 PMCID: PMC5045657 DOI: 10.1186/s12889-016-3682-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 09/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research has demonstrated health benefits of marriage and the potential for worse outcomes during widowhood in some populations. However, few studies have assessed the relevance of widowhood and widowhood duration to a variety of health-related outcomes and chronic diseases among older adults in India, and even fewer have examined these relationships stratified by gender. METHODS Using a cross-sectional representative sample of 9,615 adults aged 60 years or older from 7 states in diverse regions of India, we examine the relationship between widowhood and self-rated health, psychological distress, cognitive ability, and four chronic diseases before and after adjusting for demographic characteristics, socioeconomic status, living with children, and rural-urban location for men and women, separately. We then assess these associations when widowhood accounts for duration. RESULTS Being widowed as opposed to married was associated with worse health outcomes for women after adjusting for other explanatory factors. Widowhood in general was not associated with any outcomes for men except for cognitive ability, though men who were widowed within 0-4 years were at greater risk for diabetes compared to married men. Moreover, recently widowed women and women who were widowed long-term were more likely to experience psychological distress, worse self-rated health, and hypertension, even after adjusting for other explanatory variables, whereas women widowed 5-9 years were not, compared to married women. CONCLUSIONS Gender, the duration of widowhood, and type of outcome are each relevant pieces of information when assessing the potential for widowhood to negatively impact health. Future research should explore how the mechanisms linking widowhood to health vary over the course of widowhood. Incorporating information about marital relationships into the design of intervention programs may help better target potential beneficiaries among older adults in India.
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Affiliation(s)
- Jessica M Perkins
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Massachusetts Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Hwa-Young Lee
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul, 110-810, Korea
| | - K S James
- Jawaharlal Nehru University, New Delhi, India
| | - Juhwan Oh
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul, 110-810, Korea
| | - Aditi Krishna
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jongho Heo
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul, 110-810, Korea.,Public Health Joint Doctoral Program, San Diego State University & University of California, San Diego, CA, USA
| | - Jong-Koo Lee
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul, 110-810, Korea. .,Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - S V Subramanian
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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25
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Lee MA, Carr D. Does the Context of Spousal Loss Affect the Physical Functioning of Older Widowed Persons? A Longitudinal Analysis. Res Aging 2016. [DOI: 10.1177/0164027507303171] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examines: (1) the extent to which acute and chronic stressors related to spousal loss affect the physical functioning of bereaved spouses; and (2) how these patterns differ for men and women. We use data from the Changing Lives of Older Couples (CLOC) study, which tracks older adults prior to spousal loss, and 6, 18, and 48 months after spousal loss. The results reveal that (1) widowed persons whose spouses had serious ongoing health problems before the death report more severe perceived limitation in performing daily activities 18 and 48 months after loss; (2) widowed persons who were not with their spouses when they died have greater functional limitation 18 and 48 months after loss. However, gender interaction term analyses reveal that the health effects of spousal death context hold for widowers only. Our findings suggest that the ways older adults die may have long-term physical health consequences for their surviving spouses, and these ramifications differ for widows and widowers.
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Affiliation(s)
- Min-Ah Lee
- Purdue University, West Lafayette, Indiana,
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26
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Li CS, Lee JH, Chang LY, Liu CC, Chan YL, Wen C, Chiu ML, Tsai MK, Tsai SP, Wai JPM, Tsao CK, Wu X, Wen CP. Physical activity to overcome the adversity of widowhood: Benefits beyond physical health. Medicine (Baltimore) 2016; 95:e4413. [PMID: 27512856 PMCID: PMC4985311 DOI: 10.1097/md.0000000000004413] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 06/23/2016] [Accepted: 06/24/2016] [Indexed: 11/25/2022] Open
Abstract
Widowhood has been increasingly encountered because of increasing longevity of women, often characterized by social stigmatization and poor physical and mental health. However, applied research to overcome its adversity has been quite limited. The goal of this study is to explore the role of physical activity in improving the health of widows.A cohort of 446,582 adults in Taiwan who successively participated in a comprehensive medical screening program starting in 1994, including 232,788 women, was followed up for mortality until 2008. Each individual provided detailed health history, and extensive lab tests results.The number of widows increased with time trend. Every other woman above age 65 was a widow (44%). Widows were less active, more obese, and smoked and drank more, had sleep problems, were more depressed with taking sedatives or psychoactive drugs, leading to more suicides. In the global development of health policies by World Health Organization (WHO), physical activity is one of the main factors to reverse poor health. The poor health of inactive widow was mitigated when becoming fully active in this study. Exercise not only reduced the observed 18% increase in all-cause mortality, but also gained 4 years and as much as 14% mortality advantage over the married but inactive. More importantly, becoming physically active energized their mental status, improved sleep quality and quantity, reduced depressions and the need for psychoactive drugs, and increased socialization circles.Widows, a rapidly growing and socially stigmatized group, suffered from social and financial inequality and tended to develop poorer health. Sustained physical activity could be one of the ways for them to overcome and reverse some of the physical and mental adversities of widowhood, and improve their quality and quantity of life.
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Affiliation(s)
- Chu-Shiu Li
- Department of Risk Management and Insurance, National Kaohsiung First University of Science and Technology, Kaohsiung
- Department of International Business, Asia University, Taichung
| | - June Han Lee
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan
| | | | - Chwen-Chi Liu
- Department of Risk Management and Insurance, Feng Chia University, Taichung, Taiwan
| | - Yan-Lan Chan
- Department of International Business, Asia University, Taichung
| | - Christopher Wen
- Department of Radiological Sciences, University of California at Irvine, Irvine, CA
| | - Mu-Lin Chiu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan
- Department of Public Health, China Medical University, Liaoning
| | - Min Kuang Tsai
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan
| | - Shan Pou Tsai
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan
| | | | | | - Xifeng Wu
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chi Pang Wen
- China Medical University Hospital, Taichung and Institute of Population Health Sciences, National Health Research Institutes, Zhunan
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27
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Abstract
RÉSUMÉCet exercice de cartographie en 2014 avait comme but d’ identifier et de décrire tous les programmes et services de soutien pendant le deuil dans la province entière de l’Alberta, et de les comparer aux ceux-ci disponibles quatre années d’avant. Le deuil est une expérience commune dans la vie, en particulier chez les personnes âgées, et le soutien est souvent nécessaire pour aider leur récupération. Nous avons cherché des informations sur les programmes et les services par le biais de recherches systématiques et la technique «boule de neige» est utilisée pour identifier les fournisseurs et les interviewer. Bien qu’une croissance considérable (330%), et une plus grande diversité parmi les fournisseurs, les programmes et les services, étaient évidente, nous avons découvert que les programmes de deuil ne sont plus encore financés par l’État. Au contraire, les programmes et les services existants proviennent maintenant de la base, avec des individus et des groupes communautaires offrant, pour la plupart, la conception et la fourniture de services de soutien aux personnes en deuil. Les programmes de deuil sont importants, en particulier pour les personnes âgées qui peuvent être les plus touchées par la mort d un être cher. Les résultats de ces programmes nécessitent une évaluation comparative. Si les gouvernements devraient fournir et / ou financer de tels programmes est une question qu’on doit également prendre en compte.
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28
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Wright DM, Rosato M, O'Reilly D. Urban/rural variation in the influence of widowhood on mortality risk: A cohort study of almost 300,000 couples. Health Place 2015; 34:67-73. [PMID: 25957924 DOI: 10.1016/j.healthplace.2015.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 03/09/2015] [Accepted: 04/23/2015] [Indexed: 11/24/2022]
Abstract
Death of a spouse is associated with increased mortality risk for the surviving partner (the widowhood effect). We investigated whether the effect magnitude varied between urban, rural and intermediate areas, assembling death records (2001-2009) for a prospective cohort of 296,125 married couples in Northern Ireland. The effect was greatest during the first six months of widowhood in all areas and for both sexes. Subsequently, the effect was attenuated among men in rural and intermediate areas but persisted in urban areas (HRs and 95% CIs: rural 1.09 [0.99, 1.21]; urban 1.35 [1.26, 1.44]). Among women the effect was attenuated in all areas (rural 1.06 [0.96, 1.17]; urban 1.09 [1.01, 1.17]). The impacts of spousal bereavement varied between urban and more rural areas, possibly due to variation in social support provided by the wider community. We identify men in urban areas as being in greatest need of such support and a possible target for health interventions.
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Affiliation(s)
- David M Wright
- Centre for Public Health, Queen's University Belfast, UK.
| | - Michael Rosato
- Bamford Centre for Mental Health and Wellbeing, Ulster University, UK
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29
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Stephen AI, Macduff C, Petrie DJ, Tseng FM, Schut H, Skår S, Corden A, Birrell J, Wang S, Newsom C, Wilson S. The economic cost of bereavement in Scotland. DEATH STUDIES 2015; 39:151-157. [PMID: 25255790 DOI: 10.1080/07481187.2014.920435] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Aspects of the socioeconomic costs of bereavement in Scotland were estimated using 3 sets of data. Spousal bereavement was associated with increased mortality and longer hospital stays, with additional annual cost of around £20 million. Cost of bereavement coded consultations in primary care was estimated at around £2.0 million annually. In addition, bereaved people were significantly less likely to be employed in the year of and 2 years after bereavement than non-bereaved matched controls, but there were no significant differences in income between bereaved people and matched controls before and after bereavement.
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Affiliation(s)
- Audrey I Stephen
- a Institute for Health and Wellbeing Research , Robert Gordon University , Aberdeen , Scotland
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Seifter A, Singh S, McArdle PF, Ryan KA, Shuldiner AR, Mitchell BD, Schäffer AA. Analysis of the bereavement effect after the death of a spouse in the Amish: a population-based retrospective cohort study. BMJ Open 2014; 4:e003670. [PMID: 24435888 PMCID: PMC3902313 DOI: 10.1136/bmjopen-2013-003670] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study investigates the association between bereavement and the mortality of a surviving spouse among Amish couples. We hypothesised that the bereavement effect would be relatively small in the Amish due to the unusually cohesive social structure of the Amish that might attenuate the loss of spousal support. DESIGN Population-based cohort study. SETTING The USA. PARTICIPANTS 10,892 Amish couples born during 1725-1900 located in Pennsylvania, Ohio and Indiana. All the participants are deceased. OUTCOME MEASURES The survival time is 'age'; event is 'death'. Hazard ratios (HRs) of widowed individuals with respect to gender, age at widowhood, remarriage, the number of surviving children and time since bereavement. RESULTS We observed HRs for widowhood ranging from 1.06 to 1.26 over the study period (nearly all differences significant at p<0.05). Mortality risks tended to be higher in men than in women and in younger compared with older bereaved spouses. There were significantly increased mortality risks in widows and widowers who did not remarry. We observed a higher number of surviving children to be associated with increased mortality in men and women. Mortality risk following bereavement was higher in the first 6 months among men and women. CONCLUSIONS We conclude that bereavement effects remain apparent even in this socially cohesive Amish community. Remarriage is associated with a significant decrease in the mortality risk among Amish individuals. Contrary to results from previous studies, an increase in the number of surviving children was associated with decreased survival rate.
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Affiliation(s)
- Ari Seifter
- Department of Medicine and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sarabdeep Singh
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, DHHS, Bethesda, Maryland, USA
| | - Patrick F McArdle
- Department of Medicine and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kathleen A Ryan
- Department of Medicine and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alan R Shuldiner
- Department of Medicine and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Geriatric Research and Education Clinical Center, Veterans Administration Medical Center, Baltimore, Maryland, USA
| | - Braxton D Mitchell
- Department of Medicine and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Geriatric Research and Education Clinical Center, Veterans Administration Medical Center, Baltimore, Maryland, USA
| | - Alejandro A Schäffer
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, DHHS, Bethesda, Maryland, USA
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Excess Mortality Risks in Institutions: The Influence of Health and Disability Status. EUROPEAN STUDIES OF POPULATION 2014. [DOI: 10.1007/978-3-319-03029-6_10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Sullivan AR, Fenelon A. Patterns of widowhood mortality. J Gerontol B Psychol Sci Soc Sci 2014; 69:53-62. [PMID: 24077660 PMCID: PMC3968855 DOI: 10.1093/geronb/gbt079] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 07/17/2013] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Becoming widowed is a known risk factor for mortality. This article examines the magnitude of, explanations for, and variation in the association between widowhood and mortality. Previous research on widowhood mortality has revealed variation by socioeconomic status (SES), in that SES is not protective in widowhood, and by gender, such that men's mortality increases more than women's mortality after the death of spouse. METHOD Using data from the Health and Retirement Study, we estimated Cox proportional hazard models to estimate the association between widowhood and mortality. RESULTS Becoming widowed is associated with a 48% increase in risk of mortality. Approximately one third of the increase can be attributed to selection, in that those who become widows are socioeconomically disadvantaged. In contrast to previous studies, SES is protective for widows. Widowhood mortality risk increases for men if their wives' deaths were unexpected rather than expected; for women, the extent to which their husbands' death was expected matters less. DISCUSSION Widowhood's harmful association with mortality show how strongly social support and individual's health and mortality are related. These findings support the larger literature on the importance of social support for health and longevity.
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Affiliation(s)
- Allison R Sullivan
- Correspondence should be addressed to Andrew Fenelon, Population Studies & Training Center, Brown University, 68 Waterman Street, Providence, RI 02912. E-mail:
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Moon JR, Glymour MM, Vable AM, Liu SY, Subramanian SV. Short- and long-term associations between widowhood and mortality in the United States: longitudinal analyses. J Public Health (Oxf) 2013; 36:382-9. [PMID: 24167198 DOI: 10.1093/pubmed/fdt101] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Past research shows that spousal death results in elevated mortality risk for the surviving spouse. However, most prior studies have inadequately controlled for socioeconomic status (SES), and it is unclear whether this 'widowhood effect' persists over time. METHODS Health and Retirement Study participants aged 50+ years and married in 1998 (n = 12 316) were followed through 2008 for widowhood status and mortality (2912 deaths). Discrete-time survival analysis was used to compare mortality for the widowed versus the married. RESULTS Odds of mortality during the first 3 months post-widowhood were significantly higher than in the continuously married (odds ratio (OR) for men = 1.87, 95% CI: 1.27, 2.75; OR for women = 1.47, 95% CI: 0.96, 2.24) in models adjusted for age, gender, race and baseline SES (education, household wealth and household income), behavioral risk factors and co-morbidities. Twelve months following bereavement, men experienced borderline elevated mortality (OR = 1.16, 95% CI: 1.00, 1.35), whereas women did not (OR = 1.07, 95% CI: 0.90, 1.28), though the gender difference was non-significant. CONCLUSION The 'widowhood effect' was not fully explained by adjusting for pre-widowhood SES and particularly elevated within the first few months after widowhood. These associations did not differ by sex.
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Affiliation(s)
| | - M Maria Glymour
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Kresge Building, 7th Floor, Boston, MA 02115, USA
| | - Anusha M Vable
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Kresge Building, 7th Floor, Boston, MA 02115, USA
| | - Sze Y Liu
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Kresge Building, 7th Floor, Boston, MA 02115, USA
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Kresge Building, 7th Floor, Boston, MA 02115, USA
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Asgeirsdóttir HG, Valdimarsdóttir U, Fürst CJ, Steineck G, Hauksdóttir A. Low preparedness before the loss of a wife to cancer and the widower's chronic pain 4-5 years later-a population-based study. Psychooncology 2013; 22:2763-70. [PMID: 23839720 DOI: 10.1002/pon.3345] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 04/18/2013] [Accepted: 05/27/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The focus of this study was on the impact of spousal loss on the development of chronic pain thereafter. More specifically, the aim was to investigate the effect of experiencing low preparedness before a wife's death and the widower's chronic pain 4-5 years after loss. METHODS In a population-based study in the years 2004-2005, anonymous questionnaires were sent out to 907 men in Sweden who had lost a wife to cancer in 2000 and 2001. The questionnaires contained questions on the man's preparedness for his wife's death and his physical and psychological health at follow-up. RESULTS Altogether, 691 out of 907 questionnaires were retrieved (76%). Younger widowers (38-61 years old) with a low degree of preparedness for their wife's death had an increased risk of experiencing symptoms of chronic pain (odds ratio 6.67; 2.49-17.82) 4-5 years after loss. The same results did not apply for older widowers (62-80 years old) (odds ratio 0.81; 0.32-2.05). Widowers who experienced chronic pain were at an increased risk for psychological morbidity, depression (relative risk [RR] 2.21; 1.31-3.74), anxiety (RR 2.11; 1.33-3.37), and sleep disorders (RR 2.19; 1.30-3.69). CONCLUSION Our data suggest that low preparedness for a wife's death may increase risk of chronic pain among younger widowers 4-5 years after loss. In addition, we found comorbidity between psychological symptoms and chronic pain among widowers. These findings call for studies on possible mechanisms in the association between low preparedness and morbidity and on how to increase preparedness for a wife's death to cancer.
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Espinosa J, Evans WN. Maternal bereavement: the heightened mortality of mothers after the death of a child. ECONOMICS AND HUMAN BIOLOGY 2013; 11:371-381. [PMID: 22809832 DOI: 10.1016/j.ehb.2012.06.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 03/30/2012] [Accepted: 06/15/2012] [Indexed: 06/01/2023]
Abstract
Using a 9-year follow-up of 69,224 mothers aged 20-50 from the National Longitudinal Mortality Survey, we investigate whether there is heightened mortality of mothers after the death of a child. Results from Cox proportional hazard models indicate that the death of a child produces a statistically significant hazard ratio of 2.3. There is suggestive evidence that the heightened mortality is concentrated in the first two years after the death of a child. We find no difference in results based on mother's education or marital status, family size, the child's cause of death or the gender of the child.
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Affiliation(s)
- Javier Espinosa
- Department of Economics, Rochester Institute of Technology, 92 Lomb Memorial Drive, Rochester, NY 14623, USA.
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Sasson I, Umberson DJ. Widowhood and depression: new light on gender differences, selection, and psychological adjustment. J Gerontol B Psychol Sci Soc Sci 2013; 69:135-45. [PMID: 23811294 DOI: 10.1093/geronb/gbt058] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To document short- and long-term trajectories of depressive symptoms following widowhood and to test whether these trajectories vary by gender and anticipatory spousal loss. METHOD Eight waves of prospective panel data from the Health and Retirement Study, over a 14-year period, are used to evaluate gender differences in depressive symptoms following widowhood in late midlife. Short-term trajectories are modeled using a linear regression of change in Center for Epidemiologic Studies Depression (CES-D) score on duration of widowhood. Long-term trajectories are modeled using a mixed-effects hierarchical linear model of CES-D scores over time. RESULTS We find no gender differences in bereavement effects on depressive symptoms in either short or long term, net of widowhood duration. When spousal death is anticipated, both men and women return to their prewidowhood levels of depressive symptoms within 24 months of becoming widowed. Across marital groups, the continuously married are better off compared with the widowed even prior to spousal loss, whereas early, long-term widowhood is associated with worse outcomes compared with late widowhood. DISCUSSION Although men and women do not differ in trajectories of depressive symptoms following widowhood, given similar circumstances, women are distinctly disadvantaged in that they are more likely to become widowed and under less favorable conditions.
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Affiliation(s)
- Isaac Sasson
- Correspondence should be addressed to Isaac Sasson, Department of Sociology and Population Research Center, University of Texas at Austin, 305 E. 23rd Street, Stop G1800, Austin, TX 78712-1699. E-mail:
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King M, Vasanthan M, Petersen I, Jones L, Marston L, Nazareth I. Mortality and medical care after bereavement: a general practice cohort study. PLoS One 2013; 8:e52561. [PMID: 23372651 PMCID: PMC3556004 DOI: 10.1371/journal.pone.0052561] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 11/19/2012] [Indexed: 12/31/2022] Open
Abstract
Bereaved spouses or partners are thought to be at increased risk of morbidity and mortality. However, there are few large prospective studies and results are inconsistent. We estimated the relative mortality, prescription of psychotropic medication and use of primary medical care services in adults whose cohabitee died of cancer. To do this, we undertook a cohort study using The Health Improvement Network (THIN) UK primary care database. Participants were 1) people aged over 40, who were registered with general practices and had been exposed to the death of a cohabitee from cancer; and 2) a comparison cohort frequency matched on five year age bands and sex who were cohabiting with a living partner. The baseline was chosen as six months before the date of the cancer death for the exposed group and a random date for the unexposed group. Incidence rate ratios (IRR) with 95% confidence intervals (CI) were estimated using random effects Poisson regression to account for clustering within general practices and adjusting for other key variables. 92,129 patients were studied for a median follow up of 4 years. Cohabitees of patients who died of cancer were less likely to die of any cause (IRR 0.71, CI 0.68-0.74) after adjustment for age, gender, number of non-psychotropic prescriptions 6 months before the cancer death/index date, use of psychotropic medication 6 months before the cancer death/index date, smoking, alcohol and area deprivation score. Exposed patients were more likely to receive a prescription for antidepressant or hypnotic medication and to attend their GP both before and after the death of the cohabitee. In conclusion, we did not confirm increased mortality in cohabitees of people dying from cancer.
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Affiliation(s)
- Michael King
- Unit of Mental Health Sciences, Faculty of Brain Sciences, University College London Medical School, London, United Kingdom.
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Metsä-Simola N, Martikainen P. The short-term and long-term effects of divorce on mortality risk in a large Finnish cohort, 1990-2003. Population Studies 2012; 67:97-110. [PMID: 23237618 DOI: 10.1080/00324728.2012.746386] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study investigated time patterns of post-divorce excess mortality. Using register-based data, we followed 252,641 married Finns from 1990 until subsequent date of divorce and death until 2003. Among men, excess mortality is highest immediately after divorce, followed by a decline over 8 years. Among women, excess mortality shows little variation over time, and is lower than among men at all durations of divorce. Social and economic factors--largely adjustment for post-divorce factors--explain about half of the excess mortality. This suggests that excess mortality is partly mediated through poor social and economic resources. Mortality attributable to accidental, violent, and alcohol-related causes is pronounced shortly after divorce. It shows a strong pattern of reduction over the next 4 years among divorced men, and is high for only 6 months after divorce among divorced women. These findings emphasize the importance of short-term psychological distress, particularly among men.
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Fasse L, Flahault C, Brédart A, Dolbeault S, Sultan S. Deuil et vulnérabilité psychique chez les personnes âgées. PSYCHO-ONCOLOGIE 2012. [DOI: 10.1007/s11839-012-0395-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Shah SM, Carey IM, Harris T, DeWilde S, Victor CR, Cook DG. Do good health and material circumstances protect older people from the increased risk of death after bereavement? Am J Epidemiol 2012; 176:689-98. [PMID: 23051600 PMCID: PMC3472615 DOI: 10.1093/aje/kws162] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
An increased risk of death in persons who have suffered spousal bereavement has been described in many populations. The impact of modifying factors, such as chronic disease and material circumstances, is less well understood. The authors followed 171,120 couples 60 years of age or older in a United Kingdom primary care database between 2005 and 2010 for an average of 4 years. A total of 26,646 (15.5%) couples experienced bereavement, with mean follow up after bereavement of 2 years. In a model adjusted for age, sex, comorbid conditions at baseline, material deprivation based on area of residence, season, and smoking status, the hazard ratio for mortality in the first year after bereavement was 1.25 (95% confidence interval: 1.18, 1.33). Further adjustment for changes in comorbid conditions throughout follow up did not alter the hazard ratio for bereavement (hazard ratio = 1.27, 95% confidence interval: 1.19, 1.35). The association was strongest in individuals with no significant chronic comorbid conditions throughout follow up (hazard ratio = 1.50, 95% confidence interval: 1.28, 1.77) and in more affluent couples (P = 0.035). In the first year after bereavement, the association between bereavement and death is not primarily mediated through worsening or new onset of chronic disease. Good health and material circumstances do not protect individuals from increased mortality rates after bereavement.
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Affiliation(s)
- Sunil M Shah
- Division of Population Health Sciences and Education, St. George's University of London, London, UK.
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Abstract
The study of spousal bereavement and mortality has long been a major topic of interest for social scientists, but much remains unknown with respect to important moderating factors, such as age, follow-up duration, and geographic region. The present study examines these factors using meta-analysis. Keyword searches were conducted in multiple electronic databases, supplemented by extensive iterative hand searches. We extracted 1,377 mortality risk estimates from 123 publications, providing data on more than 500 million persons. Compared with married people, widowers had a mean hazard ratio (HR) of 1.23 (95% confidence interval (CI), 1.19-1.28) among HRs adjusted for age and additional covariates and a high subjective quality score. The mean HR was higher for men (HR, 1.27; 95% CI, 1.19-1.35) than for women (HR, 1.15; 95% CI, 1.08-1.22). A significant interaction effect was found between gender and mean age, with HRs decreasing more rapidly for men than for women as age increased. Other significant predictors of HR magnitude included sample size, geographic region, level of statistical adjustment, and study quality.
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Gender differences in widowhood effects among community-dwelling elders by causes of death in Taiwan. Ann Epidemiol 2012; 22:457-65. [PMID: 22579401 DOI: 10.1016/j.annepidem.2012.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 03/31/2012] [Accepted: 04/15/2012] [Indexed: 11/22/2022]
Abstract
PURPOSE We sought to determine whether widowhood-associated excess mortality differs by gender in terms of causes of death. METHODS Data were collected from a five-wave interview of approximately 2500 community-dwelling elders in the Survey of Health and Living Status of the Nearly Elderly and Elderly. Baseline characteristics were used to derive the risk score (RS) to reflect individual's baseline pre-widowhood vulnerability. Time-dependent Cox regression analyses were used to estimate spousal loss-related mortality by causes. RESULTS For males, the adjusted hazard ratios (aHRs) of widowhood for all-cause and some major causes of death (e.g., neoplasm) increased inversely with RS: the aHRs for all-cause death were 4.81 and 1.76 in the lowest and highest RS groups, respectively. In contrast, the corresponding aHRs were relatively homogeneous for women (1.52 and 1.70). CONCLUSIONS Identifying gender heterogeneity in widowhood effects can guide further efforts to devise gender-tailored programs to enhance healthy aging.
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Skulason B, Jonsdottir LS, Sigurdardottir V, Helgason AR. Assessing survival in widowers, and controls - a nationwide, six- to nine-year follow-up. BMC Public Health 2012; 12:96. [PMID: 22299754 PMCID: PMC3295697 DOI: 10.1186/1471-2458-12-96] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 02/02/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to assess if widowers had an increased mortality rate during the first 6 to 9 years after the death of their wife, compared initially to an age-matched control group and also compared to the general population of Iceland. METHODS The study base was comprised of all 371 men born in 1924-1969 who were widowed in Iceland in 1999-2001 and 357 controls, married men, who were matched by age and residence.The widowers and controls were followed through the years 2002-2007 using information from Statistics Iceland. Mortality rates were compared between the groups and also with the general population. The mortality rate comparisons were: study group vs. control group, on the one hand, and study group vs. general population on the other. Causes of death were also compared between widowers and their wives. RESULTS A statistically significant increase in mortality in the widowers' group, compared to controls, was observed.Lifestyle-related factors could not be excluded as contributing to cause of death in these cases. CONCLUSIONS Being a widower was related to an increased risk of death for at least 9 years after the death of their wife.
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Affiliation(s)
- Bragi Skulason
- University of Iceland, Saemundargata, Reykjavik IS101, Iceland.
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Pilling J, Thege BK, Demetrovics Z, Kopp MS. Alcohol use in the first three years of bereavement: a national representative survey. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2012; 7:3. [PMID: 22248360 PMCID: PMC3286419 DOI: 10.1186/1747-597x-7-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 01/16/2012] [Indexed: 11/10/2022]
Abstract
Background Earlier results concerning alcohol consumption of bereaved persons are contradictory. The aim of the present study was to analyze the relationship between bereavement and alcohol consumption accounting for time and gender differences on a nationally representative sample from Hungary ("Hungarostudy Epidemiological Panel Survey", N = 4457) Methods Drinking characteristics of mourning persons (alcohol consumption, dependence symptoms, and harmful consequences of alcohol use) in the first three years of grief were examined among persons between 18-75 years using the Alcohol Use Disorders Identification Test (AUDIT). Results Men bereaved for one year scored higher on two dimensions of AUDIT (dependence symptoms and harmful alcohol use), while men bereaved for two years scored higher on all three dimensions of AUDIT compared to the non-bereaved. The rate of men clinically at-risk concerning alcohol consumption among the non-bereaved is 12.9%, and among men bereaved for one year is 18.4% (a non-significant difference), while 29.8% (p < 0.001, OR = 2,781) among men bereaved for two years. However, men bereaved for three years did not differ from the non-bereaved in their drinking habits. In case of bereaved women, again no difference was found with respect to alcohol use compared to the non-bereaved. Conclusion Among bereaved men, the risk of alcohol related problems tends to be higher, which can be shown both among men bereaved for one year as well as men bereaved for two years. Considering the higher morbidity and mortality rates of bereaved men, alcohol consumption might play a mediator role. These facts draw attention to the importance of prevention, early recognition, and effective therapy of hazardous drinking in bereaved men.
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Affiliation(s)
- János Pilling
- Institute of Behavioral Sciences, Semmelweis University; Nagyvárad tér 4., Budapest, 1089, Hungary.
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Abstract
Background While the "widowhood effect" is well known, there is substantial heterogeneity in the magnitude of effects reported in different studies. We conducted a meta-analysis of widowhood and mortality, focusing on longitudinal studies with follow-up from the time of bereavement. Methods and Findings A random-effects meta-analysis was conducted to calculate the overall relative risk (RR) for subsequent mortality among 2,263,888 subjects from 15 prospective cohort studies. We found a statistically significant positive association between widowhood and mortality, but the widowhood effect was stronger in the period earlier than six months since bereavement (overall RR = 1.41, 95% CI: 1.26, 1.57) compared to the effect after six months (overall RR = 1.14, 95% CI: 1.10, 1.18). Meta-regression showed that the widowhood effect was not different for those aged younger than 65 years compared to those older than 65 (P = 0.25). There was, however, a difference in the magnitude of the widowhood effect by gender; for women the RR was not statistically significantly different from the null (overall RR = 1.04, 95% CI: 1.00, 1.08), while it was for men (overall RR = 1.23, 95% CI: 1.18, 1.28). Conclusions The results suggest that further studies should focus more on the mechanisms that generate this association especially among men.
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Khanfer R, Lord JM, Phillips AC. Neutrophil function and cortisol:DHEAS ratio in bereaved older adults. Brain Behav Immun 2011; 25:1182-6. [PMID: 21420485 DOI: 10.1016/j.bbi.2011.03.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 03/10/2011] [Accepted: 03/10/2011] [Indexed: 11/25/2022] Open
Abstract
Bereavement is a common life event for older adults and is associated with increased risk of morbidity and mortality, though the underlying reasons for this link are poorly understood. Although physical and emotional stressors and ageing are known to suppress immunity, few studies have explored the impact of bereavement upon immunity in the older population. We therefore hypothesised that the emotional stress of bereavement would suppress immune function, specifically neutrophil bactericidal activity, in older adults. A between-subjects design was used to examine the effect of recent bereavement (<2 months) on neutrophil function in elders. Participants were 24 bereaved and 24 age- and sex-matched non-bereaved controls all aged 65+ years. Neutrophil phagocytosis of Escherichia coli (E. coli) and stimulated superoxide production were assessed. Cortisol and dehydroepiandrosterone-sulphate (DHEAS) levels were determined in serum to assess potential mechanisms. Depressive and anxiety symptoms were measured by questionnaire. Neutrophil superoxide production was significantly reduced among the bereaved when challenged with E. coli (p=0.05), or phorbol 12-myristate 13-acetate (p=0.009). Further, the bereaved group had a significantly higher cortisol:DHEAS ratio compared to controls (p=0.03). There was no difference in neutrophil phagocytosis between the two groups. The psychological questionnaire results showed that the bereaved had significantly greater depressive and anxiety symptoms than the non-bereaved. The emotional stress of bereavement is associated with suppressed neutrophil superoxide production and with a raised cortisol:DHEAS ratio. The stress of bereavement exaggerates the age-related decline in HPA axis and combines with immune ageing to further suppress immune function, which may help to the explain increased risk of infection in bereaved older adults.
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Affiliation(s)
- Riyad Khanfer
- School of Sport and Exercise Sciences, University of Birmingham, Birmingham B15 2TT, UK
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Does widowhood increase mortality risk?: testing for selection effects by comparing causes of spousal death. Epidemiology 2011; 22:1-5. [PMID: 21052007 DOI: 10.1097/ede.0b013e3181fdcc0b] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We consider whether widowhood increases mortality risk. Although commonly observed, this "widowhood effect" could be due to selection effects, as married couples share various characteristics related to the risk of death. We therefore consider the widowhood effect by various causes of spousal death; some causes of death are correlated with shared characteristics in couples, while others are not. METHODS Using data from the Scottish Longitudinal Study, we compare outcomes for men and women by the causes of death of their spouse, controlling for a range of individual- and household-level characteristics. RESULTS The widowhood effect in these data is greater than has been found in other recent studies, with adjusted hazard ratios of 1.40 (95% confidence interval = 1.33-1.47) for men and 1.36 (1.30-1.44) for women. The risk is highest shortly after widowhood, but remains raised for at least 10 years. There was little evidence that these hazard ratios differed by any classification of the cause of death of the spouse, but interactions were found for those with pre-existing illness or other risk factors. The hazard ratios for widowhood were lower for persons with preexisting risks. CONCLUSIONS Our analysis of the widowhood effect uses 3 methods of classifying the causes of spousal death in an attempt to control for potential selection effects. Our results are highly consistent and suggest that this is a causal effect, rather than a result of selection.
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Ishida M, Onishi H, Wada M, Tada Y, Ito H, Narabayashi M, Sasaki Y, Nomura S, Uchitomi Y. Psychiatric Disorders in Patients Who Lost Family Members to Cancer and Asked for Medical Help: Descriptive Analysis of Outpatient Services for Bereaved Families at Japanese Cancer Center Hospital. Jpn J Clin Oncol 2010; 41:380-5. [DOI: 10.1093/jjco/hyq213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bereavement Dream? Successful antidepressant treatment for bereavement-related distressing dreams in patients with major depression. Palliat Support Care 2010; 8:95-8. [DOI: 10.1017/s1478951509990757] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:The death of a person is a stressful event. Such stress affects the physical and psychological well-being of the bereaved. As an associated mental disorder, major depressive disorder (MDD) is common. Some dream of the deceased, and these dreams are called bereavement dreams. Some MDD patients also experience dreams. These two types of dreams are sometimes difficult to differentiate. The dream of the bereaved might be only a bereavement-related dream, yet it might be a symptom of MDD. Herein, we report one patient who had distressing dreams after the death of her mother.Methods:A 63-year-old woman was referred for psychiatric consultation because of generalized fatigue and insomnia. Questioning her about recent events, she said that her mother had died of colonic carcinoma 5 months previously. Two months after the death, she suddenly started dreaming of her mother, getting angry with her almost every night. Generalized fatigue, insomnia, and distressing dreams appeared simultaneously. The dream caused much distress, making her afraid to fall asleep.Results:Her psychiatric features fulfilled the DSM-IV-TR criteria for MDD, single episode. The death of her mother was considered to be one of the causes of MDD. She was administered 25 mg/day of sertraline hydrochloride. After that, her symptoms gradually disappeared, and the frequency of distressing dreams was reduced. Five months later, physical and psychiatric symptoms of MDD were completely resolved. Subsequently, she has not suffered from any distressing dreams of her mother.Significance of results:This case indicates that dreams experienced after the death of a loved one should not be regarded simply as bereavement dreams. Some of the dreams may be symptoms of MDD. If the dreams are the symptoms of MDD, antidepressant treatment as well as psychotherapy may be useful. Therefore, we should avoid regarding symptoms of MDD as reactions to bereavement.
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