A prospective study of widowhood and changes in symptoms of depression in a community sample of the elderly

Marital experiences and depressive symptoms among older adults in rural South Africa

This paper advances the understanding of how marital transitions may influence mental health by investigating these associations among a population of rural, Black South Africans aged 40+ that was directly impacted by apartheid. Using two waves of data from 4,176 men and women in Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI), we investigated associations between marital experiences and depressive symptoms, by gender, and explored whether economic resources is a moderator of these associations. We found that experiencing a marital dissolution was associated with more depressive symptoms than remaining married for both men and women. We also found that men, but not women, report greater depressive symptoms if they remained separated/divorced, remained widowed, or remained never married between waves. We found no evidence that a decline in wealth moderated the impact of marital dissolution on depressive symptoms for women or men. These findings suggest that the documented benefits of marriage for mental health, and differences by gender in those benefits, may extend to older, rural South Africans, despite the unique experiences of this population.

Widowhood, widowhood duration, and loneliness among older adults in China

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.

Behavioral Activation and Therapeutic Exposure vs. Cognitive Therapy for Grief Among Combat Veterans: A Randomized Clinical Trial of Bereavement Interventions

Approximately two-thirds of Operations Enduring Freedom, Iraqi Freedom, and New Veterans reported knowing someone who was killed or seriously injured, lost someone in their immediate unit, or personally saw dead or seriously injured Americans (Hoge et al., 2004; Thomas et al., 2010; Toblin et al., 2012). Thus, it is not surprising that prevalence of Persistent Complex Bereavement Disorder (PCBD) is high in these groups. Importantly, PCBD impact appears to be independent of both Post-Traumatic Stress Disorder (PTSD) and Major Depressive Disorder (Bonnano, 2007), 2 disorders that are also highly prevalent in these groups, thus tailored treatments for grief are indicated. The Department of Veterans Affairs suggests Cognitive Therapy for Grief as a first line psychotherapy, however treatments relatively more focused on behavior change and exposure to grief cues also may be useful for this population. To address this question, the present study used a randomized controlled trial to compare a 7-session program of Behavioral Activation and Therapeutic Exposure for Grief vs. Cognitive Therapy for Grief among 155 OIF/OEF/OND veterans. Both treatments produced significant treatment gains over baseline, and these improvements were maintained over 6-month followup; however no differences were observed between groups. Given equal efficacy, implications for matching treatment to patient characteristics are discussed.

Widowhood and depression: a longitudinal study of older persons in rural China

Using six waves of longitudinal data (2001-2015) collected in Anhui, China (N = 2,131) and generalized estimating equations (GEE) models, this study fulfilled several objectives. First, the study compared the widowed to the married to examine if the transition to and duration of widowhood contributes to changes in depression. Second, the study examined if the bereavement-depression relationship is a process that precedes widowhood or is an abrupt change following the death of a spouse. Third, the study examined if social resources influence the bereavement-depression relationship. The study found that there is pre-widowhood effect on depression and that the widowhood event also contributes to increases in depression. Levels of post-widowhood depressive symptoms peak during the first six months bereavement and taper off within 25 months. Controlling for social support, contact with children, and living arrangements does not change the bereavement-depression relationship. The findings support Attachment Theory, which suggests that the loss of a spouse leads to emotional isolation that cannot be overcome with kin-based social support and social integration.

The association of time since spousal loss and depression in widowhood: a systematic review and meta-analysis

PURPOSE

To conduct a systematic review and meta-analysis examining the association of the prevalence of depression and time since spousal loss in widowed people.

METHODS

The databases MEDLINE, Embase and PsycInfo were searched (May 2017) for papers reporting on time since spousal loss in widowed people and the prevalence of common mental disorders. A systematic review was conducted according to MOOSE guidelines. Random effects meta-analyses of the prevalence of depression were conducted by intervals of time since spousal loss.

RESULTS

The literature search identified 12,982 studies of which 22 were eligible for inclusion in the systematic review. Of these, 14 were furthermore eligible for inclusion in the meta-analysis. The summary estimates found in the meta-analysis for the prevalence of depression in the intervals of time since spousal loss were: ≤ 1 month: 38.2% (21.9-55.8%); > 1 month to 3 months: 25.0% (17.3-33.5%); > 3 months to 6 months: 23.1% (18.0-28.7%); > 6 months to 12 months: 19.4% (15.2-24.0%); > 12 months to 18 months: 11.1% (5.3-18.7%); > 18 months to 24 months: 15.2% (12.3-18.2%); > 24 months to 60 months: 10.5% (4.3-18.5%).

CONCLUSION

Widowhood is associated with a high prevalence of depression and the study identifies a population group needing special attention in daily clinical practice. The prevalence is highest in the first month of widowhood, however, continues to be high at least 5 years into widowhood.

Psychosocial and physical factors associated with depression in older adults living in studio apartments: A cross-sectional study of a multi-ethnic Asian population

Background:

There is a rapidly ageing population globally, leading to a rise in subsidised public housing in many countries for older adults. According to the World Health Organisation, depression is the most prevalent mental disorder in older adults. There is a gap in literature on the factors associated with depression in those residing in studio apartments for older adults, characterised by small living spaces and isolated community settings.

Objective:

The aim of this study was to examine the associations between socio-demographic variables, social support, self-perceived health and mental status, life satisfaction, exercise, physical functioning, chronic conditions, and the use of eldercare services, with depressive symptoms.

Methods:

We utilised a cross-sectional study of older adults aged ⩾55 years residing in Singapore’s studio apartments. Multivariable logistic regression was applied.

Results:

Widowhood was associated with depressive symptoms, compared to being married or having a domestic partner (adjusted odds ratio (AOR) = 1.70, 95% confidence interval (CI) = 1.01 to 2.86). Odds of depressive symptoms were associated with difficulty bathing and showering (AOR = 3.74, 95% CI = 1.06 to 13.21). Depressive symptoms were associated with cataract (AOR = 1.67, 95% CI = 1.01 to 2.77) and urinary tract disorder (AOR = 4.70, 95% CI = 1.21 to 18.26). There were dose-response relationships between higher odds of depressive symptoms and poorer social support, self-perceived mental health, life satisfaction, and exercise behaviour ( p for trend < 0.001).

Conclusion:

Factors including widowhood, physical functioning difficulty, chronic conditions, low social support, low self-perceived mental health, poor life satisfaction, and lack of exercise behaviour, were associated with depressive symptoms in older adults residing in studio apartments. More attention is needed to care for the psychosocial and physical needs of older adults in studio apartments.

Bereavement, Self-Reported Sleep Disturbances, and Inflammation: Results From Project HEART

OBJECTIVE

Spousal bereavement is linked to increased mortality and morbidity from inflammatory conditions. It also has a significant impact on sleep disturbances. Evidence from experimental studies indicates that chronic stress may prime individuals to have an exaggerated inflammatory response to acute stress. In this study, we examined the association between self-reported sleep disturbances and inflammation after adjusting for depressive symptoms and determined whether this association varies by bereavement status (bereaved individuals versus controls).

METHODS

Participants included 54 bereaved individuals and 47 controls with a M (SD) age of 67.12 (12.11) years. Inflammation was measured using C-reactive protein. Self-reported sleep disturbances were measured using the Pittsburgh Sleep Quality Index. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale.

RESULTS

Sleep disturbances were not associated with elevated levels of C-reactive protein in the overall group (B = 0.030, standardized β = 0.122, 95% confidence interval [CI] = -0.027 to 0.087, p = .299) after adjusting for depressive symptoms. Results indicated, however, that bereavement moderated the association between inflammation and sleep disturbances (B = 0.104, β = 0.517, 95% CI = 0.009 to 0.198, p = .032). Stratified analyses demonstrated that these associations differed across groups. Associations were significant among bereaved individuals (B = 0.104, β = 0.406, 95% CI = 0.013 to 0.196, p = .026) and not controls (B = -0.016, β = -0.066, 95% CI = -0.096 to 0.065, p = .690).

CONCLUSIONS

These findings provide preliminary evidence that bereavement moderates the association between self-reported sleep disturbances and inflammation. Future studies should examine the course of sleep disturbances after bereavement and establish whether objective sleep has differential associations with inflammation among bereaved adults.

Factors affecting the physical and mental health of older adults in China: The importance of marital status, child proximity, and gender

Evidence is accumulating about the association between strong family ties and the emotional and physical welfare of older adults, and researchers have identified negative consequences of being unmarried, being childless, and/or living alone. These associations have been recognized in multiple contexts, including in Asia where living with a spouse and/or grown children has been shown in some studies to improve elderly well-being. Social support, especially family support, is expected to continue to be important where populations are aging and social safety nets are weak. Using longitudinal data from the 2010 and 2012 waves of the China Family Panel Studies, we focus on the effects of marital status at times 1 and 2, changes in marital status between the two surveys, and other family-related indicators of social connectedness on ratings of depression, levels of life satisfaction, and self-reported physical health among those aged 50 and over. Our sample includes 9831 respondents who have valid data on wellbeing indicators for Wave 1 and Wave 2, as well as complete information on the other covariates controlled in our analysis. In analyses of the full sample, those who were married at both points in time reported lower depression scores than those who were never-married, divorced, or widowed at both time points, and those whose unions dissolved in the interval. Those who were married at both times also generally reported greater levels of life satisfaction than those who were never married at both time points and those who became divorced during the interval. Important underlying gender differences are observed both for life satisfaction and depression. In addition, those who were married at both time points reported being in better physical health than those who became widowed during the interval (significant primarily for women), and those who had never been married (significant primarily for men). Our study contributes to the literature on social ties and the wellbeing by highlighting the importance of marital status and changing marital status, net of child co-residence and proximity, in China.

Determinants and Predictors of Grief Severity and Persistence: The Rotterdam Study

OBJECTIVE

We aimed to explore correlates and predictors of bereavement severity and persistence (triggered by "loss of a loved one"; referent group partner loss) in the Rotterdam cohort.

METHOD

We used linear regression to examine factors associated with grief severity using a cross-sectional analysis and logistic regression to determine prospective associations.

RESULTS

Cross-sectionaly, females, child-lost, higher depressive symptoms, lower education, and difficulties in daily activities were independently associated with a higher bereavement severity. Prospectively (6 years; response rate 71%), the baseline value of the grief severity was the single predictor significantly associated with grief persistence.

DISCUSSION

Our results suggest that only grief severity is independently associated with grief persistence. Further studies are needed to confirm our findings.

First use of antidepressant medication in male partners of women with breast cancer in Denmark from 1998 to 2011

OBJECTIVE

A diagnosis of breast cancer disrupts the life of the patient, but also the partner may experience adverse psychological effects. We examined partners' risk for first use of antidepressant medication, as a proxy for pharmacologically treated depression.

METHODS

By linkage of national registers, we identified 1 420 592 depression-free men living with a cancer-free female partner in 1998 to 2011. During follow-up, breast cancer was diagnosed in female partners of 26 256 men. In Poisson regression models, we estimated the rate ratios for first use of antidepressant medication compared to partners of breast cancer-free women. Cox regression analyses examined associations between exposed partners' sociodemographic characteristics, somatic comorbidity, death of female partner, and first use of antidepressant medication.

RESULTS

Male partners of women with breast cancer had an increased rate ratio of 1.08 (95% CI, 1.03-1.13) for first use of antidepressant medication compared to the background population, corresponding to excess absolute risk of 12 cases per 10 000 person-years. This increased risk persisted throughout 14 years of follow-up. Higher age, shorter education, somatic comorbidity, and death of female partner were associated with increased risk among men whose partner had breast cancer.

CONCLUSION

The modest, but long term, increased risk for first use of antidepressant medication calls for attention by health care professionals to symptoms of depression among partners of breast cancer patients.

Unforgiveness, depression, and health in later life: the protective factor of forgivingness

OBJECTIVES

Feeling unforgiven by others has been linked to poor health outcomes. The current study examined whether feeling unforgiven by others is associated with depression and self-rated health among older adults in the United States. The potential moderating roles of forgiving others and self-forgiveness in the association between unforgiveness and both depression and self-rated health was also assessed along with gender differences.

METHOD

Data were drawn from a sample of 1009 adults in Wave 2 of the Religion, Aging, and Health Survey, a national sample of adults aged over 67. Depression was measured using the eight item short form from the Center for Epidemiologic Studies-Depression (CES-D) scale. Self-rated health was assessed with a one-item indicator.

RESULTS

Analyses indicated that higher levels of self-forgiveness ameliorated the relationship between unforgiveness by others and depression for men and women and higher levels of forgiving others attenuated the association between unforgiveness by others and depression for women. Self-forgiveness was protective of depression for women who reported unforgiveness by others and low levels of forgiving others. Regardless of levels of self-forgiveness, men who were most likely to forgive others experienced a significant association between unforgiveness by others and depression. Neither forgiving others nor the self were significant moderators in the association between unforgiveness and self-rated health.

CONCLUSION

Forgiving others and the self may be protective of well-being when women feel unforgiven by others. These findings have implications for forgiveness intervention programs and contribute to literature pertaining to forgiveness and health in later life.

Marital Status and the Risk of Suicide: Experience from England and Wales, 1982–1996

This analysis examined suicide rates by age, sex, and marital status in England and Wales for the period 1982–1996. Never married, widowed, and divorced people had higher rates of suicide than those who were married, for both sexes. Among the widowed ages 20–39 years, both sexes had the highest rate, and the rate decreased with age. The suicide rate for divorced people was similar to those who had never married, except for the younger group ages 20–29 years. The male:female ratios for the relative suicide risk for never married, widowed, and divorced to married for both sexes were statistically significantly different for older adults. The decrease in suicide rates observed for the period 1982–1996 in England and Wales was mainly attributable to the reduction of suicide rates among the widowed and divorced.

Long-Term Payoffs of Work? Women's Past Involvement in Paid Work and Mental Health in Widowhood

This study examines a domain of life—involvement in paid work—that has not been explored in prior research addressing the mental health consequences of widowhood. We argue that experiences in the paid labor force increase women's economic, social and psychological resources, which compound over the life course and ease their adjustment to widowhood. Using a sample of 207 widows interviewed in the Miami-Dade County, Florida area in 2001—2002, findings from ordinary least squares (OLS) regression models support the hypothesis that widows with work histories report fewer depressive symptoms than their peers without employment experience. Further analyses reveal that social and psychological resources mediate this association suggesting that employment enhances social support and self-perceptions, which reduce the negative health effects of widowhood. Our study illustrates the importance of incorporating work histories into examinations of widowhood, particularly as cohorts of women with considerable lifetime investments in paid work enter their later years.

Widowhood and Depression

Hypotheses predicting why widowhood should be more difficult psychologically for men than women are tested on a sample of 746 older persons. Widowhood does have a stronger effect on depression for men, partly because of the intervening effects of health and time since widowhood. However, much of the gender difference remains unexplained. Possible causes, including the fact that widowhood is a more usual component of the life cycle for women, are discussed.

Widowhood, Gender, and Depression

Many cross-sectional studies have found that widowhood is psychologically a more difficult experience for men than for women. However, most longitudinal studies have found either no gender difference or a slightly greater effect for women. The authors attempted to resolve this paradox with data from the first two waves of the National Survey of Families and Households. They found that men whose wives died between the two waves were already highly depressed at time 1, compared with men whose wives survived until time 2. There was no such anticipatory effect for women. Attempts to explain men's elevated depression before widowhood, with predictors involving wife's health, caregiving, and marital quality at time 1, were largely unsuccessful. However, the authors suggest that longitudinal studies that examine change in depression after widowhood may miss the increase in depression for men that appears to occur before their wives' deaths.

The Effects of Widowhood on Disabled Older Women (The Women's Health and Aging Study)

This study examined the effects of becoming widowed for older women with pre-existing physical disability. Data from three consecutive interviews from the Women's Health and Aging Study (WHAS) were used to compare depression, quality of life, and functional difficulty for widowed and non-widowed women. The two groups of 24 women were matched by age, disability level, domains of disability, and race. Repeated measures of analyses of variance (ANOVAs) revealed that, for both groups, depression scores were low and remained relatively stable and they were satisfied with their quality of life at all three time points (T1 = 0–6 months pre-bereavement, T2 = 0–6 months bereaved, T3 = 6–12 months bereaved), with no significant group by time interaction effects. The two groups were no different on their levels of functional difficulty at T1 and T2 but by T3, surprisingly, the widows reported slightly less difficulty. Overall, the findings show that disabled women who became widows demonstrate a noticeable degree of resiliency and hardiness.

Examining the 16-year trajectories of mental health and wellbeing through the transition into widowhood

BACKGROUND

Becoming widowed is a significant event. There is considerable evidence that surviving partners report substantial changes in their wellbeing and mental health. Changes can occur prior to partner's death as an anticipatory effect and consequently during the period after partner's death. For most, declines in wellbeing and mental health dissipate over time. However, there is a limited long-term evidence to compare age-normative trajectories in mental health and wellbeing with the trajectories of those who transition into widowhood.

METHODS

Participants (n = 652) were older adults (aged 65-94 years at baseline) from the 16-year Melbourne Longitudinal Studies on Healthy Ageing project who were either married or de facto (n = 577), or recently widowed (n = 75). Generalized Estimating Equations (GEE) examined the immediate and long-term impact of widowhood. GEE piecewise regression analyses examined the trajectories of wellbeing and mental health in those who transitioned into widowed with time centered at time of partner's death. Analyses were stratified by gender.

RESULTS

For both men and women, becoming widowed was strongly related to a strong decline in positive affect post partner's death. Otherwise, no long-term impact of widowhood on negative affect or depressive symptomology was reported.

CONCLUSIONS

The impact of widowhood reports differential impacts on different indicators of wellbeing and mental health, which were inconsistent between men and women.

Online Grief Support Communities

Online grief support communities have become popular in recent years for those seeking information and empathetic others following the death of someone close to them. Hundreds of Facebook pages and Web sites are now devoted to bereavement—and health-care professionals need to assess what therapeutic benefits virtual communities might offer to help people manage grief and integrate death into their lives. In the current study of online grief support networks ( N = 185), individuals report less psychological distress as a result of joining these groups—and this psychosocial benefit increased over time. Individuals who were members for a year or more characterized their grief as less severe compared with those who had a shorter tenure in the community. Additional findings and implications are discussed.

Association between depressive symptoms and changes in sleep condition in the grieving process

PURPOSE

Bereaved families often suffer from insomnia and depression. However, the associations between depressive state and changes in sleep condition during the grieving process have not been investigated. This study aimed to clarify the prevalence of insomnia symptoms and to explore associations between present depressive state and changes in sleep condition in the grieving process in bereaved families of Japanese patients with cancer.

METHODS

A cross-sectional, multicenter survey was conducted in 103 certified palliative care units. A questionnaire asking insomnia symptoms and depressive symptoms by the Center for Epidemiological Studies Depression Scale (CES-D) was mailed to bereaved families (N = 987). The association between present depressive state (CES-D ≥7) and sleep conditions in the grieving process were analyzed.

RESULTS

A total of 561 families were enrolled for analysis. Fifty-three percent of family members were considered to be in a depressive state at the time of the investigation. Prevalence of past insomnia was 86.5% at "within a few weeks before the patient's death" (T1) and 84.5% at "within 6 months after the patient's death" (T2) in all bereaved family members. However, in contrast to decreased severity of insomnia between T1 and T2 in the non-depressive group (p < 0.05), severity of insomnia was unchanged in the depressive group during this period (p = 0.139).

CONCLUSIONS

Insomnia symptoms are highly prevalent and may be associated with posthumous depressive state in bereaved Japanese families. These results suggest the need for careful observation of changes in sleep condition during the grieving process.

Can a function-based therapy for spousally bereaved seniors accrue benefits in both functional and emotional domains?

Late-life spousal bereavement has detrimental effects in daily functioning and emotional distress. This study tested the hypothesis that a therapy based exclusively upon functioning issues (sleep and daily lifestyle regularity) would accrue benefits in both functional and emotional domains. A comparison was made with a control therapy that concentrated on emotional issues, and specifically avoided discussing sleep or lifestyle regularity. Thirty-eight spousally bereaved seniors were randomly assigned to either functional or control therapy. Assessments were made before, during, and after a 6-month, 10-session individual therapy. The functional therapy assisted in both functional and emotional domains and the hypothesis was confirmed.

Low preparedness before the loss of a wife to cancer and the widower's chronic pain 4-5 years later-a population-based study

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.

Widowhood and depression among older Europeans--the role of gender, caregiving, marital quality, and regional context

OBJECTIVES

This study investigates the role of gender, caregiving, and marital quality in the correlation between widowhood and depression among older people within a European context by applying the theory of Social Production Functions as a theoretical framework.

METHOD

Fixed-effects linear regression models are estimated using the first 2 waves (2004, 2006) of "The Survey of Health, Ageing and Retirement in Europe" (SHARE). A subsample of 7,844 respondents aged 50 and older in 11 countries, who were married at baseline and are either continuously married or widowed at follow-up, is analyzed.

RESULTS

Respondents who experienced widowhood between the 2 waves report significantly more depressive symptoms than those continuously married, with respondents living in Denmark and Sweden reporting a lower increase in depressive symptoms than those living in Greece, Spain, or Italy. There is no statistically significant interaction between gender and widowhood. Widowed persons who report higher marital quality at baseline show a larger increase in the number of symptoms of depression than those with low marital quality; widowed persons who report being a caregiver for their partner at baseline report smaller increase in the symptoms of depression compared with widowed noncaregivers.

DISCUSSION

The results support the results of previous studies using longitudinal data. Furthermore, the effect of widowhood varies among the 11 countries in the subsample although only a small amount of the variation in the increase of depressive symptoms after becoming widowed can be explained by such contextual factors.

Depression in the spousally bereaved elderly: correlations with subjective sleep measures

Complaints of poor sleep and symptoms of depression are likely to coexist in the spousally bereaved elderly. This study was concerned with the correlation between depressive symptoms and various measures of subjectively reported sleep using questionnaire and diary instruments in 38 bereaved seniors (60y+). Correlations between the sleep measures and days since loss and grief intensity were also calculated. All sleep disruption measures correlated significantly with depression score, but only sleep duration correlated with grief intensity, and no sleep measure correlated with days since loss. Therapies which address both sleep and depression are likely to be of benefit to bereaved seniors.

Gender differences in the relation between depression and social support in later life

BACKGROUND

Prevalence of depression is twice as high in women as in men, also in older adults. Lack of social support is a risk factor for late-life depression. The relation between depression and social support may be different for men and women.

METHODS

Data from the Longitudinal Aging Study Amsterdam were used to investigate gender differences in the relation between social support and depression in a population-based sample aged 55-85 years, with n = 2,823 at baseline and using the 13-year follow-up data on onset of depression.

RESULTS

Respondents without a partner in the household, with a small network, and with low emotional support were more often depressed, with men showing higher rates of depression than women. A high need for affiliation was associated with depression in women but not in men. Lack of a partner in the household and having a small network predicted onset of depression in men but not in women. In respondents with high affiliation need and low social support, depression rates were higher, with men being more often depressed than women.

CONCLUSIONS

Low social support and a high need for affiliation were related to depression in later life, with men being more vulnerable for depression than women. Considering the serious consequences of depression, especially in older people, it is important to identify the persons with low social support and a high need for affiliation, and to help them to increase their social support or to adjust their needs.

[Screening for depression in an elderly population living at home. Interest of the Mini-Geriatric Depression Scale]

BACKGROUND

Depression is the most usual mental disorder in the elderly, but underdiagnosed and undertreated. Its prevalence is variable. Symptoms of depression present in the elderly can be masked and difficult to recognize. The purpose of this study was to examine prevalence and risk factors for depression in elderly living in their home.

METHODS

A cross-sectional study of randomly selected homes in randomly selected geographical islets was carried out Monastir City (Tunisia). Questionnaire-based interviews were conducted among the elderly aged more than 65 years living in their home. Depression symptoms were assessed using a Mini-Geriatric Depression Scale. The relationship between the risk of depression and sociodemographic and health-related variables was studied using logistic regression.

RESULTS

Out of 598 (female 66 %, mean (SD) age 72.3 (7.4) years) elderly persons interviewed, 136 (22.7 %) were screened to have a Mini-Geriatric Depression Scale more than or equal to 1. Multiple logistic regression analysis revealed that the following were significant (P<0.01) independent predictors of risk of depression: female sex (OR=2.36 [95 % CI=1.43-3.94]), having a low level of education (OR=4.02 [95 % CI=1.38-11.65]), disability (OR=3.50 [95 % CI=1.94-6.46]), a history of stroke (OR=2.90 [95 % CI=1.20-7.72]) and the use of hypnotic medications (OR=2.47 [95 % CI=1.38-4.42]).

CONCLUSION

This study suggests that the risk of depression is a common psychiatric disorder in elderly living in their home, and underlines the usefulness of the Mini-Geriatric Depression Scale to detect the risk of depression in the elderly. This clinical approach should be encouraged in all medical practices to improve the prognosis of depression in the elderly.

AN INDIGENOUS PSYCHO-EDUCATIONAL GROUP FOR CHINESE BEREAVED FAMILY MEMBERS

Detrimental effects of bereavement on physical, mental, social and psychological aspects of individuals can be found among bereaved Chinese. The authors have developed an indigenous practice model to work with bereaved family members among Chinese people in Hong Kong. The concept of bereavement was re-cast to include the idea that bereavement is a challenge that can aid in personal growth. Strategies were created to deal with the feelings of loss and separation positively. Programs in a "growth-oriented" psychosocial-educational group using multiple cognitive, behavioral and spiritual strategies were introduced. Throughout the sessions, messages of "Letting Go", "Self-Love", "Forgiveness" and "Transformation" were embedded in the programs by culturally relevant terms and concepts. A pre-group and post-group questionnaire as well as long interviews were used to evaluate the impact of the group on the participants. Participants of the bereavement groups showed significant improvements in somatic symptoms, anxiety, depression, mood, self-acceptance, letting-go and transformation.

丧亲会损害家人的身、心、情绪健康。笔者们共同设计了一套本地化「善别」概念为香港华人服务。「善别」的建立是基于「去者能善终、留者能善别」的信念，希望丧亲家人能「妥善处理别离的经验」，明白「死亡」是生命的蜕变，而善别、是成长的挑战」，以积极的态度去面对丧亲所引致的别离，以个人成长及独立训练作为回报亲人的关顾。「善别」辅导小组以身、心、灵全面介入，推介「舍得」、「惜自己」、「宽恕」、和「升华」等传统观念。透过小组前、后对比及访问方式搜集善别小组成效的证据。组员在参加小组之后均于身心、情绪、自我接纳、「舍得」及「升华」方面有正面的改善。

Long-term mental health of men who lose a wife to cancer--a population-based follow-up

OBJECTIVE

This study investigated the long-term risk of psychological morbidity for men after losing a wife to cancer. A further aim of the study was to investigate if being in a new relationship at the time of follow-up affects the risk of psychological morbidity.

METHOD

In a population-based cohort study, we collected data from 907 men in Sweden who lost a wife to cancer in the breast, ovary or colon 4-5 years earlier. A control group of 330 married men was also included.

RESULTS

Six hundred ninety-one of the widowers (76%) and 262 of the controls (79%) answered a questionnaire. Widowers in a new relationship had a similar risk of psychological morbidity compared with a control group of married men. However, compared with widowers in a new relationship, single widowers reported increased risks of (among other symptoms) the following: depression (RR 2.2, confidence interval [CI] 1.5-3.2), anxiety (RR 1.6, CI 1.1-2.5) emotional numbness (RR 2.2, CI 1.7-2.8), and waking up at night with anxiety (RR 2.2, CI 1.4-3.7).

CONCLUSIONS

Men who lost a wife to cancer in Sweden in 2000 or 2001 and are single 4-5 years later have increased risks of psychological morbidity, both compared with widowers who are in a new relationship at the time of follow-up and with married men. Further scientific effort is needed for improved understanding of the most likely underlying mechanisms; that is, that enhanced emotional support of a new relationship after the loss of a wife protects against psychological morbidity, or alternatively, that the healthiest widowers enter a new relationship.

Marital Status and Risk for Late Life Depression: A Meta-Analysis of the Published Literature

This study assessed the relationship between marital status and the risk for depression in people ≥ 55 years old. Using the Medline™, EMBASE™ and Cochrane Library databases, clinical studies that published data on the association between marital status and risk of depression among individuals aged ≥ 55 years were identified. A quantitative meta-analysis of 24 cross-sectional and eight longitudinal studies was performed. Compared with married elderly people, unmarried elderly people had a higher risk for depression (odds ratio [OR], 1.55; relative risk [RR], 1.36). Compared with married elderly people, the widowed elderly people (OR 1.49; RR 1.71), divorced people (RR 2.14) and never-married people (OR 1.32) had a higher risk for depression. Among elderly unmarried people, widowed people had a higher risk for depression than those who never married (OR 1.51). In conclusion, being unmarried was an important risk factor for depression in elderly people.

Antidepressant use in geriatric populations: the burden of side effects and interactions and their impact on adherence and costs

OBJECTIVES

The study aimed to determine the prevalence of documented side effects and drug–drug interactions in older adults using antidepressants and their implications for adherence.

DESIGN

Data were from the MarketScan Medicare Database,which comprises insurance claims from retirees with employer-sponsored Medicare supplemental insurance. Subjects were aged 65 years or older, new antidepressant users, and had a depression diagnosis between July 1, 2001, and December 31, 2006.Twelve commonly reported antidepressant side effects were identified in the month after drug initiation through International Classification of Diseases, Ninth Revision,Clinical Modification diagnoses. Potential drug- drug interactions involving an antidepressant and another drug were identified during the 1 year after antidepressant initiation using MicroMedex DRUG-REAX software. Multinomial logistic regression was used to determine the association of side effects and potential interactions with refills rates, switching, and discontinuation.

RESULTS

The presence of a side effect was associated with a 4.7 percentage point increase in the probability of switching (from 16.5% to 21.7%) and a 3.7 percentage point increase in the discontinuation rate (from 22% to 25.7%). Among the 39,512 treatment-naive antidepressants users, 25.4% hadpotential contraindicated or major interactions, 36.1% had moderate interactions,and 38.5% had minor or no interactions. The presence of potential contraindicated or potential major interactions increased the probability of switching by 19.5 percentage points and had a minimal effect on discontinuation.

CONCLUSION

Although antidepressant medications have been demonstrated to be effective in treatment of geriatric depression, this study highlights the complexity of antidepressant prescribing in this population and the need for clinicians to be aware of potential drug- drug interactions and side effects.

Interpersonal effects of suffering in older adult caregiving relationships

Examining the interpersonal effects of suffering in the context of family caregiving is an important step to a broader understanding of how exposure to suffering affects humans. In this review article, the authors first describe existing evidence that being exposed to the suffering of a care recipient (conceptualized as psychological distress, physical symptoms, and existential/spiritual distress) directly influences caregivers' emotional experiences. Drawing from past theory and research, the authors propose that caregivers experience similar, complementary, and/or defensive emotions in response to care recipient suffering through mechanisms such as cognitive empathy, mimicry, and conditioned learning, placing caregivers at risk for psychological and physical morbidity. The authors then describe how gender, relationship closeness, caregiving efficacy, and individual differences in emotion regulation moderate these processes. Finally, the authors provide directions for future research to deepen understanding of interpersonal phenomena among older adults, and they discuss implications for clinical interventions to alleviate the suffering of both caregivers and care recipients.

Late- versus early-onset geriatric depression in a memory research center

OBJECTIVE

To contrast early-onset (<60 years) and late-onset (>60 years) depression in geriatric patients by evaluating differences in cognition, vascular comorbidity and sociological risk factors. Both patient groups were compared with normal subjects.

MATERIALS AND METHODS

We recruited 76 patients with depressive symptoms (37 late onset and 39 early onset) and 17 normal controls matched by age and educational level. All subjects were assessed using a semistructured neuropsychiatric interview and an extensive neuropsychological battery. Vascular and sociological risk factors were also evaluated.

RESULTS

We found a significant variation in performance between depressive patients and normal controls in most cognitive functions, especially memory (P < 0.0001), semantic fluency (P < 0.0001), verbal fluency, and digit-symbol (P < 0.0001). Late-onset depression patients scored lower and exhibited more severe impairment in memory domains than early-onset depression patients (P < 0.05). Cholesterol levels and marital status were significantly (P < 0.05) different between the depressive groups. Both depressed groups (early- and late-onset) were more inactive than controls (P < 0.05; odds ratio: 6.02).

CONCLUSION

Geriatric depression may be a manifestation of brain degeneration, and the initial symptom of a dementia. It is important to consider this in the treatment of patients that exhibit late-onset depressive symptoms.

Suicide and marital status in Italy

BACKGROUND

Completed suicide has been reported as being linked to marital status, with being unmarried associated with a higher suicide rate as compared with being married or living with a partner.

METHOD

Data were obtained from the Italian Data Base on Mortality, collected by the Italian Census Bureau (ISTAT) and processed by the Italian National Institute of Health-Statistics Unit. The Italian population in the last Italian census (October 2001) was used to estimate age-standardized mortality rates from suicide by marital status (ICD-9 revision: E950-E959) and "natural" causes (ICD-9 revision: 0-280; 320-799). Rate ratios and 95% confidence intervals were calculated using married individuals as a reference. All analyses were conducted separately for men and women and for three different age groups (25-44 years, 45-64 years and 65 years and over) for 2000-2002, the most recent years with data available. Logistic regression analysis was used to compare differences by marital status for suicide versus death from natural causes.

RESULTS

Being married appears to be a protective factor for suicide, but the impact of being never-married, divorced/separated or widowed varies with age and gender. It is noteworthy that the differences between married and non-married women were less consistent than those among men, especially for elderly women. The results confirm that the protective impact of marriage is higher for suicide than for natural causes of death, and the comparison between the risks of suicide and natural causes of death reveals that the groups relatively more at risk for suicide are divorced/separated women, divorced/separated men (under the age of 64) and widowed men.

CONCLUSIONS

Both among men and women, being unmarried, widowed or divorced/separated is associated with a higher suicide rate. This study, however, adds information on suicide mortality in specific age-groups compared to mortality from natural causes of death. Overall, these findings support the notion that marital status may dramatically influence the risk of suicide.

Marital status and health: exploring pre-widowhood

BACKGROUND

Health and function vary by marital status across the life-course, but little is known about older adults approaching spousal loss (pre-widowed).

OBJECTIVE

To explore health and function by marital status focusing on the pre-widowed and to examine factors associated with shorter time to spousal loss. PARTICIPANTS, DESIGN, AND MEASUREMENTS: We used 3 years of data from African American and white community-dwelling older adults in the UAB Study of Aging (N = 1000). Participants were categorized as "continuously married" (married at baseline and 3 years), "widowed" (widowed at baseline), "single" (never married/divorced); and "pre-widowed" (married at baseline and widowed within 3 years). Assessments included sociodemographic characteristics, and measures of depression, anxiety, life-space mobility, and self-reported health. chi(2) and analysis of variance (ANOVA) were used to examine baseline differences. Using Cox regression, we explored factors having independent and significant associations with shorter time to spousal loss among married older adults.

RESULTS

There were significant differences by marital status category for sociodemographic factors, health, and function. Pre-widows differed from other categories by sociodemographic characteristics as well as levels of depression, anxiety and self-reported health. Among married older adults, being female and having lower self-reported health at baseline were independent significant hazards for shorter time to widowhood; while rural residence and providing spousal care were independent significant hazards for a longer progression to widowhood.

CONCLUSIONS

Health deficits associated with spousal bereavement may be evident earlier in the marital transition than previously thought, warranting attention to the health of elderly persons whose spouses have chronic/life-limiting conditions.

Widowhood and Spirituality: Coping Responses to Bereavement

Nearly half of women age 65 or older are widows and nearly 70% of these women live alone. Because older women are three times more likely than their male counterparts to be widowed, widowhood has been labeled a primarily female phenomenon. This review article has two aims: (a) to discuss the impact of widowhood on the lives of older women and (b) to discuss how religion and spirituality may be used as coping methods for conjugal loss. After reviewing the literature the authors conclude that older women use religious coping as well as religious and spiritual beliefs and behaviors to facilitate positive adjustment to the loss of a spouse.

Sleep and circadian rhythms in spousally bereaved seniors

A laboratory study of sleep and circadian rhythms was undertaken in 28 spousally bereaved seniors (> or =60 yrs) at least four months after the loss event. Measures taken included two nights of polysomnography (second night used), approximately 36 h of continuous core body temperature monitoring, and four assessments of mood and alertness throughout a day. Preceding the laboratory study, two-week diaries were completed, allowing the assessment of lifestyle regularity using the 17-item Social Rhythm Metric (SRM) and the timing of sleep using the Pittsburgh Sleep Diary (PghSD). Also completed were questionnaires assessing level of grief (Texas Revised Inventory of Grief [TRIG] and Index of Complicated Grief [ICG]), subjective sleep quality (Pittsburgh Sleep Quality Index [PSQI]), morningness-eveningness (Composite Scale of Morningness [CSM]), and clinical interview yielding a Hamilton Depression Rating Scale (HDRS) score. Grief was still present, as indicated by an average TRIG score of about 60. On average, the bereaved seniors habitually slept between approximately 23:00 and approximately 06:40 h, achieving approximately 6 h of sleep with a sleep efficiency of approximately 80%. They took about 30 min to fall asleep, and had their first REM episode after 75 min. About 20% of their sleep was in Stage REM, and about 3% in Stages 3 or 4 (slow wave sleep). Their mean PSQI score was 6.4. Their circadian temperature rhythms showed the usual classic shape with a trough at approximately 01:00 h, a fairly steep rise through the morning hours, and a more gradual rise to mid-evening, with an amplitude of approximately 0.8 degrees C. In terms of lifestyle regularity, the mean regularity (SRM) score was 3.65 (slightly lower than that usually seen in seniors). Mood and alertness showed time-of-day variation with peak alertness in the late morning and peak mood in the afternoon. Correlations between outcome sleep/circadian variables and level of grief (TRIG score) were calculated; there was a slight trend for higher grief to be associated with less time spent asleep (p=0.07) and reduced alertness at 20:00 h (p=0.05). Depression score was not correlated with TRIG score (p>0.20). When subjects were divided into groups by the nature of their late spouse's death (expected/after a long-term chronic illness [n=18] versus unexpected [n=10]), no differences emerged in any of the variables. In conclusion, when studied at least four months after the loss event, there appears to be some sleep disruption in spousally bereaved seniors. However, this disruption does not appear to be due to bereavement-related disruptions in the circadian system.

The emotional toll of spousal morbidity and mortality

OBJECTIVE

Spouse caregivers have an increased risk of mental and physical illness during caregiving and widowhood. The authors sought to evaluate whether partners of an ill spouse have a higher likelihood of developing mental health or substance abuse (MHSA) disorders than partners who have healthy spouses, accounting for both spousal illness and death.

METHODS

The authors used Medicare claims from 1993-2001 for 474,228 married couples. The authors used Cox models to determine the effect of spouse illness on partner MHSA diagnosis, controlling for demographic and clinical characteristics.

RESULTS

A wife's hospitalization increased the husband's risk of MHSA diagnosis by 1.29 (95% confidence interval [CI]: 1.28-1.29) and his risk of depression by 1.49 (95% CI: 1.48-1.51). A husband's hospitalization increased the risk of a wife's MHSA diagnosis by 1.33 (95% CI: 1.32-1.33) and her risk of depression by 1.41 (95% CI: 1.39-1.42). A wife's death increased the risk of the husband's MHSA diagnosis by 1.12 (95% CI: 1.11-1.13) and increased his risk of depression by 1.49 (95% CI: 1.46-1.51). A husband's death increased the risk of the wife's MHSA diagnosis by 1.14 (95% CI: 1.14-1.15) and increased her risk of depression by 1.41 (95% CI: 1.39-1.42).

CONCLUSION

Spouse hospitalizations and spouse death independently increase the risk for partner MHSA and depression diagnoses. These findings can identify which individuals are at greatest risk for emotional distress and should be targeted for interventions to relieve caregiver burden that can arise separately and additively from both spousal illness and death.

Spousal bereavement in older adults: common, resilient, and chronic grief with defining characteristics

The purpose of this study was to identify empirically patterns of grief among 141 older bereaved spouses. A longitudinal hierarchical cluster procedure with the Ward agglomeration method was used to identify distinct clusters based on grief scores. Three clusters were identified: common (49%), resilient (34%), and chronic (17%) grief. Members of the common grief cluster experienced elevated levels of grief and depressive symptoms that decreased over time. Members of the resilient cluster experienced the lowest levels of grief and depression and the highest quality of life. The chronic grief cluster experienced the highest levels of grief and depression, more sudden deaths, the lowest self-esteem, and the highest marital dependency. The majority in this chronic cluster also met proposed criteria for a diagnosis of complicated grief. Five out of every six bereaved spouses adjusted well over time, and about a third of these showed considerable resilience without negative consequences. One out of six experienced a chronic grief syndrome. Early identification of this syndrome can lead to referral to newly emergent treatments specific for grief.

Risk of mortality related to widowhood in older Mexican Americans

PURPOSE

To examine the risk and correlates of mortality after death of a spouse and whether mortality risk varies by sex.

METHODS

Prospective cohort study (1993 to 2000) of 1693 Mexican Americans ages 65 years and older who were married at baseline. Mortality was confirmed by matching records with the National Death Index or through proxy report. Risk of death related to incidence of widowhood was estimated by using proportional hazard regression and adjusted for age, education, US nativity, financial strain, social support, health behaviors, medical conditions, disability, and depressive symptoms.

RESULTS

In the unadjusted Cox hazard analysis, widowed men are significantly more likely to die (HR=2.32, CI=1.48 to 3.61), but loss of spouse has no significant effect on the subsequent risk of death for widowed women (HR=1.50, CI=0.90 to 2.49). After adjustment for covariates known to influence survival, the association between widowhood and mortality in men remained significant, but the magnitude of the association decreased by 26%, which suggests a partial mediation effect of these factors on survival. The trajectory of the survival curve shows that the risk of death associated with widowhood is highest within the first 2 years.

CONCLUSIONS

Widowhood in older Mexican American men is a risk factor for mortality.

Predicting the changes in depressive symptomatology in later life: how much do changes in health status, marital and caregiving status, work and volunteering, and health-related behaviors contribute?

This study examined the unique effects of four variable groups on changes in older adults' depressive symptoms for a 2-year period: (1) baseline health and disability status, (2) changes in health and disability since baseline, (3) stability and changes in marital and caregiving status and in work and volunteering, and (4) stability and changes in health-related behaviors. With data from the 1998 and 2000 interview waves of the Health and Retirement Study, the authors used gender-separate multistep (hierarchical) residualized regression analyses in which the Center for Epidemiological Studies Depression scale (CES-D) score at follow-up is modeled as a function of the effect of each group of independent variables. As hypothesized, changes in health, disability, marital, and caregiving status explained a larger amount of variance than the existing and stable conditions, although each group of variables explained a relatively small amount (0.3-3.4%) of variance in the follow-up CES-D score.

An adaptation of the Center for Epidemiologic Studies Depression Scale for use in non-psychiatric Spanish populations

To adapt the Center for Epidemiologic Studies Depression Scale for use in non-psychiatric Spanish populations, a Spanish translation of the scale was interviewer-administered to 554 subjects aged 18-34 years (65.9% women) and the ratings so obtained were compared with the SCID-CV-based diagnoses of expert clinicians. The internal consistency of the scale was satisfactory (Cronbach's alpha=0.89). Four factors identified by exploratory factor analysis (Depressive/Somatic, Positive Affect, Retarded Activity and Interpersonal Relations) accounted for 55.9% of the variance. A score of 26 was identified as a suitable cut-off for screening purposes, affording a sensitivity of 0.906 and a specificity of 0.918.

Widowhood and depressive symptoms among older Chinese: do gender and source of support make a difference?

In this study, we examined the effects of gender and pre-bereavement social support from three different sources (spouse, adult children, and friends) on widowhood adjustment among older adults in China. Hypotheses were developed by integrating the literature in the West and the cultural context of China. Data came from a panel survey, conducted in 1991 (baseline) and 1994 (follow-up), of a probability sample of older persons in Wuhan, China. For the present analysis, only those who were married with children at baseline were selected (N = 1,263). About 10% of the sample experienced spousal death between the two measurement points. Multiple regression analyses suggest that widowhood had a negative mental health consequence for older Chinese. Social support from adult children buffered the deleterious effect of widowhood, whereas spousal support during the marriage increased one's vulnerability. Support from friends was not found to have a significant effect. Gender difference in the effect of widowhood was also not evident. In this study, we have extended bereavement and social support research to a developing nation, with some findings similar to and some different from studies in Western developed nations.

The quality of life of spouse dementia caregivers: changes associated with yielding to formal care and widowhood

The focus of the study was the effect on spouse dementia caregivers of relinquishing care. The study used a longitudinal design, in which a group of 150 dementia caregivers were interviewed 2 years apart (designated Time 1 and Time 2), with data collected from both continuing caregivers and those who had relinquished care. The aims were to determine the extent to which changes over time in quality of life differed between continuing caregivers, those who had yielded to formal care, and those who had been widowed; and to examine whether change in quality of life variables was associated with time since yielding to formal care and time since death of the spouse. Quality of life was defined in terms of health status, psychological well-being, and activity participation. All participants were interviewed in their own homes. Three groups of participants were identified at Time 2: those who continued to provide care for their spouses (n=60); those who had yielded their caregiver role by admitting their spouses to permanent residential care (n=53); and those who had admitted their spouses to permanent institutional care, but whose spouse had then died (n=37). Different patterns of quality of life changes were observed between the three groups, with both positives and negatives associated with disengagement from the caregiving role. Positive changes were particularly evident in psychological well-being and activity participation. These findings were discussed in terms of their relevance for a life transitions approach to the relinquishment of caregiving.

Increased hospitalization risk for recently widowed older women and protective effects of social contacts

This study examines effects of recent widowhood on health for a nationally representative sample of older women in the United States. Mediating effects of social connectedness on the health of recently widowed women are also explored. Using data from the 1984-1990 Longitudinal Study of Aging and Medicare claims, discrete-time hazard models estimate the risk of hospitalization for any 30-day period for women who were married at the time of the baseline survey (n = 1,138). Compared to women who are not recently widowed, those recently widowed have a 40% higher risk of hospitalization. Social connectedness, measured by having phoned a friend/neighbor or family member in the period prior to the baseline survey, significantly decreases hospitalization risk for the recently widowed. The findings indicate that recent widowhood has a large adverse effect on the health of older women. Results highlight the need to provide additional support to recently widowed older women.

Widowhood and other demographic associations of pain in independent older people

OBJECTIVES

To determine if psychosocial factors, as suggested by the demographic variables of widowhood and living alone, are associated with pain, particularly severe pain, in a representative sample of independent older people.

DESIGN

One thousand older people (65+) randomly selected from independent residents living in a major city were surveyed about their health status (Health Status of Older People Study). Demographic characteristics, including age, gender, education, income, living alone, widowhood, and childlessness, were analyzed by logistic regression for their association with pain report of differing severity. Path analysis was used to confirm the association with pain severity and further define the role of mood disturbance in mediating this relationship.

RESULTS

The prevalence of any pain report for the preceding 12 months was 56.3%. This was reduced when using more restrictive criteria, such that moderate-to-severe pain "at worst" and "at present" was found in 48.7% and 4.1% of the sample, respectively. After adjusting for type 1 error rate, the status of living alone was primarily associated with moderate-to-severe pain at worst, and being a widow(er) was associated with moderate-to-severe pain at present. The latter association had an estimated odds ratio greater than 3 and was characterized by more recent bereavement. Using path analysis, the model that severe pain was secondary to mood disturbance of widowhood, particularly recent bereavement, was tested and confirmed. The model explained 17% of the variance of pain severity in widow(er)s.

CONCLUSION

The mood disturbance related to spousal bereavement aggravates pain in older people. This lends support to the biopsychosocial model of pain.

The role of self-enhancing evaluations in a successful life transition

The objective of the study was to investigate how self-enhancing evaluations, obtained via positive social comparisons and reflected appraisals, were related to mental health in a later life transition. The sample consisted of 266 women who were interviewed once before and 3 times after the experience of community relocation. Results extended prior findings suggesting the dynamic impact of self-enhancing evaluative processes on psychological well-being and depressive symptoms. Additional analyses showed evidence for reverse causality, that is, that mental health also influenced self-evaluative processes. This study underscores the significance of holding a positive view of self vis-à-vis others in negotiating life challenges as well as the reciprocal influence of well-being on social self-evaluative processes.