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Strand BH, Håberg AK, Eyjólfsdóttir HS, Kok A, Skirbekk V, Huxhold O, Løset GK, Lennartsson C, Schirmer H, Herlofson K, Veenstra M. Spousal bereavement and its effects on later life physical and cognitive capability: the Tromsø study. GeroScience 2024:10.1007/s11357-024-01150-y. [PMID: 38594472 DOI: 10.1007/s11357-024-01150-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/31/2024] [Indexed: 04/11/2024] Open
Abstract
Spousal bereavement is associated with health declines and increased mortality risk, but its specific impact on physical and cognitive capabilities is less studied. A historical cohort study design was applied including married Tromsø study participants (N=5739) aged 50-70 years with baseline self-reported overall health and health-related factors and measured capability (grip strength, finger tapping, digit symbol coding, and short-term recall) at follow-up. Participants had data from Tromsø4 (1994-1995) and Tromsø5 (2001), or Tromsø6 (2007-2008) and Tromsø7 (2015-2016). Propensity score matching, adjusted for baseline confounders (and baseline capability in a subset), was used to investigate whether spousal bereavement was associated with poorer subsequent capability. Spousal bereavement occurred for 6.2% on average 3.7 years (SD 2.0) before the capability assessment. There were no significant bereavement effects on subsequent grip strength, immediate recall, or finger-tapping speed. Without adjustment for baseline digit symbol coding test performance, there was a negative significant effect on the digit symbol coding test (ATT -1.33; 95% confidence interval -2.57, -0.10), but when baseline digit symbol coding test performance was taken into account in a smaller subsample, using the same set of matching confounders, there was no longer any association (in the subsample ATT changed from -1.29 (95% CI -3.38, 0.80) to -0.04 (95% CI -1.83, 1.75). The results in our study suggest that spousal bereavement does not have long-term effects on the intrinsic capacity components physical or cognition capability to a notable degree.
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Affiliation(s)
- Bjørn Heine Strand
- Department for Physical Health and Aging, Norwegian Institute of Public Health, Oslo, Norway.
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
| | - Asta K Håberg
- Department for Physical Health and Aging, Norwegian Institute of Public Health, Oslo, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Harpa Sif Eyjólfsdóttir
- Aging Research Center (ARC), Karolinska Institutet, Stockholm, Sweden
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Stockholm University, Stockholm, Sweden
| | - Almar Kok
- Department of Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life Programme, Amsterdam, The Netherlands
| | - Vegard Skirbekk
- Department for Physical Health and Aging, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Gøril Kvamme Løset
- NOVA - Norwegian Social Research, Oslo Metropolitan University, Oslo, Norway
| | - Carin Lennartsson
- Aging Research Center (ARC), Karolinska Institutet, Stockholm, Sweden
- Swedish Institute for Social Research (SOFI), Stockholm University, Stockholm, Sweden
| | - Henrik Schirmer
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Cardiology, Akershus, University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Katharina Herlofson
- NOVA - Norwegian Social Research, Oslo Metropolitan University, Oslo, Norway
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Zülke AE, Pabst A, Luppa M, Roehr S, Seidling H, Oey A, Cardona MI, Blotenberg I, Bauer A, Weise S, Zöllinger I, Sanftenberg L, Brettschneider C, Döhring J, Lunden L, Czock D, Haefeli WE, Wiese B, Hoffmann W, Frese T, Gensichen J, König H, Kaduszkiewicz H, Thyrian JR, Riedel‐Heller SG. A multidomain intervention against cognitive decline in an at-risk-population in Germany: Results from the cluster-randomized AgeWell.de trial. Alzheimers Dement 2024; 20:615-628. [PMID: 37768074 PMCID: PMC10917033 DOI: 10.1002/alz.13486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/22/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION We investigated the effectiveness of a multidomain intervention to preserve cognitive function in older adults at risk for dementia in Germany in a cluster-randomized trial. METHODS Individuals with a Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) risk score ≥ 9 aged 60 to 77 years were recruited. After randomization of their general practitioner (GP), patients received a multidomain intervention (including optimization of nutrition and medication, and physical, social, and cognitive activity) or general health advice and GP treatment as usual over 24 months. Primary outcome was global cognitive performance (composite z score, based on domain-specific neuropsychological tests). RESULTS Of 1030 participants at baseline, n = 819 completed the 24-month follow-up assessment. No differences regarding global cognitive performance (average marginal effect = 0.010, 95% confidence interval: -0.113, 0.133) were found between groups at follow-up. Perceived restrictions in intervention conduct by the COVID-19 pandemic did not impact intervention effectiveness. DISCUSSION The intervention did not improve global cognitive performance. HIGHLIGHTS Overall, no intervention effects on global cognitive performance were detected. The multidomain intervention improved health-related quality of life in the total sample. In women, the multidomain intervention reduced depressive symptoms. The intervention was completed during the COVID-19 pandemic.
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Affiliation(s)
- Andrea E. Zülke
- Institute of Social MedicineOccupational Health and Public Health (ISAP), Medical FacultyUniversity of LeipzigLeipzigGermany
| | - Alexander Pabst
- Institute of Social MedicineOccupational Health and Public Health (ISAP), Medical FacultyUniversity of LeipzigLeipzigGermany
| | - Melanie Luppa
- Institute of Social MedicineOccupational Health and Public Health (ISAP), Medical FacultyUniversity of LeipzigLeipzigGermany
| | - Susanne Roehr
- Institute of Social MedicineOccupational Health and Public Health (ISAP), Medical FacultyUniversity of LeipzigLeipzigGermany
- School of PsychologyMassey UniversityManawatū CampusPalmerston NorthNew Zealand
- Global Brain Health Institute (GBHI)Trinity College DublinDublinIreland
| | - Hanna Seidling
- Department of Clinical Pharmacology and PharmacoepidemiologyHeidelberg University HospitalHeidelbergGermany
| | - Anke Oey
- Institute for General PracticeWork Group Medical Statistics and IT‐InfrastructureHannover Medical SchoolHannoverGermany
| | - Maria Isabel Cardona
- German Center for Neurodegenerative Diseases (DZNE)Rostock/GreifswaldGreifswaldGermany
| | - Iris Blotenberg
- German Center for Neurodegenerative Diseases (DZNE)Rostock/GreifswaldGreifswaldGermany
| | - Alexander Bauer
- Institute of General Practice and Family MedicineMartin‐Luther‐University Halle‐WittenbergHalle (Saale)Germany
| | - Solveig Weise
- Institute of General Practice and Family MedicineMartin‐Luther‐University Halle‐WittenbergHalle (Saale)Germany
| | - Isabel Zöllinger
- Institute of General Practice/Family MedicineUniversity Hospital of LMU MunichMunichGermany
| | - Linda Sanftenberg
- Institute of General Practice/Family MedicineUniversity Hospital of LMU MunichMunichGermany
| | - Christian Brettschneider
- University Medical Center Hamburg‐EppendorfDepartment of Health Economics and Health Service ResearchHamburgGermany
| | | | - Laura Lunden
- Institute of General PracticeUniversity of KielKielGermany
| | - David Czock
- Department of Clinical Pharmacology and PharmacoepidemiologyHeidelberg University HospitalHeidelbergGermany
| | - Walter E. Haefeli
- Department of Clinical Pharmacology and PharmacoepidemiologyHeidelberg University HospitalHeidelbergGermany
| | - Birgitt Wiese
- Institute for General PracticeWork Group Medical Statistics and IT‐InfrastructureHannover Medical SchoolHannoverGermany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE)Rostock/GreifswaldGreifswaldGermany
- Institute for Community MedicineUniversity Medicine GreifswaldGreifswaldGermany
| | - Thomas Frese
- Institute of General Practice and Family MedicineMartin‐Luther‐University Halle‐WittenbergHalle (Saale)Germany
| | - Jochen Gensichen
- Institute of General Practice/Family MedicineUniversity Hospital of LMU MunichMunichGermany
| | - Hans‐Helmut König
- University Medical Center Hamburg‐EppendorfDepartment of Health Economics and Health Service ResearchHamburgGermany
| | | | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE)Rostock/GreifswaldGreifswaldGermany
- Institute for Community MedicineUniversity Medicine GreifswaldGreifswaldGermany
- Faculty V–Faculty of Life SciencesUniversity of SiegenSiegenGermany
| | - Steffi G. Riedel‐Heller
- Institute of Social MedicineOccupational Health and Public Health (ISAP), Medical FacultyUniversity of LeipzigLeipzigGermany
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Li Q, Smith JP, Zhao Y. Understanding the Effects of Widowhood on Health in China: Mechanisms and Heterogeneity. JOURNAL OF THE ECONOMICS OF AGEING 2023; 25:100458. [PMID: 37389325 PMCID: PMC10306321 DOI: 10.1016/j.jeoa.2023.100458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
This paper analyzes the impact of widowhood on the health of mid-aged and older individuals in China using data from the China Health and Retirement Longitudinal Study (CHARLS) data. Our results show that widowhood significantly increases the risk of depression, chronic diseases, and body pain while reducing cognitive function, sleeping time, and daily activity functions. The effects on depression and daily functions are immediate, that on chronic diseases is lagged, and the effects on cognitive function and sleeping hours persist over time. We find that rural widows are particularly vulnerable to negative health outcomes due to their weaker economic positions, for whom widowhood leads to more grandchild care responsibility and corresponding workforce and social withdrawals. Moreover, rural widows' income loss is not compensated by children, either by co-residence or financial transfers, leading to reduced living standards. Overall, our findings suggest that China needs to strengthen economic security for older people, especially among rural women, in order to avoid significant negative consequences of widowhood.
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Affiliation(s)
- Qin Li
- South China Agricultural University, Guangzhou, China
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Kim JW, Byun MS, Lee JH, Yi D, Kim MJ, Jung G, Lee JY, Lee YS, Kim YK, Kang KM, Sohn CH, Lee DY. Spouse bereavement and brain pathologies: A propensity score matching study. Psychiatry Clin Neurosci 2022; 76:490-504. [PMID: 35751876 PMCID: PMC9796777 DOI: 10.1111/pcn.13439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/25/2022] [Accepted: 06/16/2022] [Indexed: 01/07/2023]
Abstract
AIM Spouse bereavement is one of life's greatest stresses and has been suggested to trigger or accelerate cognitive decline and dementia. However, little information is available about the potential brain pathologies underlying the association between spouse bereavement and cognitive decline. We aimed to investigate that lifetime spouse bereavement is associated with in vivo human brain pathologies underlying cognitive decline. METHODS A total of 319 ever-married older adults between the ages of 61 and 90 years underwent comprehensive clinical assessments and multimodal brain imaging including [11 C] Pittsburgh compound B-positron emission tomography (PET), AV-1451 PET, [18 F] fluorodeoxyglucose-PET, and magnetic resonance imaging. Participants were classified as experiencing no spouse bereavement or spouse bereavement, and comparisons using propensity score matching (59 cases and 59 controls) were performed. RESULTS Spouse bereavement was significantly associated with higher cerebral white matter hyperintensity (WMH) volume compared with no spouse bereavement. Interaction and subsequent subgroup analyses showed that spouse bereavement was significantly associated with higher WMH in the older (>75 years) subgroup and among those with no- or low-skill occupations. In addition, spouse bereavement at 60 years or older affects WMH volume compared with no spouse bereavement, whereas spouse bereavement at younger than 60 years did not. No group differences were observed in other brain pathologies between spouse bereavement categories. CONCLUSIONS The findings suggest that the spouse bereavement may contribute to dementia or cognitive decline by increasing cerebrovascular injury, particularly in older individuals and those with no- or low-skill occupations.
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Affiliation(s)
- Jee Wook Kim
- Department of Neuropsychiatry, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea.,Department of Psychiatry, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Min Soo Byun
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun Ho Lee
- Department of Geriatric Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Dahyun Yi
- Medical Research Center Seoul National University, Institute of Human Behavioral Medicine, Seoul, Republic of Korea
| | - Min Jung Kim
- Department of Psychiatry, Eulji University Nowon Eulji Medical Center, Seoul, Republic of Korea
| | - Gijung Jung
- Medical Research Center Seoul National University, Institute of Human Behavioral Medicine, Seoul, Republic of Korea
| | - Jun-Young Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Neuropsychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Yun-Sang Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yu Kyeong Kim
- Department of Nuclear Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Koung Mi Kang
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Young Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Medical Research Center Seoul National University, Institute of Human Behavioral Medicine, Seoul, Republic of Korea
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Jain U, Liu H, Langa KM, Farron M, Kabeto M, Lee J. Widowhood and cognition among older women in India: New insights on widowhood duration and mediators. SSM Popul Health 2022; 19:101242. [PMID: 36193099 PMCID: PMC9525895 DOI: 10.1016/j.ssmph.2022.101242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 01/10/2023] Open
Abstract
Background Widowhood, a marital status that disproportionately affects older women, has been associated with poorer health compared to married individuals. However, relatively little is known about the association between widowhood in later-life and cognitive health in low- and middle-income countries. Methods To address this research gap, we used data from the Longitudinal Aging Study in India (2017-19) to investigate the widowhood disparity in cognitive health among mid-aged and older women in India, including how this relationship varies by the duration of widowhood. We further examined the extent to which economic, social, and health conditions mediate this association. Results Cognition scores for widowed women were on average lower by almost 0.1 standard deviations compared to married women. Overall, this disparity increased with widowhood duration, with non-linearities in this association. The disparity in cognition scores increased with widowhood duration up to twenty years but did not increase further among those with longer widowhood duration. Worse physical and mental health were found to mediate almost thirty percent of the total association between widowhood and cognition. These mediators were most useful in explaining the association between lower cognition and widowhood among women who experienced widowhood for ten years or longer. Conclusion The study highlights the significant disadvantage in cognitive functioning among older widowed women in India. The study also provides evidence on potential mediators, suggesting differential effects of mediators at different stages of widowhood.
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Affiliation(s)
- Urvashi Jain
- Department of Economics, Finance and Real Estate, Mitchell College of Business, University of South Alabama, USA
| | - Hui Liu
- Department of Sociology, Michigan State University, USA
| | - Kenneth M. Langa
- Department of Internal Medicine, Institute for Social Research, and VA Center for Clinical Management Research, University of Michigan, USA
| | - Madeline Farron
- Department of Internal Medicine, University of Michigan, USA
| | - Mohammed Kabeto
- Department of Internal Medicine, University of Michigan, USA
| | - Jinkook Lee
- Center for Economic and Social Research, and Department of Economics, University of Southern California, USA
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Wu-Chung EL, Leal SL, Denny BT, Cheng SL, Fagundes CP. Spousal caregiving, widowhood, and cognition: A systematic review and a biopsychosocial framework for understanding the relationship between interpersonal losses and dementia risk in older adulthood. Neurosci Biobehav Rev 2022; 134:104487. [PMID: 34971701 PMCID: PMC8925984 DOI: 10.1016/j.neubiorev.2021.12.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 01/18/2023]
Abstract
Accumulating research suggests that stressful life events, especially those that threaten close intimate bonds, are associated with an increased risk of dementia. Grieving the loss of a spouse, whether in the form of caregiving or after the death, ranks among 'life's most significant stressors', evoking intense psychological and physiological distress. Despite numerous studies reporting elevated dementia risk or poorer cognition among spousal caregivers and widow(er)s compared to controls, no review has summarized findings across cognitive outcomes (i.e., dementia incidence, cognitive impairment rates, cognitive performance) or proposed a theoretical model for understanding the links between partner loss and abnormal cognitive decline. The current systematic review summarizes findings across 64 empirical studies. Overall, both cross-sectional and longitudinal studies revealed an adverse association between partner loss and cognitive outcomes. In turn, we propose a biopsychosocial model of cognitive decline that explains how caregiving and bereavement may position some to develop cognitive impairment or Alzheimer's disease and related dementias. More longitudinal studies that focus on the biopsychosocial context of caregivers and widow(er)s are needed.
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Affiliation(s)
| | | | - Bryan T. Denny
- Department of Psychological Sciences, Rice University, Houston, TX
| | | | - Christopher P. Fagundes
- Department of Psychological Sciences, Rice University, Houston, TX,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX,Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX
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Bi T, Kou H, Kong Y, Shao B. Widowhood Impairs Emotional Cognition Among Elderly. Front Aging Neurosci 2022; 13:808885. [PMID: 35173602 PMCID: PMC8841410 DOI: 10.3389/fnagi.2021.808885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/31/2021] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe negative impacts of spousal bereavement on the emotional health of the elderly (e.g., depression and anxiety) have been revealed. However, whether widowhood impairs emotional cognition among the elderly is less known. The purpose of this study is to reveal the emotional cognitive deficits among the widowed elderly.MethodsIn this study, we recruited 44 widowed elderly (WE) and 44 elder couples (non-widowed elderly, NWE) and examined their emotional cognition including attention and visual working memory, which were measured by the visual search task and delayed-match-to-sample task, respectively. Three kinds of emotional faces (i.e., sad, angry, and happy) were adopted as the attentional or mnemonic targets.ResultsIt revealed that WE had a general deficit in search efficiency across emotional types, while they showed mnemonic deficits in negative faces but not positive faces. Furthermore, the modeling analysis revealed that the level of depression or state anxiety of the elderly moderated the effects of widowhood on the deficits of mnemonic processing, i.e., the deficits were only evident among WE with the high level of depression or state anxiety.ConclusionThese findings reveal the attentional deficits in sad, angry, and happy faces and the mnemonic deficits in sad and angry faces among elderly who suffer from widowhood and point out the important role of emotional problems such as depression and state anxiety in modulating these emotional cognitive deficits.
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Zhao Y, Inder B, Kim JS. Spousal bereavement and the cognitive health of older adults in the US: New insights on channels, single items, and subjective evidence. ECONOMICS AND HUMAN BIOLOGY 2021; 43:101055. [PMID: 34530393 DOI: 10.1016/j.ehb.2021.101055] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/13/2021] [Accepted: 08/16/2021] [Indexed: 06/13/2023]
Abstract
This study provides novel insights into older adults' cognitive functioning before and after widowhood onset and possible effect channels. It further examines gender heterogeneity in the adaptation to (anticipated or actual) spousal bereavement, comparing objective evidence with subjective evidence of cognitive abilities. We used longitudinal data of up to 26,584 participants of the Health and Retirement Study, aged over 50 at recruitment, assessed biennially between 1998 and 2016. Two-way fixed effects with dynamic treatment effects were estimated for various cognitive measures, including six aggregated indices and six single item scales. After adjusting for effect channels including depression, social vulnerability, and stress, there remained significant widowhood effects on older adults' cognitive health. Using single item scales, we established the adverse contemporaneous and adaptation effects on bereaved older females' short-term memory, semantic memory, and numeracy. For bereaved older males, working memory and focus-of-attention deteriorated after widowhood onset. Meanwhile, subjective memory rating remained intact, contrary to objective evidence. We conclude that cognitive transitions to and from widowhood can exhibit distinctive patterns across objective and subjective cognitive domains. With the effect channels in mind, cognitive intervention for widowed older adults should be tailored to the temporal distance to spousal loss, gender, and task.
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Affiliation(s)
- Yuejun Zhao
- Department of Economics, University of Gothenburg, Sweden.
| | - Brett Inder
- Department of Econometrics and Business Statistics, Monash University, Australia.
| | - Jun Sung Kim
- Department of Economics, College of Politics and Economics, Kyung Hee University, Korea.
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Zaheed AB, Sharifian N, Morris EP, Kraal AZ, Zahodne LB. Associations between life course marital biography and late-life memory decline. Psychol Aging 2021; 36:557-571. [PMID: 34166026 DOI: 10.1037/pag0000617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Late-life marital status is associated with cognitive aging; however, the influence of life course marital biography (i.e., changes in marital status) on late-life cognitive trajectories, as well as gender differences in the effects of marital biography, remain to be explored. Associations between (a) marital status at study baseline (currently married, previously married, never married) and (b) retrospectively reported life course marital biography (i.e., age at first marriage, time spent unmarried following initial marriage, history of divorce, history of widowhood) and up to 20 years of subsequent episodic memory trajectories were examined using latent growth curve models in 3,061 participants aged 51 + in the Health and Retirement Study 2017 Life History Mail Survey. Gender differences were examined with multiplicative interaction terms and stratified models. Participants who were married at study baseline demonstrated higher initial memory than previously and never married individuals. Older age at first marriage and shorter duration spent unmarried were each associated with better initial episodic memory among previously married individuals only; longer duration spent unmarried was associated with slower memory decline. Stratified models suggested that these associations may be driven by women. These results highlight the importance of considering multiple aspects of marital biography, not just current marital status, in cognitive aging research. Marital biography may have an enduring influence on cognitive aging, particularly among previously married older women. Future work is needed to identify mechanisms (e.g., socioeconomic resources, cognitive stimulation, self and spousal health, emotional support) through which marital histories influence cognitive aging. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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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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Wörn J, Comijs H, Aartsen M. Spousal Loss and Change in Cognitive Functioning: An Examination of Temporal Patterns and Gender Differences. J Gerontol B Psychol Sci Soc Sci 2020; 75:195-206. [PMID: 30219919 DOI: 10.1093/geronb/gby104] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The study investigates whether the disadvantaged position of men in the adverse consequences of widowhood for health and mortality also exists for changes in cognitive health. METHODS We used data of up to 1,269 men and women aged 65 years and older who participated in the Longitudinal Aging Study Amsterdam in 3-yearly assessments between 1992 and 2012 (5,123 person-observations). All were married and without cognitive impairment (Mini-Mental State Examination ≥ 24) at baseline and up to 419 lost their spouse. In fixed effects regression models, the effect of spousal loss on change in four domains of cognitive functioning was estimated independently of age-related cognitive change. RESULTS For women, a robust temporary decrease was found in the second year after spousal loss in the reasoning domain, but not in global cognitive functioning, processing speed, or memory. No robust effects were found for men. DISCUSSION Considering that only one cognitive domain was affected and effects were temporary, cognitive functioning seems rather robust to the experience of spousal loss. Despite men having often been reported to be in a disadvantaged position in other health domains, our analyses indicate no such pattern for cognitive functioning.
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Affiliation(s)
- Jonathan Wörn
- Research Training Group SOCLIFE, Albertus-Magnus-Platz, Cologne, Germany.,Institute of Sociology and Social Psychology, University of Cologne, Albertus-Magnus-Platz, Cologne, Germany
| | - Hannie Comijs
- GGZinGeest/Amsterdam Public Health Research Institute, VU University Amsterdam, Amsterdam, The Netherlands
| | - Marja Aartsen
- NOVA, Norwegian Social Research, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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Lee Y, Chi I, A Palinkas L. Widowhood, leisure activity engagement, and cognitive function among older adults. Aging Ment Health 2019; 23:771-780. [PMID: 29634291 DOI: 10.1080/13607863.2018.1450837] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Maintaining cognitive function is an essential aspect of successful aging. Widowhood is a salient life transition that can affect older adults' cognitive function. Leisure engagement has received increasing attention because it is still modifiable in later life to help prevent cognitive decline. Nonetheless, limited longitudinal studies have examined how widowhood influences cognitive function, and even fewer studies have tested the role of leisure activities in this relationship. METHOD This study delineated the mechanism of widowhood, leisure activity engagement, and cognitive function among older adults using a national longitudinal dataset, the Health and Retirement Study, and its supplementary dataset, the Consumption and Activities Mail Survey, which repeatedly measured individuals' leisure activity engagement. RESULTS Findings showed no significant association between widowhood and cognitive function during a 4-year period. However, engagement in mental activities moderated the impact of widowhood on cognitive function. Specifically, the benefit of mental activity engagement on cognition was more pronounced among individuals who were recently widowed compared to those who were married. This implies a protective role of mental activities in the relationship between widowhood and cognitive function. CONCLUSION Interventions with mentally stimulating activities at the community level to retain cognition among individuals in early phase widowhoodare suggested. Future studies are necessary to explore whether other factors such as changes in physical and mental health and intergenerational support from adult children during widowhood may further influence this mechanism among widowhood, leisure activities, and cognitive function.
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Affiliation(s)
- Yura Lee
- a Department of Social Work , Helen Bader School of Social Welfare , University of Wisconsin-Milwaukee , Milwaukee , Wisconsin, United States
| | - Iris Chi
- b Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , California , United States
| | - Lawrence A Palinkas
- b Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , California , United States
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Huang FY, Hsu AL, Hsu LM, Tsai JS, Huang CM, Chao YP, Hwang TJ, Wu CW. Mindfulness Improves Emotion Regulation and Executive Control on Bereaved Individuals: An fMRI Study. Front Hum Neurosci 2019; 12:541. [PMID: 30745865 PMCID: PMC6360180 DOI: 10.3389/fnhum.2018.00541] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/31/2018] [Indexed: 01/30/2023] Open
Abstract
The grief of bereavement is recognized as a severe psychosocial stressor that can trigger a variety of mental and physical disorders, and the long-lasting unresolved grief has a detrimental effect on brain functionality. Literature has documented mindfulness-based cognitive therapy (MBCT) as an efficient treatment for improving well-being, specifically related to the mood and cognition, in a variety of populations. However, little attention has been devoted to neural mechanisms with regard to bereaved individuals' cognition after MBCT intervention. In this study, we recruited 23 bereaved participants who lost a significant relative within 6 months to 4 years to attend 8-week MBCT course. We used self-reporting questionnaires to measure emotion regulation and functional magnetic resonance imaging (fMRI) with the numerical Stroop task to evaluate the MBCT effect on executive control among the bereaved participants. The self-reported questionnaires showed improvements on mindfulness and reductions in grief, difficulties in emotion regulation, anxiety, and depression after the MBCT intervention. The fMRI analysis demonstrated two scenarios: (1) the activity of the fronto-parietal network slightly declined accompanied with significant improvements in the reaction time of incongruent trials; (2) the activities in the posterior cingulate cortex and thalamus were positively associated with the Texas Revised Inventory of Grief, implying emotional interferences on cognitive functions. Results indicated that MBCT facilitated the executive control function by alleviating the emotional interferences over the cognitive functions and suggested that the 8-week MBCT intervention significantly improved both executive control and emotion regulation in bereaved individuals.
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Affiliation(s)
- Feng-Ying Huang
- Department of Education, College of Education, National Taipei University of Education, Taipei, Taiwan
| | - Ai-Ling Hsu
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Li-Ming Hsu
- Department of Radiology and Biomedical Research Imaging Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - 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
| | - Chih-Mao Huang
- Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Yi-Ping Chao
- Graduate Institute of Medical Mechatronics, Chang Gung University, Taoyuan, Taiwan
| | - Tzung-Jeng Hwang
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Changwei W. Wu
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan
- Research Center of Brain and Consciousness, Shuang Ho Hospital, New Taipei, Taiwan
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Pérez HCS, Ikram MA, Direk N, Tiemeier H. Prolonged Grief and Cognitive Decline: A Prospective Population-Based Study in Middle-Aged and Older Persons. Am J Geriatr Psychiatry 2018; 26:451-460. [PMID: 29329723 DOI: 10.1016/j.jagp.2017.12.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 12/01/2017] [Accepted: 12/05/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Bereavement can result in unresolved and prolonged grief, often termed prolonged grief disorder (PGD). The impact of PGD on cognitive functioning is poorly understood. The aim of the study was to compare the cognitive decline, assessed by repeated measures of different cognition domains, between persons with normal and PGD and a non-grieving reference population in a 7-year follow-up study. METHODS The study sample comprised 3126 non-demented persons, mean age: 64 years, of the Rotterdam Study. Participants were classified into three groups: no grief (reference group, N = 2,582), normal grief (N = 418), and prolonged grief disorder (N = 126). Participants were assessed with the Complicated Grief Inventory and underwent cognitive testing (Mini-Mental State Examination [MMSE], Letter-Digit Substitution test, Stroop test, Word fluency task, Word learning test). Analyses were adjusted for baseline cognition and depressive symptoms; persons with major depressive disorders were excluded. RESULTS Compared with the reference group, participants with PGD showed a decrease in global cognitive function, MMSE scores, and World learning test (immediate and delayed) over time. Participants with normal grief did not show a stronger cognitive decline in any of cognitive tests than the reference group. CONCLUSIONS Participants with PGD showed a stronger cognitive decline than the reference group during 7 years of follow-up. This suggests that PGD is a risk factor for cognitive decline, but this study cannot detect the psychobiological mechanism underlying this longitudinal association.
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Affiliation(s)
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Nese Direk
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Psychiatry, Dokuz Eylul University, Izmir, Turkey
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands.
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The Impact of Complicated Grief on Diurnal Cortisol Levels Two Years After Loss: A Population-Based Study. Psychosom Med 2017; 79:426-433. [PMID: 27879552 DOI: 10.1097/psy.0000000000000422] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Few studies have focused on the effect of complicated grief-unresolved and prolonged grief-on the neuroendocrine systems. The present study examined the association of complicated grief and normal grief with the diurnal cortisol patterns in a large population-based study. METHODS This study was set in the Rotterdam Study and comprised 2084 persons aged older than 55 years (mean [SD] age, 64.9 [5.5] years). Participants were assessed with the Complicated Grief Inventory and classified into no grief (n = 1922), normal grief (n = 131), or complicated grief (n = 31) if they experienced the loss in the past 2 years. Saliva samples were collected to measure cortisol levels. Morning cortisol and summary measures (area under the curve and the slope) were studied to account for the diurnal pattern of cortisol. Persons with depressive disorders were excluded, and analyses were additionally adjusted for depressive symptoms. RESULTS Compared to normal grievers, participants with complicated grief showed lower levels of morning cortisol (11.26 vs 15.51 nmol/L; difference, -4.24; 95% confidence interval [CI] = -7.87 to -0.62; p = .022), and lower levels of overall diurnal cortisol (6.89 vs 8.98 nmol/L; difference, -2.09; 95% CI = -3.81 to -0.37; p = .017). No difference was observed in slope between both groups. Participants with complicated grief also showed lower levels of morning cortisol than the nongrievers (11.26 vs 14.71; difference, -3.46; 95% CI = -6.78 to -0.13; p = .042). In contrast, cortisol secretion patterns did not differ between persons with normal grief and nongrieving controls. CONCLUSIONS Participants with complicated grief showed low levels of morning cortisol and low overall diurnal cortisol levels characteristic for a chronic stress reaction.
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Gibbons JA, Fehr AMA, Brantley JC, Wilson KJ, Lee SA, Walker WR. Testing the fading affect bias for healthy coping in the context of death. DEATH STUDIES 2016; 40:513-527. [PMID: 27261212 DOI: 10.1080/07481187.2016.1186760] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Affect fades faster for unpleasant events than for pleasant events (e.g., Walker, Vogl, & Thompson, 1997 ), which is referred to as the fading affect bias (FAB; Walker, Skowronski, Gibbons, Vogl, & Thompson, 2003 ). Although research has generally shown that the FAB is a healthy coping mechanism, this same finding has not been demonstrated at a specific level of analysis accounting for particular event types and related individual differences (e.g., Gibbons et al., 2013 ). Given the strong unpleasant emotions associated with death (Rask, Kaunonen, & Paunonen-Ilmonen, 2002 ), the current study examined FAB in the context of death events and participant attitudes toward death. General healthy coping was shown by robust FAB across death and control (i.e., everyday) events and by a negative correlation between negative religious coping and FAB. Although healthy coping at a specific level of analysis was supported by increased FAB for participants who held accepting attitudes toward death when they recalled everyday events, it was not supported by decreased FAB for the same participants when they recalled death events. This effect was mediated by rehearsal ratings, not depression. Implications are discussed.
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Affiliation(s)
- Jeffrey A Gibbons
- a Department of Psychology , Christopher Newport University , Newport News , Virginia , USA
| | - Ashley M A Fehr
- a Department of Psychology , Christopher Newport University , Newport News , Virginia , USA
| | - J Claire Brantley
- a Department of Psychology , Christopher Newport University , Newport News , Virginia , USA
| | - Kalli J Wilson
- a Department of Psychology , Christopher Newport University , Newport News , Virginia , USA
| | - Sherman A Lee
- a Department of Psychology , Christopher Newport University , Newport News , Virginia , USA
| | - W Richard Walker
- b Department of Psychology , Winston Salem State University , Winston-Salem , North Carolina , USA
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Saavedra Pérez HC, Ikram MA, Direk N, Prigerson HG, Freak-Poli R, Verhaaren BFJ, Hofman A, Vernooij M, Tiemeier H. Cognition, structural brain changes and complicated grief. A population-based study. Psychol Med 2015; 45:1389-1399. [PMID: 25363662 DOI: 10.1017/s0033291714002499] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Several psychosocial risk factors for complicated grief have been described. However, the association of complicated grief with cognitive and biological risk factors is unclear. The present study examined whether complicated grief and normal grief are related to cognitive performance or structural brain volumes in a large population-based study. METHOD The present research comprised cross-sectional analyses embedded in the Rotterdam Study. The study included 5501 non-demented persons. Participants were classified as experiencing no grief (n = 4731), normal grief (n = 615) or complicated grief (n = 155) as assessed with the Inventory of Complicated Grief. All persons underwent cognitive testing (Mini-Mental State Examination, Letter-Digit Substitution Test, Stroop Test, Word Fluency Task, word learning test - immediate and delayed recall), and magnetic resonance imaging to measure general brain parameters (white matter, gray matter), and white matter lesions. Total brain volume was defined as the sum of gray matter plus normal white matter and white matter lesion volume. Persons with depressive disorders were excluded and analyses were adjusted for depressive symptoms. RESULTS Compared with no-grief participants, participants with complicated grief had lower scores for the Letter-Digit Substitution Test [Z-score -0.16 v. 0.04, 95% confidence interval (CI) -0.36 to -0.04, p = 0.01] and Word Fluency Task (Z-score -0.15 v. 0.03, 95% CI -0.35 to -0.02, p = 0.02) and smaller total volumes of brain matter (933.53 ml v. 952.42 ml, 95% CI -37.6 to -0.10, p = 0.04). CONCLUSIONS Participants with complicated grief performed poorly in cognitive tests and had a smaller total brain volume. Although the effect sizes were small, these findings suggest that there may be a neurological correlate of complicated grief, but not of normal grief, in the general population.
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Affiliation(s)
- H C Saavedra Pérez
- Department of Epidemiology,Erasmus Medical Center,Rotterdam,The Netherlands
| | - M A Ikram
- Department of Epidemiology,Erasmus Medical Center,Rotterdam,The Netherlands
| | - N Direk
- Department of Epidemiology,Erasmus Medical Center,Rotterdam,The Netherlands
| | - H G Prigerson
- Department of Psychiatry,Brigham and Women's Hospital,Boston,MA,USA
| | - R Freak-Poli
- Department of Epidemiology,Erasmus Medical Center,Rotterdam,The Netherlands
| | - B F J Verhaaren
- Department of Epidemiology,Erasmus Medical Center,Rotterdam,The Netherlands
| | - A Hofman
- Department of Epidemiology,Erasmus Medical Center,Rotterdam,The Netherlands
| | - M Vernooij
- Department of Epidemiology,Erasmus Medical Center,Rotterdam,The Netherlands
| | - H Tiemeier
- Department of Epidemiology,Erasmus Medical Center,Rotterdam,The Netherlands
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Hatch DJ, Schwartz S, Norton MC. Depression and antidepressant use moderate association between widowhood and Alzheimer's disease. Int J Geriatr Psychiatry 2015; 30:292-9. [PMID: 24798942 DOI: 10.1002/gps.4140] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 04/04/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In recent decades, biological evidence has implicated chronic stress in the etiology of Alzheimer's disease (AD). As a result, the relationship between widowhood, one of the most stressful life events, and AD has also received attention. This study extends this literature by investigating whether depression, which may indicate proneness to distress, and antidepressant use, which can protect against hippocampal shrinkage, moderate the relationship between widowhood and increased risk for AD. METHODS To investigate this, this study utilized data from the Cache County Memory Study, a large population-based epidemiological study of AD, and the Utah Population Database, one of the world's foremost linked genealogical databases, to regress AD on the interaction between widowhood and history of depression and antidepressant use. RESULTS In Cox regression analyses, history of depression and antidepressant use moderated the association between widowhood and AD (p = 0.007 and p = 0.006, respectively), in that widowhood was associated with 73% and 94% increased hazard of AD among those reporting depression (hazard ratio [HR] = 1.73, 95% confidence interval [CI]: 1.001 to 2.99) and those reporting antidepressant use (HR = 1.94, 95% CI: 1.13 to 3.33). A significant three-way interaction between widowhood, depression, and antidepressant use was also found (p = 0.02), showing depression to moderate the association between widowhood and AD only among those not using antidepressants (p = 0.02). CONCLUSIONS These findings advance clinical and scientific knowledge concerning the effects of widowhood on risk for AD and underscore the importance of depression and antidepressant use in understanding vulnerability to and protection from these effects.
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Affiliation(s)
- Daniel J Hatch
- Department of Psychology, Utah State University, Logan, UT, USA
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Vable AM, Subramanian SV, Rist PM, Glymour MM. Does the "widowhood effect" precede spousal bereavement? Results from a nationally representative sample of older adults. Am J Geriatr Psychiatry 2015; 23:283-92. [PMID: 24974142 PMCID: PMC5511695 DOI: 10.1016/j.jagp.2014.05.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 05/09/2014] [Accepted: 05/13/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Increased mortality risk following spousal bereavement (often called the "widowhood effect") is well documented, but little prior research has evaluated health deteriorations preceding spousal loss. DESIGN Data are from the Health and Retirement Study, a nationally representative sample of Americans over 50 years old. METHOD Individuals who were married in 2004 were considered for inclusion. Outcome data from 2006 on mobility (walking, climbing stairs), number of depressive symptoms, and instrumental activities of daily living (IADLs) were used. Exposure was characterized based on marital status at the time of outcome measurement: "recent widows" (N=396) were bereaved between 2004 and 2006, before outcomes were assessed; "near widows" (N=380) were bereaved between 2006 and 2008, after outcomes were assessed; "married" individuals (N=7,330) remained married from 2004 to 2010, the follow-up period for this analysis. Linear regression models predicting standardized mobility, depressive symptoms, and IADLs, were adjusted for age, race, gender, birthplace, socio-economic status, and health at baseline. RESULTS Compared to married individuals, recent widows had worse depressive symptoms (β=0.71, 95% confidence interval (CI): [0.57, 0.85]). Near widows had worse depressive symptoms (β=0.21, 95% CI: [0.08, 0.34]), mobility (β=0.14, 95%CI: [0.01, 0.26]), and word recall (β=-0.13, 95%CI: [-0.23, -0.02]) compared to married individuals. CONCLUSIONS Health declines before spousal death suggests some portion of the "widowhood effect" may be attributable to experiences that precede widowhood and interventions prior to bereavement might help preserve the health of the surviving spouse.
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Affiliation(s)
- Anusha M. Vable
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
| | - S. V. Subramanian
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
| | - Pamela M. Rist
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA,Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA,Division of Preventive Medicine, Department of Medicine, Brigham and Woman’s Hospital, Harvard Medical School, Boston, MA, USA
| | - M. Maria Glymour
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA,Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco
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Harris H, Lee C, Yancey G. Cognition in Adult Bereavement: Preliminary Findings From Five Hospice Bereavement Focus Groups. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2015; 11:283-306. [PMID: 26654062 DOI: 10.1080/15524256.2015.1115801] [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: 06/05/2023]
Abstract
Grief is an experience of both common and unique responses (Hooyman & Kramer, 2006). Grief affects people in various ways including emotionally, cognitively, socially, physically, and spiritually (Corr, 2007; Doka, 2014). Little has been published on the cognitive domain of loss affecting attention, and concentration of bereaved adults. This qualitative study explored these effects among adults in one hospice bereavement program in Central Texas. Five focus groups included facilitated bereavement topical conversations resulting in descriptions of memory, concentration, and attention deficits after loss. These results suggested that participation in bereavement programming may normalize the experience facilitating cognitive task accomplishment. Referrals for bereavement care may be appropriate in order to facilitate equilibrium in individual's lives following a significant death.
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Affiliation(s)
- Helen Harris
- a Baylor University School of Social Work , Waco , Texas , USA
| | | | - Gaynor Yancey
- a Baylor University School of Social Work , Waco , Texas , USA
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Bradford D, Tschanz JT, Smith KR, Østbye T, Corcoran C, Welsh-Bohmer KA, Norton MC. Impact of offspring death on cognitive health in late life: the Cache County study. Am J Geriatr Psychiatry 2014; 22:1307-15. [PMID: 23954042 PMCID: PMC3923854 DOI: 10.1016/j.jagp.2013.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 04/21/2013] [Accepted: 05/09/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Experiencing the death of a child is associated with negative short-term mental health consequences, but less is known about cognitive outcomes and whether such associations extend to late life. We tested the hypothesis that experiencing an offspring death (OD) is associated with an increased rate of cognitive decline in late life. METHODS This population-based longitudinal study observed four cognitive statuses spaced 3-4 years apart, linked to an extensive database containing objective genealogic and vital statistics data. Home visits were conducted with 3,174 residents of a rural county in northern Utah, initially without dementia, aged 65-105. Cognitive status was measured with the Modified Mini-Mental State Exam at baseline and at 3-, 7-, and 10-year follow-ups. OD was obtained from the Utah Population Database, which contains statewide birth and death records. RESULTS In linear mixed models, controlling for age, gender, education, and apolipoprotein E status, subjects who experienced OD while younger than age 31 years experienced a significantly faster rate of cognitive decline in late life, but only if they had an ε4 allele. Reclassifying all OD (regardless of age) according to subsequent birth of another child, OD was only related to faster cognitive decline when there were no subsequent births. CONCLUSION Experiencing OD in early adulthood has a long-term association with cognitive functioning in late life, with a gene-environment interaction at the apolipoprotein E locus. Subsequent birth of another child attenuates this association.
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Affiliation(s)
- Daylee Bradford
- Department of Family Consumer and Human Development, Utah State University
| | - JoAnn T. Tschanz
- Department of Psychology, Center for Epidemiologic Studies, Utah State University
| | - Ken R. Smith
- Department of Family and Consumer Studies; Population Sciences, Huntsman Cancer Institute, University of Utah
| | - Truls Østbye
- Duke Global Health Institute, Duke University, and Duke – NUS Graduate Medical School, Singapore
| | - Chris Corcoran
- Department of Mathematics and Statistics, Center for Epidemiologic Studies, Utah State University
| | | | - Maria C. Norton
- Department of Family Consumer and Human Development, Utah State University,Department of Psychology, Center for Epidemiologic Studies, Utah State University
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Blasco-Fontecilla H, Delgado-Gomez D, Legido-Gil T, de Leon J, Perez-Rodriguez MM, Baca-Garcia E. Can the Holmes-Rahe Social Readjustment Rating Scale (SRRS) be used as a suicide risk scale? An exploratory study. Arch Suicide Res 2012; 16:13-28. [PMID: 22289025 DOI: 10.1080/13811118.2012.640616] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The objective of this research was to examine whether the Holmes-Rahe Social Readjustment Rating Scale, a life event scale, can be used to identify suicide attempters. The Holmes-Rahe Social Readjustment Rating Scale's ability to identify suicide attempters was tested in 1183 subjects (478 suicide attempters, 197 psychiatric inpatients, and 508 healthy controls) using the Fisher Linear Discriminant Analysis and traditional psychometric methods. The Fisher Linear Discriminant Analysis outperformed traditional psychometric approaches (area under the curve: 0.85 vs. 0.78; p < 0.05) and indicated that this scale may be used to identify suicide attempters. The life events that better characterized suicide attempters were change in frequency of arguments, marital separation, and personal injury. The Holmes-Rahe Social Readjustment Rating Scale may help identify suicide attempters.
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Affiliation(s)
- Hilario Blasco-Fontecilla
- Department of Psychiatry, Jimenez Diaz Foundation, Autonoma University, IIS, CIBERSAM, Madrid, Spain.
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Corruble E, Falissard B, Gorwood P. DSM bereavement exclusion for major depression and objective cognitive impairment. J Affect Disord 2011; 130:113-7. [PMID: 21059473 DOI: 10.1016/j.jad.2010.10.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 10/12/2010] [Accepted: 10/12/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND The bereavement exclusion criterion for DSM major depressive episodes (MDE) has been challenged regarding symptom severity. This study aimed at assessing objective cognitive impairment, reflecting hippocampal function, in patients excluded from the diagnosis of major depression because of the bereavement exclusion. We expected that the bereavement excluded (BE) individuals would have less objective cognitive impairment than matched MDE patients. METHODS 1138 individuals seeking treatment and meeting all DSM MDE criteria except the bereavement exclusion criterion (BE group) were matched for age, gender, educational level and the number of past MDE with 1138 MDE patients (MDE group). They were compared for the delayed paragraph recall index from the Wechsler Memory Scale-Revised at baseline and 6-week follow-up. RESULTS The BE and MDE groups were not different in terms of immediate and delayed recall at baseline and follow-up. In both groups, multiple regression analyses showed that the number of correct answers of delayed recall at follow-up was not correlated with the HAD depression score but was correlated with the number of past major depressive episodes. CONCLUSIONS Instead of identifying subjects with less cognitive impairment, the bereavement exclusion selected subjects with similar cognitive impairment than MDE patients and similar neurotoxic effect on the hippocampus. The DSM bereavement exclusion for MDE is inadequate according to objective cognitive impairment, at least in this sample of individuals seeking treatment for depressive symptoms. Bereavement, just as any stressful event, could be quoted, but without interfering in the definition of major depressive episodes.
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Affiliation(s)
- Emmanuelle Corruble
- Paris XI University, INSERM U 669, Department of Psychiatry, Bicêtre University Hospital, 78 rue du General Leclerc, Assistance Publique-Hôpitaux de Paris, 94275 Le Kremlin Bicêtre, France.
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