The Role of Late-Life Work Among Widowed Adults in Korea: A Buffer or Burden for Widow(er)s' Health?

To examine the role of work in the bereavement process, we focused on health changes among widowed adults. We analyzed a sample of 518 adults (aged 52-95) from the Korean Retirement and Income Study (2011-2019) who experienced spousal loss during the study period. The widowed participants provided data on their employment status and perceived health at both pre-loss and post-loss. Widowed participants reported worse physical and mental health after the bereavement, but the significant health deterioration was not observed among employed participants. Adjusting for pre-loss health status and other covariates, employed widow(er)s showed a smaller decrease in physical and mental health, compared to their counterparts. The effect of employment on physical health changes was more pronounced for economically vulnerable widow(er)s. Work might serve as a restoring coping strategy for widowed individuals; economic benefits from the job may also contribute to their health and well-being.

Widowed Young: The Role of Stressors and Protective Factors for Resilience in Coping with Spousal Loss

While distressing, late life spousal loss is considered a normative life event and most demonstrate resilient recovery from grief. However, for 5-7% of the population spousal loss comes early, before the age of 50, and little is known about the factors that influence adjustment in this population. We used the DPM integrative framework to examine correlates and predictors of mental wellbeing and grief intensity in an international sample of 603 young widows and widowers. Contrary to existing bereavement research, loss-orientated stressors (e.g., expectedness and cause of death) did not predict bereavement outcomes. Employment and financial wellbeing were the only statistically significant restoration-orientated stressors associated with coping, mental wellbeing and grief intensity. We found no significant associations between parental status and coping or bereavement outcomes. Loss-orientated coping, followed by inter and intrapersonal protective factors for resilience and financial wellbeing were the greatest predictors of grief intensity. Loss-orientated coping was highest in early bereavement, the greatest predictor of grief intensity and associated with being unemployed, financial insecurity and decreased protective factors for resilience. Restoration-orientated coping was highest in later bereavement, was a weak predictor of grief intensity and associated with being employed, increased financial wellbeing and protective factors for resilience. Overall, we found the young-widowed population is at heightened risk of poor adjustment. Almost two-thirds reported decreased functioning, probable depression with high rates of psychological distress. Nearly half met diagnostic criteria for prolonged grief disorder. We discuss implications for research and clinical practice.

The multidimensional nature of social support and engagement in contributing to adjustment following spousal loss

Objectives: Spousal loss is a significant life event that can negatively affect multiple facets of mental and physical health. Social support and engagement are generally found to improve adjustment following adversity, but much less is known regarding which facet of social support and engagement is most predictive of adjustment following spousal loss. This study examined changes in mental health and well-being following spousal loss and which facets of social support and engagement are associated with positive adjustment following spousal loss.Method: Latent growth curve modeling was applied to longitudinal data from 265 individuals who became widowed from the Changing Lives of Older Couples Study to examine: (1) adjustment following spousal loss in depressive symptoms, anxiety and well-being and (2) whether different facets of social support and engagement predict positive adjustment.Results: Depressive symptoms increased following spousal loss, whereas anxiety and well-being remained relatively stable before and after spousal loss. Receiving more instrumental support was associated with lower levels of depressive symptoms and anxiety 6-months following spousal loss. Higher levels of emotional support from one's spouse at baseline was associated with more depressive symptoms and anxiety 6-months following spousal loss.Conclusion: Instrumental support received was the most beneficial facet of social support and engagement. The discussion focuses on how these findings fit into the larger literature of the ways through which social support and engagement lead to adjustment following adversity.

A Systematic Review of the Dual Process Model of Coping With Bereavement (1999-2016)

This systematic review addressed the question whether the Dual Process Model of Coping with Bereavement (DPM) accurately represents the bereavement experience, and whether DPM-based interventions are more effective than traditional grief therapy. Twenty databases were searched to identify publications related to the DPM between 1999 and June 30, 2016. Coded material included source, title, research design, research question(s), data source, measures, method, and outcomes. Of the 474 articles initially identified, 86 underwent full-text review, with 22 quantitative or mixed-methods studies included. The DPM accurately represents the bereavement experience and can be used to understand how bereaved individuals cope. Interventions based upon the DPM may be more effective than traditional grief therapy. Further research is needed to test both the model and intervention design, especially in regard to oscillation, with use of consistent measures between studies.

How do risk factors affect bereavement outcomes in later life? An exploration of the mediating role of dual process coping

This study is an exploratory study that aims to examine the mediating role of dual process coping in the relationship between risk factors and bereavement outcomes. A total of 178 Hong Kong Chinese bereaved older adults reported their bereavement-related information, dual process coping (Dual Coping Inventory, DCI), complicated grief (Inventory of Complicated Grief; ICG), depression (Geriatric Depression Scale, GDS) and loneliness (De Jong Gierveld Loneliness Scale, DJG) in face-to-face structured interviews. Results suggested that subjective traumatic death predicted complicated grief, depression, and loneliness via loss-orientated (LO) coping, whereas having lost a spouse rather than having lost a parent predicted loneliness via restoration-orientated (RO) coping. Future interventions may reconsider the use of LO coping and explore alternatives for traumatized bereaved older adults, and encourage RO coping for those experiencing spousal loss.

Mothers Coping With Bereavement in the 2008 China Earthquake: A Dual Process Model Analysis

The purpose of this study is to explore the grief experiences of mothers after they lost their children in the 2008 China earthquake. Informed by the dual process model, this study conducted in-depth interviews to explore how six bereaved mothers coped with such grief over a 2-year period. Right after the earthquake, these mothers suffered from intensive grief. They primarily coped with loss-oriented stressors. As time passed, these mothers began to focus on restoration-oriented stressors to face changes in life. This coping trajectory was a dynamic and integral process, which bereaved mothers oscillated between loss- and restoration-oriented stressors. This study offers insight in extending the existing empirical evidence of the dual process model.

Same-Sex Partner Bereavement: Non-HIV-Related Loss and New Research Directions

The experience of same-sex-attracted people who have lost a partner is neglected in the existing literature on bereavement. Previous research on lesbian, gay, bisexual, transgender, intersex, queer and questioning (LGBTIQ) populations tends to focus on the loss of a partner to HIV-related causes, and there is scant research concerning non-HIV-related bereavement. The purpose of this article is to investigate the non-HIV-related bereavement experiences of same-sex partners and to address the potential complications of disenfranchised grief. Coping with the loss of a same-sex partner and the impact of bereavement on subsequent relationships are also discussed. Implications for counseling of bereaved same-sex-attracted individuals are drawn, and recommendations for future psychological research on the experience of bereavement are made.

Mothers Coping With Bereavement in the 2008 China Earthquake: A Dual Process Model Analysis

The purpose of this study is to explore the grief experiences of mothers after they lost their children in the 2008 China earthquake. Informed by the Dual Process Model, this study conducted in-depth interviews to explore how six bereaved mothers coped with such grief over a 2-year period. Right after the earthquake, these mothers suffered from intensive grief. They primarily coped with loss-oriented stressors. As time passed, these mothers began to focus on restoration-oriented stressors to face changes in life. This coping trajectory was a dynamic and integral process, which bereaved mothers oscillated between loss- and restoration-oriented stressors. This study offers insight in extending the existing empirical evidence of the Dual Process Model.

Daily life stressors and coping strategies during widowhood: A diary study after one year of bereavement

The present study examined the frequency and types of bereavement-related stressors and coping strategies that 40 widowed people encountered and reported in a diary over the course of 1 week. The results indicated that, after 1 year of bereavement, (a) the most frequent stressors were oriented to the loss of the spouse, (b) specific coping strategies were used and found effective to deal with specific types of stressors,

Bereavement Experience in the General Population: Incidence, Consequences, and Coping in a National Sample of Japan

The present study was conducted to investigate the actual status of bereavement experience in the general population of Japan. Data were collected via questionnaires from a nationally representative sample of Japanese aged 12 years and older from the National Survey of Trends of Health and Welfare by the Department of Health and Welfare of Japan in 2000. The number of valid questionnaires was 32,022 (15,217 male, 16,597 female, and 208 unidentified). Among them, 1082 people (410 males and 672 females) answered that they had experienced the death of a person close to them within the last month. This means that approximately 5% of the general population had experienced bereavement within the month prior to the survey. The bereavement experience caused modest but substantial elevation in depressive symptoms. The middle-aged population most commonly experienced bereavement, and women were more likely to be affected seriously by bereavement. These results suggested that appropriate mental health strategies for bereaved people are important from a public mental health point of view.

Dual Process Model of Coping With Bereavement in the Test of the Subjective Experiences of Bereaved Spouses

The Dual Process Model of Coping With Bereavement (DPM) was developed to better understand the dynamic coping processes adopted by bereaved people. In the present study, we investigated the daily subjective experiences of widowed people and examined whether they recognized themselves in the model. Thirteen out of the 16 interviewed widowed persons reported that their bereavement experience basically fitted the model. However, they also identified discrepancies. Interviews with six bereaved spouses were subjected to an interpretative phenomenological analysis. Three main issues were identified: (a) the interdependence versus distinctiveness of coping processes, (b) the conscious and intentional nature of coping strategies, and (c) the very nature of respite in the grief experience. The results indicated that, although relevant, the DPM did not always match the grieving experiences reported by the widowed individuals. Clinical and research perspectives are discussed.

Promoting Self-Care and Daily Living Skills among Older Widows and Widowers: Evidence from the Pathfinders Demonstration Project

While most bereavement intervention programs for the recently widowed focus primarily on loss and grief issues, few, if any, specifically address ways to engage in necessary self-care activities, to assume new responsibilities that once belonged to their deceased spouse, and to remain socially connected to the larger community. The Pathfinders demonstration project was designed to provide important health and wellness information in a supportive environment where the participants could develop self-care and daily living skills and learn how to access additional community resources to meet their specific needs. This article describes changes in self-care and daily living abilities reported by the Pathfinders participants and ways in which they used what they learned in the classes to achieve health and independence and to meet the daily challenges of widowed life. Eight-four widows and widowers (age 50+) participated in one of five 11-week class sequences. Statistically significant, although incremental improvements over time were reported in active coping, health care participation, household management, home safety, and nutritional self-care skills. Almost all the participants reported applying at least some of the class content in their daily lives and nearly 70% sought additional information from sources outside the classes. After completing the program, many participants believed they were better prepared to take care of themselves and to address the daily challenges of widowed life. The results of the Pathfinders demonstration project suggest a promising new line of research focused on bereavement interventions other than those that traditionally address grief and loss issues alone.

“Widowerhood”: Masculinities and Spousal Loss in the Late-1960s

This study examined the distinctly gendered experiences of young widowers. Using qualitative longitudinal data from the 1960's Harvard Bereavement Study, we evaluated the interview transcripts of 19 widowers (median age = 38) who had been interviewed 3 weeks, 8 weeks, 13 months, and 2–4 years after the wife's death. Our findings indicate that the off-time spousal loss ruptured the ontological security that marriage provided and created two types of difficult situations for the widowers. Coping with deep sadness and grief, the men divulged their unspoken dependency on their marriage and on their late wife. They also struggled as single fathers, especially if they tried to singlehandedly care for their children. Becoming an off-time widower in the 1960s compelled the men to reclaim their masculine identity. Men's identity-rebuilding strategies involved promptly returning to work, and many men began dating and repartnering to recoup the normalcy of being married.

Wellbeing in Bereavement and Widowhood

This article will examine how beveavement and widowhood affect wellbeing drawing on psychological, gerontological, and sociological research. The article will begin with an outline of what is meant by bereavement and widowhood. It will then present an overview of the effects that bereavement and widowhood has on wellbeing. In the next section, a brief history of approaches to bereavement will be presented. Next, more recent approaches will be discussed including the Dual Process Model of Bereavement (Stroebe & Schut, 1999), and a discussion of the debate concerning continuing and relinquishing bonds. The focus will then turn to factors which influence wellbeing with a focus both on pre- and post-bereavement experiences, and on such factors as age and gender. Finally, there will be a discussion of factors which may enhance wellbeing, such as resilience, identity reconstruction, and coping strategies.

"Cycling around an emotional core of sadness": emotion regulation in a couple after the loss of a child

In contrast to the traditional view of working through grief by confronting it, recent theories have emphasized an oscillating process of confronting and avoiding the pain of loss. In this qualitative study, we sought a better understanding of this process by conducting a detailed case study of a bereaved couple after the loss of their infant daughter. We employed multiple data collection methods (using interviews and written feedback) and an intensive auditing process in our thematic analysis, with special attention to a recurrent metaphor used by this bereaved couple in describing their personal and relational experience. The findings suggest the presence of a dialectic tension between the need to be close to the deceased child and the need for distance from the pain of the loss, which was evidenced on both individual and relational levels. For this couple, the image of "cycling around an emotional core of sadness" captured their dynamic way of dealing with this dialectic of closeness and distance.

Late-life bereavement and complicated grief: a proposed comprehensive framework

OBJECTIVES

The construct of complicated grief (CG) has garnered increased empirical attention since it has been proposed as a diagnostic category for the upcoming Diagnostic and Statistical Manual of Mental Disorders-V. The aim of this article is to critically examine construct validity in light of a proposed conceptual framework, with special emphasis on understanding late-life bereavement.

METHOD

This is a review article that critically examined current bereavement and grief models. We explored discriminant and convergent validity between CG and uncomplicated grief (UG) and other psychopathological constructs in terms of symptom intensity, symptom trajectories, bereavement outcomes, and treatment response.

RESULTS

The findings from this review show mixed support for differentiating CG from other outcomes of bereavement for the following reasons: (1) a clear boundary between CG and UG has not been adequately supported, (2) symptoms of CG and bereavement-related depression and anxiety overlap, although there is some evidence of incremental validity in that CG symptoms predict global functioning above and beyond symptoms of depression, and (3) the treatment literature demonstrated that general grief interventions and treatment targeted for improving depression are ineffective at treating symptoms of CG, whereas interventions specially tailored to treating CG have been moderately effective. The findings also emphasize the importance of considering pre-bereavement circumstances, such as preexisting depression, in the conceptualization of broader bereavement outcome.

CONCLUSION

There were mixed findings supporting the construct validation of CG. A comprehensive framework that emphasizes pre-bereavement circumstances was proposed in order to better predict various grief trajectories and outcomes of late-life loss.

Loss and restoration in later life: an examination of dual process model of coping with bereavement

The Dual Process Model (DPM) of Coping with Bereavement identified two oscillating coping processes, loss and restoration (Stroebe & Schut, 1999). The utility of the model is investigated in two studies. In the first, we carried out secondary analyses on a large-scale qualitative study that we had conducted previously. In the second, we conducted a small-scale study specifically examining the DPM. In the first study we re-examined the interviews for Loss- (LO) and Restoration-Oriented (RO) Coping and examined whether these were associated with psychological adjustment. The results showed that those adjusting well reported the stressors New Roles/Identities/ Relationships and Intrusion of Grief significantly more. Those adjusting less well reported the stressors Denial/Avoidance of Restoration Changes and Distraction/Avoidance of Grief significantly more. In the second study, we asked participants about four RO stressors of the DPM: Attending to Life Changes; New Roles/Identities/Relationships; Distraction from Grief; and New Activities. These data showed that not all participants experienced all aspects of RO Coping. In particular, participants had diverse views about the utility of Distraction from Grief as a coping mechanism. The article concludes by discussing the challenges of testing the DPM empirically.

Length of caregiving and well-being among older widowers: implications for the dual process model of bereavement

The intent of this study was to examine if length of caregiving was associated with older widowers' adjustment to bereavement and to identify factors, based on principles underlying the Dual Process Model of Bereavement, that might mitigate the potential adverse effects of time spent caring. Two-hundred men over the age of 60 and in the second year of bereavement were identified from death records of older women who had died within a 12-month period. Interviews lasted about 2 hours and focused on widowers' experiences surrounding their wives' deaths along with questions about social support, health, retirement, and other demographic information. The Bradburn Affect Scale was used to measure positive and negative affect. Restoration-oriented coping, such as starting new relationships and activities were measured. These variables included extent of family contact, number of friends, having a confidante, involvement with neighbors, and participation in sports and clubs. Time since death and demographic variables were used as controls. Hierarchical linear regression was conducted on positive and negative affect after which potentially moderating effects were analyzed. Results indicated that the most important influences on negative affect were time since death, ethnicity, and participation in clubs while for positive affect the most significant factors included length of caregiving, number of friends, and having a confidante. Although no interaction effects were significant, patterns emerged. Implications for applying the DPM with older bereaved men are made.

The dual process model of coping with bereavement: a decade on

The Dual Process Model of Coping with Bereavement (DPM; Stroebe & Schut, 1999) is described in this article. The rationale is given as to why this model was deemed necessary and how it was designed to overcome limitations of earlier models of adaptive coping with loss. Although building on earlier theoretical formulations, it contrasts with other models along a number of dimensions which are outlined. In addition to describing the basic parameters of the DPM, theoretical and empirical developments that have taken place since the original publication of the model are summarized. Guidelines for future research are given focusing on principles that should be followed to put the model to stringent empirical test.

Experiences and early coping of bereaved spouses/partners in an intervention based on the dual process model (dpm)

This study was designed to test the effectiveness of the Dual Process Model (DPM) of coping with bereavement. The sample consisted of 298 recently widowed women (61%) and men age 50+ who participated in 14 weekly intervention sessions and also completed before (O1) and after (O2) self-administered questionnaires. While the study also includes two additional follow-up assessments (O3 and O4) that cover up to 14-16 months bereaved, this article examines only O1 and O2 assessments. Based on random assignment, 128 persons attended traditional grief groups that focused on loss-orientation (LO) in the model and 170 persons participated in groups receiving both the LO and restoration-orientation (RO) coping (learning daily life skills). As expected, participants in DPM groups showed slightly higher use of RO coping initially, but compared with LO group participants they improved at similar levels and reported similar high degrees of satisfaction with their participation (i.e., having their needs met and 98-100% indicating they were glad they participated. Even though DPM participants had six fewer LO sessions, they showed similar levels of LO improvement. Qualitative data indicate that the RO component of the DPM might be more effective if it is tailored and delivered individually.

Religion and spirituality in adjustment following bereavement: an integrative review

Surprisingly little research has examined the widely held assumption that religion and spirituality are generally helpful in adjusting to bereavement. A systematic literature search located 73 empirical articles that examined religion/spirituality in the context of bereavement. The authors describe the multidimensional nature of religion/spirituality and use this framework to organize and integrate the findings of these empirical articles. Overall, results suggest that relations between religion and adjustment to bereavement are generally positive but inconsistent and vary depending in part on how religion/spirituality is measured. The authors conclude with a critique of the current research and directions for future research.

Toward the development of an inventory of daily widowed life (IDWL): guided by the dual process model of coping with bereavement

The Dual Process Model of Coping with Bereavement (M. Stroebe & H. Schut, 1999) suggests that the most effective adaptation involves oscillation between 2 coping processes: loss-orientation (LO) and restoration-orientation (RO). A 22-item Inventory of Daily Widowed Life (IDWL) was developed to measure these processes and the oscillation between them and assessed by examining 163 bereaved widow(er)s, ages 45-94 years. The LO and RO subscales produced alpha coefficients of .90 and .79, respectively. The more recently widowed demonstrated a high degree of oscillation balance between the two processes, while there was a greater emphasis on restoration-orientation among those bereaved longer. Both subscales generated significant relationships with the bereavement outcome measures used in this study. Furthermore, restoration-orientation was directly related to the level of self-care and daily living skills as well as personal growth. We identify six dimensions of oscillation that warrant further consideration and encourage others to help develop and refine all features of the IDWL and make it adaptable to other loss relationships.

A dual process model of grief counseling: findings from the Changing Lives of Older Couples (CLOC) study

This paper tests Stroebe and Schut's Dual Process Model of Bereavement using data from the Changing Lives of Older Couples (CLOC), a prospective study of 1,532 married persons over the age of 65. This analysis focused on a weighted sample of 104 widowers and 492 widows at six months, 18 months, and four years later. Bradburn's Affect Balance Scale was used as the dependent variable, and the independent variables were based on Stroebe and Schut's bereavement model. The multiple regression analyses revealed that loss- and restoration-oriented activities were important throughout bereavement. Implications for bereavement counseling are discussed.

Attachment in Coping with Bereavement: A Theoretical Integration

Researchers have deplored shortcomings in theoretically based models of coping with bereavement. Integration of cognitive stress with attachment theory is proposed to predict adjustment to bereavement, describe different forms of effective coping, and resolve ongoing debates about continuing versus relinquishing bonds. These 2 generic approaches are integrated within a bereavement-specific perspective, the dual-process model of coping ( Stroebe & Schut, 1999 ). Accordingly, (a) different coping styles are adopted by, and are differentially efficacious for, bereaved people according to their style of attachment; (b) bereaved people's ways of continuing bonds differ according to their attachment style; and (c) grief complications are associated with insecure attachment styles. The authors conclude that it is better for some bereaved individuals to work toward retaining ties and for others to work toward loosening ties.

PARENTAL DEATH IN THE LIVES OF PEOPLE WITH SERIOUS MENTAL ILLNESS

Nearly a fourth (22%) of the participants within a research sample of 148 individuals with serious mental illness reported the death of a loved one as a significant loss, and two thirds of these deaths involved the loss of one or both parents. The key determinant of the severity and duration of grief in response to the death of a parent was whether or not there were extenuating circumstances that complicated the death event, such as co-residence with the deceased at the time of death or a lack of regular social contact with anyone other than the deceased. In all instances of severe or prolonged grief, there was no preparation for the parental death, either through preparatory counseling or practical plans for funeral arrangements, financial repercussions, life-style changes, or residential relocation. Mental health agencies serving people with serious mental illness should begin to incorporate financial and emotional preparation for parental deaths and bereavement counseling as essential services.