Bereavement Reactions, Consequences, and Care (1984) / Chapter Skim
Currently Skimming:
2 Epidemiologic Perspectives on the Health Consequences of Bereavement
2 Epidemiologic Perspectives on the Health Consequences of Bereavement
Pages 15-46
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 15... ...
The identification of risk factors, even in the absence of full understanding of the etiology of disease, has in the past contributed to the development of public health measures for control and prevention. The application of such methods to bereavement phenomena will, it is hoped, also lead to intervention strategies that can reduce long-term negative outcomes, as well as to research that increases understanding of the bereavement process.
|
From page 16... ...
Although mortality rates are readily available for the general population and for specific subgroups, rates of bereavement cannot be readily extrapolated from death rates because the number of surviving family members will vary depending on many different factors. Estimates of one-year incidence rates of bereavement in the general population range from 5 to 9 percent.
|
From page 17... ...
Because of the complexity and logistical difficulties of doing prospective studies of whole populations, the more commonly used approach is to study samples of recently bereaved people, and to compare them to a control group matched for relevant characteristics. Such groups are folTowed in order to observe the subsequent occurrence of symptoms, particular behaviors, and health changes.
|
From page 18... ...
Remarriage may sometimes be a useful outcome measure of conjugal bereavement; for elderly women, however, it is unrealistic to expect high rates of remarriage because there are not enough elderly men available in the population. Clinicians have described a number of processes associated with poor outcomes, including absent, delayed, prolonged, or chronic grief.
|
From page 19... ...
Both are naturally occurring conditions for which many individuals seek medical attention. Grieving individuals may seek medical attention and may be prescribed tranquilizers, steeping pills, and sedatives, but they seldom seek psychiatric care.
|
From page 20... ...
ADVERSE HEALTH CONSEQUENCES OF BEREAVEMENT Mortality Notwithstanding methodological shortcomings in both retrospective and prospective controlled studies, it is clear from the epidemiologic evidence that some people are at increased risk for mortality following bereavement. The most important evidence is from studies that demonstrate an increase in overall mortality among the recently bereaved See Table ~ for a summary of the studies discussed in this section)
|
From page 21... ...
Clayton, USA Cohort of 109 widows and No increased risk of 19749 widows and widowers and mortality. widowers matched controls followed for 4 years.
|
From page 22... ...
When all these disease groups were combined, the mortality rate was at least seven times greater among the young widowed group (under age 451 than for the matched young mar r~eo control group. ~ ne mortality rate for death from cardiovascular disease was 10 times higher for young widowers than for married men of the same age.
|
From page 23... ...
Several studies of relatively small cohorts of widows and widowers9 i0 25 75 found no significant increase in mortality in the first or subsequent years following bereavement. However, Young et al.77 found that among recent widowers over the age of 55, mortality rates were significantly higher for the first six months of bereavement than in married controls of the same age.
|
From page 24... ...
In fact, age-specific mortality rates among widowed males who remarried were lower than the rates among married males. The ratio of remarried/not remarried mortality rates for mates ranged from about l: ~ to I :2; the small numbers of widowed females who remarried plus the already low mortality rate among the widowed females made their remarried/not remarried ratios meaningless.
|
From page 25... ...
Comparisons of the retrospective study from vital statistics by Kraus and Lilienfeld39 and the prospective study by Helsing and Szklo3~ reveal somewhat different findings with regard to mortality rates and specific causes of death. These may be attributable to differences in sample characteristics Kraus and Lilienfeld studied only widowers who had not remarried, whereas Helsing and Szklo included widowers who had remarried and examined the interaction between remarriage and mortality.
|
From page 26... ...
MacMahon and Pugh43 found that the suicide rate among a widowed population was 2.5 times higher in the first six months after bereavement and I.5 times higher in the first, second, and third years after bereavement than in the fourth or subsequent years, thus suggesting that bereavement itself is a powerful etiologic factor in death by suicide. These figures were based on a study of 320 widowers and widows who had committed suicide (excluding homicide-suicide combinations)
|
From page 27... ...
As described earlier in this chapter, all studies have documented that distress and depressive symptoms dominate the emotional life of the bereaved during the first year. But how often do the bereaved meet criteria for true psychiatric illness?
|
From page 28... ...
Of the three studies reported, only Paykel et al.~8 found an increased risk of clinical depression following bereavement. The authors studied life events in IS5 depressed outpatients and inpatients and a group of matched community controls.
|
From page 29... ...
Parkes53 observed that sedative Unugs were prescribed seven times more frequently for widows under the age of 65 during the first six months of bereavement than in the period preceding the death. For widows agea oo ana other, there was no significant increase in the prescription of sedatives.
|
From page 30... ...
Among widows considered to be at high risk, Raphael62 found marked deterioration in health in the first year following bereavement as evidenced by numerous physical symptoms, diminution of work capacity, weight loss, and health-damaging behaviors. Parkes and WeissS7 report marked differences between well-matched young widowed spouses and married controls in self-reported symptoms, reflecting the somatic effects of anxiety.
|
From page 31... ...
Bereavement as a specific stressor and the "depression of grief" as distinct from other types of depression are often not distinguished, thus rendering it difficult to draw definitive conclusions about the association between bereavement and specific diseases. Adequate testing of the hypothesized associations requires prospective studies with large samples.
|
From page 32... ...
Studies have shown that patients with congestive heart failures and with essential hypertension76 are particularly prone to exacerbation of their condition in response to threatened or actual loss of human rela .
|
From page 33... ...
And in diagnosis-specific health care use studies, Parkes52 found that increased rates of physician visits in the first six months following bereavement were due largely to increased consultations for vascular and articular conditions, especially osteoarthritis in a widowed population under 65 years of age. Aside from psychosomatic mechanisms involving physiologic changes, Jacobs and Ostfeld36 suggest that excess mortality, and presumably morbidity, in the recently bereaved may be mediated by behavioral changes that compromise health maintenance or chronic disease management.
|
From page 34... ...
study of elderly widows in a prepaid health plank do show an increase in physician visits for some people following bereavement. This discrepancy suggests that payment method may have a powerful effect on people's decisions to visit a physician, with fee-for-service systems inhibiting health care utilization.
|
From page 35... ...
i9 These issues are discussed further in Chapters 3, 5, and 10. As discussed earlier in this chapter there is some evidence suggesting that mortality rates remain high for certain categories of bereft individuals beyond the first year-perhaps into the sixth year after their loss.
|
From page 36... ...
10. Variables Associated Adults' Specific Particular Socio- Inter WithHealth Outcomes Reactions Losses Types cultural venti Characteristics of bereaved individuals Sex Age Prior physical health Prior mental health Personality factors Alcohol abuse Socioeconomic status Sociocultural factors Relationship to the deceased Kinship Ambivalence, dependence Nature of the death Suddenness Suicide Behaviors and attitudes appearing early in the grieving process Consumption of alcohol, drugs Smoking x Perceived social support x x Suicidal thoughts x Morbid guilt x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x aChapters 6, 7, and 9 do not discuss these variables in any detail.
|
From page 37... ...
These and other assessments were done both six months and two years after the bereavement. Ideally, these personality variables should be tested before the terminal illness or when a spouse first becomes ill, as distress itself could confound the personality inventories.
|
From page 38... ...
In Parkes' data55 the young widowed who experienced a sudden death had a poorer outcome, as did widows in the study by Vachon et al.73 However, studies by Clayton et ads and by Fulton and Gottesman24 did not find this to be true. In a study by Gerber et al.23 of older men and women, there was a negative correlation between length of illness and outcome; that is, the longer the terminal illness, the more likely there was to be a poor outcome for the surviving spouse.
|
From page 39... ...
As discussed in several later chapters, there is mounting evidence to suggest that social support has a positive effect on general health status and may serve as a protective factor to buffer or modify the impact of adversity and stressors, not only on the mental health of an individual, but also upon his or her physical health.s Perceived lack of social support is one of the most common risk factors cited in the bereavement literature. The perception by the recently bereaved that there is no one to talk to or lean on appears to be a reliable predictor of poor outcome.73 Research testing the magnitude of these hypothesized risk factors is difficult because of lack of agreement on relevant outcome measures.
|
From page 40... ...
It appears that it is only in prepaid health care delivery systems that utilization of services increases in the year following bereavement. · Risk factors for poor outcome include poor previous physical and mental health, alcoholism and substance abuse, and the perceived lack of social supports.
|
From page 41... ...
Emotional stress in the precipitation of congestive heart failure. Psychosomatic Medicine 15:38-60, 1953.
|
From page 42... ...
Recent life events and diabetes In adults. Psychosomatic Medicine 37: 121-128, 1974.
|
From page 43... ...
The effects of bereavement and grief on physical health and general well-being. Advances in Psychosomatic Medicine 9:63-104, 1977.
|
From page 44... ...
Health after bereavement: a controlled study of young Boston widows and widowers. Psychosomatic Medicine 34:449-461, 1972.
|
From page 45... ...
Adults' Reactions to Bereavement
|
From page 46... ...
~ ~ ~ ~" . 1~ - - ~ ~ ~ ~ ~ ~ ~ ~ ~ - - ~ - ~ ~ ~ ~ ~ ~ ~ Hi: - ~ ~ - # ~ ~ ~ - ~ ~ ~ - - - ~ - ~ ~ ~ ~ ~ - ~ ~ ~ __ _ ~ ~ ale ~ ~ ~ ~ ~ ~.~ _ ' ha_ _ ~ _ _ 1111 _ lilt 3 __ _ _ _ ~ ~ ~ ~_D _ _.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.