Grief, Depressive Symptoms, and Physical Health Among Recently Bereaved Spouses

The death of a spouse is one of the most common, yet most distressing, transitions faced by older persons (Holmes & Rahe, 1967). Surviving spouses commonly experience changes in psychological well-being, evidenced by the increased prevalence of grief and depression following widowhood (Stroebe, Hansson, & Schut, 2008). Grief is an emotional response specific to the loss of an intimate partner, whereas depression is a more global measure of negative affect and symptomology (Bonanno & Kaltman, 2001; Jacobsen, Zhang, Block, Maciejewski, & Prigerson, 2010). Although most widowed persons show resiliency over time (Bonanno, Wortman, & Nesse, 2004), some widowed persons sustain intense and prolonged emotional responses that they may be diagnosed with major depression or complicated grief (CG) disorders (Lichtenthal, Cruess, & Prigerson, 2004). In addition to intense feelings of emotional distress (both normal and pathological), bereaved persons often report physical pain and ailments, such as fatigue, heart palpitations, and backaches (Stroebe, Schut, & Stroebe, 2007). These somatic responses rarely signify an underlying physical malady and may be considered symptomatic of typical grief experiences (Worden, 2009), just as the presence of grief and depressive symptoms are considered normal responses to widowhood (Bonanno et al., 2004). One of the reasons why widowhood represents such a potent life stressor is because it requires the surviving spouse to manage both the emotional loss associated with the death of an intimate partner as well as the shattering of one’s behavioral, social, and economic environments that were once shared by the married couple (Carr & Utz, 2001; Donnelly & Hinterlong, 2010; Ha, 2010; Stroebe & Schut, 2010; Utz, Carr, Nesse, & Wortman, 2002). Managing these two disparate stressors has the potential to suppress one’s immune system (Gerra et al., 2003), which then may decrease overall health and increase mortality risk (Stroebe et al., 2007). A recent meta-analysis reported that widowed persons have an 11% higher risk for mortality when compared with married persons (Manzoli, Villari, M Pirone, & Boccia, 2007). Extant literature has documented the health benefits associated with marriage (Waite & Gallagher, 2000), as well as the health detriments associated with marital dissolution (Williams & Umberson, 2004). Another body of literature has outlined the pervasive effect that stressful life transitions can have on subsequent morbidity, mortality, and psychological well-being (Miller, 2010). Still, another body of literature has identified potential risk factors for the most severe psychological reactions that sometimes accompany widowhood (Lichtenthal et al., 2004; Lobb et al., 2010). However, much less research has explored how physical health might affect older adults’ ability to adapt to the stresses of widowhood (Telonidis, Lund, Caserta, Guralnick, & Pennington, 2005). Do frail or ill persons experience bereavement in the same way as healthy robust individuals? Are some individuals more susceptible to health declines at the time of widowhood and thus more susceptible to prolonged or heightened bereavement experiences? Given the strong theoretical and empirical correlation between physical and mental health (Edwards & Cooper, 1988), especially during times of high life stress (Aneshensel, 1992), this analysis explores the dynamics between physical health and psychological well-being among recently bereaved spouses or partners. Past research has suggested that those in poor health may be more susceptible to the intense clinical outcomes, such as prolonged or CG disorders (M. Horowitz et al., 1998), whereas those with the most intense grief experiences have elevated risks of morbidity and mortality (Ott, 2003; Prigerson, Shear, Frank, & Beery, 1997). Very little research has focused on how physical health, as both a static and a dynamic characteristic of the widow(er), may alter one’s bereavement experience. The results that do exist are largely based on small clinical samples or anecdotal evidence from practitioners working with bereaved persons. This study utilized a community-based sample of older widowed persons to explore the complex relationships between physical health and psychological well-being from approximately two to eighteen months postloss, the time period that captures the most intense health-related changes associated with widowhood (D. A. Lund, Caserta, & Dimond, 1993). The specific research objectives include the following: Aim 1: To explore how “health” changes during the first year and a half of widowhood. Aim 2: To explore how (a) physical health at the time of widowhood and (b) changes in physical health that accompany widowhood modify the individual trajectory of grief and depressive symptoms over time. Aim 3: To explore whether physical health might be a risk factor for clinical outcomes major depression and/or CG. The first set of analyses, Aim 1, provides a descriptive background of how physical health changes over the first year and a half of bereavement. The primary objective is to illustrate the natural or typical responses to spousal loss. Aim 2 explores whether physical health might modify the common fluctuations in psychological distress over time, whereas Aim 3 explores whether physical health might be a characteristic to help identify those persons who are most at risk for the prolonged and intense clinical outcomes following spousal bereavement.