Effective Services for Bereaved Spouses: A Content Analysis of the Empirical Literature

The death of a spouse can be one of the most stressful events of the life cycle (Holmes & Rahe, 1967). Common grief reactions include depression, anxiety, insomnia, increased use of alcohol or drugs, decreased social interaction, and work disruption (Clayton, 1974; Maddison & Viola, 1968). Furthermore, physical illness increases: Widowed individuals show higher rates of disabling illness and hospitalization compared with married people, as well as higher rates of suicide and death from other causes (Barrett, 1978). Death sometimes occurs soon after the loss of the spouse (Constantino, 1981). Poor psychological, social, and physical health lasting 13 months or longer is experienced by 15 percent to 25 percent of widowed people (Marmar, Horowitz, Weiss, Wilner, & Kaltreider, 1988). In addition, financial and legal worries often inhibit the recovery process. Widowed people initiate the use of health and mental health services more frequently than do married people (Barrett, 1978; Raphael, 1977). Consequently, many social workers encounter issues of bereavement in their caseloads, even when a client's presenting problem is in another area. As the baby boom generation ages, the number of widowed people in the United States will increase substantially in the early decades of the next century, posing a significant challenge for social workers employed in the health and mental health fields. Social workers are in a position to affect the grief process at three points: before a loss occurs (primary prevention); following a loss, before the grief process becomes dysfunctional (secondary prevention); and after symptoms of morbid grief appear (tertiary prevention). To investigate the elements of effective practice with this population, a content analysis of the literature on bereavement programs was conducted. METHOD Previous systematic studies of practice effectiveness with a variety of client populations have identified five relevant areas for investigation: characteristics of the client population, the practitioner, the intervention, the research methodology, and the outcomes (for example, see Videka-Sherman, 1988; Wood, 1978). This study addresses the following research questions for each of these variables: * client characteristics - What subgroups of widowed people are most in need of or gain the most benefit from bereavement services? - What are appropriate case-finding strategies? * practitioner characteristics - What practitioner characteristics are most conducive to effective outcomes? * intervention characteristics - What interventions are most effective for preventing or reducing symptoms of unhealthy grief reactions? * methodology characteristics - What methodological characteristics should be incorporated into evaluations of bereavement services? * outcome characteristics - What are appropriate goals of bereavement services? - What outcome measures are most appropriate for use with bereaved clients? Selection of Studies Studies for inclusion in the analysis were identified through searches of the PsycLIT database from January 1974 to June 1990 and all issues of Social Work Research & Abstracts through September 1990. For this analysis, experimental investigations of practice effectiveness with bereaved adults that were published in major peer-reviewed journals were included. Only experimental studies were selected because descriptive and correlational studies, although providing valuable data, do not lend themselves to a structured analysis because of their wide-ranging methodological approaches. In addition, the use of only experimental studies increases the validity of the findings of a content analysis, because those findings are derived from studies in which internal validity (that is, the extent to which the outcomes of the study can be attributed to the effects of the intervention) is high. …