Bereavement phenomena and helath-related behaviour in recently widowed older men

Background and Aims

Older widowers suffer excess mortality in comparison with matched married men, although the extent to which they also experience excess physical and psychological morbidity is uncertain. In particular, it is unclear from the literature whether those older widowers who experience the greatest psychological distress following conjugal bereavement are also at greatest risk of physical ill health. Whilst the conjugal bereavement reaction has been well characterised in women and younger men, relatively little is known about conjugal bereavement in older men.

Against this background, the aims of the thesis were to examine in fine detail the nature of the conjugal bereavement reaction in older men and to investigate the possible relationships between the psychological and psychiatric concomitants of bereavement, and reported adverse health outcomes in this group.

Study Outline

To examine bereavement-specific phenomena, a three-phase longitudinal design was used to study a cohort (N = 78) of recently widowed older men identified from official records. One group of 57 widowers was compared with a second group of 21 widowers on a waiting list. A structured questionnaire was used to rate the frequency of 22 self-reported bereavement-specific phenomena over the first 13 months post-bereavement.

To investigate the possible relationships between the psychological and psychiatric concomitants of bereavement and reported adverse health outcomes in older widowers, 57 widowers were matched with 57 married men identified from the electoral roll. Both groups were followed longitudinally for 13 months post-bereavement or its equivalent. Structured interviews and self-report questionnaires were used to measure: (i) non-bereavement-specific psychological symptoms; (ii) categorical psychiatric diagnoses of depressive and anxiety disorders; (iii) health-related behaviours; (iv) physical illness and injury; and (v) health services utilisation.

Findings and Conclusions

Bereavement phenomena in the elderly widowers exhibited a pattern similar to that conventionally described for younger persons and for women. There was evidence of persisting bereavement phenomena at 13 months post-bereavement, with nostalgia and sadness, as well as intrusive thoughts about the deceased person, being reported by more than half the widowers at this time. A strategy for identifying individuals at high risk of persistent grief was described. In a correlational analysis, education and income were found to be associations of low scores on the measure of bereavement-specific phenomena, suggesting a protective role for these variables. In contrast, widowers who reported that their wives’ deaths had been unexpected reported a higher frequency of bereavement specific phenomena.

In terms of non-bereavement-specific psychological symptoms, the overall response to conjugal bereavement was characterised more by anxiety symptoms than by symptoms of depression or loneliness. However, at six weeks post-bereavement, widowers had a higher prevalence than married men of non-hierarchical current Major Depressive Disorder as well as a higher prevalence of current Generalised Anxiety Disorder. Furthermore, widowers were more likely than married men to report thoughts of death and suicide throughout the first 13 months post-bereavement. Widowers were more likely than married men to report current and lifetime tobacco smoking, current hazardous levels of alcohol consumption, current use of hypnotic medication, and recent consultations with non-medical health personnel. However, no significant relationships were found between measures of bereavement-specific phenomena, non-bereavement-specific psychological symptoms or psychiatric diagnoses, and reported health-related behaviour, physical illness or injury, or health services utilisation.

The findings lend support to the hypothesis that adverse health-related behaviour is an intervening variable between recent conjugal bereavement and the excess mortality found in older widowers. However, reported adverse health-related behaviour was not significantly related to the psychological and psychiatric concomitants of bereavement. Nevertheless, the findings indicate the need for a high level of clinical awareness amongst clinicians when dealing with recently widowed older men. The findings point also to the need for further research into the nature of dimensional and categorical psychopathology in older men. In particular, the nature of anxiety symptoms and anxiety disorders following adverse life events warrants further investigation in this group.