Stroebe et al., 2007
Absolute numbers: about 5% of widowers versus 3%
The health consequences of bereavement: A review of married men in 55 years and older age category
dying in the first 6 months of bereavement
Bereavement: Having recently lost a significant person
through death Physical ill health
It can be viewed as a normal, natural human Greater occurrence of physical health complains
experience, one which most people manage to Worse health for mothers after the violent death of
come to terms with over the course of time. a child than fathers
Bereavement is associated with a period of intense The health of fathers deteriorated rather than
suffering for most individuals, with an increased improved over time
risk of developing mental and physical health Older bereaved spouses at 2 months after their
problems. loss, had 40 times more risk than non-bereaved
It is associated with excess risk or morality, people
particularly in the early weeks/months after loss Self-reported medication use was higher among
bereaved individuals (73 times higher)
Interventions should be targeted: By 6 months, most of these differences had
High risk people declined
Those with complicated grief or bereavement- Women who reported high intensities of grief had
related depression and stress disorders reduced use of health services for physical health
disorders
Death of a spouse ranks as the life-event needing the
most intense readjustment, confirming the status of Bereaved people who are most in need of help
bereavement as a highly stressful event. might not be obtained such help
Grief is defined as the mainly emotional reaction to Note: visits to doctors did not increase
bereavement, incorporating diverse psychological and Women with high intensity of grief reduced in the
physical reactions use of health services for physical health
High intensities of grief at earlier point predicts
Mortality of bereavement severe physical health disorders
Dying of a broken heart – does the death of a loved Substantially increased activity-limiting pain and
one increase the mortality risk of the bereaved person? moderate to severe current pain in people shortly
Yes, early excess risk or mortality, in some research after bereavement
risk persists longer than 6 months Individuals who had not undertaken caregiving of
their spouse before their death were more likely to
Greater risk of bereavement-related mortality in: have weight loss in bereavement + likely to be
White people than in black people using non-tricyclic antidepressants
Widowers associated with alcohol consumption Attributable to unpredictable nature of the
and the loss of the wife who would have overseen death
the husband’s health status
Women when kinship in a child Psychological reactions (see image below) were most
Younger people when losing a spouse intense in early bereavement
Note: caution in interpreting age differences: Affective, cognitive, behavioral, and physiological-
institutionalized individuals are sometimes somatic, immunological and endocrine changes
excluded from large samples and rates for Depression and grief distinct but related clusters of
residential relocation increase on the death of reaction
a partner. People who are fail and who’s
mortality risk is high could be excluded from Psychological reactions differ in cultures:
samples, boosting the survival rate of elderly Egyptian Muslims: express intense overt grief
populations compared to young people Bali Muslims: avoid any display of grief (crying)
Nevertheless, It is likely that the fundamental
Causes of death - greater risk of mortality: manifestations of grief are universal
Bereaved for a short time
Accidental and violent causes of death There are specific reaction patterns to various different
Moderate after chronic ischeamic and lung types of bereavement:
cancer Grandparents feel enormous sadness and pain for
Being a mother losing their child (extends to 18 their grieving adult child and a sens of survivors
years) after natural causes guilt
Greater risk for fathers early in bereavement from
unnatural causes Changes in symptoms of bereavement over time were
Death by suicide originally described in terms of stages or phases:
Shock, yearning & protest, despair and recovery
Note from author: see the interaction effect between
subgroup difference and cause of death
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, Task model used in guiding counselling and therapy
1. Accepting reality of the loss Theory
2. Experiencing the pain of grief Research on attachment supports the view that the
3. Adjusting to the environment without the deceased quality of nature of the lost relationship has much
4. Relocating the deceased emotionally and moving effect on outcome
on Robust individuals adjust better to bereavement
than fragile people. These patterns are related to
Be careful: Individual and cultural differences play attributional and emotional regulation processes
a role, bereaved people are not uniform! Attributions refer to the interpretations with
which people make sense of what is
Resilience versus vulnerability happening to them
In the long-term, most bereaved people are resilient, Emotion regulation processes refer to the
recovering from their loss, emotionally and physically, strategies people use to modify aspects of
with time – in line with general scientific opinion that their emotions
bereavement is a normal life event to which most
people adjust. Example: Depression is a normal Powerful predictors of later adjustment
response to early (less than 2 months) bereavement Adequacy of remaining parental care (e.g., warmth
and discipline) after the death of one parent
Psychiatric disorders Personal characteristics of the child (i.e., factors
25-45% mild depression – 10-20% clinical levels of contributing to resilience)
depression These are more powerful predictors of later
PTSS when loss of life has been massive, or death adjustment than the loss of a parent perse
horrific
7% mothers / 5% fathers vs 5% women / 3% Social support is a buffer, but general, does not hold
men in normative samples for the emotional loss
Mothers especially high rates of first psychiatric
admission, particularly during first year of Coping with bereavement is important because –
bereavement unlike many other variables – coping can be changed
Intervention possibilities
Complication in the Grieving Process
In some cases the grieving process can be disturbed People who do not work though their grief
or complicated frequently recover as well
Complicated grief (CG) Grief work is confronting the reality of loss and
A deviation from the normal (in cultural and societal relinquishing the bond to the deceased individual and
terms) grief experience in either time course, intensity, is essential for overcoming bereavement
or both, entailing a chronic and more intense emotional
experience or an inhibited process, which either lacks Dual process model of coping with bereavement
the usual symptoms or in which onset of symptoms is Both positive and negative cognitions and the
delayed regulation of emotion. In the grieving process are very
Separation Distress (preoccupation with thoughts important: oscillation process
of the deceased) The bereaved individual confront and avoid
Traumatic Distress (feelings of disbelief about the stressors to deal with the loss
death)
Bereaved individuals would confront and avoid
Numbers of occurrence of CG differ stressors to do directly with the loss, such as going
9 - 20% adults over death events (loss orientation) versus sources of
78% in parents after suicide or accidents secondary stress, such as dealing with finances
58% in parents sudden infant death syndrome (restoration orientation)
Adaptive grieving entails both confrontation and
Additional medical implications avoidance of the two types of stressors
Impaired memory, nutritional problems, work and
relationship difficulties and difficulties concentrating,
decreases in social participation + health-care costs
are higher
Researchers use the term risk factor to signify the
situational and intrapersonal and interpersonal
characteristics associated with increased vulnerability
to the range of bereavement outcomes
Unclear specific risk factor is general or
bereavement-specific
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