Margaret S. Stroebe

Handbook of Bereavement: Determinants of adjustment to bereavement in younger widows and widowers

This chapter reviews the major findings of the Tubingen longitudinal study of bereavement, an in-depth study of younger widows and widowers that provides information about health deterioration following bereavement, the course of recovery and coping strategies over a 2-year period, and the risk factors that affect adjustment to the loss. The study employed methodological safeguards to avoid some of the pitfalls that typically threaten the validity of in-depth studies of bereavement. Background When we planned our longitudinal study, the decline in mental and physical health and general well-being following marital bereavement had already been well documented (for reviews, see Osterweis, Solomon, & Green, 1984, and W. Stroebe & Stroebe, 1987). A few earlier studies (e.g., Clayton, 1979) had tended to minimize the severity of these effects. However, epidemiological, clinical, and in-depth interview and questionnaire investigations strongly suggest otherwise. Although the majority of bereaved manage to adjust to their loss without professional help, a significant minority do succumb to a variety of ailments and ills, and the risk of this persists for a considerable time. Therefore, instead of merely charting the health consequences of marital bereavement, it seemed important to identify the characteristics of people who were likely to suffer long-term health impairment, because they were the risk group that would need professional help. We investigated whether bereaved individuals adjustment to loss was influenced by sociodemographic (e.g., socioeconomic status, age, gender) and individual (e.g., personality traits, religiosity) characteristics, by antecedent situational factors such as the quality of the marital relationship, by mode of death (sudden vs. expected loss), or by circumstances after the loss, like the extent to which the bereaved received social support (cf. W. Stroebe & Stroebe, 1987).

Handbook of bereavement: The mortality of bereavement: A review

Increasingly in recent years researchers have focused on positive aspects of the experience of bereavement, emphasizing that it is a “growth experience,” that people are “resilient,” and that the illness metaphor should be abandoned in describing the consequences of grief. The chapters in this volume by Silverman and Worden, McCrae and Costa, and Shuchter and Zisook, to name only a few, underline this message. Yet the reason that so much research has focused on bereavement is because the loss of a loved one is associated with extreme mental and physical suffering, not for everyone, and not always lastingly, but for a significant minority. Even more disturbing are the statistics for mortality. Not only do some bereaved individuals fall ill following the loss of a loved one, but they also die. Given that fatal consequences occur for some bereaved, it is important to identify those who are vulnerable and to understand why they and not others succumb. A decade ago we reviewed the research on mortality (M. Stroebe, Stroebe, Gergen, & Gergen, 1981) and concluded that there was some evidence that bereavement results in excess mortality. However, the surveyed research suffered from many methodological shortcomings. In the meantime, much research has been done and much has been written about the bereavement-mortality relationship. The goals of this chapter, therefore, are to review the scientific evidence that is now available, examine subgroup differences that suggest high-risk categories, and review and evaluate theoretical explanations that could account for the bereavement-mortality relationship.