Margaret Stroebe

Health outcomes of bereavement

In this Review, we look at the relation between bereavement and physical and mental health. Although grief is not a disease and most people adjust without professional psychological intervention, bereavement is associated with excess risk of mortality, particularly in the early weeks and months after loss. It is related to decrements in physical health, indicated by presence of symptoms and illnesses, and use of medical services. Furthermore, bereaved individuals report diverse psychological reactions. For a few people, mental disorders or complications in the grieving process ensue. We summarise research on risk factors that increase vulnerability of some bereaved individuals. Diverse factors (circumstances of death, intrapersonal and interpersonal variables, ways of coping) are likely to co-determine excesses in ill-health. We also assess the eff ectiveness of psychological intervention programmes. Intervention should be targeted at high-risk people and those with complicated grief or bereavement-related depression and stress disorders.In this Review, we look at the relation between bereavement and physical and mental health. Although grief is not a disease and most people adjust without professional psychological intervention, bereavement is associated with excess risk of mortality, particularly in the early weeks and months after loss. It is related to decrements in physical health, indicated by presence of symptoms and illnesses, and use of medical services. Furthermore, bereaved individuals report diverse psychological reactions. For a few people, mental disorders or complications in the grieving process ensue. We summarise research on risk factors that increase vulnerability of some bereaved individuals. Diverse factors (circumstances of death, intrapersonal and interpersonal variables, ways of coping) are likely to co-determine excesses in ill-health. We also assess the effectiveness of psychological intervention programmes. Intervention should be targeted at high-risk people and those with complicated grief or bereavement-related depression and stress disorders.

The role of loneliness and social support in adjustment to loss : a test of attachment versus stress theory

A longitudinal study of a matched sample of 60 recently widowed and 60 married men and women tested predictions from stress and attachment theory regarding the role of social support in adjustment to bereavement. Stress theory predicts a buffering effect, attributing the impact of bereavement on well-being to stressful deficits caused by the loss and assuming that these deficits can be compensated through social support. In contrast, attachment theory denies that supportive friends can compensate the loss of an attachment figure and predicts main effects of marital status and social support. Attachment theory further suggests that marital status and social support influence well-being by different pathways, with the impact of marital status mediated by emotional loneliness and the impact of social support mediated by social loneliness. Results clearly supported attachment theory.

The Dual Process Model of Coping with Bereavement: A Decade on:

The Dual Process Model of Coping with Bereavement (DPM; Stroebe & Schut, 1999) is described in this article. The rationale is given as to why this model was deemed necessary and how it was designed to overcome limitations of earlier models of adaptive coping with loss. Although building on earlier theoretical formulations, it contrasts with other models along a number of dimensions which are outlined. In addition to describing the basic parameters of the DPM, theoretical and empirical developments that have taken place since the original publication of the model are summarized. Guidelines for future research are given focusing on principles that should be followed to put the model to stringent empirical test.

Gender differences in adjustment to bereavement An empirical and theoretical review

The loss of a marital partner results in substantial increases in morbidity and mortality among both men and women, but the effects are relatively greater for widowers than for widows in the acute grieving period. Evidence is reviewed, and explanations of the pattern are examined. An interpretation in terms of gender differences in social support (cf. M. Stroebe & W. Stroebe, 1983), although plausible, has not yet been empirically confirmed. Likewise, with respect to gender differences in coping styles, women are more confrontive and expressive of their emotions than men, but there has been little validation of the generally accepted grief work hypothesis (working through grief by women brings about their better recovery). Cognitive processes underlying effective coping with bereavement are analyzed, and a stressor-specific framework, the dual-process model of coping with loss, is suggested to help explain gender differences in health outcomes.

Broken Hearts Or Broken Bonds: Love And Death In Historical Perspective

Psychological theories and practices frequently neglect the extent to which their subject matter is historically and culturally defined. This issue is explored in the context of theories and therapies related to bereavement. Contemporary orientations emphasize the importance of breaking bonds with the deceased and the return of survivors to autonomous lifestyles. Placing the orientation in cultural and historical context reveals that it is largely a product of a modernist worldview. Within the romanticist ethos of the preceding century, such breaking of bonds would destroy ones identity and the meaning of life. In light of contemporary variations in subcultural meanings and values, a postmodern view is suggested in which reflexive responsibility is focal.

Couples at Risk Following the Death of Their Child: Predictors of Grief Versus Depression

This longitudinal study examined the relative impact of major variables for predicting adjustment (in terms of both grief and depression) among bereaved parents following the death of their child. Couples (N = 219) participated 6, 13, and 20 months postloss. Use of multilevel regression analyses enabled assessment of the impact of several predictors and facilitated analysis of factors that were either shared by parents or individual. Grief was predicted mainly by shared parent factors: childs age, cause and unexpectedness of death, and number of remaining children. By contrast, depression was predicted by individual parent factors: gender, religious affiliation, and professional help seeking. Theoretical implications of these findings are discussed.

Coping with Bereavement: A Review of the Grief Work Hypothesis.

The article challenges the longstanding belief in the importance of “grief work” for adjustment to bereavement (the grief work hypothesis). It examines claims made in theoretical formulations and principles of grief counseling and therapy concerning the necessity of working through loss. Empirical evidence is reviewed, and cross-cultural findings are described to document alternative patterns of coping with grief. It is argued that there are grounds for questioning the hypothesis: 1) existing definitions and operationalizations are problematic; 2) the few empirical studies that have examined the impact of grief work have yielded equivocal results; 3) grief work is not a universal concept. Limitations of the grief work hypothesis as an explanation of coping with bereavement are identified and a differential approach is suggested. Implications for counseling and therapy are discussed.

Bereavement research: methodological issues and ethical concerns

Principles of conducting research in the field of bereavement are introduced. The review focuses on issues of design and methodology, and considers ethical concerns, particularly in view of the fact that bereaved people are frequently in acute grief when scientific study is conducted. Accurate assessment is fundamental, and requires methodologically stringent procedures. The merits and disadvantages of different types of investigation are considered, the often-neglected need for control groups is described, and quantitative versus qualitative methodological approaches are reviewed. Also considered are biases due to selection and limits on generalizability. Understanding of ethical matters arising in this field of research is essential for the conduct of worthwhile research, and involves methodological sophistication.

Attachment in Coping With Bereavement: A Theoretical Integration

Researchers have deplored shortcomings in theoretically based models of coping with bereavement. Integration of cognitive stress with attachment theory is proposed to predict adjustment to bereavement, describe different forms of effective coping, and resolve ongoing debates about continuing versus relinquishing bonds. These 2 generic approaches are integrated within a bereavement-specific perspective, the dual-process model of coping (Stroebe & Schut, 1999). Accordingly, (a) different coping styles are adopted by, and are differentially efficacious for, bereaved people according to their style of attachment; (b) bereaved peoples ways of continuing bonds differ according to their attachment style; and (c) grief complications are associated with insecure attachment styles. The authors conclude that it is better for some bereaved individuals to work toward retaining ties and for others to work toward loosening ties.

Who participates in bereavement research? A review and empirical study.

Despite high attrition rates in bereavement research, the issue of selection biases on health measures has been neglected. This raises doubt about many of the generalizations concerning health characteristics and recovery patterns among bereaved people. If it is the least distressed individuals who participate in bereavement research, such research would underestimate the impact of bereavement on health. If, on the other hand, it is the most distressed who agree to participate (e.g., because they want to talk about their loss), the health consequences of bereavement would be exaggerated. The first part of this article reviews attrition rates in bereavement research and demonstrates both the prevalence of low acceptance rates and the lack of knowledge about the bias due to such self-selection. In the second part, an empirical study is reported which provides evidence on the two conflicting hypotheses described above. The findings of our study show that depression does indeed affect willingness to participate but operates differently for males and females: Whereas widowers who were less depressed agreed to participate in an interview, the opposite was the case for widows: Those who were more depressed did so. This sex difference is explained in terms of sex roles in coping styles and norms for exhibiting emotions. Empirical studies of bereavement reactions need to take such selection biases in sampling into account.