Selby Jacobs

Depressions of bereavement

The clinical significance of the depressions of bereavement is controversial. Although evidence suggests that most of these depressions remit spontaneously, some of them do require professional attention. Using a trained, non-professional screener, a study to screen for depressions of bereavement at 6 and 12 months after loss of a spouse was performed to determine the rate of depression and its characteristics. The relative value of using a dimensional assessment of depression (20-item Center for Epidemiologic Studies Depression [CES-D] Scale) and a structured diagnostic schedule for depression (Structured Clinical Interview for the DSM [SCID]) as telephone screening measures was evaluated. We found that while the CES-D overestimated, the SCID more precisely reflected the true rate of depression as determined in a subsample. The criterion for depression in this analysis was a diagnostic interview by a psychiatrist using DSM-III criteria and the Hamilton Rating Scale for Depression (HRSD). The study confirmed the existing literature on the high rate of depressions at 6 months (32% of bereaved spouses) and 12 months (27% of bereaved spouses) after a loss. These depressions were more common in widows than widowers. Past personal history (PPH) of depression and family history (FH) of depression were common among bereaved spouses, but did not enhance the risk of depression. Most of these depressions lasted considerably longer than 1 month. Anxiety, restlessness, and psychomotor retardation were prominent; melancholia was occasionally observed; and intense grief was associated with the depression.

Stressful Life Events Interacting With Cognitive/Personality Styles to Predict Late-Onset Major Depression

The current work evaluated the interaction of life stressors with cognitive/personality styles in predicting late-onset depression in 42 elderly outpatients with DSM-IV unipolar Major Depression and 42 nondepressed controls. Control subjects were matched to cases on age, sex, race, and years of education. As suggested by Becks cognitive theory of depression, a multivariate model indicated that specific stressful-event types interacted with specific cognitive/personality styles in strongly predicting depression onset, adjusting for the positive associations of medical illness and reduced physical functioning with depression.

Attachment Theory and Multiple Dimensions of Grief

In this article data from questionnaires completed by acutely bereaved widows and widowers were examined to identify the dimensions of psychological distress associated with bereavement. Using factor analysis, four factors that were meaningfully understood within the framework of attachment theory were found. These findings were consistent with the idea that grief is not a simple, decrescendoing emotional state, but rather a complex, evolving process with multiple dimensions. Our observations on the subjective distress of bereavement were related to other recently developed structured assessments of grief that are now available for the study of bereavement.

Urinary free cortisol and separation anxiety early in the course of bereavement and threatened loss

Among 56 persons who were acutely bereaved or threatened with a loss, a group with worsening separation anxiety over a period of a month early after the event had higher urinary free cortisol output than a group experiencing improvement in grief. Although not tested in this study, both these psychological and physiological measures may have potential for serving as early predictors of poor outcome in bereavement for the 15%-20% of exposed persons who are at risk for unresolved grief or persistent depressive syndromes.

Bereavement and catecholamines

Urinary catecholamine output was studied in 59 middle-aged and elderly persons who were either acutely bereaved (n = 39) or threatened with the loss of a spouse (n = 20). The study was done with the hypothesis that urinary catecholamine output would be elevated among the bereaved subjects both in comparison to norms in the literature for non-stressed controls and to the group of subjects who were threatened with a loss. It was also expected that individually high measures of psychological distress would be associated with high urinary catecholamines. Twenty-four hour urinary output of norepinephrine and epinephrine was observed to be higher than normal during acute bereavement but was not associated with depression scores. No differences were found between those who had experienced an actual loss two months earlier and those who were threatened with a loss. Expected relationships between indices of psychological distress and catecholamine output were not observed. Finally, an association was found between increasing age and higher levels of urinary norepinephrine and epinephrine output among acutely bereaved subjects, suggesting that the adaptation of the sympathetic-adrenal medullary system to stress among older persons is slower.

The course of psychological distress following threatened and actual conjugal bereavement

We measured multiple dimensions of distress among spouses (N = 440) of patients hospitalized for serious illness or elective surgery and compared the course of distress over 2 years of follow-up among five groups according to whether and when spouses were bereaved. Distress was related to the severity of the patients illness, the actuality and timing of the bereavement, as well as the gender and age of the respondent.

Past Personal History of Dysphoria, Social Support, and Psychological Distress Following Conjugal Bereavement

OBJECTIVE: This study describes the course and risk factors of psychological distress following bereavement, controlling for factors often omitted from studies of grief: psychiatric history, social support, and coping choices of the bereaved.

Acute Bereavement, Threatened Loss, Ego Defenses and Adrenocortical Function

In this study of 43 acutely bereaved widows and widowers and a comparison group of 24 nonbereaved married persons who experienced critical illness in a spouse, we found no evidence of higher levels of affective arousal, higher levels of adrenocortical activity, less effective ego defenses, or higher levels of defensive work among bereaved persons by comparison with nonbereaved persons. Furthermore, we failed to observe expected relationships between ego defensive function and adrenocortical activity among either bereaved or nonbereaved persons. These observations are consistent with one previous study of bereaved parents.