The spectrum of depressive phenomena after spousal bereavement

Major depressive syndromes have been found to be prevalent, disabling, and often persistent during the stress of bereavement. To add to the burden of mood changes associated with bereavement, a substantial number of bereaved individuals may suffer from depressive symptoms that do not quite equal the requisite number to meet criteria for a major depressive episode, but which also may be quite disabling, if not be actual forerunners of major depression. This study evaluates the frequency, morbidity, and stability of subsyndromal symptomatic depressions.

350 widows and widowers were evaluated for depressive symptoms and syndromes at 2, 13, and 25 months after the death of their spouse. An additional 126 demographically similar men and women also were evaluated. In addition to the presence of a number of depressive symptoms, a number of outcome measures were obtained: use of antidepressant medication, self-perceived physical health, satisfaction with work performance, number of days of social activity per month, self-rated adjustment to widow-hood, satisfaction with ongoing interpersonal relationships, and development of a new relationship.

Both symptomatic major depression (SMD) syndromes and subsyndromal symptomatic depression (SSD) were prevalent throughout the first 2 years of widowhood. More than one third of subjects with SSD 2 months after their spouse's death either continue to have SSD after the first full year of bereavement (28%) or worsen (9%) during that time. On most outcome measures, subjects with SSD stand between subjects with no depression and those with SMD and are significantly more likely than euthymic subjects to complain of poor physical health, be dissatisfied with their work performance, and refrain from social activity; they show a statistical trend for more disturbed ongoing relationships with friends and to be less likely to be involved in a new romantic relationship.

Although heretofore relatively unrecognized, SSDs are prevalent, often persist, and are associated with substantial morbidity in widows and widowers during the first 2 years of bereavement.