[Factors influencing grief due to bereavement among elderly widows and widowers]

To identify the factors that influence the grief of bereaved elderly people due to the death of a spouse.

Subjects consisted of 172 widows and widowers (137 females, 35 males) aged 60 or older who experienced bereavement of a spouse in the last three years. Between August 1994 and October 1996, the subjects were interviewed using a semi-structured questionnaire and data was also obtained from self-report measures which were returned by mail. A questionnaire consisting of 26 items was prepared based on the theories of Parkes and Deeken. These responses were classified into 4 categories (sensory paralysis, deep attachment and protest, disintegration, reconstruction) and analysis was made by these categories. The time course of the grief was evaluated at 1 week, 49 days and 1 year after the death of the spouse and the time of survey.

(1) Of the 172 subjects, general health was graded as poor or slightly poor in 33.6%, 67.4% cared for their spouse during medical treatment; and the average GDS depression score was 5.85 (SD = 3.50). (2) With respect to anticipated grief, while their spouses were under medical treatment, more than 50% of the subjects were thinking "I will do Whatever I can to cope". (3) Change in grief response over time: For "sensory paralysis", "I have done whatever I can" rated the highest at 3 points or more on a scale of 4, from immediately after the spouse's death to the present. For "deep attachment and protest", deep attachment including "always thinking of the lost one" marked higher (3.4 points immediately after death to 2.9 at present) than protest. For "disintegration", "nobody understands what I feel" rated the highest (2.6-2.9 points). For "reconstruction", the subjects gradually accepted the death as "unavoidable" and had started to adapt. (4) Factors that significantly influenced grief were the subject's health condition, whether the subject had been notified of the name of the disease or given a prognosis; whether subject provided care for the spouse and GDS depression score.

Sufficient anticipated grief resulted in a feeling of achievement in the sensory paralysis aspect of the grief response and in a long lasting feeling of deep attachment as loneliness and solitude. Disintegration was largely related to depression according to GDS score. Grief was less deeply felt when the subject was healthy, had been informed of the name of the spouse's disease, and had cared for the spouse during medical treatment before bereavement.