Salivary Cortisol and Psychopathology in Adults Bereaved by the September 11, 2001 Terror Attacks

Objective: This prospective study aimed to describe the nature and time course of HPA axis dysregulation and psychopathology among terror-bereaved spouses. Method: Twenty-three spouses bereaved from September 11, 2001 terror attacks and 22 nonbereaved spouses were compared using a psychiatric diagnostic interview (SCID), 3 days of salivary cortisol collection, and a dexamethasone suppression test. Most subjects had repeated assessments at 6 month intervals during the 2 year study. Results: After September 11, 2001, bereaved compared to nonbereaved had significantly higher rates of posttraumatic stress disorder (PTSD; 68.1% versus 0%) and major depressive disorder (MDD; 45.5% versus 9.5%). Bereaved had significantly higher morning basal cortisol and less afternoon postdexamethasone cortisol suppression than nonbereaved. Among bereaved, those with PTSD without comorbid MDD had significantly greater afternoon postdexamethasone cortisol suppression than those without psychiatric disorders. Conclusions: Terror-related spouse death is a severe stressor associated with persistent HPA axis activation, PTSD, and MDD. However, bereaved spouses who developed PTSD and were not depressed had enhanced post-dexamethasone cortisol suppression, evidence of heightened glucocorticoid receptor sensitivity.

Life After a Death: The Experience of Bereavement in South Wales

ABSTRACTThis paper looks at the experience of bereavement in old age in a South Wales locality and traces the immediate and long-term effects it has on the bereaved. It examines various categories of bereavement – death of spouse, death of the mother, death of a child, siblings and friends, with death of spouse as specially significant. In each category it closely relates the experience of bereavement to the nature of the relationship formerly maintained, arguing that the significance of bereavement can only be appreciated within the context of social structure which defines the meaning of these relationships. It suggests that the special position occupied by female networks in the social structure enables old women to cope with the effects of bereavement more successfully than old men. For both old men and old women however, the special position they occupy with respect to contemporary society gives death a particular and unique resonance.