Does the suddenness matter? Antidepressant use before and after a spouse dies suddenly or expectedly of stroke

Aims: Changes in mental health at the time of widowhood may depend on the expectedness of spousal death, but scant evidence is available for spousal deaths attributable to stroke. Methods: Using register-linkage data for Finland, we assessed changes in antidepressant use before and after spousal death for those whose spouses died suddenly of stroke between 1998 and 2003 ( N=1820) and for those whose spouses died expectedly of stroke, with prior hospitalisation for cerebrovascular disease ( N=1636). We used both population-averaged logit models and individual fixed-effects linear probability models. The latter models control for unobserved time-invariant heterogeneity between the individuals. Results: Our study indicates that the suddenness of a spouse’s death from stroke plays a role in the well-being of the surviving spouse. Increases in antidepressant use appeared larger following widowhood for those whose spouses died suddenly of stroke relative to those whose spouses had a medical history of cerebrovascular disease. Conclusions: The suddenness of a spouse’s death from stroke plays a role for the surviving spouse. The results suggest multifaceted timings of distress surrounding spousal death, depending on the suddenness of a spouse’s death from stroke.

Short-Term Mental Health Sequelae of Bereavement Predict Long-Term Physical Health Decline in Older Adults: U.S. Health and Retirement Study Analysis

Objectives Spousal death is a common late-life event with health-related sequelae. Evidence linking poor mental health to disease suggests the hypothesis that poor mental health following death of a spouse could be a harbinger of physical health decline. Thus, identification of bereavement-related mental health symptoms could provide an opportunity for prevention. Methods We analyzed data from N = 39,162 individuals followed from 1994 to 2016 in the U.S. Health and Retirement Study; N = 5,061 were widowed during follow-up. We tested change in mental and physical health from prebereavement through the 5 years following spousal death. Results Bereaved spouses experienced an increase in depressive symptoms following their spouses’ deaths but the depressive shock attenuated within 1 year. Bereaved spouses experienced increases in disability, chronic-disease morbidity, and hospitalization, which grew in magnitude over time, especially among older respondents. Bereaved spouses were at increased risk of death compared to nonbereaved respondents. The magnitude of depressive symptoms in the immediate aftermath of spousal death predicted physical-health decline and mortality risk over 5 years of follow-up. Discussion Bereavement-related depressive symptoms indicate a risk for physical health decline and death in older adults. Screening for depressive symptoms in bereaved older adults may represent an opportunity for intervention to preserve healthy life span.

Short-term mental health sequelae of bereavement predict long-term physical health decline in older adults: US Health and Retirement Study Analysis

ObjectiveDeath of a spouse is a common late-life event with mental- and physical-health sequelae. Whereas mental-health sequelae of spousal death tend to be transient, physical-health sequelae may persist, leading to disability and mortality. Growing evidence linking poor mental health to aging-related disease suggests the hypothesis that transient poor mental health following death of a spouse could be a harbinger of physical health decline. If so, identification of bereavement-related mental health symptoms could provide an opportunity for prevention.MethodsWe analyzed data from N=35,103 individuals followed from 1994-2014 in the US Health and Retirement Study (HRS) and identified N=4,629 who were widowed during follow-up. We tested change in mental and physical health from pre-bereavement through the 5-year period following spousal death.ResultsBereaved spouses experienced an immediate increase in depressive symptoms following their spouses’ deaths but the depressive shock attenuated within one year. Bereaved spouses also experienced increases in disability, chronic-disease morbidity, and hospitalization, which grew in magnitude with time since spousal death, especially among older HRS participants. Bereaved spouses were at increased risk of death compared to HRS participants who were not bereaved. The magnitude of depressive symptoms in the immediate aftermath of spousal death predicted physical-health decline and mortality risk over 5 years of follow-up.ConclusionsBereavement-related depressive symptoms provide an indicator of risk for physical health decline and death in older adults. Screening for depressive symptoms in bereaved older adults may represent an opportunity for intervention to preserve healthy lifespan.Plain Language SummaryThe clinical significance of depressive symptoms during bereavement for long-term health is not well understood. We analyzed longitudinal data tracking mental and physical health of more than 4,000 older adults who were widowed during follow-up. Widows and widowers who experienced more severe depressive symptoms immediately following their spouse’s death were at increased risk for incident disability, chronic disease, hospitalization, and mortality over the five years following their spouse’s death. Transient depressive symptoms related to bereavement may provide a clinical indicator of risk for long-term physical health decline in older adults. Findings motivate increased integration of psychiatric assessment in geriatric care.

Spousal Death Anxiety in Old Age

Anxiety toward one’s own death has been extensively studied and conceptualized. However, the fear of death of others particularly of spouse in later life, which may be worse than individual’s death anxiety, has not been investigated. The present research aims to study spousal death anxiety among Malaysian middle-aged and older couples. The study subjects, consisting of 300 couples aged 50 years and older, were obtained from a national cross-sectional survey entitled “Poverty among Elderly Women: Case Study of Amanah Ikhtiar” conducted in Peninsular Malaysia. Women reported significantly higher levels of spousal death anxiety than their partners t(299) = 2.48, p < .05. About 45% of older men and 52% of their spouses reported high spousal death anxiety. The results of two separate stepwise regression analyses yielded a two-variable model for men and a four-variable model for women. The most important concern of older men that may increase spousal death anxiety was caregiving issues. For older women, financial security following widowhood was most important factor toward spousal death anxiety. The findings suggest that the majority of the older couples are prone to death anxiety of their spouse and factors contributing to the fear of death of spouse are different for men and women.