Normal Limits

"Chance is the very guide of life"

"In practical medicine the facts are far too few for them to enter into the calculus of probabilities... in applied medicine we are always concerned with the individual" -- S. D. Poisson

November 29, 2005

Widowhood and Mental Illness

During rotations I have taken care of a couple of elderly widows and widowers. Suffice to say that they are quite a unique group of patients to take care of. So some research is warranted...

In the U.S., 60% of women between ages 75 to 84 are widowed (Merck Manual of Geriatrics). With their longer life expectancy, the majority of women seem destined to share the common experience of widowhood. But the loss of a spouse is an intensely personal experience�after all, the spouse is the most physically and emotionally intimate companion in life. Across age groups and cultures, the death of a spouse is consistently rated as the most stressful life event (Holmes and Rahe 1967). So traumatic is the experience that many new widows fit the diagnosis of PTSD (Zisook et al 1998). But the mental illness the widow is most at risk of, unsurprisingly, is depression.

The spouse is arguably the most important person in one�s social network. The disappearance of the spouse, then, represents a fundamental perturbation on the network. Feelings of isolation and loneliness are common. She must adapt to the loss by re-structuring her social network, substituting roles played by her husband and compensating for her unmet social needs. This substitution may take any of 3 forms:

  • Formation of new social ties

  • Rekindling of dormant ties

  • Intensification of existing ties

In a fascinating cohort study, Zettel and Rook (2004) conducted serial interviews on 322 older women, ages 60 to 85, widowed for 3 to 30 months, over the course of a year. Among some of their findings were the surprising observations that

  1. Widows whose social network included more rekindled ties or more intensified ties developed significantly more depressive symptoms over the course of a year.

  2. Widows whose social network included more new social ties developed significantly higher loneliness ratings over a year.

Unexpected as these findings may be at first glance, they authors present a number of plausible explanations. Most importantly, I think these associations may be useful clinically.

Of course, this was an observational study that measured profound emotional responses with structured interviews. But we could hardly do any better.

Technorati Tags:
/ / / /

No comments: