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Cited by 261Grief, Bereavement, and Mental HealthNursing care and researchPalliative Care and End-of-Life Issues

Involvement in Caregiving and Adjustment to Death of a Spouse: Findings From the Caregiver Health Effects Study

Schulz, Richard, Beach, Scott R., Lind, Bonnie, Martire, Lynn M., Zdaniuk, Bozena, Hirsch, Calvin, Jackson, Sharon, Burton, Lynda·2001·JAMA
DOI 10.1001/jama.285.24.3123
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Abstract

CONTEXT: Most deaths in the United States occur among older persons who have 1 or more disabling conditions. As a result, many deaths are preceded by an extended period during which family members provide care to their disabled relative. OBJECTIVE: To better understand the effect of bereavement on family caregivers by examining predeath vs postdeath changes in self-reported and objective health outcomes among elderly persons providing varying levels of care prior to their spouse's death. DESIGN AND SETTING: Prospective, population-based cohort study conducted in 4 US communities between 1993 and 1998. PARTICIPANTS: One hundred twenty-nine individuals aged 66 to 96 years whose spouse died during an average 4-year follow-up. Individuals were classified as noncaregivers (n = 40), caregivers who reported no strain (n = 37), or strained caregivers (n = 52). MAIN OUTCOME MEASURES: Changes in depression symptoms (assessed by the 10-item Center for Epidemiological Studies-Depression [CES-D] scale), antidepressant medication use, 6 health risk behaviors, and weight among the 3 groups of participants. RESULTS: Controlling for age, sex, race, education, prevalent cardiovascular disease at baseline, and interval between predeath and postdeath assessments, CES-D scores remained high but did not change among strained caregivers (9.44 vs 9.19; P =.76), while these scores increased for both noncaregivers (4.74 vs 8.25; F(1,116) = 14.33; P<.001) and nonstrained caregivers (4.94 vs 7.13; F(1,116) = 4.35; P =.04). Noncaregivers were significantly more likely to be using nontricyclic antidepressant medications following the death than the nonstrained caregiver group (odds ratio [OR], 12.85; 95% confidence interval [CI], 1.02-162.13; P =.05). The strained caregiver group experienced significant improvement in health risk behaviors following the death of their spouse (1.47 vs 0.66 behaviors; F(1,118) = 20.23; P<.001), while the noncaregiver and nonstrained caregiver groups showed little change (0.27 vs 0.27 [P =.99] and 0.46 vs 0.27 [P =.39] behaviors, respectively). Noncaregivers experienced significant weight loss following the death (149.1 vs 145.3 lb [67.1 vs 65.4 kg]; F(1,101) = 8.12; P =.005), while the strained and nonstrained caregiving groups did not show significant weight change (156.2 vs 155.2 lb [70.3 vs 69.8 kg] [P =.41] and 156.2 vs 154.0 lb [70.3 vs 69.3 kg] [P =.12], respectively). CONCLUSIONS: These data indicate that the impact of losing one's spouse among older persons varies as a function of the caregiving experiences that precede the death. Among individuals who are already strained prior to the death of their spouse, the death itself does not increase their level of distress. Instead, they show reductions in health risk behaviors. Among noncaregivers, losing one's spouse results in increased depression and weight loss.

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  • Other longitudinal studies have found that caregivers show some improvement in psychological functioning after bereavement, albeit without returning to normative levels.

    “Other longitudinal studies have found that caregivers show some improvement in psychological functioning after bereavement, albeit without returning to normative levels (7, 45, 46).”

    From Chronic stress and age-related increases in the proinflammatory cytokine IL-6. (2003) · cites this paper as [45]

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Authors
Schulz, R., Beach, S. R., Lind, B., Martire, L. M., Zdaniuk, B., Hirsch, C., Jackson, S., & Burton, L.
Affiliations
  • University of Pittsburgh (US)
  • University of Washington (US)
  • University of California, Davis (US)
  • Wake Forest University (US)
  • Johns Hopkins University (US)
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2001-06-27
Volume
285
Issue
24
Pages
3123
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.285.24.3123
OpenAlex
W2045262702
Cited by
261
References
17
Citations by year
2026: 4 · 2025: 8 · 2024: 6 · 2023: 3 · 2022: 6 · 2021: 7 · 2020: 3 · 2019: 8 · 2018: 6 · 2017: 5 · 2016: 12 · 2015: 9 · 2014: 10 · 2013: 14 · 2012: 18
FWCI
13.97
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (n01hc085079-024, n01hc085086-022, 5r01mh046015-09)
  • National Institute on Aging (U01AG013305, AG 13305, AG01532)
  • National Heart, Lung, and Blood Institute (HL65111, HL65112, N01 HC85086, P50HL065112, P50HL065111, N01-HC85079)
  • National Institute of Mental Health (T32MH019986, R01 MH-52247, R01 MH46015)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
  • Health Sciences › Health Professions › Pharmacy › Nursing care and research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
Keywords
caregiver burden, bereavement, death of a spouse, widowhood, depression, antidepressant use, health risk behaviors, weight change, older adults, family caregivers
MeSH terms
Aged, Aged, 80 and over, Antidepressive Agents, Bereavement, Death, Depression, Female, Follow-Up Studies, Humans, Male, Socioeconomic Factors, Weight Loss, Health Behavior, Caregivers, Spouses

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