The DOI matches its Crossref record; 17 of the 17 references it cites were found in a registry or an index.
Involvement in Caregiving and Adjustment to Death of a Spouse: Findings From the Caregiver Health Effects Study
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.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“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]
Citations
Cites
The Cardiovascular Health Study: design and rationale.
Fried, L. P., Borhani, N. O., Enright, P., Furberg, C. D., Gardin, J. M., Kronmal, R. A., Kuller, L. H., Manolio, T. A., Mittelmark, M. B., Newman, A., et al. (1991) · Annals of Epidemiology · doi:10.1016/1047-2797(91)90005-w · Cited by 3,652
Caregiving as a Risk Factor for Mortality: The Caregiver Health Effects Study
Schulz, R., & Beach, S. R. (1999) · JAMA · doi:10.1001/jama.282.23.2215 · Cited by 3,340 · cited 5×
“Participants were asked 6 yes or no questions about the following health risk behaviors: (1) missing at least 1 physician appointment in the last 6 months; (2) not having enough time to go to the physician; (3) not having enough time to exercise; (4) forgetting to take medication; (5) not getting enough rest in genera…”
BackgroundInfluentialSelf-citationSchulz, R., O'Brien, A. T., Bookwala, J., & Fleissner, K. (1995) · The Gerontologist · doi:10.1093/geront/35.6.771 · Cited by 1,765
Self-citationRecruitment of adults 65 years and older as participants in the cardiovascular health study
Tell, G. S., Fried, L. P., Hermanson, B., Manolio, T. A., Newman, A. B., & Borhani, N. O. (1993) · Annals of Epidemiology · doi:10.1016/1047-2797(93)90062-9 · Cited by 558
Schulz, R., Newsom, J. T., Mittelmark, M. B., Burton, L. C., Hirsch, C. H., & Jackson, S. (1997) · Annals of Behavioral Medicine · doi:10.1007/bf02883327 · Cited by 466
Self-citationMethods of assessing prevalent cardiovascular disease in the Cardiovascular Health Study
Psaty, B. M., Kuller, L. H., Bild, D. E., Burke, G. L., Kittner, S. J., Mittelmark, M. B., Price, T. R., Rautaharju, P. M., & Robbins, J. B. (1995) · Annals of Epidemiology · doi:10.1016/1047-2797(94)00092-8 · Cited by 446
Emanuel, E. J., Fairclough, D. L., Slutsman, J., & Emanuel, L. L. (2000) · Annals of Internal Medicine · doi:10.7326/0003-4819-132-6-200003210-00005 · Cited by 433
Emanuel, E. J., Fairclough, D. L., Slutsman, J., Alpert, H. R., Baldwin, D. C., & Emanuel, L. L. (1999) · New England Journal of Medicine · doi:10.1056/nejm199909233411306 · Cited by 352
Reliability and validity of screening scales: Effect of reducing scale length
Shrout, P. E., & Yager, T. J. (1989) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(89)90027-9 · Cited by 255
The effects of bereavement on eating behaviors and nutrient intakes in elderly widowed persons
Rosenbloom, C. A., & Whittington, F. J. (1993) · Journal of Gerontology · doi:10.1093/geronj/48.4.s223 · Cited by 170
Cited by
Sorted by citations
Items 201–260 of 260
Effects of Spouse Bereavement in Old Age on Emotion and Social Interaction
손종미, & Byun, S.-H. (2015) · The Journal of the Korea Contents Association · doi:10.5392/jkca.2015.15.09.233 · Cited by 4
Monserud, M. A. (2018) · Marriage & Family Review · doi:10.1080/01494929.2018.1458007 · Cited by 4
Estimating the Prevalence of Unpaid Adult Care Over Time
Hirst, M. A. (2005) · White Rose Research Online (University of Leeds, The University of Sheffield, University of York) · Cited by 4
Crossing the digital divide : family caregivers' acceptance of technology
Kinney, J. M., Murdoch, L. D., Ziemba, T. F., & Kart, C. S. (2002) · Cited by 4
Health Risk Factors in Caregivers of Terminal Cancer Patients
Corà, A., Partinico, M., & Palomba, D. (2012) · Cited by 4
Green, M. (2014) · ePrints Soton (University of Southampton) · Cited by 4
Lane, B. N. (2006) · OakTrust (Texas A&M University Libraries) · Cited by 4
Victor, V. (2026) · Economics & Human Biology · doi:10.1016/j.ehb.2026.101585 · Cited by 3
Olagunju, O., Olaogun, A. A., Afolabi, E. K., & Adereti, C. S. (2014) · African Journal of Midwifery and Women s Health · doi:10.12968/ajmw.2014.8.1.36 · Cited by 3
Papa, A., & Litz, B. T. (2010) · Springer eBooks · doi:10.1007/978-1-4419-6510-3_12 · Cited by 4
Family influences on older adults' problem drinking: A representative nationwide study of China
Ye, Y., Feng, J., Zhang, Y., Wang, M., Chen, J., Wu, D., Kathleen, Y., & Jiang, S. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.850931 · Cited by 2
Adaptive Grief in Bereaved Dementia Caregivers: An Evolutionary Concept Analysis
O’Donnell, M. G., Fleury, J., & Baker, Z. G. (2025) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228251338143 · Cited by 2
Scheffer, J. A., Wells, J. L., Yee, C., Merrilees, J. J., & LEVENSON, R. W. (2025) · Aging & Mental Health · doi:10.1080/13607863.2025.2522374 · Cited by 2
Yang, G. M., Neo, S. H., Teo, I., Lee, G. L., Thumboo, J., Chia, J. W.-K., Lau, A., Koh, A. R. X., Qu, D. L., Lam, W. W., et al. (2019) · Journal of Patient Experience · doi:10.1177/2374373519836477 · Cited by 2
Anticipating Loss: Healthcare for Older Patients and Their Family Caregivers
Shore, B. (2005) · Springer eBooks · doi:10.1007/0-387-26310-1_15 · Cited by 2
Measurement of Social Factors in Aging Research
Fredman, L., & Lyons, J. G. (2012) · Springer eBooks · doi:10.1007/978-94-007-5061-6_9 · Cited by 2
Boyle, D. A. (2005) · Oncology nursing forum · doi:10.1188/05.onf.913-917 · Cited by 2
The Psychology of Death and Dying in Later Life
Balk, D. E. (2016) · Elsevier eBooks · doi:10.1016/b978-0-12-411469-2.00024-8 · Cited by 2
Unicorns, Carravaggio, and Fetal Surgery
Howe, E. G. (2001) · The Journal of Clinical Ethics · doi:10.1086/jce200112401 · Cited by 2
The provision of health and social care services for older people by respite providers
Evans, D. J. (2013) · Contemporary Nurse · doi:10.5172/conu.2013.3555 · Cited by 2
My Life in Research: From Theory to Policy in 40 Years
Schulz, R. (2017) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2016.12.011 · Cited by 2
Self-citationHayslip, B., & Hansson, R. O. (2007) · Elsevier eBooks · doi:10.1016/b0-12-370870-2/00091-3 · Cited by 2
Yu, Q., Shi, D., Wang, H., Hu, X., Chen, F., Wang, Y., Jiang, M., Wang, X., & Wang, W. (2026) · Journal of Public Health Research · doi:10.1177/22799036261495154 · Cited by 2
How Do Stress Management and Personal Characteristics Improve the Quality of Life?
Baek, Y., Lee, K. C., & Chae, S. W. (2012) · Communications in computer and information science · doi:10.1007/978-3-642-35521-9_57 · Cited by 1
Understanding Stress, Immunity, and Sleep Disturbances in Caregivers of Persons with Dementia
Lehman, B. (2008) · University of Florida Digital Collections (University of Florida) · Cited by 1
Mantelzorg voor ouderen is geen vanzelfsprekendheid
Videler, A. C., van Meekeren, E., & van Alphen, S. P. J. (2013) · GZ - Psychologie · doi:10.1007/s41480-013-0035-5 · Cited by 1
The Role of Social Support in the Health and Well-Being of Older Adult Widows
Bisconti, T. L., Bergeman, C. S., SCOTT, S., & Pitzer, L. (2012) · Elsevier eBooks · doi:10.1016/b978-0-12-384978-6.00102-3 · Cited by 1
Managing Employees’ Occupational Stress
O’Brien, K. E., & Beehr, T. A. (2015) · Emerald Group Publishing Limited eBooks · doi:10.1108/978-1-68123-341-320251015 · Cited by 1
Government Restrictions During the COVID-19 Pandemic and Depressive Symptoms Following Widowhood
Winkle, Z. V., & Konechni, B. A. (2025) · Demography · doi:10.1215/00703370-11790737 · Cited by 2
The relationship between caregiving and bereavement: A series of three studies
Burton-Chase, A. M. (2005) · Digital Commons - University of South Florida (University of South Florida) · Cited by 1
Fredericks, M. A., Kondellas, B., Ross, M. W. V., Hang, L., & Fredericks, J. (2009) · Journal of Chiropractic Humanities · doi:10.1016/j.echu.2010.02.003 · Cited by 1
Physical Health and Marital Status
Yorgason, J. B., & Stott, K. L. (2015) · The Encyclopedia of Adulthood and Aging · doi:10.1002/9781118521373.wbeaa295 · Cited by 1
Raveis, V. H. (2009) · CRC Press eBooks · doi:10.1201/b13272-128 · Cited by 1
Thomeer, M. B., & Umberson, D. (2014) · Springer eBooks · doi:10.1007/978-94-007-0753-5_3238 · Cited by 1
Emotion regulation and positive growth in spousal dementia carers
Ash, R. (2014) · ERA · Cited by 1
Piazza, J. R., & Charles, S. T. (2012) · Wiley eBooks · doi:10.1002/9781118392966.ch14
Service utilization among bereaved spouses and family caregivers
Bergman, E. (2008) · Digital Commons - University of South Florida (University of South Florida)
Fredericks, M. A., Kondellas, B., Hang, L., Fredericks, J., & Ross, M. W. V. (2011) · Journal of Chiropractic Humanities · doi:10.1016/j.echu.2011.10.003
Boelk, A. Z. (2010) · Texas ScholarWorks (Texas Digital Library)
Takahashi, N. Y. (2016) · eScholarship (California Digital Library) · Cited by 1
Batista, M. P. P., Paro, D., Guimarães, S., & Vieira, T. (2009)
Economic Burdens and Access to Care Barriers for the Older Cancer Patient
Ramsey, S. D., Scoggins, J. F., & Shankaran, V. (2012) · Elsevier eBooks · doi:10.1016/b978-1-4377-1398-5.10030-x
Psychological Health of Older Women in Hong Kong: Do Demographic Characteristics Make a Difference?
Boey, K. W., & Ng, A. H. N. (2017) · Women’s Health Bulletin · doi:10.5812/whb.45104
Thomeer, M. B., & Umberson, D. (2021) · Springer eBooks · doi:10.1007/978-3-319-69909-7_3238-2
Wakefield, J. C., Horwitz, A. V., & Parot, F. (2010) · Mardaga eBooks · doi:10.3917/mard.horwi.2010.01.0323
Zech, E. (2006) · Mardaga eBooks · doi:10.3917/mard.zech.2006.01.0237
The Impact of Productive Engagement on BMI Classification in Middle Age and Later Life
Curl, A. (2021) · Journal of Mental Health and Social Behaviour · doi:10.33790/jmhsb1100131
Clark, J., Kinchin, I., Kochovska, S., Johnson, M. J., & Currow, D. C. (2023) · Journal of Palliative Medicine · doi:10.1089/jpm.2022.0498
Thomeer, M. B., & Umberson, D. (2023) · Springer eBooks · doi:10.1007/978-3-031-17299-1_3238
The biological consequences of grandparental death for children: An analysis of telomere length
Livings, M. S., Smith‐Greenaway, E., Wagner, B., & Verdery, A. M. (2025) · SSM - Population Health · doi:10.1016/j.ssmph.2025.101843
L’accompagnement de la personne en fin de vie et le deuil
Dumont, I., & Dumont, S. (2025) · Cahiers francophones de soins palliatifs · doi:10.7202/1119885ar
Yang, M., Collier, N., Rigdon, J., & Hugenschmidt, C. E. (2025) · Alzheimer s & Dementia Translational Research & Clinical Interventions · doi:10.1002/trc2.70159
Correlates of prolonged grief symptoms after bereavement in a Turkish population-based sample
Erel, S., Topuz, A. G., Alpay, E. H., & Tüfekci, H. (2025) · Death Studies · doi:10.1080/07481187.2025.2604572
Seiler, A., Amann, M., Hertler, C., Christ, S. M., Schettle, M., Kaeppeli, B. M., Jung-Amstutz, J., Nigg, C., Pestalozzi, B. C., Imesch, P., et al. (2024) · Figshare · doi:10.6084/m9.figshare.25414884
Seiler, A., Amann, M., Hertler, C., Christ, S. M., Schettle, M., Kaeppeli, B. M., Jung-Amstutz, J., Nigg, C., Pestalozzi, B. C., Imesch, P., et al. (2024) · Figshare · doi:10.6084/m9.figshare.25414977
Post-Intensive Care Syndrome – Family
Shin, J. W., & Tate, J. A. (2026) · Cambridge University Press eBooks · doi:10.1017/9781009501477.049
Derr, A. S., & Schandelmeier, E. (2026) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228261478337
Ahronheim, J. C., Huang, Z., Yen, V., Davitt, C., & Barile, D. (2011) · Cambridge University Press eBooks · doi:10.1017/cbo9780511663499.007
Metadata
- 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)
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2001-06-27
- Volume
- 285
- Issue
- 24
- Pages
- 3123
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- 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 › Nursing › Research and Theory › 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
