Widowhood: The First Anniversary Spousal BereavementRelated Stress, Coping and WellBeing in Older Wo

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Widowhood The First Anniversary Spousal
Bereavement-Related Stress, Coping and Well-Being
in Older Women

• Mary E. Minton, PhD, RN
• South Dakota State University
• College of Nursing

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Acknowledgements

• Sigma Theta Tau Zeta Zeta and Phi Chapter
• Dr. Jeffrey French Primate
  Laboratory
• Widows in the Study

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We are healed of a suffering only by experiencing
it to the full
Marcel Proust
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Background

• 13 million widowed people in the United States
  10 million are older adults 80 are women
  (Fields Casper, 2001).
• 43 of women over 65 years of age were widows in
  2003,
• 8.2 million widows as opposed to 2.0 million
  widowers
• 49.9 women live alone by age 75 (Greenberg,
  2005).
• Spousal bereavement Normative, stressful life
  transition with biopsychosocial changes,
  lifestyle adaptations and role challenges for the
  older woman (Zettel Rook, 2004).

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Review of the Literature

• Spousal Bereavement Individual, multifaceted
  process
• (Lev McCorkle, 1998).
• Bereavement process Cognitive appraisals, coping
  and emotional involvement, personal and
  environmental resources, health implications,
  poignant reminders of the deceased (Hall Irwin,
  2001 Lazarus, 1991 Schaeffer Moos, 2001).
• Limited research regarding the first anniversary
  of spousal death (Anderson Dimond, 1995).

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Purpose of the Study

• Examine spousal bereavement-related stress,
  coping with spousal bereavement-related stress,
  and well-being in widows 65 years of age and
  older at three points in time, starting at month
  11 and continuing through month 13 following the
  death of the spouse.

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Primary Aim

• Determine relationships among
• personal (optimism) and environmental (social
  network)
• resources,
• spousal bereavement-related stress (salivary
  cortisol, intrusion-avoidance),
• coping with spousal bereavement-related stress
  (spiritual, social support), and well-being
  (spiritual, psychosocial, physical)
• in widows 65 years of age and older during
  the first year anniversary of spousal death,
  starting at month 11 and continuing through month
  13 following the death.

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Aim 1 Hypotheses

• H 1A Personal resources will be negatively
  related to spousal bereavement-related stress of
  the first anniversary and positively related to
  coping and well-being.
• H 1B Environmental resources will be negatively
  related to spousal bereavement-related stress of
  the first anniversary and positively related to
  coping and well-being.
• H 2 Spousal bereavement-related stress will be
  positively correlated with coping.
• H 3 Coping with spousal bereavement-related
  stress will be positively correlated with
  well-being.

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Secondary Aim

• Determine if there are differences in
• spousal bereavement-related stress (salivary
  cortisol, intrusion-avoidance),
• coping with spousal bereavement-related stress
  (spiritual, social support), and
• well-being (spiritual, psychosocial, physical)
• in widows 65 years of age and older across three
  time periods, i.e., 11 through 13 months
  following the death of the spouse.

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Aim 2 Hypotheses

• H 4 Spousal bereavement-related stress will be
  higher at the 12th month when compared to the
  11th and 13th months following the death of the
  spouse.
• H 5 Coping with spousal bereavement-related
  stress will differ at the 12th month when
  compared to the 11th and 13th months following
  the death of the spouse.
• H 6 Well-being will be lower at the 12th month
  when compared to the 11th and 13th months
  following the death of the spouse.

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First Anniversary of Spousal Bereavement
Conceptual Framework
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Methods

• Design Prospective, correlational, longitudinal
• Setting Rapid City and surrounding area within a
  150 mile geographical radius
• Sample Self-selected convenience sample of 47
  widows age 65 and older
• Recruitment Newspaper obituaries, flyers,
  community referrals

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Eligibility Criteria

• Inclusion Criteria
• Women 65 years of age and older
• Read and write English
• Death of the spouse had occurred 10 months prior
  to entrance into study
• Resided in a private residence or independent
  retirement setting
• Lived in Rapid City, SD or within a 150 mile
  radius
• Had access to a telephone
• Cognitive competence

• Exclusion Criteria
• Remarriage
• Currently taking steroid medication
• In terminal stages of an illness

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Instruments

• Personal Resource
• Optimism- Life Orientation Test-Revised
  (LOT-R)
• Environmental Resource
• Social Network- Lubben Social Network
  Scale (LSNS)
• Spousal Bereavement-Related Stress
• Physiological Salivary Cortisol 3
  consecutive days,
• 
  morning/evening samples
• Psychological Intrusion-Avoidance-
  Impact of Event Scale (IES)

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Instruments

• Coping with Spousal Bereavement-Related Stress
• Spiritual Coping Religious Coping
  Activities Scale
• 
  (RCAS-Spiritual Activities Subscale)
• Social Support Coping Personal Resource
  Questionnaire
• 
  (PRQ85/2000)
• Well-Being
• Spiritual Well-Being Spiritual
  Well-Being Scale (SWBS)
• Psychosocial Well-Being Life
  Satisfaction Index-A (LSI-A)
• Physical Well-Being Self-Rated Health
  (SRH)

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Additional Information

• Demographic Data
• Salivary Cortisol Diary
• Anniversary Activity

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Data Collection Schedule

• Month 11 Month 12
  Month 13
• Demographic Data
• Questionnaire Packet Questionnaire
  Packet Questionnaire Packet
• 6 Saliva Samples 6 Saliva
  Samples 6 Saliva Samples

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Procedure

• Saliva samples
• Salivettes
• Freezer stored
• Overnight dry iced to Omaha
• EIA Dr. Jeff French, UNO
• Questionnaire Packets
• All handled via mail
• Nurse researcher visits
• Month 11 and Month 13

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Cortisol Biomarker for Stress in Adults

• REGULATED
• Healthy individuals Morning high/evening low
• Healthy individuals Flat cycles (10-15)
• DISREGULATED Aberrant Diurnal Rhythms
• Women with Breast Cancer Levels consistently
  high or fluctuations erratic
• rhythms associated with prognostic
• indicators and marital status

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Aberrant Diurnal Rhythms (contd)

• Depression
• Unemployment
• PTSD
• Chronic Stress
• Elderly
• Bereavement

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Saliva Sampling in the Adult

• Salivettes (Sarstedt, Inc)
• Convenient
• Price 50/box of 100
• Mail safe
• Sample in upright position
• Nothing to drink 5 minutes before
• No eating or smoking 30 minutes before
• Chew 1-2 minutes
• Room temp 7 days
• Freeze

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Sampling Considerations

• Daily samples
• Variable depending on study purpose
• provoked or unprovoked stress
• Range 2-6 samples daily
• Number of days

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Analysis Considerations

• EIA University of Nebraska-Omaha
• Dr. Jeff French
• Area under the curve value
• Daily mean (average of all daily samples)
• Mean of morning samples
• Mean of evening samples
• Diurnal slope

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Demographics N47
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Analysis

• Salivary Cortisol
• Monthly average of morning samples
• Monthly average of evening samples
• Monthly Area under the Curve (AUC12)
• Instrument Scores
• LOT-R, LSNS, IES, RCAS, PRQ2000, SWBS,
  LSI-A, SRH
• Content Analysis
• Salivary Cortisol Diary
• Anniversary Activity

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H 1A Optimism will be inversely related with
Bereavement-Related Stress

• Hypothesis partially supported

p .05 (two-sided) p .01 (two-sided)
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H 1A Optimism will be positively related with
Coping and Well-Being

• Hypothesis partially supported

p .05 (two-sided) p .01 (two-sided)
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H 1B Social Network will be inversely related
with Bereavement-Related Stress

• Hypothesis partially supported

p .05 (two-sided) p .01 (two-sided)
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H 1B Social Network will be positively related
with Coping and Well-being

• Hypothesis partially supported

p .05 (two-sided) p .01 (two-sided)
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H 2 Spousal Bereavement-Related Stress will
be positively related with Coping

• Hypothesis not supported

p .05 (two-sided) p .01 (two-sided)
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H 3 Coping will be positively related
with Well-Being

• Hypothesis partially supported

p .05 (two-sided) p .01 (two-sided)
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H 3 Coping will be positively related
with Well-Being

• Hypothesis partially supported

p .05 (two-sided) p .01 (two-sided)
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H 4 Bereavement-Related Stress will be
higher at Month 12 when compared to
Month 11 and 13

• Psychological Stress (IES) higher for month 12
  vs. month 13
• t(43) 2.54,
  p .015
• Hypothesis partially supported

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H 5 Bereavement-Related Coping will differ
at month 12 when compared to Month 11 and
13

• Hypothesis not supported

H 6 Well-Being will be lower at Month 12
when compared to Month 11 and 13

• Hypothesis not supported

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Preliminary Summary

• 1. Hypotheses 2, 5, 6 not supported
• 2. Hypotheses 1A, 1B, 3, and 4 partially
  supported
• 3. Variables with significant relationships at
  all three months
• Optimism with Bereavement-Related Psychological
  Stress
• Optimism with Well-Being
• Social Network with Social Support Coping
• Spiritual Coping with Spiritual Well-Being

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Descriptive Data PRQ85

• Consistent Support Choices
• Children
• Relative Exception with financial advice
• Friend Urgent needs, Advice, Loneliness,
  Sickness, Talking, Work-related problem
• Satisfaction with Received Support
• 50 or greater satisfaction reported for all
  support issues
• except help caring for sick family and
  needed advice

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Descriptive Data Salivary Cortisol Diary

• 
  Frequency (n)
• Stress Categories
  Mo 11 Mo 12 Mo 13_
• Daily life 2
  4 5
• Death
  2 17 4
• Health
  15 5 5
  
• Holidays 3 1 2
  
• Household 9
  7 10
• Study-Related
  3 1 3
• War
  1 1
• Weather
  1 1 1

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Descriptive Data Anniversary Activity

• Remembrance Activity Frequency (n)
• Religious/Memorial 11
  
• Communicating with Others 10
  
• Communicating with Husband 11
• Grave-Related 16
  
• Personal Care 3

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Limitations of the Study

• 1. Sample
• Size
• Ethnic homogeneity
• Self-selected, convenience sample
• 2. Length of study
• 3. Number of daily cortisol samples

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Implications
There are years that ask questions and years
that answer
Zora Neale Hurston
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Implications Optimism

• Optimism with Stress and Well-Being
• Assess early in bereavement process
• Assess risk for those who are less optimistic
• Contrast with widower sample
• Optimism with Coping
• Further examine social support coping spiritual
  coping
• Examine other types of coping in relationship
  with optimism
• Assess throughout the bereavement process

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Implications Stress

• Bereavement-Related Psychological Stress
• Intrusive-avoidant thought patterns
• Differentiate age-related stress
• Stress appraisal Loss, threat, challenge
• Combine quantitative and qualitative methodology
• Identify presence of stress
• Clarify the source of stress
• Determine effectiveness of coping
  strategies

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Implications Social Support

• Social Support Components and Change
• Network composition
• Network burden
• Support needs Informational, Emotional,
  Instrumental
• Reciprocity

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