1. The Illness of Grief The death of a spouse is considered one of the most distressing, yet most common, transitions faced by older persons. The majority of research focuses on the short-term emotional reactions – most often referred to as grief or bereavement. In addition to the intense emotional responses associated with loss, widowed persons often report a variety of physical symptoms such as fatigue, insomnia, pain, gastrointestinal symptoms, chest pressure, palpitations, stomach pains, backaches, panic attacks, or increased anxiety. Although a large body of literature has documented the health benefits associated with marriage, and although many have anecdotally suggested that widowed persons might be at increased risk for mortality due to a “broken heart,” few empirical studies have documented how health behaviors and health outcomes change following the loss of a spouse, or how the grief response may be heightened or minimized as a result of one’s physical health. This study documents the physical health outcomes, symptoms, and health behaviors of older persons who have recently lost their spouse. In addition, it documents whether physical health might impact one’s ability to grieve or cope with the loss. Research has suggested that those with worse physical health may experience prolonged, heightened, or traumatic grief, given their reduced physical capacity to cope with the intense emotional loss. Program funded by National Institute on Aging Grant #R01 AG023090 No relationships to disclose This analysis was motivated by an assumption that if a person does not have good physical health or is physically run down, it will be more difficult for him or her to psychologically cope with the loss. Thus, the more physically ill or feeble one is at the start of widowhood, the more difficult his or her grief recovery might be. These findings document substantial changes in physical health and health behaviors that appear to be fairly common among recently widowed persons. As well, they have confirmed a consistent and strong correlation between poor physical health and impaired psychological well-being. However, we did not find support for the overarching and motivating hypothesis that poor health may exacerbate one’s ability to cope with the loss, thus sustaining a higher or heightened level of grief. Instead, the process or longitudinal trajectory of grief appears to be fairly universal across persons. Our data suggest that those with poorer physical health may have initially higher grief levels and maintain that higher level of grief up to 16 months post-loss compared to those with better physical health, but the gradual decline in grief over time is the same for all persons regardless of whether they are in good or bad health. Ideally, we would have been able to model similar longitudinal processes of adjustment for physical health outcomes – that is, whether unusually high levels of grief exacerbate the grief or bereavement experience of older widowed persons. Unfortunately, the longitudinal change in in physical health was minimal in this sample (< 5% change in self-rated health variable over time), so did not permit us to explore whether particularly high levels of grief set off worse physical health profiles among older widowed persons. That is, we were unable to test whether the grieving spouse might suffer physically from a broken heart with these data. Together, these results remind us that grief often entails an acute physical reaction, as well as an intense emotional reaction. Fortunately, both the physical and psychological disruptions appear to dissipate over time for most, but unfortunately, neither disappear completely. BackgroundConclusion Rebecca Utz 1, Srichand Jasti 2, Michael Caserta 3, Dale Lund 4, Brian de Vries 5 1 Sociology, University of Utah 2 Duke University 3 Gerontology, University of Utah 4 Sociology, California State University San Bernardino 5 San Francisco State University Analysis 3: Correlation of Mental & Physical Health Analysis 1: Changes in Physical Health from 2 to 16 Months Post-Loss Analysis 4 : The Effect of Physical Health on the Process of Grief Physical Health Mental Health Months Bereaved Four separate analyses were explored: Analysis 1 – How does physical health change over the course of bereavement (up to 16 months)? Analysis 2 – How does mental health change over the course of bereavement (up to 16 months)? Analysis 3 – Are physical and mental health correlated over the course of bereavement? Analysis 4 – How does physical health affect the process of grief? Analysis 2: Changes in Mental Health Among Recently Bereaved Repeated measures ANOVA were used to assess within-factor changes for each variable, * p<.05, ** p<.01, p<.001. + indicates an increase in symptoms, - indicates a decrease in symptoms over time Summary of Findings General health decreased over time although the decrease is very small and probably not clinically relevant (5.2 to 5.0). Over the course of bereavement, prescription drug use increased, while over the counter medication usage decreased. The number of meals eaten per day increased while alcohol and substance abuse remained very infrequent among widowed persons. Physical activity did not change over time. Some physical health symptoms increased over time : joint pain and bladder/urinary problems. These increases are likely a result of normal aging. Some physical health symptoms decreased over time: sleep problems, fatigue, problems concentration, loss of appetite, rapid heart beat, chest pain. These decreases are perhaps indicative of fewer physical manifestations of bereavement over time. Repeated measures ANOVA were used to assess within-factor changes for each variable, * p<.05, ** p<.01, p<.001. Summary of Findings All three measures of mental health decreased, suggesting that there is a general improvement in psychological well being over time The longitudinal change in grief was best fit to a quadratic growth model equation (rather than linear), suggesting that the relief in negative feelings decelerates over time. The figure here presents the unconditional changes in grief with no covariates. Conditional models were estimated, revealing the same robust quadratic trajectory over time, and also finding the following similarities & differences by subgroups: Sex: No differences in intercept or slope Age: Initial grief levels are higher among younger persons, but the longitudinal trajectory follows same pattern regardless of age Race: Whites and non-whites have similar initial levels of grief, but whites decline less over time than non-whites. Education: No differences in intercept or slope Income: those with lower financial resources had higher levels of initial grief, but the trajectory of grief did not differ between financial status groups Study Design: no effects attributable to the LAL study design Summary of Findings There was a consistent relationship between poor physical health and worse mental health outcomes All three measures of psychological wellbeing were most strongly associated with the self-assessed measurement of global health The strength of the association between self- rated health and grief attenuated over time Pearson Correlation values (r) presented in table; * p<.05, ** p<.01, p<.001. Measures: Physical Health was assessed with a self-report scale of global health, measured on a likert scale ranging from 1 poor health and 7 excellent health. Additional self-report measures of physical symptoms and health behaviors were also explored. Mental Health was measured primarily with the Texas Revised Inventory of Grief (TRIG), a 13-item index with a range of 13 to 65. We also explored the Geriatric Depression Scale and the UCLA Loneliness Scale as additional mental health outcomes. Higher numbers indicate higher levels of grief, depression, and loneliness. Covariates: All multivariate models control for gender, age, race, financial status, education, site (San Francisco or Salt Lake City), and study condition. Analytic Plan: We used repeated measures ANOVA to characterize descriptive changes in physical and mental health among a bereaved sample from approximately 3 months to 16 months post-loss. We used multivariate growth modeling techniques to estimate the longitudinal trajectory of grief, while controlling for the covariates that may confound the relationship between physical & mental health. We then assessed whether the trajectories of grief differed by those with better and worse physical health. Methods Data: Data come from the Living After Loss (LAL) project, a study that followed 328 bereaved spouses and partners over the age of 50 from two months up to 16 months post-loss. Recently bereaved spouses from two cities in the western United States were identified through local obituaries and a random sample of county-maintained vital records. Participants completed an initial questionnaire at approximately three months following the spouse’s death, and then three follow-up questionnaires at approximately six months, nine months, and 15 months post- loss (February 2005 and June 2009). Summary of Findings The significant negative effect associated with physical health indicates that those with better physical health assessments had lower levels of grief. The magnitude of this effect is strongest for the baseline measurement, as opposed to the time-varying assessment of health, suggesting that the relationship between physical health and psychological well-being is strongest during the earliest months of bereavement The non-significant effects associated with the interaction of health*time indicates that the process of grief, or the longitudinal trajectory of grief over time, did not differ by one’s health status These findings remain constant after controlling for covariates, and regardless of whether physical health is measured at baseline or as a time-varying characteristic Months Bereaved Grief Score (13-65)