Short Educational Series #1; The Widowhood Effect

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If you have experienced the death of your loved one, you might/might not have gone through all the five components of grief described by Elisabeth Kubler-Ross. Nowadays, on the internet, if you try to search through this area of psychology, you would find hundreds of articles which have been written to describe the events that might take place at each stage. Some might really illustrate what you've been through and some are not. You might even stumble upon articles which were published to prove the errors in the model proposed for grieving. The truth is, not every single thing will abide by specific laws described by any individual even with a meticulous research or so especially when it involves the human emotions. Grief, for example, is a complicated reaction towards any bad news received by a perceived individual which vary between people.

Originally, this concept was introduced to give an explanation and exposure to a clinician regarding a series of responses when a patient trying to accept the fact that they are being diagnosed with terminal diseases i.e cancer. It was never intended for people who have just lost their loved one by means of death but after a considerable amount of times, people realised that both of this situations started to resemble each other. People who lost someone they love would undergo the 5 stages which have been described by Kubler-Ross:

• Denial
• Anger
• Bargaining
• Depression
• Acceptance

In some medical schools if not all of them, grief is a subject which is being incorporated into the curriculum to educate people who are going to be doctors. However, the subject was taught superficially without being given much attention by lecturers thus, students were often deprived of an in-depth discussion regarding the topic which makes it difficult for them to deal with patients who experiencing grief later on. Of course, clinical experience is different from theoretical knowledge but one might say that people who don't have adequate knowledge regarding a specific subject were guaranteed to perform poorly.

The Widowhood Effect

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People usually underestimate the significance of social relations in our everyday life. We may have taken this luxury for granted without knowing its impact towards our general health. Among all others, the widowhood effect is one of the most profound examples which prove that social relations were not only needed for keeping us healthy, emotionally.

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The widowhood effect described a long observed phenomenon whereby there is an increased mortality among individuals who lose their spouses as a consequence of bereavement

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This effect was found to affect men more than women and young adult more than an elderly. Multiple studies conducted in the past has proved that this effect was profound within six months following the death of a spouse. In some literature, however, the mortality rate among widows was found to increase significantly within 3 months after their spouses' death. The surviving spouses are more likely to be diagnosed with chronic diseases, experienced worsening of existing medical conditions and involved in an unexpected incidence within that critical period.

If people who are grieving for their spouses were to have a significant increase in the rate of mortality, then ideally, we should monitor them strictly for the first 3-6 months. However, realistically, people it is difficult to monitor people who are grieving especially for the first three months or so. People want to be left alone for a specific duration to mourn for the death of their loved one and in that particular situation, anything can potentially happen. Despite rigorous research being carried out in the past, there is no known mechanism which could explain the increased mortality rate among widows. It can be due to anything which includes:

• Anxiety
• Depression
• Existing medical condition
• Suicide

In a longitudinal study conducted in 1995, the increased in mortality rate among elderly widows were found to vary between 30-90% within the first three months following their spouses' death. After the critical duration, the rate of mortality plummeted to 15% which suggest a causal link between the duration of the death of the loved one with the mortality rate of the surviving spouses. What about the cause of deaths of the surviving spouses? Well, in a study conducted by Felix Elwert in 2008, he found that elderly surviving spouses have an increased rate of developing certain kind of cancers particularly lung and colon. He also concludes that there is an increased incidence of vascular diseases in both genders following the death of their loved one. This phenomenon cannot be explained yet. I mean how do we know the exact reason why people who are having an emotional response towards the death of their loved one being diagnosed with lung or colon cancer.

There are around 380,000 elderly couples who have been included in the study conducted by Elwert which end up with the death of 317,000 elderly couples. The cause of grieves vary between genders; men are usually affected by the cause of the death of their spouses which include terminal illnesses and motor vehicle accident while women were affected by the death of their spouses (doesn't matter what the cause is).

It is important for us to encourage widows to be more actively involved in the community during the first 3 months period. There are a lot of things that can be provided by the community which include social support groups, an activity which focused on the overall individual health (health and non-health related) etc.

Sources:

• ZISOOK, S., & SHEAR, K. (2009). Grief and bereavement: what psychiatrists need to know. World Psychiatry, 8(2), 67–74.
• Elwert, F., & Christakis, N. A. (2008). Variation in the Effect of Widowhood on Mortality by the Causes of Death of Both Spouses. American Journal of Public Health, 98(11), 2092.
• Helsing KJ, Comstock GW, Szklo M. Causes of death in a widowed population. Am J Epidemiol 1982;116:524–532