Sleep in spousally bereaved elders with subsyndromal depressive symptoms

Pasternak, Rona E.; Reynolds, Charles F.; Hoch, Carolyn C.; Buysse, DJ; Schlernitzauer, Maryann; Machen, Maryann; Kupfer, David J.

doi:10.1016/0165-1781(92)90140-x

Cited by 33 publications

(30 citation statements)

References 22 publications

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“…Two criteria sets have been proposed for this condition (Horowitz, Siegel, Holen, Bonanno, Milbrath, & Stinson, 1997;Prigerson, Frank, et al, 1995), and neither includes sleep disturbance. Nevertheless, sleep has been found to be disrupted following bereavement (Allaert & Urbinelli, 2004;Hardison et al, 2005;McDermott et al, 1997;Parkes, 1970;Parkes & Brown, 1972;Pasternak et al, 1992;Reynolds et al, 1992;Reynolds et al, 1993), and we have previously documented significant sleep disturbance among individuals participating in this CGT study (Germain et al, 2005). The findings reported here extend these observations to show that CGT responders show statistically significant, albeit modest, sleep improvements posttreatment.…”

Section: Discussionsupporting

confidence: 77%

Treating Complicated Grief: Effects on Sleep Quality

Germain¹,

Shear²,

Monk³

et al. 2006

Behavioral Sleep Medicine

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Complicated grief (CG) is characterized by recurrent distressing emotions and intrusive thoughts related to the loss of a loved one and avoidance of reminders of the deceased. Poor sleep quality characterizes CG. Cognitive-behavioral therapy and interpersonal psychotherapy reduce CG symptom severity. The effect of these treatments on sleep quality is not known, however. We investigated whether complicated grief treatments (CGTs) improve sleep quality, as assessed by the Pittsburgh Sleep Quality Index. Data collected from 95 adults who participated in a randomized controlled trial were reviewed. Poor sleep quality persisted despite clinically significant improvements in CG severity posttreatment. Given that sleep disturbance is a risk factor for poor health outcomes, adjunctive sleep interventions may be necessary to enhance CGT outcomes.

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Section: Discussionsupporting

confidence: 77%

Treating Complicated Grief: Effects on Sleep Quality

Germain¹,

Shear²,

Monk³

et al. 2006

Behavioral Sleep Medicine

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“…Thus, while the amount of actual sleep obtained by a bereaved senior is indeed related to grief from the loss event, it would appear that by >4 months postloss, the architecture of the sleep stages would seem to be relatively normal. This is in line with the findings of Pasternak et al (1992), who also reported no correlation between PSG sleep stage measures and time since loss in subsyndromally depressed widow(er)s. Such effects have been found, however, when analyses are limited to those formally diagnosed with MDD .…”

Section: Discussionsupporting

confidence: 91%

“…Although sleep disturbance is particularly prevalent in the depressed bereaved, even bereaved persons who fail to meet a formal diagnosis of depression have measurable sleep impairment. When a group of spousally bereaved seniors with sub-syndromal symptoms of depression were compared with an age-and gender-matched control group, all of the bereaved subjects scored ≥5 on the Pittsburgh Sleep Quality Index (PSQI), compared to only 4 of the 14 control subjects (Pasternak et al, 1992). More recent, large-scale, epidemiological studies in both Japan (Doi et al, 2000) and Sweden (Valdimarsdottir et al, 2003) have reported that being widowed increases the risk of sleep disorders by up to 90%.…”

Section: Introductionmentioning

confidence: 99%

Sleep and Circadian Rhythms in Spousally Bereaved Seniors

Monk

Begley

Billy

et al. 2008

Chronobiology International

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A laboratory study of sleep and circadian rhythms was undertaken in 28 spousally bereaved seniors (≥60 yrs) at least four months after the loss event. Measures taken included two nights of polysomnography (second night used), ∼36 h of continuous core body temperature monitoring, and four assessments of mood and alertness throughout a day. Preceding the laboratory study, two-week diaries were completed, allowing the assessment of lifestyle regularity using the 17-item Social Rhythm Metric (SRM) and the timing of sleep using the Pittsburgh Sleep Diary (PghSD). Also completed were questionnaires assessing level of grief (Texas Revised Inventory of Grief [TRIG] and Index of Complicated Grief [ICG]), subjective sleep quality (Pittsburgh Sleep Quality Index [PSQI]), morningness-eveningness (Composite Scale of Morningness [CSM]), and clinical interview yielding a Hamilton Depression Rating Scale (HDRS) score. Grief was still present, as indicated by an average TRIG score of about 60. On average, the bereaved seniors habitually slept between ∼23:00 and ∼06:40 h, achieving ∼6 h of sleep with a sleep efficiency of ∼80%. They took about 30 min to fall asleep, and had their first REM episode after 75 min. About 20% of their sleep was in Stage REM, and about 3% in Stages 3 or 4 (slow wave sleep). Their mean PSQI score was 6.4. Their circadian temperature rhythms showed the usual classic shape with a trough at ∼01:00 h, a fairly steep rise through the morning hours, and a more gradual rise to mid-evening, with an amplitude of ∼0.8°C. In terms of lifestyle regularity, the mean regularity (SRM) score was 3.65 (slightly lower than that usually seen in seniors). Mood and alertness showed time-of-day variation with peak alertness in the late morning and peak mood in the afternoon. Correlations between outcome sleep/ circadian variables and level of grief (TRIG score) were calculated; there was a slight trend for higher grief to be associated with less time spent asleep (p = 0.07) and reduced alertness at 20:00 h (p = 0.05). Depression score was not correlated with TRIG score (p > 0.20). When subjects were divided into groups by the nature of their late spouse's death (expected/after a long-term chronic illness [n = 18] versus unexpected [n = 10]), no differences emerged in any of the variables. In conclusion, when studied at least four months after the loss event, there appears to be some sleep disruption in spousally bereaved seniors. However, this disruption does not appear to be due to bereavement-related disruptions in the circadian system.

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“…Six studies found that sleep quality declined following bereavement, and two found no change. Pasternak et al (1992) found that subjective sleep quality (prolonged sleep latency, daytime dysfunction) was worse among bereaved elders during the first 6 months postloss compared to controls. However, no significant differences in objective measures of sleep (EEG) emerged, except among bereaved elders with subsyndromal depression symptoms.…”

Section: Resultsmentioning

confidence: 89%

“…The most common instrument used to measure sleep was the Pittsburgh Sleep Quality Index (PSQI) (Buysse et al, 1989), which evaluates sleep quality along seven dimensions (self-reported sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction). Objective estimates of sleep were assessed in several studies by conducting overnight laboratory sleep assessments using polysomnography and electroencephalographic (EEG) evaluations (Anderson, 1999; Pasternak et al, 1992; Reynolds et al, 1992; Reynolds et al, 1993); two studies used actigraphy to monitor rest/activity cycles (Monk et al, 2009; Okun et al, 2011). …”

Section: Resultsmentioning

confidence: 99%

Changes in Routine Health Behaviors Following Late-life Bereavement: A Systematic Review

Stahl

Schulz

2013

J Behav Med

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This systematic review examines the relationship between late-life spousal bereavement and changes in routine health behaviors. We review six behavioral domains/modifiable risk factors that are important for maintaining health among elderly populations: physical activity, nutrition, sleep quality, alcohol consumption, tobacco use, and body weight status. Thirty-four articles were identified, derived from 32 studies. We found strong evidence for a relationship between bereavement and nutritional risk and involuntary weight loss, and moderate evidence for impaired sleep quality and increased alcohol consumption. There was mixed evidence for a relationship between bereavement and physical activity. We identify several methodological shortcomings, and describe the clinical implications of this review for the development of preventive intervention strategies.

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Sleep in spousally bereaved elders with subsyndromal depressive symptoms

Cited by 33 publications

References 22 publications

Treating Complicated Grief: Effects on Sleep Quality

Treating Complicated Grief: Effects on Sleep Quality

Sleep and Circadian Rhythms in Spousally Bereaved Seniors

Changes in Routine Health Behaviors Following Late-life Bereavement: A Systematic Review

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