The association of time since spousal loss and depression in widowhood: a systematic review and meta-analysis

Kristiansen, Christina Blanner; Kjær, Jesper; Hjorth, Peter; Andersen, Kjeld; Prina, Matthew

doi:10.1007/s00127-019-01680-3

Cited by 41 publications

(33 citation statements)

References 56 publications

(123 reference statements)

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“…Differently, however, only experiences of death and losses were associated with a high level of maternal self-reported depressive symptoms when the infant was six months, but they continued to increase depressiveness also at 18 months. The trauma-specificity concurs with research linking severe losses to depression (Busch, 2009), although empirical studies are mainly available on loss of parents in childhood predicting depression later in life (Simbi et al., 2019) and complex grief leading to depression among widows (Kristiansen et al., 2019).…”

Section: Discussionsupporting

confidence: 55%

The role of maternal attachment in mental health and dyadic relationships in war trauma

Punamäki

Qouta

Diab

2019

Heliyon

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Background: Infant care is a demanding task in dangerous war conditions, but research on the wellbeing of mother-infant dyads is mainly available in peaceful conditions. Knowledge on protective versus risking processes is especially vital for tailoring effective help, and the present study proposes the maternal attachment style to play an important role in dangerous war conditions. Objective: The study analyses, first, how various traumatic war events, such as losses, horrors and life-threat, are associated with maternal mental health and dyadic mother-infant interaction quality, indicated by maternal emotional availability (EA). Second, it tests a hypothesis that maternal insecure attachment risks and secure attachment protects good mental health and optimal EA from negative impacts of traumatic war events. Method: The prospective three-wave study involved 502 Palestinian mothers, who were pregnant during the 2014 War on Gaza, and participated at delivery (T1), and when the infant was seven (T2; N ¼ 392) and eighteen (T3; N ¼ 386) months. Mothers reported about war events at T1 and T2 (death and losses, witnessing horrors and lifethreat), and posttraumatic stress disorder (PTSD) and depression symptoms at T2 and T3. Dyadic interaction quality was assessed by mother-perceived emotional availability (EA) scale at T2 and T3, and attachment styles by mothers' self-reports at T3. Results: Death and losses, witnessing horrors, and life-threat were all associated with a high level of maternal PTSD, but only at T2, whereas death and losses were associated with her depressive symptoms both at T2 and T3. Witnessing horrors was associated with a low close and positive and a high distant and negative emotional availability at T2 and T3. As hypothesized, maternal avoidant attachment was associated with a low level of close and positive EA in general, and especially when the dyads were exposed to a high level of traumatic war events, thus indicating a risking function. Against the hypothesis, secure attachment did not show any protective function on emotional availability, while, unexpectedly, maternal preoccupied attachment was associated with close and positive emotional availability, when dyads were exposed to a high level of traumatic war events. Conclusion: Mothering in conditions of war and military violence is an overwhelmingly demanding task, and mother-infant dyads need legal, social, and psychological assistance. Knowledge and reflection of unique responses and meanings of different attachment styles would be fruitful in tailoring effective help.

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Section: Discussionsupporting

confidence: 55%

The role of maternal attachment in mental health and dyadic relationships in war trauma

Punamäki

Qouta

Diab

2019

Heliyon

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“…Epidemiology and Psychiatric Sciences (Kristiansen et al, 2019a(Kristiansen et al, , 2019b, a possible target for preventive interventions in terms of mortality in widowhood could be depression and consequently suicide in widowed people.…”

Section: Widowedmentioning

confidence: 99%

“…Reduced self-care, increased risk behaviour and an increased risk of suicide have been associated with depression (Hawton and van Heeringen, 2009;Einio and Martikainen, 2019). As the prevalence of depression is high in widowed people (Kristiansen et al, 2019a(Kristiansen et al, , 2019b), this could be a possible explanation for some of the excess mortality in widowhood, and depression could thus be a relevant target for preventive interventions in the future. However, to be able to design and aim relevant interventions, more knowledge of causes of death, also in the oldest old, is needed, in order to understand the pathways into the increased mortality in widowhood.…”

Section: Introductionmentioning

confidence: 99%

Widowhood and mortality: a Danish nationwide register-based cohort study

Blanner

Mejldal

Prina

et al. 2020

Epidemiol Psychiatr Sci

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Aims Widowed people have increased mortality compared to married people of the same age. Although most widowed people are of older age, few studies include the oldest old. As life expectancy is increasing, knowledge of widowhood into older age is needed. This study aimed to examine mortality and widowhood in older age by comparing mortality in widowed and married people by sex, age, time since spousal loss and cause of death. Methods A Danish register-based matched cohort study of 10% of widowed persons ⩾65 years in the years 2000–2009. For each randomly drawn widowed person, five married persons were matched on sex and age. Mortality rate ratios (MRR) were calculated using Poisson regression, and stratified according to sex and 5-year age intervals. MRRs were furthermore calculated by time since spousal loss and by specific cause of death. Results The study included 82 130 persons contributing with 642 914.8 person-years. The overall MRR between widowed and married persons with up to 16 years of follow-up was 1.25 (95% CI 1.23–1.28). At age ⩾95 years for men, and ⩾90 years for women, no differences in mortality rates were seen between widowed and married persons. Mortality in widowed persons was increased for most specific causes of death, with the highest MRR from external causes (MRR 1.53 [1.35–1.74]) and endocrine diseases (MRR 1.51 [1.34–1.70]). Conclusions Widowhood was associated with increased mortality in older age for both men and women until age ⩾95 and ⩾90 years, respectively. Increased mortality was observed for almost all causes of death.

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“…The primary investigator was a medical doctor (MD) and PhD student working within the field of psychiatry. The primary investigator had concurrent with the present study examined common mental disorders (Kristiansen et al, 2019a(Kristiansen et al, , 2019b and mortality in widowhood (Blanner et al, 2020) and thus had a preexisting understanding of adverse effects of widowhood. The primary investigator had experience in conducting qualitative research from a previous study (Blanner Kristiansen et al, 2015).…”

Section: Considerations Of Trustworthinessmentioning

confidence: 99%

Experiences of becoming widowed in old age – a cross-countries study with qualitative interviews from Denmark and quantitative measures of association in a Swedish sample

Blanner

Elliott

Hjorth

et al. 2021

International Journal of Qualitative Studies on Health and Well

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Purpose: Becoming widowed is a stressful health-threatening event causing major life changes. We explored how widowed people experience becoming widowed and examined if these experiences are quantitatively associated with widowhood. Methods: A multi-methods study using an exploratory sequential mixed-methods approach including a qualitative descriptive study with widowed people from Denmark and a Swedish cohort study. Qualitative interviews (n = 9) were analysed using qualitative content analysis, describing experiences as explained by the widowed people. The quantitative association of the experiences was examined by identifying proxies for the qualitative experiences of widowhood in the cohort study and examining the occurrence in widowed people compared to married people (n = 1,095). Results: Six categories of experiences emerged: the circumstances around spousal death, mental health and well-being, physical health, social relations, activities and practicalities. The quantitative examination showed a significant association with widowhood regarding mental and physical health problems. Conclusion:The circumstances around spousal death and the time before spousal death, in general, were important to how participants felt being widowed. Being ill negatively affected mental health and well-being, partly because of the inability to participate in activities and social relations. This is important, as health problems are more common among widowed people than married people.

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The association of time since spousal loss and depression in widowhood: a systematic review and meta-analysis

Cited by 41 publications

References 56 publications

The role of maternal attachment in mental health and dyadic relationships in war trauma

The role of maternal attachment in mental health and dyadic relationships in war trauma

Widowhood and mortality: a Danish nationwide register-based cohort study

Experiences of becoming widowed in old age – a cross-countries study with qualitative interviews from Denmark and quantitative measures of association in a Swedish sample

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