When a Spouse Dies, Resilience Can Be Uneven

Courtesy of The New York Times.com | By Jane E. Brody | Illustration by Paul Rogers | Originally Published 09.26.2016 | Posted 02.12.2018

Losing a beloved life partner is never easy at any age, no matter the circumstance. The loss can be sudden and totally unexpected — a fatal heart attack, traffic accident or natural tragedy like a flood or earthquake. Or the loss can be long in coming from a progressive illness that gives the surviving spouse weeks, months, even years to prepare for and presumably ”adjust” to its eventual inevitability.

Psychologists have long maintained that after a brief period of sometimes intense bereavement, the vast majority of surviving spouses adjust well, returning to their previous work, daily routines and prior state of contentment within a few months to a year – a psychological outcome referred to as resilience. Studies by George A. Bonanno and colleagues at Columbia University as well as others, for example, have found that 60 percent of people who lost a spouse were resilient — satisfied with their lives and not depressed.

But new research is calling this global assessment inadequate to describe the aftermath of spousal loss for many if not most people, suggesting a need for more effective and specific ways to help them return to their prior state of well-being. Someone who ranks high in life satisfaction may nonetheless be having considerable difficulty in other domains that can diminish quality of life, like maintaining a satisfying social life, performing well at work or knowing who can help when needed.

The Jewish faith in which I was raised offers one such source of support, specifying a period of mourning that gives survivors needed time to adjust to a new normal. It designates a weeklong visitation — the shiva — during which friends and relatives gather with the bereaved to express condolences and relate memories of the deceased. It also calls for a 30-day period of readjustment that includes daily prayers.

Indeed, my father, who faithfully abided by this ritual period of mourning, seemed to emerge relatively unscathed when my mother, the love of his life, died after a yearlong battle with cancer. With two children to worry about and provide for, perhaps he had little time for protracted mourning. After 18 months as a widower, at age 51 he remarried a lovely woman who became our loving stepmother.

But when he died suddenly of a heart attack 20 years later, she did not fare as well. She was intensely lonely and seemed trapped in a restricted, relatively joyless existence. Only after she died did we realize that her former joie de vivre had been dampened by a persistent low-grade depression and limited social connections after my father’s death.

The new research shows that even those who express overall satisfaction with their lives after the loss of a spouse often experience significant declines in specific aspects of physical and emotional health and well-being. In other words, their resilience is not uniform across all dimensions that most of us would consider important. Scratch the surface and you’re likely to find that the surviving spouse who seems happy and well adjusted may have considerable difficulties that are not apparent to a casual observer.

The research was conducted by Frank J. Infurna and Suniya S. Luthar, psychologists at Arizona State University, Tempe, who took advantage of a unique data set gathered annually for 13 years in Australia. It is called the Household Income and Labour Dynamics of Australia Study, conducted from 2001 through 2013 among a nationally representative sample of Australians aged 15 and older who responded via a combination of face-to-face and telephone interviews and self-completed questionnaires.

During the study, 421 participants lost a spouse. The Arizona psychologists analyzed five specific aspects of how they were faring for each of the five years before and five years after they became widowed. Sixty-six percent returned to their pre-loss level of life satisfaction within a year, whereas 34 percent experienced a precipitous decline after the death and had not returned to their prior level even five years later.

When responses to questions about positive feelings like “Did you feel full of life?” “Have you felt calm and peaceful?” “Did you have a lot of energy?” were assessed, only 26 percent had returned to their previous level; 74 percent, who had started at a lower level before their loss, sank even lower at the time of death and never bounced back fully.

With regard to negative feelings like “Have you been a nervous person?” “Have you felt so down in the dumps nothing could cheer you up?” “Did you feel worn out?,” only 19 percent were found to be resilient, no worse off after than before their loss.

The participants also reported on their general health and whether they had trouble performing daily activities like carrying groceries, climbing stairs, walking several blocks, bathing and dressing. Thirty-seven percent were resilient in terms of general health, but for 63 percent health was poor to begin with and sank lower with time. Physical functioning declined as well for 55 percent, with only 29 percent showing resilience.

Of the entire group, only 8 percent of the bereaved individuals were in good shape for all five indicators of resilience studied, while 20 percent were not resilient in any of them.

Given that 92 percent of participants experienced declines in one or more areas of functioning, the researchers concluded that it is wrong to define resilience “based on a limited set of measured outcomes.” In fact, they added, people who lost a spouse may have difficulties beyond those assessed in this study, like problems at work or general feelings of loneliness.

All told, the findings showed pronounced differences from what has been generally believed about how resilient people are to the loss of a spouse. It depends on the particular aspect of life in question.

Most important to resilience in the face of bereavement were how vulnerable or protected surviving spouses felt and how well they functioned in their everyday roles, Dr. Infurna said in an interview.

He and Dr. Luthar described three factors that influenced overall resilience: 1) Reliable comfort – having someone to confide in or lean on in times of trouble, and being able to get help from other people when needed; 2) Social connectedness – whether their physical health or emotional problems interfered with social activities like visiting friends and relatives and interacting socially with neighbors or groups, and 3) Daily functioning – having difficulties with their normal activities because of emotional problems like depression or anxiety.

Based on their data, the researchers concluded that “it can take two to three years or even longer for some to recover from bereavement” and return “to their pre-loss levels of functioning.”

What they found to help most was remaining socially connected and engaged in the usual activities of everyday life and knowing where they could turn for help and comfort and receiving support when they needed it.

Correction: September 30, 2016 
The Personal Health column on Tuesday, about resilience after the death of a spouse, misstated the length of the Jewish period of mourning for a spouse. It is 30 days, not a year. (The one-year period is for those who have lost a parent.)



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