CHICAGO - Following the death of a spouse, older people who were caregivers and who experienced strain prior to the death had reductions in health risk behaviors and no further increases in depressive symptoms, use of antidepressant drugs, or significant weight loss. Among non-caregivers, losing a spouse resulted in increased depression and weight loss, according to an article in the June 27 issue of The Journal of the American Medical Association (JAMA).

Richard Schulz, Ph.D., of the University of Pittsburgh, and colleagues conducted a study in four U.S. communities between 1993 and 1998 to better understand the effect of bereavement on family caregivers. The Caregiver Health Effects Study (CHES) was an ancillary study of the Cardiovascular Health Study, a large population-based study of elderly people. Participants in this aspect of the CHES included 129 people, aged 66 to 96, whose spouses had died.

According to background information cited in the article, more than two million people die in the United States each year. Most deaths occur among older people who have one or more disabling conditions. As a result, many deaths are preceded by an extended period during which family members provide care to their disabled relative. Although researchers have repeatedly documented the psychiatric and physical health effects of family caregiving, caregivers are rarely followed up long enough to assess the effect of the death of the disabled relative on the caregiver. Among widowed participants in the CHES, 40 people were classified as non-caregivers, 52 were caregivers who experienced strain, and 37 were caregivers who reported no strain. The authors examined changes in depression symptoms-assessed by the 10-item Center for Epidemiological

Studies-Depression (CES-D) scale - the use of antidepressant medication, and weight changes among the three groups. They also questioned participants about six health risk behaviors: missing at least one physician appointment in the last six months, not having enough time to go to the physician, not having enough time to exercise, forgetting to take

medication, not getting enough rest in general, and not being able to slow down and get enough rest when sick.

"Controlling for age, sex, race, education, prevalent cardiovascular disease at baseline, and interval between pre-death and post-death assessments, CES-D scores remained high but did not change among strained caregivers (9.44 vs. 9.19), while these scores increased for both non-caregivers (4.74 vs. 8.25) and non-strained caregivers (4.94 vs. 7.13)," the authors write.

"The strained caregiver group experienced significant improvement in health risk behaviors following the death of their spouse (1.47 vs. 0.66 behaviors), while the non-caregiver and non-strained caregiver groups showed little change (0.27 vs. 0.27 and 0.46 vs. 0.27 behaviors, respectively)," they report. "Overall, these data support the hypothesis that the death of a spouse among strained caregivers represents a significant reduction in burden and does not further tax their ability to cope," the authors write.

Non-caregivers were nearly 13 times more likely to be using antidepressant medications following the death of a spouse than the non-strained caregiver group. Non-caregivers also experienced significant weight loss following the death, while the strained and non-strained caregiver groups did not show significant weight change. The authors suggest that clinicians should explore the caregiving experience of the surviving spouse and tailor their interventions accordingly.

"Bereaved strained caregivers with significant depression symptoms should receive treatment with medication and/or psychosocial intervention. Bereaved non-caregivers should also be monitored for medication use and significant weight loss, which may place them at risk for significant health decline," they write. "In addition, knowing that depression levels of strained caregivers persist through the bereavement experience suggests they may be candidates for the prevention of bereavement depression," they continue.

"Providing indicated medication or counseling prior to the death of their disabled spouse may help shorten the period of distress after bereavement," the authors conclude.

(JAMA. 2001; 285:3123-3129)

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Editor's Note: Preparation of this article was supported in part by grants from the National Institute of Mental Health, the National Institute on Aging, and the National Heart, Lung, and Blood Institute. The Cardiovascular Health Study is supported by contracts from the National Heart, Lung, and Blood. For copies of the article, contact the Center for the Advancement of Health at 202.387.2829 or e-mail press@cfah.org