Advertisement

The Impact of Stressful Life Events after Bereavement: A Nationwide Cross-sectional Survey

      Abstract

      Context

      Bereaved family members sometimes experience distress due to stressful life events. However, the effects of this distress on depression and grief remain unclear.

      Objectives

      To clarify the degree of distress due to postbereavement stressful life events, its associated factors, especially social isolation, and its effects on major depressive disorder (MDD) and complicated grief (CG) risks among bereaved family members of patients with cancer.

      Methods

      This cross-sectional questionnaire survey was conducted in 2018 as part of the J-HOPE4 study. We recruited 1740 bereaved family members of patients with cancer who died from July to August of 2018. We assessed distress due to postbereavement stressful life events with the Bereavement Secondary Stressor Scale, social isolation with the Lubben Social Network Scale Short-Form, and the MDD and CG risk with the Patient Health Questionnaire-9 and Brief Grief Questionnaire, respectively.

      Results

      Among the 913 (52.5%) respondents, 88%, 57%, 46%, 28%, and 19% experienced distress due to incidental tasks, daily life difficulties, financial problems, problems with other people, and deterioration of family relationships, respectively. More distress was associated with higher risks of MDD (odds ratio [OR] = 2.5, P < 0.01) and CG (OR = 2.5, P < 0.01). Social isolation and specific backgrounds were associated with more distress in response to stressful life events.

      Conclusion

      Most family members experienced distress due to stressful life events, which were risk factors for MDD and CG. Assessing risk factors for maladaptation to post-bereavement life changes and enhancing readiness to adapt to them is important.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pain and Symptom Management
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Garrido MM
        • Prigerson HG
        The end-of-life experience: modifiable predictors of caregivers' bereavement adjustment.
        Cancer. 2014; 120: 918-925
        • Aoyama M
        • Sakaguchi Y
        • Morita T
        • et al.
        Factors associated with possible complicated grief and major depressive disorders.
        Psycho-oncology. 2018; 27: 915-921
        • Nielsen MK
        • Neergaard MA
        • Jensen AB
        • et al.
        Predictors of complicated grief and depression in bereaved caregivers: a nationwide prospective cohort study.
        J Pain Symptom Manage. 2017; 53: 540-550
        • Lobb EA
        • Kristjanson LJ
        • Aoun SM
        • et al.
        Predictors of complicated grief: a systematic review of empirical studies.
        Death studies. 2010; 34: 673-698
        • Stroebe MS
        The broken heart phenomenon - an examination of the mortality of bereavement.
        J Community Appl Soc Psychol. 1994; 4: 47-61
        • Stroebe M
        • Schut H.
        The dual process model of coping with bereavement: rationale and description.
        Death studies. 1999; 23: 197-224
        • Stroebe W
        • Stroebe M
        • Abakoumkin G
        • Schut H.
        The role of loneliness and social support in adjustment to loss: a test of attachment versus stress theory.
        J Pers Soc Psychol. 1996; 70: 1241-1249
        • Wills TA
        • Ainette MC.
        Social networks and social support. Handbook of health psychology.
        2nd ed. Psychology Press, New York, NY, US2012: 465-492
      1. Ameican Psychological Association. APA Dictionary of psychology. Available from: https://dictionary.apa.org/social-support. (Latest access: Dec. 1. 2022)

      2. Cabinet office. Annual report on the ageing society 2020. Available from: https://www8.cao.go.jp/kourei/whitepaper/w-2020/html/zenbun/index.html. (Latest access: Dec. 1. 2022)

        • De Jong Gierveld J
        • van Tilburg T.G.
        • Dykstra P.A.
        Loneliness and social isolation.
        (editor)in: Vangelisti DPaA The Cambridge Handbook of Personal Relationships. Cambridge University Press, Cambridge2006: 485-500
        • Lubben J
        • Blozik E
        • Gillmann G
        • et al.
        Performance of an abbreviated version of the Lubben Social Network Scale among three European community-dwelling older adult populations.
        Gerontologist. 2006; 46: 503-513
        • Iliffe S
        • Kharicha K
        • Harari D
        • et al.
        Health risk appraisal in older people 2: the implications for clinicians and commissioners of social isolation risk in older people.
        Br J Gen Pract. 2007; 57: 277-282
        • Shimada K
        • Yamazaki S
        • Nakano K
        • et al.
        Prevalence of social isolation in community-dwelling elderly by differences in household composition and related factors: from a social network perspective in urban Japan.
        J Aging Health. 2014; 26: 807-823
        • Nicholson NR.
        A review of social isolation: an important but underassessed condition in older adults.
        J Prim Prev. 2012; 33: 137-152
        • Kawachi I
        • Colditz GA
        • Ascherio A
        • et al.
        A prospective study of social networks in relation to total mortality and cardiovascular disease in men in the USA.
        J Epidemiology Community Health. 1996; 50: 245-251
        • Cacioppo JT
        • Hawkley LC
        • Thisted RA.
        Perceived social isolation makes me sad: 5-year cross-lagged analyses of loneliness and depressive symptomatology in the Chicago health, aging, and social relations study.
        Psychology and aging. 2010; 25: 453-463
        • Sorkin D
        • Rook KS
        • Lu JL.
        Loneliness, lack of emotional support, lack of companionship, and the likelihood of having a heart condition in an elderly sample.
        Ann Behav Med. 2002; 24 (a publication of the Society of Behavioral Medicine): 290-298
        • Fratiglioni L
        • Wang HX
        • Ericsson K
        • et al.
        Influence of social network on occurrence of dementia: a community-based longitudinal study.
        Lancet (London, England). 2000; 355: 1315-1319
        • Shankar A
        • Rafnsson SB
        • Steptoe A.
        Longitudinal associations between social connections and subjective wellbeing in the English longitudinal study of ageing.
        Psychol Health. 2015; 30: 686-698
        • Stroebe MS
        • Folkman S
        • Hansson RO
        • et al.
        The prediction of bereavement outcome: development of an integrative risk factor framework.
        Soc Sci Med. 2006; 63: 2440-2451
        • Bennett KM
        • Gibbons K
        • Mackenzie-Smith S
        Loss and restoration in later life: an examination of dual process model of coping with bereavement.
        Omega. 2010; 61: 315-332
        • Sakaguchi Y.
        The relationship between secondary stressors and somatic/mental health after conjugal loss.
        JPN J Health Psychol. 2001; 14: 1-10
        • Masukawa K
        • Aoyama M
        • Morita T
        • et al.
        The Japan hospice and palliative evaluation study 4: a cross-sectional questionnaire survey.
        BMC Palliat Care. 2018; 17: 66
        • Kurimoto A
        • Awata S
        • Ohkubo T
        • et al.
        Reliability and validity of the Japanese version of the abbreviated Lubben social network scale.
        Nippon Ronen Igakkai Zassh. 2011; 48: 149―57
        • Kroenke K
        • Spitzer RL
        • Williams JBW.
        The PHQ-9: validity of a brief depression severity measure.
        J Gen Intern Med. 2001; 16: 606-613
        • Spitzer RL
        • Kroenke K
        • Williams JB.
        Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders. patient health questionnaire.
        Jama. 1999; 282: 1737-1744
        • Inagaki M
        • Ohtsuki T
        • Yonemoto N
        • et al.
        Validity of the Patient Health Questionnaire (PHQ)-9 and PHQ-2 in general internal medicine primary care at a Japanese rural hospital: a cross-sectional study.
        Gen Hosp Psychiatry. 2013; 35: 592-597
        • Shear KM
        • Jackson CT
        • Essock SM
        • Donahue SA
        • Felton CJ.
        Screening for complicated grief among project liberty service recipients 18 month after September 11, 2001.
        Psychiatr Serv. 2006; 57: 1291-1297
        • Ito M
        • Nakajima S
        • Fujisawa D
        • et al.
        Brief measure for screening complicated grief: reliability and discriminant validity.
        Plos One. 2012; 7e31209https://doi.org/10.1371/journal.pone.0031209
        • Kissane DW
        • Bloch S
        • Dowe DL
        • et al.
        The Melbourne family grief study, I: perceptions of family functioning in bereavement.
        Am J Psychiatry. 1996; 153: 650-658
        • Kissane DW
        • Bloch S
        • Onghena P
        • et al.
        The Melbourne family grief study .2. psychosocial morbidity and grief in bereaved families.
        Am J Psychiatry. 1996; 153: 659-666
        • Hiratsuka R
        • Aoyama M
        • Masukawa K
        • et al.
        The association of family functioning with possible major depressive disorders and complicated grief among bereaved family members of patients with cancer: results from the J-HOPE4 study, a nationwide cross-sectional follow-up survey in Japan.
        J Pain Symptom Manage. 2021; 62: 1154-1164
        • Hamano J
        • Morita T
        • Igarashi N
        • Shima Y
        • Miyashita M.
        The association of family functioning and psychological distress in the bereaved families of patients with advanced cancer: a nationwide survey of bereaved family members.
        Psycho-oncology. 2021; 30: 74-83
        • Nielsen MK
        • Neergaard MA
        • Jensen AB
        • et al.
        Preloss grief in family caregivers during end-of-life cancer care: a nationwide population-based cohort study.
        Psycho-oncology. 2017; 26: 2048-2056
        • Shimizu Y
        • Hayashi A
        • Maeda I
        • et al.
        Changes in depressive symptoms among family caregivers of patients with cancer after bereavement and their association with resilience: A prospective cohort study.
        Psycho-oncology. 2022; 31: 86-97