title: Psychological adjustment to sudden and anticipated spousal loss among older widowed persons.
abstract: OBJECTIVE
  This study examined if older adults' psychological adjustment to widowhood varies based on whether the death was sudden or anticipated and if these effects are mediated by death context characteristics (e.g., predeath caregiving, nursing home use, spouse's age at death, and couple's communication about the death).
  
  
  METHODS
  The effects of forewarning on multiple indicators of mental health and grief were examined in a sample of 210 widowed persons who participated in the Changing Lives of Older Couples (CLOC) study. The CLOC is a probability sample of 1,532 married individuals aged 65 and older for whom baseline information was collected in 1987-88, with widowed persons reinterviewed 6, 18, and 48 months after spousal loss.
  
  
  RESULTS
  Forewarning did not affect depression, anger, shock, or overall grief 6 or 18 months after the loss. Prolonged forewarning was associated with elevated anxiety both 6 and 18 months after the death. Sudden spousal death elevated survivors' intrusive thoughts at the 6-month follow-up only. Sudden death was associated with slightly higher levels of yearning among women but significantly lower yearning among men both 6 and 18 months after the loss.
  
  
  CONCLUSIONS
  The findings call into question the widespread belief that grief is more severe if death is sudden and suggest a more complex relationship between bereavement and circumstances of spousal death.
authors.affiliation: Institute for Social Research, University of Michigan, Ann Arbor, USA. carrds@umich.edu
authors.forename: D
authors.initials: D
authors.lastname: Carr
authors.forename: J S
authors.initials: JS
authors.lastname: House
authors.forename: C
authors.initials: C
authors.lastname: Wortman
authors.forename: R
authors.initials: R
authors.lastname: Nesse
authors.forename: R C
authors.initials: RC
authors.lastname: Kessler
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D001007:Anxiety; D001601:Bereavement; D005260:Female; D006117:Grief; D006801:Humans; D016018:Least-Squares Analysis; D008297:Male; D013850:Thinking; D017805:Widowhood / Q000523:psychology*