title: Analysis of the bereavement effect after the death of a spouse in the Amish: a population-based retrospective cohort study.
abstract: OBJECTIVE
  This study investigates the association between bereavement and the mortality of a surviving spouse among Amish couples. We hypothesised that the bereavement effect would be relatively small in the Amish due to the unusually cohesive social structure of the Amish that might attenuate the loss of spousal support.
  
  
  METHODS
  Population-based cohort study.
  
  
  METHODS
  The USA.
  
  
  METHODS
  10,892 Amish couples born during 1725-1900 located in Pennsylvania, Ohio and Indiana. All the participants are deceased.
  
  
  METHODS
  The survival time is 'age'; event is 'death'. Hazard ratios (HRs) of widowed individuals with respect to gender, age at widowhood, remarriage, the number of surviving children and time since bereavement.
  
  
  RESULTS
  We observed HRs for widowhood ranging from 1.06 to 1.26 over the study period (nearly all differences significant at p<0.05). Mortality risks tended to be higher in men than in women and in younger compared with older bereaved spouses. There were significantly increased mortality risks in widows and widowers who did not remarry. We observed a higher number of surviving children to be associated with increased mortality in men and women. Mortality risk following bereavement was higher in the first 6 months among men and women.
  
  
  CONCLUSIONS
  We conclude that bereavement effects remain apparent even in this socially cohesive Amish community. Remarriage is associated with a significant decrease in the mortality risk among Amish individuals. Contrary to results from previous studies, an increase in the number of surviving children was associated with decreased survival rate.
authors.affiliation: Department of Medicine and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: Ari
authors.initials: A
authors.lastname: Seifter
authors.forename: Sarabdeep
authors.initials: S
authors.lastname: Singh
authors.forename: Patrick F
authors.initials: PF
authors.lastname: McArdle
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Ryan
authors.forename: Alan R
authors.initials: AR
authors.lastname: Shuldiner
authors.forename: Braxton D
authors.initials: BD
authors.lastname: Mitchell
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Schäffer
mesh_terms: D061365:Amish / Q000523:psychology*; D001601:Bereavement; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008393:Marriage; D008875:Middle Aged; D009026:Mortality; D012189:Retrospective Studies; D017805:Widowhood / Q000523:psychology*
keywords: Epidemiology; Geriatric Medicine; Mental Health; Public Health