Bereavement Outcomes among Spousal Hospice Caregivers: The Role of Rumination, Feelings of Relief, and Perceived Suffering

Background: The death of a spouse is among the most distressing life events faced by older adults and frequently follows long periods of providing extensive care and support. Although many spouses are resilient following loss, a number of bereaved spousal caregivers have poor psychological well-being and may benefit from clinical services. However, it can be difficult to determine who may most benefit from bereavement services and why some individuals are at greater risk for poor bereavement; thus, there is a need for greater understanding of the process of bereavement. Therefore, the purpose of this dissertation was to investigate a number of theoretically relevant factors within the context of bereavement after caregiving as possible predictors of psychological well-being following loss. Specifically, former caregivers\u27 perceptions of loved ones\u27 end-of-life suffering, rumination, and feelings of relief were investigated as possible predictors of caregivers symptoms of depression, grief, and complicated grief following loss. Method: Participants included 61 former spousal caregivers of hospice patients 50 years of age or older who lost a spouse in the last 6-18 months. Individuals completed an interview that included retrospective recall of perceptions of loved ones\u27 physical, emotional, and existential suffering, current frequency of thoughts about loved ones\u27 suffering, stress-reactive rumination, and feelings of relief following the death. Participants also completed measures assessing current symptoms of depression, present feelings of grief, and complicated grief. Descriptive information about care recipients was obtained via retrospective review of hospice electronic medical records following participant interview. Several regression analyses were conducted to investigate the relationship of possible predictor variables to bereavement outcomes and interactions among predictor variables. Results: Findings revealed important relationships between rumination, feelings of relief, and former caregivers\u27 psychological well-being follow loss. Higher rumination and less feelings of relief were associated with worse bereavement outcomes. In addition, interaction analyses revealed that rumination and feelings of relief moderated the relationship between participants\u27 perceptions of their spouses\u27 emotional end-of-life suffering and psychological distress. Other descriptive predictors of depression, grief, and complicated grief were identified. Discussion: Participants were highly distressed former caregivers who were highly engaged in caregiving duties prior to loss. About 40% reported no feelings of relief following the loss, and over one-fourth of participants still had frequent ruminations about their loved ones\u27 suffering. High stress-reactive rumination was an important predictor of bereaved spouses\u27 psychological distress. Clinical interventions, such as cognitive behavioral therapy, could focus on identifying, redirecting, and reducing distressing thoughts or the negative feelings associated with them, such as ruminations associated with loved ones\u27 end-of-life suffering. Future longitudinal research should examine the relationships between rumination, feelings of relief, perceived suffering, and bereavement outcomes in order to identify patterns that may inform clinical interventions