Towards improved care and long-term well-being of men who lose a wife to cancer : A population based study

Background: Grief can be seen as the mirror of love. However, some persons suffer beyond what can be viewed as normal grief, experiencing long-lasting decline of both mental and physical health - and even death. Investigating additional and avoidable risk factors connected to the loss may therefore be of vital importance for the development of preventive interventions. Aims: To identify avoidable risk factors for the long-term psychological morbidity of widowers. We hypothesized that widowers, compared to married men, have a higher risk for psychological morbidity 4-5 years after their loss. We also postulated that this excess morbidity is determined by the degree of preparedness for the wife s death at the time of death. Moreover, we suggest that such preparedness can be facilitated by providing several kinds of health-care interventions. Methods: Following a qualitative phase for study preparation, a study specific questionnaire (including questions on psychological morbidity and questions about the wife s disease period) was constructed and tested for face validity and for response rate and logistics in a pilot study on 76 widowers. The study base in the main study consisted of 907 men in Sweden who had lost a wife to cancer in the breast, ovary or colon in 2000 and 2001. Furthermore, we collected data from a control group of 330 married men who were frequency matched for age and residence. The questionnaires were sent out from November 2004 to November 2005. Results: Participation rate was 76 percent for the widowers and 79 percent for the married men. Single widowers reported more psychological morbidity 4-5 years after the loss of a wife than widowers who were in a new romantic relationship at the time of follow-up. Highest relative risks obtained were for depression (RR 2.3), emotional numbness (RR 2.2) and waking up at night with anxiety (RR 2.3). Widowers in a new romantic relationship did not report more morbidity compared to married men. Eighty-six percent of the widowers reporteded that the next-of-kin should be told immediately when the patient s cancer cannot be cured. Eighty percent of the widowers reported that they were told that the wife's cancer was incurable and a quarter of them were informed within one week before the patient's death. Our data indicated that a low degree of preparedness at the time of wife s death increases a younger widower s (38 to 61 years old) risk for (among other symptoms): anxiety (RR 2.3), emotional numbness (RR 2.2) and having difficulty falling asleep (RR 2.2) 4-5 years after loss. For older widowers (62 to 80 years old), this pattern was not as evident. Several possible avoidable predictors for preparedness were identified: longer duration of the widower s intellectual awareness time before his wife s death (RR 4.1), if the widower could take in the information that his wife s disease could not be cured (RR 3.5), the couple had arranged their economic affairs (RR 1.5) and if the wife had stayed at a palliative care unit during the last months of her life (RR 1.2). Findings: Widowers who remain single 4-5 years after their loss are at increased risk of psychological morbidity. Furthermore, the degree of preparedness before the wife s death may affect the long-term psychological well-being for widowers. Several care-related facilitators of preparedness were identified. Implication: Improved care of men whose wives are dying of cancer may diminish the widowers risk of long-term morbidity. An intervention study, aiming at influencing preparedness before the death of a loved one, can be designed based on our findings. Such an intervention may entail significant public health effects by decreasing psychological and even physical morbidity of widowers