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A descriptive study: the effects of depression and

adaptation among elderly widows and widowers
Alexia Laverne Wicker
Clark Atlanta University

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ETD Collection for AUC Robert W. Woodruff Library. Paper 634.

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 THESIS TRANSMITTAL FORM

Name of Student AI.KYTA I.AVKRNE WTCKFR

Title of Thesis A DESCRIPTIVE STUDY: THE EFFECTS OF

DEPRESSION AND ADAPTATION AMONG ELDERLY

WIDOWS AND WIDOWERS

We the undersigned members of the Committee advising this thesis have

ascertained that in every respect it acceptably fulfills the final requirements for the degree
of M.S.W. in Social Work

M.A., M.S., Specialist, etc. Department or School

ssw g Zb&O
Major Advisor* Department

Name Date Name Date

Name Date Name Date

As Chair of the Department of Social Work t have verified that this

manuscript meets the School's Department's standards of forms and content governing
theses for the degree sought.

Chair
J
'

As Dean of the School of Social Work I have verified that this

manuscript meets the School's regulations governing the content and form of theses.

Dean

As Dean of Graduate Studies I have verified that this manuscript meets the
governing the content and form of theses.

~Dean~o uidies
 ABSTRACT

SOCIAL WORK

Wicker, Alexia Laverne B.S.W. GRAMBLING STATE UNIVERSITY,

1996

A DESCRIPTIVE STUDY; THE EFFECTS OF DEPRESSION

AND ADAPTATION AMONG ELDERLY

WIDOWS AND WIDOWERS

Advisor: Professor Hattie M. Mitchell

Thesis dated July, 2000

The overall objective of this correlational descriptive

study was to explore the effects of depression and

adaptation among elderly widows and widowers.

A total of thirty-four male and female elderly persons

participated in this study. Simple descriptive statistics

were used to analyze the data.

The findings of this study accepted the hypothesis that

there is no significant statistical difference between

elderly widows and widowers and the effects of depression

and adaptation.
 A DESCRIPTIVE STUDY: THE EFFECTS OF DEPRESSION

AND ADAPTATION AMONG ELDERLY

WIDOWS AND WIDOWERS

A THESIS

SUBMITTED TO THE FACULTY OF CLARK ATLANTA UNIVERSITY

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR

THE DEGREE OF MASTER OF SOCIAL WORK

BY

ALEXIA LAVERNE WICKER

SCHOOL OF SOCIAL WORK

ATLANTA, GEORGIA

JULY, 2000

V
 © 2000

ALEXIA LAVERNE WICKER

All Rights Reserved

 CLARK ATLANTA UNIVERSITY THESIS OR DISSERTATION

DEPOSITED IN THE ROBERT W. WOODRUFF LIBRARY

STATEMENT OF UNDERSTANDING

In presenting this thesis as a partial fulfillment of the

requirements for an advanced degree from Clark Atlanta

University, I agree that the Robert W. Woodruff Library

shall make it available for inspection and circulation in

accordance with its regulations governing materials of this

type. I agree that permission to quote from, to copy from,

or to publish this thesis may be granted by the author or,

in his/her absence, the Dean of the School of Social Work

at Clark Atlanta University. Such quoting, copying, or

publication must be solely for scholarly purposes and must

not involve potential financial gain. It is understood that

any copying from or publication of this thesis which

involves potential financial gain will not be allowed

without written permission of the author.

Signature of Author Date

 NOTICE TO BORROWERS

All theses deposited in the Robert W. Woodruff Library must be used only in accordance
with the stipulations prescribed by the author in the preceding statement.

The author of this thesis is:

Alexia Laverne Wicker

Name:

Street Address: 2547 Allison Drive

City, State, Zip: MilledgeviUe, Georgia 31061

The director of this thesis is:

Hattie M. Mitchell
Professor

^ - — Social Work
Department:

_ . . Social Work
School:
Clark Atlanta University

(404) 880-6616
Office Telephone:

Users ofthis thesis not regularly enrolled as students of the Atlanta University Center are
required to attest acceptance of the preceding stipulations by signing below. Libraries
borrowing this thesis for use of patrons are required to see that each user records here the
information requested.

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 ACKNOWLEDGMENTS

First, I would like to thank the Almighty God for

giving me strength, courage, and guidance during this very

stressful time in my life. Though now, I look back on my

experiences and I am thankful for all of the challenges I

have faced thus far.

I would like to thank my family for the love, support,

constant prayers and encouragement during the times that I

was ready to give up. Special thanks go to Professor Hattie

Mitchell for her guidance, patience and assistance in the

completion of this thesis, Mrs. Cara Dixon (practicum

supervisor-2nd year) and Mrs. Marion Harper (practicum

supervisor-lst year) for your wisdom, experience and

knowledge of the field of social work.

I would also like to thank my colleagues of Hospice of

the Oconee Milledgeville, Georgia for your encouragement and

understanding.

ii
 TABLE OF CONTENTS

PAGE

ACKNOWLEDGMENTS ii

LIST OF TABLES v

CHAPTER

I. INTRODUCTION 1

Statement of Problem 3

Purpose of Study 6

Significance of Study 10

II. REVIEW OF LITERATURE 11

Theoretical Framework 20

Definition of Terms 24

Hypothesis 24

III. METHODOLOGY 25

Research Design 25

Sampling 25

Setting 25

Data Collection 26

Data Analysis 27

IV. PRESENTATION OF RESULTS 28

Null Hypothesis 28

Part I - Demographics 28

Part II - Death Depression Scale (DDS) 33

Part III - Death Anxiety Scale (DAS) 34

Part IV - Geriatric Depression Scale (GDS) 35

iii
 TABLE OF CONTENTS

(continued)

Chapter Page

V. SUMMARY AND CONCLUSION 36

Limitations of the Study 36

Suggested Research Direction 37

IV. IMPLICATIONS FOR SOCIAL WORK PRACTICE 38

APPENDICES 40

A. Questionnaire 41

B. Additional Tables 46

BIBLIOGRAPHY 59

IV
 LIST OF TABLES

TABLE PAGE

1. Gender (N=34) 28

2. Age (N=30) 29

3. Race (N=30) 29

4. Present Marital Status (N=34) 30

5. Years Married to Deceased (N=34) 31

6. Number of Years Since Death (N=34) 31

7. Present Total Yearly Income (N=34) 32

8. T-Test Analysis of the Death Depression Among

Elderly Widows and Widowers (N=34) 33

9. T-Test Analysis of Death Anxiety Among Elderly

Widows and Widowers (N=34) 34

10. T-Test Analysis of Geriatric Depression Among

Elderly Widows and Widowers (N=34) 35

1A. I get depressed when I think about death (N=34) 46

2A. Hearing the word death makes me feel sad (N=34) 46

3A. Passing by cemeteries make me sad (N=34) 46

4A. Death means terrible loneliness (N=34) 47

5A. I become terribly sad when I think about friends or

relatives who have died or relatives who have died

(N=34) 47

6A. I am terribly upset by the shortness of life (N=34)..47

v
 LIST OF TABLES

(continued)

TABLE PAGE

7A. I worry about dying alone (N=34) 48

8A. Death does not rob life of its meaning (N=34) 48

9A. When I think of death, I feel tired and lifeless

(N=34) 48

10A. Death is something to be depressed about (N=34) 49

11A. I feel sad when I dream of death (N=34) 49

12A. I am very much afraid to die (N=34) 49

13A. The thought of death seldom enters my mind (N=34)....5O

14A. It doesn't make me nervous when people talk about

death (N=34) 50

15A. I dread to think about having to have an operation

(N=34) 50

16A. I am not at all afraid to die (N=34) 51

17A. I am particularly afraid of getting cancer (N=34)....51

18A. The thought of death never bothers me (N=34) 51

19A. I am often distressed by the way time flies so very

rapidly (N=34) 52

20A. The subject of life after death troubles me greatly

(N=34) 52

21A. I often think about how short life really is (N=34)..52

vi
 LIST OF TABLES

(continued)

TABLE PAGE

22A. The sight of a dead body is horrifying to me (N=34)..53

23A. Are you basically satisfied with your life (N=34)?...53

24A. Have you dropped many of your activities and

interests (N=34)? 54

25A. Do you feel that your life is empty (N=34)? 54

26A. Do you often get bored (N=34)? 55

27A. Are you in good spirits most of the time (N=34)? 55

28A. Are you afraid that something bad is going to

happen to you (N=34) ? 56

29A. Do you feel happy most of the time (N=34)? 56

30A. Do you often feel helpless (N=34)? 57

31A. Do you feel you have more problems with memory loss

than most (N=34)? 57

32A. Do you feel full of energy (N=34)? 58

33A. Do you feel that most people are better off than

you are (N=34)? 58

VII
 CHAPTER ONE

INTRODUCTION

Death is universal and unavoidable. To some, it is a

tragic event; to others, it is a blessing. However, the

subject of death is taboo in our society, and this situation

contributes to the difficulties many have in accepting and

coping with the death of a loved one, impeding the process

of bereavement. As Grollman (1974) puts it, "dead11 is a

four letter word often disguised through euphemistic

language. People do not simply die; they "pass away," "move

on," "expire," or "go to a better place." Many people live

by the myth that if death is not talked about, it will pass

without the pain associated with the loss of a loved one.

Once a person has died, family members and friends move

into the phase of bereavement. Parkes (1987) describes

bereavement as an experience in which the loss forces people

to give up the world as they knew and experienced it and to

create another reality for themselves. Each family member

experiences many emotions that are profound and

consequential.

Bereavement, grief, and mourning have received

increasing attention in the last two decades. Much of the

early literature was descriptive. Later research focused on

1
 2

symptomatology, primarily psychological, that differentiated

"normal" from "pathological" grief with emphasis on duration

and intensity as critical factors (Brabant, 1989-90). More

recently, researchers have concentrated on types of loss

such as loss of child (Rando, 1986) or loss of spouse

(Raphael, 1982). Irrespective of focus, the emphasis has

either been on women alone (Gentry & Shulman, 1988) or

gender differences have been ignored or minimized (Ferraro

et al., 1984; Jacobs et al., 1987-88; Lieberman, 1989). The

result is a sparsity of material on male grief (Narvaez,

1990).

This descriptive exploratory study will examine the

effects of depression and adaptation among elderly widows

and widowers and explore gender differences in each area.

The impact of bereavement on men has not come under

close scrutiny as a major interest until recent years. The

work of Kubler-Ross was not published until 1969.

Undoubtedly, the late arrival of her work was not influenced

by the prevailing attitudes that death and dying were taboo

topics as areas for empirical research, in spite of

Lindemann's earlier classic study in 1944 and 1945 on

catastrophic grief.

This emerging pool of knowledge has helped social

workers, counselors, and psychotherapists address client's

grief on a day-to-day basis. Yet, many new questions focus

on differences in grief and grief reactions among men,

 3

women, children, the aged, and among varied ethnic and

social groups.

A perusal of literature in social work reveals that

"gender and adaptation to widowhood in later life," elderly

wives caring for husbands, children's response to "loss and

death," and "complicated grief, and depression and

widowhood" have been explored with varying degrees of

success by various researchers.

Statement of the Problem

Much has been written about the necessity of the

mourning process, dating back to Freud's classic paper,

"Mourning and Melancholia" (1917). In that paper, Freud

described the course of mourning as beginning with a period

of shock and denial and continuing with a long period of

"working through" the loss. According to Freud, once one

has finished the mourning process, the psychic energy that

had been devoted to the loved one is freed. The depression

suffered by many long after a loss may be the result of

their inability to mourn dead relatives. When mourning is

postponed or avoided, losses may never be worked through,

and people may never be able to fully develop new emotional

bonds or sustain bonds with other loved ones.

Melanie Klein (1964a) posited that the attainment of

"full object relationships" was based on the capacity to

mourn and recover from loss, and Burch (1989), too, among

many others, wrote that the ability to master losses is a

 4

fundamental predictor of future development. According to

Klein (1964b), experience of loss and mourning in adult

years reawaken the tasks of early development that expose

deficits that still remain from childhood; one's ability to

cope with death as an adult is dependent on these early

processes.

John Bowlby (1961) described a distinct sequence after

the death of a loved one, consisting of numbing, distress

and anger, yearning and searching, disorganization and

despair and then, optimally, reorganization.

"Reorganization" refers to both a move toward substitutions

for the lost loved one and the maintenance of values and

behaviors that keep the old bond alive even in the face of

permanent separation and loss.

Elizabeth Kubler-Ross talks about stages of coming to

terms with death in her book, on Death and Dvina (1969).

The stages she describes are denial, anger, bargaining,

depression, and acceptance. These stages, she says, both

delay the final working through and acceptance of a death as

well as enable it to eventually happen. The work of

Kubler-Ross and others has been instrumental in beginning to

challenge the taboos against talking about death.

Today, the loss of a husband or wife through death is

generally considered the most disruptive of all experiences

of ordinary life (Holmes and Rahe, 1967). As such, spousal

bereavement has been associated with frequent and persistent

 5

depressive syndromes (Clayton et al., 1972), possibly

leading to a relative increase in suicide rates (Jacobs et

al., 1987-1988); increases in physician consultations and

non-psychiatric hospitalizations (Madison and Viola, 1968;

Parkes, 1987); increases in health compromising behaviors,

such as alcohol consumption and smoking (Clayton, 1982;

Klerman and Izen, 1977); the possible onset of new illnesses

or exacerbations of existing illnesses (Madison and Viola,

Klerman and Izen), and mortality rates over and above the

expected norm for age matched married individuals, (Jacobs

et al., 1987-1988, Kelsing and Szklo, 1981; Kaprio et al.,

1987).

It is thus of clinical significance to learn about the

stress of widowhood and to identify those factors that may

influence the potential adverse consequences of spousal

bereavement on the surviving spouse.

A question that has evoked considerable study in the

area of bereavement following the loss of a spouse is

whether the gender of the surviving spouse is relevant to

the heightened risk of physical and mental illness and of

mortality among the recently bereaved. The fact that

married women exhibit more symptoms of physical and mental

distress than married men is one reason why the impact of

bereavement appears to be less strong on them than it is on

men. Stroebe and Stroebe (1987) suggest that marriage is a

 6

more effective support system for men than for women, and

therefore men are more negatively affected by its loss.

Purpose of Study

Despite the growing body of literature on bereavement,

grief, and mourning, little attention has been given to the

impact of bereavement on men. Numerous books and articles

have focused on the impact of the death of the wife on the

widower. As a result, two related assumptions about male

grief abound. One assumption is that men are less

emotionally involved in the conjugal relationship thus not

as impacted by the death of a spouse. The second assumption

is that men may be strongly affected but cultural

prohibitions against any show of emotion prevent them from

revealing their true feelings. If, in fact, the second

assumption is true, then it seriously limits both the

possibility that a man will seek help or that resources will

be available if, indeed, he does. Therefore, further study

into the nature of male grief is indicated in planning

realistic support services.

The research and the therapeutic interest in this

question derives from the need to account for data

indicating that the longevity of widows is greater than that

of widowers. The question of who suffers more, widows or

widowers, is discussed in the literature mainly in terms of

the stress theory, the basic assumption being that stressful

life events play an important role in the etiology of

 7

various somatic and psychiatric disorders, particularly if a

predisposition toward the disorder already exists. Strobe

and Strobe (1987), in their survey of cross-sectional and

longitudinal studies, state that there is no consensus in

the conclusions about which gender suffers more or even

about the existence of sex differences in vulnerability to

the effects of loss. Most studies, they point out, find

that there is no difference between gender on this question.

However, some studies have found a difference, showing that

men reported more severe reactions than women to conjugal

bereavement, greater social isolation and less emotional

restitution. By contrast, other studies found that

adjustment to loss is more rapid in men, reflected in higher

rates of remarriage and less articulation of sorrow.

Significantly, very few studies have been undertaken on

the bereavement of spouses of cancer victims, and no known

study has investigated whether differences exist in levels

of adjustment to bereavement between widowers and widows of

these victims. The situation of this population is unique

because they are in a state of continuing stress due to both

the anticipated death of the patient as the illness

progresses, as well as to the prolonged treatment beginning

with the diagnosis and followed by surgical intervention,

adjuvant therapy and especially terminal care, when the

patient is fully dependent on the care giver.

 8

The purpose of this study is to investigate if there is

a difference between widowers and widows regarding

depression and adjustment to the loss of the spouse.

To summarize widowhood and depression, widowhood may be

more of a difficult experience for women than men because of

the greater financial strains experienced by women. But

widowed men appear to be in worse health, to sustain greater

social losses, and to have more difficulty developing social

networks to replace the support and companionship lost with

the death of their wives. Lieberman (1996), on the basis of

Bernard's (1972) argument that marriage is more beneficial

for men than women, suggests that widowhood is an

unmitigated loss for men, whereas in addition to loss, it

may create growth opportunities for women. Widowed women,

after the initial period of grief, are relieved of the

constraints of caring for their husbands and experience

increased potential to explore new directions. Women also

lose less in terms of social and emotional support when

widowed, because husbands are less supportive of their

spouses than wives are.

Previous research suggests more reasons why widowhood

should be more depressing for men than for women

particularly in the long run. Also, most of the studies

that show no gender differences in the effects of

depression, or stronger effects for women, were longitudinal

 9

studies beginning at or near the point of widowhood and

extending no more than two or three years.

Because most women have longer life expectancies and

marry men who are older than themselves, they are much more

likely than their husbands to assume the role of care giver

for a spouse. Research indicates that there is a paucity of

substitute care giving sources (Cicirelli, 1981; Rakowski &

Clark, 1985), indicating that in old age men generally

depend more on their wives than women depend on their

husbands. Studies have shown that even when an aged wife

becomes ill due to stress and the burden of care giving and

needs assistance, she will neglect her health and continue

to care for her disabled husband (Rakowski & Clark, 1985;

Soldo & Manton, 1985).

Adequate care of impaired and disabled elderly people

depends on a particular dimension of societal expectations

from women. Traditionally, women have been susceptible to

what has been appropriately called by feminists "the

compassion trap." Because of their nurturing skills and

sensitivity to human interaction, women are considered more

responsive to pain and suffering and more willing to take on

arduous and often unrewarded personal duties. Performing

stressful and often painful duties without pay is assumed to

be a labor of love, and activity that is taken for granted

for the female population. The wife is generally drawn into

the role with little thought for planning based on the idea
 10

that there is no other choice. Many elderly wives believe

that, for better or for worse, they must respond to the

needs of their disabled spouse without regard for their own

personal and emotional sacrifices.

Significance of Study

Two review studies on gender differences in bereavement

outcome arrive at rather different conclusions. The

question "who suffers more?" remains open and may never be

resolved due to differences in sampling and methods of

various studies, and the fact that gender differences are

not general but specific for different cultures or

subcultures. An alternative approach is to examine the

similarities and differences in the experience of widows and

widowers in adapting the loss of the partner in a particular

culture in order to identify ways in which the process of

adaptation is influenced by gender.

 CHAPTER TWO

REVIEW OF LITERATURE

To say that widowhood is a depressing experience is an

understatement. The loss of a spouse to death is associated

in the expectable directions with a variety of indicators of

psychological well-being (Bengtson et al., 1990; Berardo,

1970; Gallagher et al., 1983; Lopata, 1973; Lund, 1989;

Stroebe and Stroebe, 1987, 1983; Umberson et al., 1992).

The most intriguing aspect of the research on widowhood to

date is not the finding that widowhood is accompanied by

lower levels of psychological well-being, but rather that

the differences between widowhood and married persons are

not greater than they appear to be (Faletti et al., 1989;

Lund, et al., 1989; Umberson et al., 1992). Many of the

above mentioned studies, as well as others (e.g., Siegel and

Kutkendall, 1990), have found quite minimal differences in

psychological well-being between married and widowed

persons.

There are at least two possible kinds of reasons for

these small differences. First, most studies agree that the

adverse effects of widowhood diminish with time (Faletti et

al., 1989; Ferraro et al., 1984; Lund et al., 1989; Mendes

de Leon, et al., 1994; Umberson et al., 1992; Van Zandt, et

11
 12

al., 1998). Schaie and Willis (1991) suggest this may be

explained by a two-stage process in which the initial stage

of acute grief is gradually replaced by the development of a

new identity as a partnerless person. Cross-sectional

studies may underestimate the effects of widowhood, if time

since widowhood is not controlled, since many widows have

had years to adjust to the loss of their spouses. Second,

it is possible that widowhood affects different types of

people differently. Gender differences are prominent among

these possibilities. Some investigators claim that women

are more likely to become depressed, others assert that men

are more vulnerable (e.g., Stroebe and Stroebe, 1983) and

still others argue that there is no gender differences in

depression following widowhood (e.g., Lund, 1989). Because

most widowed persons are women, most studies of widowhood

have been done on women (Bengtson et al., 1990; Lopata,

1973).

Several studies have found no gender differences in the

effects of widowhood on depression, life satisfaction, or

mental health in general (Faletti et al., 1989; Gallagher et

al., 1983; Heyman and Gianturco, 1973; Lund et al., 1989;

Thompson et al., 1989; Van Zandt et al., 1989). Others have

observed more negative effects of widowhood for men (Mendes

de Leon et al., 1994; Stroebe and Stroebe, 1983, 1988;

Umberson et al., 1992). These widely discrepant results may

reflect differences in the conceptualization and measurement

 13

of dependent variables or random variation around a true

population parameter of no difference. However, there are

reasons to expect widowhood to be a more difficult

experience psychologically for each gender.

Widowhood has been suggested to be a more difficult

experience for women psychologically because it is a greater

financial strain for women than for men (Wortman et al.,

1993). In general, economic strain is associated with lower

levels of psychological well-being (Ross et al., 1991;

Voydannoff, 1991). Unmarried women have lower incomes than

unmarried men throughout the life cycle, and particularly in

old age (Marini, 1989). Umberson et al. (1992) found that

the degree of financial strain experienced by widowed women

is positively related to depression; no relation between

these variables was observed for men. Research thus

suggests that widowed women experience more financial strain

than widowed men, and that this strain is likely to increase

depression among women.

However, other differences between widowed men and

women seem likely to produce higher levels of depression

among men. One demographic differences that may be relevant

is that, because of gender differences in life expectancies

at any single point in time men are likely to have been

widowed for a shorter period than women. Men are less

likely to survive their spouses for many years, partly

because widowhood elevates mortality rates more for men than

 14

women (Bowling, 1988-89; DeSpelder and Strickland, 1992;

Hyman, 1983). As, noted above, most research suggests a

positive effect of time since widowhood on psychological

well-being, and widowed women may have had more time to

adjust to widowhood.

Second, widowed men appear to have more health problems

than widowed women (Bengtson et al., 1990; Berardo, 1970;

Gove, 1973; Hyman, 1983; Lopata, 1973). Widowhood has an

adverse effect on health, as well as mortality, for both

genders, but this effect is apparently stronger for men.

Men may be less competent in the performance of domestic

tasks (Umberson et al., 1992), including cooking, and may

therefore suffer a nutrition deficit in comparison to

widowed women. Men may also engage in more behaviors

deleterious to health, such as smoking and drinking (Zisook

et al., 1990). Poor health is related to depression among

widows as well as others (Faletti et al., 1989; Schuster and

Butler, 1989).

Third, there are many differences in social relations

between men and women. Women provide more emotional support

to their spouses than do men (Bernard, 1973; Gove, 1973;

Lee, 1988; Umberson et al., 1992), so the loss of a spouse

may leave a greater void in men's social and emotional

worlds. In addition, women receive more support from their

children following widowhood (Bengtson et al., 1990;

Umberson et al., 1992), perhaps because the mother-daughter

 15

tie is the strongest of all kinship relations (Rossi and

Rossi, 1990). Women also are likely to have larger and more

active social networks than men both prior to and following

widowhood (Antonucci, 1990; Bengtson et al., 1990; Berardo,

1970; Umberson et al., 1992). Schuster and Butler (1989)

note that widowhood may cause women to lose contact with

married friends, but over the long run they tend to develop

more ties with widowed friends. This is not necessarily the

case with men, in part because there are fewer widowed men;

men's opportunities to develop friendships with others

similar to themselves are constrained by the very fact that

widowhood is uncommon among men. Pihlblad and Adams (1972)

found that after five years of widowhood, men's numbers of

friends had decreased by half, whereas women experienced no

decrease in the size of their friendship networks.

Social contact and emotional support from others are

positively related to psychological well-being (Antonucci,

1990; Bengtson et al., 1990; Duran et al., 1989; House et

al., 1988; Lopata, 1996; Schuster and Butler, 1989;

Silverstein and Bengtson, 1994; Umberson et al., 1992).

However, many studies suggest that support from friends is

more important than support from children or other family

members (Dean et al., 1990; Lee and Ishii-Kuntz, 1987; Matt

and Dean, 1993).

One explanation for lack of attention to male grief

with respect to death of a spouse is demographic. Widows

 16

far outnumber widowers. According to the National Widowed

Persons Service in Washington D.C., there were 13,532,000

widowed persons in the United States in 1988; of these, 83%

were women, while only 17% were men.

A second factor may be accessibility. Although there

is literature indicating that widowers have higher death

rates and take longer to recover from depression than

widows, widowers are less likely to engage in self report

than widows (Bowling, 1987), and they are much less likely

to be a part of a population either recognized or easily

accessed by researchers. Indeed, Hansson and Remondet

(1988) noted that although widowers "also experience serious

adjustment problems," widowhood "is primarily a women's

issue."

When researchers have looked at gender differences

between widows and widowers, they have found for the most

part, more similarities than differences. Raphael (1982)

argued the "patterns of 'normal' bereavement for widows and

widowers are essentially the same," but suggested that

intensity of grief may differ. Differences between widows

and widowers, however, may "be very superficial, bringing

misleading assumptions about the needs of both."

Morgan (1984) found no gender differences in effect of

loss of spouse on the total amount of interaction with

family members. VandeCreek (1988) found both widows and

widowers perceiving family and friends more supportive than

 17

professionals. Feinson (1986) reported no differences in

psychological distress by gender even though males may be at

higher risk with respect to mortality and male patterns of

social participation may differ.

Lund et al. (1986) found no differences with respect to

coping two years following bereavement. Gass and Change

(1989) found that although the men in their sample had

greater resource strength, gender may not have been an

important factor in psychosocial health following

bereavement.

Bowling (1988-89) found men to have greater mortality

risk after the death of a spouse. Zick and Smith (1988)

focusing on remarriage found men less likely to outlive

their wives, but more likely to remarry. Sabatini (1988-89)

reported gender differences with respect to efficacy of a

treatment program, but the number of men in the sample was

too small to test for significance. Rosik (1989) found

widowers remaining depressed longer than widows following

the death of the spouse.

A few researchers have studied men exclusively. Moss

and Moss (1984-85) found men carrying deep attachments to

the deceased wife. This was expressed in the continuation

of basic components of the marriage, such as the widower's

maintaining the home the way his wife had kept it before she

died. Rubinstein (1986) studied the ways in which elderly

widowers organized their time each day and found those who
 18

appeared to be working through grief were more likely to

perceive a day as a unit of experience rather than part of a

meaningless passage of time.

In perhaps the major work on male grief, Campbell and

Silverman (1987) found evidence of the narrow range of

emotions men generally, and widowers specifically, are

permitted to express. This notion that men are prohibited

from showing emotions is further substantiated by the work

of Stroebe, Stroebe, and Domittner (1988) who suggested that

widowers who are less depressed are the ones who agree to be

interviewed, whereas with widows the opposite is the case.

The need for additional information on male grief is clearly

indicated.

A question that is often addressed in literature

examining adaptation to loss of the partner is: who suffers

more, widows or widowers? Stroebe and Stroebe (1987, 1983)

provide one of the most extensive reviews of research on the

consequences of bereavement for health. They draw the

following conclusions regarding gender differences in

outcome: "If there is a difference (and evidence is not

entirely conclusive) it is the widower who is at higher

risk, for when widows and widowers are compared with

same-gender, non-bereaved persons (thus controlling for the

main effects of gender on health), widowers are found to

suffer greater detriments compared with married men than are

widows compared to married women" (Stroebe and Stroebe).

 19

The fact that married women exhibit more symptoms of

physical and mental distress than married men is one reason

why the impact of bereavement appears to be less strong on

them than it is on men. Stevens suggests that marriage is

more negatively affected by its loss.

In a similar vein, Feinson (1986, 1987) has reviewed

studies on social behavior, physiological responses and

mental health following bereavement; her goal was to test

the popular assumption that losing a wife is more

distressing than losing a husband. She concludes: 'The

behavioral studies indicate different patterns of social

participation but do not support the perception of men as

more affected by bereavement than women. The mortality

studies provide tentative support for the notion that

widowers in some age categories may be at higher risk,

applies to all age cohorts and particularly to men over

seventy-five. Finally, the studies of psychological

distress clearly do not provide any support for the

perception about aging widowers. (Feinson 1986).

Research on factors influencing adaptation to

bereavement identified income, health, and social support as

important assets in the adaptation process (Ares, 1982;

Gallagher et al., 1981-82; Krause, 1986; Norris and Murrell,

1990; Vachon et al., 1982). Lopata (1973) has emphasized

the importance of education for women's adaptation to

widowhood. These resources for reorganizing one's life

 20

following the loss of the partner are often distributed

differentially, with older men at an advantage in terms of

higher income and education (Taylor and Ford, 1983; Centraal

Bureau voor de Statistiek, 1990).

Although women tend to live longer than men, they are

more often plagued by chronic health problems (e.g.,

arthritis, high blood pressure, diabetes) which are not

fatal but cause pain, discomfort, and limitations in their

social and physical activities (Verbrugge, 1983).

Epidemiological research in the Netherlands has found that

the older women report more illnesses and experience more

restrictions in daily functioning due to health problems

than older men (Bosma, 1988).

While women are in a disadvantageous position regarding

resources such as income, education and health, various

studies suggest that they have an advantage in terms of the

amount and quality of social support that is available to

them (Antonucci and Akiyama, 1987; Depner and Ingersoll-

Dayton, 1988; Vaux, 1985).

Theoretical Framework

The theoretical model used to compare the widows and

widowers has been adapted from the additive burden model

which was originally developed to explain social class

differences in the development of psychopathology

(Dohrenwend and Dohrenwend, 1981).

 21

Well-being is considered as the outcome of the process

of adaptation to widowhood. Gender has been substituted for

social class as the background variables influencing the

three mediating factors related to well-being. The first

factor consists of background variables which serve as

resources in the adaptation process; these include income,

social class and education and health. A second important

aspect influencing well-being is the social situation of the

widowed person. The types of relationships and the quality

of support available within the primary relationship network

are included within the second factor. The assumption is

that within these relationships the widowed person seeks

compensation for the loss of the partner and the support

which he or she provided. A third factor involves the

personal disposition of the widowed person. In this study

the acknowledged needs and desires in relationships are

included as a personal disposition which influences the

outcome of the adaptation process.

In the theoretical model each mediating factor has a

direct influence on well-being. Gender has an indirect

influence on well-being, through its effect on the three

mediating factors. According to the model, the effect of

the three factors is cumulative.

The present study is designed to address the gaps and

problems that characterize the existing literature. The

framework was developed to also explain how widowhood may

 22

contribute to enduring depression and why widowhood may

affect men and women differently. Drawing from this

framework, a national survey is used to (1) determine

whether having ever experienced widowhood is associated with

current levels of depression, (2) estimate gender

differences in the effect of widowhood on depression, and

(3) consider several social-structural mechanisms that may

partly explain gender differences in the link between

widowhood and depression.

This theoretical framework brings together research and

theory on (1) gender differences in marital and social

relationships, and (2) stressful life events and gender

differences in psychological distress. These different

types of literature lead us to expect gender differences in

vulnerability to depression following widowhood. The

experience of widowhood will be very different for men and

women because of the social structural contingencies

associated with gender and marital status. Past and present

differences in life experiences cause men and women to face

different sources and degrees of strain in dealing with

widowhood. Similar arguments have been advanced for gender

differences in the effects of marriage (Bernard, 1972; Gove,

1973). Cross-sectional data show indirectly that marriage

is more beneficial to the mental and physical health of men

than women (Gove, 1972, 1973), and several investigators

have pointed to specific socio-emotional and instrumental

 23

aspects of marriage that may differ for men and women (e.g.,

Bernard, 1972; Gove, 1973). This previous research on

gender and the effects of marriage on psychological distress

suggests possible differences in the widowhood experience

for men and women.

The purpose of this study is to find out if in fact

there are gender differences relating to the effects of

depression and adaptations among widows and widowers. The

research examines the grief reactions of men and women who

experienced the loss of their spouse. In analyzing the

results, the following questions were addressed: (1) Are

there significant differences between widows and widowers'

well-being one to three years after the loss of the partner?

(2) Who suffers more in the area of depression and adapting,

widows or widowers?

In this study, the researcher hypothesizes that

widowhood has a stronger positive effect on depression for

men than for a variety of economic, health related, and

social variables in an attempt to explain any observed

gender difference. Within the constraints of the data set,

these variables represent the factors noted above that may

account for gender differences in the effects of widowhood

on depression. They include indicators of socioeconomic

status (education and income), social support (relationship

with children and friends, church attendance, and household

composition), and personal characteristics (age, health and

 24

employment status). The researcher hypothesized that

socioeconomic status, interaction with friends, church

attendance, and health are negatively related to depression.

Exchange of assistance with children has been shown in some

prior research (Lee et al., 1995) to be positively related

to depression, possibly because it indicates an inability to

maintain independence on the part of older parents. Because

many of these variables are also related to gender, they may

contribute to the explanation of any observed gender

differences in the relation of depression, adaptation and

widowhood.

Definition of Terms

Elderly widows and widowers - Male and female between the

ages of sixty-years old and seventy-eight.

Depression - The act of being depressed; signs and symptoms

include: overwhelming, excessive crying spells, insomnia,

over-eating or binge eating, and sad/lonely feelings after

the death of a spouse.

Adaptation - The act of adjusting; being alone after the

death of a spouse. Coping with responsibilities, living

arrangements and life style changes.

Hypothesis

There is no statistically significant difference

between widows and widowers when measuring depression and

adaptation after the death of a spouse.

 CHAPTER THREE

METHODOLOGY

Research Design

This is a descriptive exploratory study. It is

intended to explore gender differences and the effects of

depression and adaptation among elderly widows and widowers

around Milledgeville, Georgia.

Sampling

A non-probability convenience sample was used. This

sample consisted of individuals who were convenient to the

research and were willing to respond to the questionnaire.

The sampling population was drawn from elderly widowed

persons residing in the Milledgeville, Georgia area.

A total of thirty-four elderly persons were asked to

complete the questionnaire. Of the fourteen male and twenty

female participants, all were between the ages of sixty and

seventy-eight. All subjects have been widowed between one

and two years.

Setting1

The study took place at persons' homes, churches, and

the hospital.

25
 26

Data Collection

The data for this study were obtained through a self-

reported questionnaire. Elderly persons in various

churches, bereavement support groups and the local Hospice

organizations were approached by the researcher and asked if

they would agree to completing the questionnaire.

Confidentiality and anonymity were ensured. Persons were

also given the option to refuse to participate in the study.

The questionnaire took between ten and fifteen minutes

to complete. Expression of thanks were given to all

subjects. The questionnaire was collected from participants

the same day as administration.

The instrument consisted of forty questions (See

Appendix A). It had four parts. Part I consisted of seven

questions focusing on demographics. Part II consisted of

the Death Depression Scale (DDS) by Terapler, LaVoie,

Chalgujiam, and Thomas-Dobson. This instrument was made up

of eleven true/false statements. "The DDS has fair internal

consistency, with a Kuder-Richardson coefficient of .77."

No information on stability was reported. The DDS has very

good concurrent validity, with the Death Anxiety Scale (DAS)

by Templer. "The DAS has fairly good internal consistency

with a Kuder-Richardson formula coefficient of .76." The

DAS also has good stability with a three week test-retest

correlation of .83. The DAS had good concurrent validity,

correlation .74 with the Fear of Death Scale. "Part IV

 27

consisted of the Geriatric Depression Scale (GDS) by Brink

and Yesavage." This instrument was made up of eleven yes/no

statements. "The GDS has excellent internal consistency

with an alpha of .94 and split-half reliability of .94."

The GDS also has excellent stability with a one-week test-

retest correlation of .85.

The GDS has excellent concurrent validity with

correlations of .83 between the GDS and Zung's Self-Rating

Depression Scale and .84 with the Hamilton Rating Scale for

Depression. The GDS also has good known-groups validity in

distinguishing significantly among respondents classified as

normal, mildly depressed, and severely depressed.

Data Analysis

The collection data were coded and analyzed using the

SPSSX batched system on the VAX computed system of the

Atlanta University Center. Descriptive statistics were used

to analyze the data, this included frequency distributions

and percentages and t-tests.

 CHAPTER FOUR

PRESENTATION OF RESULTS

Null Hypothesis

HA: There is no significant statistical difference between

elderly widows and widowers when measuring depression

and adaptation after the death of a spouse.

Part I - Demographics

Table 1. Gender (N=34)

Gender Frequency Percent

Male 14 41.0

Female 20 59.0

Total 34 100.0

The above graph shows that of the 34 subjects

participating in this study, fourteen or 41.0% were male and

the remaining twenty or 59.0% were female.

28
 29

Table 2. Age (N=30)

Age Range Male Female Percent

60-65 4 16 58.8

65-70 6 22 3.5

70-75 3 1 11.8

75 and over 1 1 5.8

Totals 14 20 100.0

As demonstrated in Table 2, four males and sixteen

females or a total of 58.8 percent were between the ages of

60 and 65. Six males and two females or a total of 23.5

percent were between the ages of 65 and 70. Three males and

one female or a total of 11.8 percent were between the ages

of 70 and 75. One males and one female or a total of 5.8

percent were over the age of 75.

Table 3. Race (N=30)

Ethnicity Male Female Percent

African American 4 6 24.3

White 10 13 72.8

Other 0 1 2.9

Total 14 20 100.0
 30

Table 3 shows that of 34 subjects participating in this

study, four males were African American and six females were

African American for a total of 24.3 percent. Ten male and

two females were white for a total of 24.3 percent. Zero

male and one female participant, at 2.9 percent responded in

the other category.

Table 4. Present Marital Status (N=34)

Status Male Female Percent

Married 10 5 41.6

Widowed 4 15 58.4

Total 14 20 100.0

As the above table indicates, of the 34 participants,

ten males and five females, for a total of 41.6 percent were

married after the death. Four males and fifteen females,

for a total of 58.4 percent remained widowed.

 31

Table 5. Years Married to the Deceased (N=34)

Years Male Female Percent

10-25 2 4 12.2

26-40 7 9 61.7

41-55 3 5 20.4

56 and over 2 2 5.7

Total 14 20 100.0

As the above table indicates, of the 34 participants,

two male and four female participants, for a total of 12.2

percent were married between ten and twenty-five years.

Seven male and nine female, for a total of 61.7 percent were

married between twenty-six and forty years. Three male and

five female, for a total of 20.4 percent were married

between forty-one and fifty-five years. Two male and two

female participants, for a total of 5.7 percent were married

over fifty-six years.

Table 6. Number of Years Since Death (N=34)

# of Years Since Death Male Female Percent

1-2 10 14 74.2

Over 3 years 4 6 25.8

Total 14 20 100.0
 32

As indicated in the above cross tabulation of the 34

study participants, ten male and fourteen female, for a

total of 74.2 percent has been in bereavement between one

and two years. Four male and six female, for a total of

25.8 percent has been in bereavement over 3 years.

Table 7. Present Total Yearly Income (N=34)

Total Yearly Income Male Female Percent

Less than 10,000 0 1 5.0

10,001-20,000 1 5 14.5

20,001-30,000 5 7 37.8

30,001-40,000 5 4 28.2

Over 40,000 3 3 14.5

Total 14 20 100.0

As the previous table indicates, of the 34

participants, zero male and one female, for a total of 5

percent earned less than $10,000 per year. One male and

five female, for a total of 14.5 percent earned between

$10,001 and $20,000 per year. Five male and seven female,

for a total of 37.8 percent earned between $20,001 and

$30,000 per year. Five male and four female, for a total of

28.2 earned between $30,001 and$ 40,000 per year. Three male
 33

and three female, for a total of 14.5 percent earned over

$40,000 per year.

Part II - Death Depression Scale (DDS)

Table 8. T-Test Analysis of the Death Depression Among

Elderly Widows and Widowers (N=34)

(Pooled Variance) (Separated Variance)

F value 2 Tail T value Df 2 Tail T value Df 2 Tail

Prob. Prob. Prob.

1.05 .954 -.28 32 .779 -.28 28. 55 .778

Variables Numbers of Mean Score Standard Standard

Subjects Deviation Error

Male 14 28 .1 2.8 2.9

Female 20 28 .4 2.9 .64

As indicated in the above table, there is no

statistical significance in the effects of depression of

elderly widower participants and the effects of depression

of elderly widowed participants.

 34

Part III - Death Anxiety Scale (DAS)

Table 9. T-Test Analysis of Death Anxiety Among Elderly

Widows and Widowers (N=34)

F value 2 Tail T value Df 2 Tail T value Df 2 Tail

Prob. Prob. Prob.

4.67 .003 -1.06 32 .295 -.94 16 .93 .358

Variables Numbers of Mean Score Standard Standard

Subjects Deviation Error

Male 14 23 .1 2.8 .75

Female 20 23 .9 1.3 .29

As indicated in the above table, there is no

statistical significance in the death anxiety among elderly

widowed participants.
 35

Part IV - Geriatric Depression Scale (GDS)

Table 10. T-Test Analysis of Geriatric Depression Among

Elderly Widows and Widowers (N= 34)

F value 2 Tail T value Df 2 Tail T value Df 2 Tail

Prob. Prob. Prob.

2.46 .073 -1.62 32 .116 -1.5 20 .32 .150

Variables Numbers of Mean Score Standard Standard

Subjects Deviation Error

Male 14 33 .6 10.6 2.8

Female 20 38 .5 6.8 1.5

As indicated in the previous table, there is no

statistical significance in the effects of depression/gender

differences among elderly widowed and widower participates.

 CHAPTER FIVE

SUMMARY AND CONCLUSION

The study was designed to determine whether or not a

difference exists between the effects of depression and

adaptation among elderly widows and widowers.

The null hypothesis stated that there was no

statistical significance between the two groups and the

t-test analysis accepts this hypothesis. In this particular

group of subjects, gender was not linked to depression or

adaptation.

These findings lead this researcher to believe that

regardless of gender, individuals experience some of the

same emotions when dealing with depression and adapting to

the loss of a spouse. Since there are limitations in the

empirical research, it is not certain whether or not the

findings of this study are consistent with other research

studies.

Limitations of the Study

Due to the sample population size, the findings cannot

be generalized to the total population. The findings of

this particular study may not be directed toward the sample

population.

36
 37

The time factor was also a limitation in this

particular study. This research project had a specific time

restriction which may have contributed to the findings. An

additional limitation may have been the response bias or

socially desirable responses of the subjects. Grief and

bereavement, as well as depression and adaptation are

sensitive and emotional topics for some individuals. In

order to prevent volatile emotions from surfacing or

re-surfacing, subjects may have responded to the

questionnaire in a particular pattern or the way in which

they thought they should respond.

Suggested Research Direction

The topic of grief and bereavement as it relates to

depression and adaptation is an important one especially in

regards to social work students. Further research may

involve a broadening of the sample population in number and

creating more research in the area of male bereavement and

grief.
 CHAPTER SIX

IMPLICATIONS FOR SOCIAL WORK PRACTICE

Documenting that a broad range of emotional responses

to grief among widows and widowers may be more similar than

different is important for counselors, social workers, and

psychotherapists involved with bereaved adults and families.

The apparent similarity among men and women in the grief

process causes us to pause and consider how this may

influence our practice in this field. This finding does not

dismiss the practice wisdom of bereavement counselor that

social expectations for men about grieving differ from

social expectations for women, and, behavioral needs of men

and women, recognizing that there may be this similarity in

the range of emotional responses.

It is important to emphasize, however, that within

gender categories, unique differences occur. It would be

highly misleading to think categorically in terms of male or

female grief. The findings that length of time since the

death and decreasing intensity of grief are not necessarily

related and that the establishment of new relationships does

not necessarily mean that grief disappears, affirm the

uniqueness of individual grief. There are, however, some

38
 39

general characteristics that should be considered in program

development.

Most importantly, because there is little research that

provides clarity in the social and psychological expression

of grief with a non-androgynous lens, further sociometric

instrument development and additional exploratory

ethnographic studies may be valuable. This research area is

especially salient as bereavement specialists aim to promote

sensitivity for the gender differences and similarities

required for effective practice.

APPENDICES

40
 41

APPENDIX A

QUESTIONNAIRE

IF YOU HAVE SURVIVED THE DEATH OF A SPOUSE, PLEASE TAKE THE

TIME TO COMPLETE THE FOLLOWING QUESTIONNAIRE.

After the death of a spouse, the individual left behind

is faced with having to work through the grief process.

There are seguences which characterize grief and depression,

therefore, I would appreciate your assistance in sharing

ideas which would help me to relate the differences and

commonalities in gender differences. This information would

be useful in rendering assistance and aiding in maintaining

needed eguilibrium in resolving inevitable life crises.

All guestionnaire material will be anonymous.

Thank you.

Alexia Wicker

Directions: Read each item carefully and indicate the best

response that describes your situation. Thank You!

Part I - Demographics

1. My gender is:

1) Male

2) Female
 42

APPENDIX A

(continued)

2. Age

1) 60-64

2) 65-69

3) 70-74

4) 75 and over

3. The one racial or ethnic group that best describes me

is:

1) African American

2) White

3) Hispanic

4) Asian

5) Other

4. Present Marital Status

1) Married

2) Widowed

5. Years Married to the Deceased

1) 10-25 years

2) 26-40 years

3) 41-55 years

4) 56 and over

6. Number of Years since Death

1) 1-2 years

2) over 3 years
 43

APPENDIX A

(continued)

7. Present Total Yearly Income

1) Less than 10,000

2) 10,001 - 20,000

3) 20,001 - 30,000

4) 30,001 - 40,000

5) Over 40,000

Directions: Please circle T for true or F for false in each

item as it applies to you. Thank you!

Part II- Death Depression Scale (DDS)

T F 1. I get depressed when I think about death.

T F 2. Hearing the word death makes me feel sad.

T F 3. Passing by cemeteries makes me sad.

T F 4. Death means terrible loneliness.

T F 5. I become terribly sad when I think about

friends/relatives who have died or

relatives who have died.

T F 6. I am terribly upset by the shortness of

life.

T F 7. I worry about dying alone.

T F 8. Death does not rob life of its meaning.

T F 9. When I think of death, I feel tired and

lifeless.
 44

APPENDIX A

(continued)

T F 10. Death is something to be depressed about.

T F 11. I feel sad when I dream of death.

Directions: If a statement is true or mostly true as applied

to you, circle "T." If a statement is false or mostly

false as applied to you, circle "F." Thank You!

Part III - Death Anxiety Scale (DAS)

T F 1. I am very much afraid to die.

T F 2. The thought of death seldom enters my mind.

T F. 3. It doesn't make me nervous when people talk

about death.

T F 4. I dread to think about having to have an

operation.

T F 5. I am not at all afraid to die.

T F 6. I am not particularly afraid of getting

cancer.

T F 7. The thought of death never bothers me.

T F 8. I am often distressed by the way time flies

so very rapidly.

T f 9. The subject of life after death troubles me

greatly.

T F 10. I often think about how short life really

is.
 45

APPENDIX A

(continued)

T F 11. The sight of a dead body is horrifying to

me.

Directions: Please circle Y for "Yes" or N for "No" in

choosing the best answer for how you felt over the pass

week.

Part IV - Geriatric Depression Scale (GDS)

Y N 1. Are you basically satisfied with your life?

y n 2. Have you dropped many of your activities and

interests?

y n 3. Do you feel that your life is empty?

Y N 4. Do you often get bored?

y n 5. Are you in good spirits most of the time?

Y N 6. Are you afraid that something bad is going

to happen to you?

y n 7. Do you feel happy most of the time?

y n 8. Do you often feel helpless?

y n 9. Do you feel you have more problems with

memory than most?

Y N 10. Do you feel full of energy?

Y N 11. Do you feel that most people are better off

than you are?

 46

APPENDIX B

ADDITIONAL TABLES

Table 1A. I get depressed when I think about death (N=34)

Response Male Female Percent

True 7 8 44.0

False 7 12 56.0

Total 14 20 100.0

Table 2A. Hearing the word death makes me feel sad (N=34)

Response Male Female Percent

True 4 8 35.0

False 10 12 65.0

Total 14 20 100.0

Table 3A. Passing by cemeteries make me sad (N=34)

Response Male Female Percent

True 0 3 9.0

False 14 17 91.0

Total 14 20 100.0
 47

APPENDIX B

(continued)

Table 4A. Death means terrible loneliness (N=34).

Response Male Female Percent

True 6 11 50.0

False 8 9 50.0

Totals 14 20 100.0

Table 5A. I become terribly sad when I think about friends

or relatives who have died (N=34).

Response Male Female Percent

True 6 11 50.0

False 8 9 50.0

Totals 14 20 100.0

Table 6A. I am terribly upset by the shortness of life

(N=34).

Response Male Female Percent

True 4 5 26.0

False 10 15 74.0

Totals 14 20 100.0
 48

APPENDIX B

(continued)

Table 7A. I worry about dying alone (N=34).

Response Male Female Percent

True 3 7 26.5

False 11 13 73.5

Totals 14 20 100.0

Table 8A. Death does not rob life of its meaning (N=34)

Response Male Female Percent

True 10 15 73.5

False 4 5 26.6

Totals 14 20 100.0

Table 9A. When I think of death, I feel tired and

lifeless (N=34).

Response Male Female Percent

True 1 2 8.8

False 13 18 91.2

Totals 14 20 100.0
 49

APPENDIX B

(continued)

Table 10A. Death is not something to be depressed about

(N=34).

Response Male Female Percent

True 10 11 61.8

False 4 9 38.2

Totals 14 20 100.0

Table 11A. I feel sad when I dream of death (N=34)

Response Male Female Percent

True 7 9 47.1

False 7 11 52.9

Totals 14 20 100.0

Table 12A. I am very much afraid to die (N=34)

Response Male Female Percent

True 3 9 35.3

False 11 11 64.7

Totals 14 20 100.0
 50

APPENDIX B

(continued)

Table 13A. The thought of death seldom enters my mind

(N=34).

Response Male Female Percent

True 8 7 44.1

False 6 13 55.9

Totals 14 20 100.0

Table 14A. It doesn't make me nervous when people talk

about death (N=34).

Response Male Female Percent

True 9 12 61.8

False 5 8 38.2

Totals 14 20 100.0

Table 15A. I dread to think about having to have an

operation (N=34).

Response Male Female Percent

True 9 13 64.7

False 5 7 35.3

Totals 14 20 100.0
 51

APPENDIX B

(continued)

Table 16A. I am not at all afraid to die (N=34)

Response Male Female Percent

True 6 5 32.4

False 8 15 67.6

Totals 14 20 100.0

Table 17A. I am not particularly afraid of getting cancer

(N=34).

Response Male Female Percent

True 7 7 41.2

False 7 13 58.8

Totals 14 20 100.0

Table 18A. The thought of death never bothers me (N=34).

Response Male Female Percent

True 6 2 23.5

False 8 18 76.5

Totals 14 20 100.0
 52

APPENDIX B

(continued)

Table 19A. I am often distressed by the way time flies

(N=34).

Response Male Female Percent

True 10 6 44.1

False 4 14 55.1

Totals 14 20 100.0

Table 20A. The subject of life after death troubles me

greatly (N=34).

Response Male Female Percent

True 2 0 5.9

False 12 20 94.1

Totals 14 20 100.0

Table 21A. I often think about how short life really is

(N=34).

Response Male Female Percent

True 7 9 47.1

False 7 11 52.9

Totals 14 20 100.0
 53

APPENDIX B

(continued)

Table 22A. The sight of a dead body is horrifying to me

(N=34).

Response Male Female Percent

True 4 11 41.2

False 10 9 58.8

Totals 14 20 100.0

Table 23A. Are you basically satisfied with your life

(N=34)?

Response Male Female Percent

1 (Not At All) 3 2 14.7

2 (Rarely) 2 4 17.6

3 (Sometimes) 7 7 41.2

4 (Often) 2 7 26.5

Totals 14 20 100.0
 54

APPENDIX B

(continued)

Table 24A. Have you dropped many of your activities and

interests (N=34)?

Response Male Female Percent

1 (Not At All) 4 3 20.6

2 (Rarely) 3 0 8.8

3 (Sometimes) 5 11 47.1

4 (Often) 2 6 23.5

Totals 14 20 100.0

Table 25A. Do you feel that your life is empty (N=34)?

Response Male Female Percent

1 (Not At All) 3 3 17.6

2 (Rarely) 5 4 26.5

3 (Sometimes) 2 11 38.2

4 (Often) 4 2 17.6

Totals 14 20 100.0
 55

APPENDIX B

(continued)

Table 26A. Do you often get bored (N=34)?

Response Hale Female Percent

1 (Not At All) 4 4 23.5

2 (Rarely) 6 10 47.1

3 (Sometimes) 3 5 23.5

4 (Often) 1 1 5.9

Total 14 20 100.0

Table 27A. Are you in good spirits most of the time (N=34)?

Response Male Female Percent

1 (Not At All) 2 1 8.8

2 (Rarely) 4 4 23.5

3 (Sometimes) 6 11 50.0

4 (Often) 2 4 17.6

Totals 14 20 100.0
 56

APPENDIX B

(continued)

Table 28A. Are you afraid that something bad is going to

happen to you (N=34)?

Response Male Female Percent

1 (Not At All) 7 5 35.3

2 (Rarely) 4 8 38.2

3 (Sometimes) 3 4 17.6

4 (Often) 0 3 8.8

Totals 14 20 100.0

Table 29A. Do you feel happy most of the time (N=34)?

Response Male Female Percent

1 (Not At All) 4 8 35.3

2 (Rarely) 6 5 29.4

3 (Sometimes) 3 5 23.5

4 (Often) 1 2 11.8

Total 14 20 100.0
 57

APPENDIX B

(continued)

Table 30A. Do you often feel helpless (N=34)?

Response Male Female Percent

1 (Not At All) 7 5 35.3

2 (Rarely) 3 3 17.6

3 (Sometimes) 2 10 35.3

4 (Often) 2 2 11.8

Totals 14 20 100.0

Table 31A. Do you feel you have more problems with memory
than most (N=34)?

Response Male Female Percent

1 (Not At All) 3 4 20.6

2 (Rarely) 7 6 38.2

3 (Sometimes) 2 8 29.4

4 (Often) 2 2 11.8

Total 14 20 100.0
 58

APPENDIX B

(continued)

Table 32A. Do you feel full of energy (N=34)?

Response Male Female Percent

1 (Not At All) 4 0 11.8

2 (Rarely) 8 9 50.0

3 (Sometimes) 1 7 23.5

4 (Often) 1 4 14.7

Totals 14 20 100.0

Table 33A. Do you feel that most people are better off than
you are (N=34)?

Response Male Female Percent

1 (Not At All) 4 1 14.7

2 (Rarely) 2 6 23.5

3 (Sometimes) 7 9 47.1

4 (Often) 1 4 14.7

Totals 14 20 100.0
 BIBLIOGRAPHY

Antonucci, T. G. & Akiyama, H. (1987). An examination

of sex differences in social support among older men and

women. Sex Roles. 17, 737-749.

Ares, D. A. (1982). Widowhood and well-being: An

examination of sex differences within a causal model.

International Journal of Aaincr and Human Development. 15,

27-40.

Bengtson, V. L., Rosenthal, C. & Burton, L. (1990).

"Families and Aging: Diversity and Heterogeneity." Handbook

of Aaina. 263-287. San Diego: Academic Press.

Berardo, F. M. (1970). "Survivorship and Social

Isolation: The Case of the Aged Widower." Family

Coordinator. 19, 11-25.

Bernard, J. (1972). The Future of Marriage. New

Haven: Yale University Press.

Bosnia, A. (1988). De Gezondheid van Mensen in de Derde

Levensfase: Een Onderzoek naar Lichameliike en Psvchische

Aspekten. The health of persons in the third phase of life:

A study on physical and mental aspects. Afdeling Preventieve

en Sociale Psychiatrie, GGD Einhoven.

Bowlby, J. (1961). "Process of Mourning." Journal of

Psycho-Analysis. 42, 317-340.

59
 60

Bowling, A. (1987). Mortality after bereavement: A

review of the literature on survival periods and factors

affecting survival. Social Science and Medicine. 24(2),

117-124.

Bowling, A. (1988-1989). Who dies after widow(er)hood?:

A discriminant analysis. Omega, 19(2), 135-153.

Brabant, S. (1989-1990). Old pain or new pain: A

social psychological approach to recurrent grief. Omega,

20(4), 273-279.

Brink, T. L. & Yesavage, J. A. (1983). Geriatric

Depression Scale (GDS). Palo Alto, California.

Burch, B. (1989). "Mourning and Failure to Mourn: An

Object-Relations View." Contemporary Psycho-Analysis.

25(4), 608-623.

Campbell, S. & Silverman, P. (1987). widower. New York:

Prentice Hall Press.

Carey, R. G. (1979). "Weathering Widowhood: Problems

and Adjustments of the Widowed During the First Year."

Omeaa: The Journal of Death and Dvina. 10, 163-174.

Centraal Bureau voor de Statistiek. (1990). statistisch

vademecum Ouderen 1990. SDU Uitgeverij, *s Gravenhage.

Cicirelli, V. G. (1981). Helping elderly parents: The

role of adult children. Boston: Auburn House.

Clayton, P. J., Halikas, J. A., & Maurice, W. L.

(1972). "The Depression of Widowhood." British Journal of

Psychiatry. 120, 71-78.

 61

Cook, A. S. & Dworkin, D. S. (1992). Helping the

Bereaved. New York: Basic Books, A Division of Harper

Collins Publishers.

Dean, A., Kolody, B., & Wood, P. (1990). "The Effects

of Social Support from Various Sources on Depression in

Elderly Persons." Journal of Health and Social Behavior.

Depner, C. E. & Ingerso11-Dayton, B. (1988).

Supporting Relationships in Later Life. Psychology and

Aging■ 3, 348-357.

DeSpelder, L. A. & Strickland, A. L. (1992). Te Last

Dance; Encountering Death and Dying. Mountain View, Ca.:

Mayfield.

Dohrenwend, B. P. & Dohrenwend, B. S. (1981).

Socioenvironmental factors, stress and psychopathology.

American Journal of Community Psychology. 9, 128-164.

Duran, A., Turner, C, & Lund, D. (1989). "Social

Support, Perceived Stress, and Depression Following the

Death of a Spouse in Later Life." Older Bereaved Spouses;

Research with Practical Applications, ed. Lund, D. New

York: Hemisphere.

Faletti, M. V., Gibbs, J. H., Clark, M. C, Pruchno, R.

A. & Berman, E. A. (1989). "Longitudinal Course of

Bereavement in Older Adults." Older Bereavement Spouses:

Research with Practical Applications. New York: Hemisphere.

 62

Feinson, M. C. (1986). Aging widows and widowers: Are

there mental health differences? International Journal of

Aging and Human Development. 23, 241-255.

Feinson, M. C. (1987). Mental health and aging: Are

there gender differences? Gerontologist, 27, 703-711.

Ferraro, K. F., Mutran, E. & Barresi, C. M. (1984).

"Widowhood, Health and Friendship in Later Life." Journal

of Health and Social Behavior, 25, 245-259.

Freud, S. (1917). "Mourning and Melancholia." SE 14.

Gallagher, D. E., Breckenridge, J. N., Thompson, L. W.

& Peterson, J. A. (1983). "Effects of Bereavement on

Indicators of Mental Health in Elderly Widows and Widowers."

Journal of Gerontology. 38, 565-571.

Gallagher, D. E., Thompson, L. W. & Peterson, J. A.

(1981-1982). "Psychosocial factors affecting adaptation to

bereavement in the elderly." International Journal of Aaina

and Human Development. 14, 79-95.

Gass, K. & Change, A. (1989). Appraisals of

Bereavement, Coping, Resources and Psychosocial Health

Dysfunction in Widows and Widowers. Nursing Research.

38(1), 31-36.

Gentry, M. & Shulman, A. (1988). Remarriage as a

coping response for widowhood, psychology and Aging. 3(2),

191-196.
 63

Gove, W. R. (1973). "Sex, Marital Status and

Mortality." The American Journal of Sociology,, 79(1),

45-67.

Gove, W. R. (1973). "Sex, Marital Status and

Psychiatric Treatment: A Research Note." Social Forces,

58, 89-93.

Grollman, A. (1974). Concerning Death: A Practical

Guide for the Living. Boston: Beacon Press.

Hansson, R. & Remondet, J. (1988). Old age and

widowhood: Issues of personal control and independence.

Journal of Social Issues. 44(3), 159-174.

Hartman, H. I. (1981). "The Family as the Locus of

Gender, Class and Political Struggle: The Example of

Housework." Signs: The Journal of Women in Culture and

Society. 6(3), 366-394.

Helsing, K. J. and Szklo, M. (1981). "Mortality after

bereavement." American Journal of Epidemiology.

Heyman, D. & Gianturco, D. (1973). "Long-term

Adaptation by the Elderly to Bereavement." Journal of

Gerontology. 28, 359-362.

Holmes, T. H. & Rahe, R. H. (1967). The social

readjustment rating scale. Journal of Psychosomatic

Research. 11, 213-218.

House, J. S., Umberson, D., & Landis, K. R. (1988).

"Structures and Processes of Social Support." Annual Review

of Sociology. California.
 64

Hyman, H. H. (1983). Of Time and Widowhood:

Nationwide Studies of Enduring Effects. Durham, NC: Duke

University Press.

Jacobs, S., Hansen, F. & Berkman, L., et al. (1989).

Depressions of Bereavement. Comprehensive Psychiatry, 30,

218-224.

Jacobs, S., Kosten, T., Kasl, S., Ostfeld, A., Berkman,

L. & Charpentier, P. (1987-1988). Attachment theory and

multiple dimensions of grief. Omega, 18(1), 41-45.

Jacobs, S. and Ostfeld, A. (1977). "An

epidemiological review of the mortality of bereavement."

Psychosomatic Medicine.

Kaprio, J., Koskenvuo, M., & Rita H. (1987).

"Mortality after bereavement: A prospective study of widowed

persons." American Journal of Public Health.

Klein, M. (1964a). "A Contribution to the

Psychogenesis of Manic-Depressive States." Contributions to

Psycho-Analysis. 1921-1945. New York: McGraw-Hill.

Klein, M. (1964b). "Mourning and Its Relation to

Manic-Depressive States." Contributions to Psvcho-Analvsis.

1921-1945. New York: McGraw-Hill.

Klerman, G. L. & Izen, J. (1977). "The effects of

bereavement and grief on physical health and general

well-being." Advances in Psychosomatic Medicine.

 65

Krause, W. (1986). "Social support, stress, and

well-being among older adults." Journal of Gerontology. 41,

512-519.

Kubler-Ross, E. (1969). On Death and Dying. New York:

Macmillan.

Lee, G. R. (1988). "Marital Intimacy Among Older

Persons: The Spouse as Confidant." Journal of Family

Issues. 273-284.

Lee, G. R. & Ishii-Kuntz, M. (1987). "Social

Interactions, Loneliness, and Emotional Weil-Being Among the

Elderly." Research on Aging. 9, 459-482.

Lee, G. R., Netzer, J. K., & Coward, R. T. (1995).

"Depression Among Older Parents: The Role of

Intergenerational Exchange." Journal of Marriage and the

Family. 57, 823-833.

Lieberman, M. (1989). Group properties and outcomes:

A study of group norms in self-help groups for widows and

widowers. International Journal of Group Psychotherapy.

39(2), 191-208.

Lieberraan, M. (1996). Doors Close. Doors Open:

Widows. Grieving and Growing. New York: Grosset/Putnam.

Lindemann, E. (1944-1945). "Symptomatology and

Management of Acute Grief." American Journal of Psychiatry.

101 (141).

Lopata, H. Z. (1973). Widowhood in an American City.

Cambridge, Massachusetts: Schenkman Publishing Company, Inc.

 66

Lopata, H. Z. (1975). On widowhood: grief work and

identity reconstruction. International Journal of Geriatric

Psychiatry. VIII, 41-53.

Lund, D. A., Caserta, M. S. & Diamond, M. F. (1986).

Gender Differences through Two Years of Bereavement among

the Elderly. The Gerontoloaist. 26(3), 314-320.

Lund, D. A. (1989). Older Bereaved Spouses: Research

With Practical Applications. New York: Hemisphere.

Lund, D. A., Caserta, M. S. & Diamond, M. F. (1989).

"Impact of Spousal Bereavement on the Subjective Well-Being

of Older Adults." Older Bereaved Spouses: Research with

Practical Applications. 3-15. New York: Hemisphere.

Maddison, D. & Viola, A. (1968). "The Health of

Widows in the Year Following Bereavement." Journal of

Psychosomatic Research.

Marini, M. M. (1989). "Sex Differences in Earnings in

the United States." Annual Review of Sociology. 15, 343-

380. Palo Alto, CA.

Matt, G. E. & Dean, A. (1993). "Social Support from

Friends and Psychological Distress Among Elderly Persons:

Moderator Effects of Age." Journal of Health and Social

Behavior. 34, 187-200.

Mendes de Leon, C. F., Kasl, S. V. & Jacobs, S. (1994).

"A Prospective Study of Widowhood and Changes in Symptoms of

Depression in a Community Sample of the Elderly."

Psychological Medicine. 24, 613-624.

 67

Morgan, L. (1984). Changes in family interaction

following widowhood. Journal of Marriage and the Familyf

46(2), 323-331.

Moss, M. & Moss, S. (1984-1985). Some aspects of the

elderly widow(er)'s persistent tie with the deceased spouse.

Omega. 15(3), 195-206.

Narvaez, M. (1990, May). Widowed Men. Paper

presented at meeting of Area VII Widowed Persons Service

Regional Conference, Dallas, TX.

Norris, F. H. & Murrell, S. A. (1990). Social

support, life events and stress as modifiers of adjustment

to bereavement by older adults. Psychology and Aging. 5,

429-436.

Parkes, C. M. (1987). Bereavement, studies of grief

in adult life. Madison, CT: International Universities

Press, Inc.

Pihlblad, C. T. & Adams, D. L. (1972). "Widowhood,

Social Participation and Life Satisfaction." Acting and

Human Development. 3(4), 323-330.

Rakowski, W. & Clark, N. M. (1985). "Future outlook,

caregiving, and care-receiving in the family context." The

Gerontologist.

Rando, T. A. (1986). Loss and Anticipatory Grief.

Lexington, Mass: Lexington.

Raphael, B. (1982). The Anatomy of Bereavement. New

York: Basic Books.

 68

Rosik, C. (1989). "The Impact of Religious

Orientation in Conjugal Bereavement Among Older Adults."

International Journal of Aging and Human Development f

251-266.

Ross, C. E., Mirowsky, J. & Goldsteen, K. (1991).

"The Impact of Family on Health." Contemporary Families:

Looking Forward, Looking Back. 341-360. Minneapolis, MN:

National Council on Family Relations.

Rossi, A. S. & Rossi, P. H. (1990). Of Human Bonding:

Parent-Child Relations Across the Life Course. New York:

Aldine.

Rubinstein, R. (1986). The construction of a day by

elderly widows. International Journal of Aging and Human

Development. 23(3), 161-173.

Sabatini, L. (1988-1989). Evaluating a treatment

program for newly widowed people. Omega. 19(3), 229-236.

Schaie, K. W. & Willis, S. L. (1991). Adult

Development and Aging. 3rd ed. Boston: Little, Brown.

Schuster, T. L. & Butler, E. W. (1989). "Bereavement,

Social Networks, Social Support and Mental Health." Older

Bereaved Spouses: Research With Practical Applications.

New York: Hemisphere.

Siegel, J. M. & Kuykendall, D. H. (1990). "Loss,

Widowhood, and Psychological Distress Among the Elderly."

Journal of Consulting and Clinical Psychology. 5, 519-524.

 69

Silverstein, M. & Bengtson, V. L. (1994). "Does

Intergenerational Social Support Influence the Psychological

Weil-Being of Older Parents? The Contingencies of Declining

Health and Widowhood." Social Science and Medicine. 38,

943-957.

Smith, K. R. & Zick, C. D. (1986). "The Incidence of

Poverty Among the Recently Widowed: Mediating Factors in

the Life Course." Journal of Marriage and the Family. 48,

166-177.

Soldo, B. J. & Manton, K. G. (1985). "Health status

and service needs of the oldest old." Milbank Memorial Fund

Quarterly/Health & Society. 63, 286-319.

Stroebe, M. S. & Stroebe, W. (1983). Who suffers

more? Sex differences in health risks of the widowed.

Psychological Bulletin. 93, 279-301.

Stroebe, M. S., Stroebe, W. & Domittner, G. (1988).

Individual and situational differences in recovery from

bereavement: A risk group identified. Journal of Social

Issues. 44(33), 143-158.

Stroebe, M. S. & Stroebe, W. (1987). Bereavement and

Health: The Psychological and Physical Consequences of

Partner Loss. New York: Cambridge University Press.

Taylor, R. & Ford, G. (1983). Inequalities in old

age: An examination of age, sex and class differences in a

sample of community elderly. Aging and Society. 3, 183-208.

 70

Templer, D. I. (1980). Death Depression Scale (DDS).

Fresno, California.

Templer, D. I. (1983). Death Anxiety Scale (DAS).

Fresno, California.

Thompson, L. W., Gallagher, D., Cover, H., Galewski, M.

& Peterson, J. (1989). "Effects of Bereavement on Symptoms

of Psychopathology in Older Men and Women." Older Bereaved

Spouses: Research With Practical Applications, 17-24. New

York: Hemisphere.

Umberson, D., Wortman, C. B. & Kessler, R. C. (1992).

"Widowhood and Depression: Explaining Long-Term Gender

Differences in Vulnerability." Journal of Health and Social

Behavior. 33, 10-24.

U.S. Bureau of Census. (1995). Statistical Abstract

of the United Statesr 1994. Washington, DC: Government

Printing Office.

Vachon, M. L. S., Sheldon, A. R., Lancee, W. A. L.,

Rogers, L. J. & Freeman, F. J. J. (1982). "Correlates of

Enduring Stress Patterns Following Bereavement: Social

Networks, Life Situations and Personality." Psychological

Medicine. 12, 783-788.

Van Zandt, S., Mou, R. & Abbott, D. (1989). Mental

and Physical Health of Rural Bereaved and Nonbereaved

Elders: A Longitudinal Study." Older Bereaved Spouses:

Research with Practical Applications. 25-35. New York:

Hemisphere.
 71

VandeCreek, L. (1988). Sources of support in conjugal

bereavement. The Hospice Journal. 4(4), 81-92.

Vaux, A. (1985). Variations in social support

associated with gender, ethnicity and age. Journal of

Social Issues. 41, 89-110.

Verbrugge, L. M. (1983). Women and men: mortality

and health of older people. In M.W. Riley, B.B. Hess and K.

Bond (eds), Aging in Society: Selected Reviews of Recent

Research, 139-174. Lawrence Erlbaum Associates, London.

Voydanoff, P. (1991). "Economic Distress and Family

Relations." Contemporary Families: Looking Forward. Looking

Back. 429-445. Minneapolis, MN: National Council on Family

Relations.

Wortman, C. B., Silver, R. C. & Kessler, R. C. (1993).

"The Meaning of Loss and Adjustment to Bereavement."

Handbook of Bereavement: Theory. Research and Intervention.

349-366. New York: Cambridge University Press.

Zick, C. & Smith, K. (1988). Recent widowhood,

remarriage and changes in economic well-being. Journal of

Marriage and the Family. 50(1), 233-244.

Zisook, S., Shuchter, S. R. & Mulvihill, M. (1990).

"Alcohol, Cigarette and Medication Use During the First Year

of Widowhood." Psychiatric Annals. 20, 318-326.