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M. Dreier * ESHMS - SISS International Joint Congress * Bologna 2004
Health and the Life Event ´Death of Spouse´ in Elderly Women
Maren Dreier, Heike Koch-Gießelmann, Siegfried Geyer
Hannover Medical School, HannoverHannover Medical School, Hannover
Department of General Medicine and Medical Sociology
M. Dreier * ESHMS - SISS International Joint Congress * Bologna 2004
IntroductionTwo-factor-model (Geyer,1999, based on Brown & Harris, 1978):
The association between life events and the development of illness
Changes in health status
Provoking agents
Vulnerability factors
Life events
Chronic difficulties
biological
mental/social vulnerability
Subject
environmental
Loss
Threat
Personal factors
Early loss events
Mat. ressources
Social support
aquired
congenital
M. Dreier * ESHMS - SISS International Joint Congress * Bologna 2004
AimTwo-factor-model (Geyer,1999, based on Brown & Harris, 1978):
The association between life events and the development of illness
Changes in health status
Provoking agents
Vulnerability factors
Life events
Chronic difficulties
biological
mental/social vulnerability
Subject
environmental
Loss
Threat
Personal factors
Early loss events
Mat. ressources
Social support
aquired
congenital
M. Dreier * ESHMS - SISS International Joint Congress * Bologna 2004
AimTwo-factor-model (Geyer,1999, based on Brown & Harris, 1978):
The association between life events and the development of illness
Changes in health status
Provoking agents
Vulnerability factors
Life events
Chronic difficulties
biological
mental/social vulnerability
Subject
environmental
Loss
Threat
Personal factors
Early loss events
Mat. ressources
Social support
acquired
congenital
Death of spouse
M. Dreier * ESHMS - SISS International Joint Congress * Bologna 2004
AimTwo-factor-model (Geyer,1999, based on Brown & Harris, 1978):
The association between life events and the development of illness
Changes in health status
Provoking agents
Vulnerability factors
Life events
Chronic difficulties
biological
mental/social vulnerability
Subject
environmental
Loss
Threat
Personal factors
Early loss events
Mat. ressources
Social support
aquired
congenital
Death of spouse
Coping dimension:• hope/optimism• self-blame
M. Dreier * ESHMS - SISS International Joint Congress * Bologna 2004
AimTwo-factor-model (Geyer,1999, based on Brown & Harris, 1978):
The association between life events and the development of illness
Changes in health status
Provoking agents
Vulnerability factors
Life events
Chronic difficulties
biological
mental/social vulnerability
Subject
environmental
Loss
Threat
Personal factors
Early loss events
Mat. ressources
Social support
aquired
congenital
Death of spouse
Coping dimension:• hope/optimism• self-blame
Mental health
M. Dreier * ESHMS - SISS International Joint Congress * Bologna 2004
Design
Case-control-study 3/02-3/04:• cases: bereaved women, age >= 70 years,
bereaved for 2-5 months controls: married women, age >= 70 years
• interviews at home: standardized instruments, a qualitative semi-structured interview (tape-recorded); medical questionnaire completed by the family doctor
• t0 : cases/controls n= 45/83
t1 : cases/controls n= 44/78
• loss to follow-up: 4,7%
M. Dreier * ESHMS - SISS International Joint Congress * Bologna 2004
Measures
Outcome: Mental health• Health-related Quality of Life: SF-12, mental component
summary (Bullinger M, Kirchberger I, 1998) • Screening for Depression: Geriatric Depression Scale GDS-15
(Yesavage JA et al, 1983)
• Antidepressive medication: prescription of antidepressants by general practioners
Coping:• Bedford College Coping Inventory COPI (Bifulco A, Brown GW, 1996) • Life Events and Difficulties Schedule LEDS (Brown GW, Harris T,
1978)
M. Dreier * ESHMS - SISS International Joint Congress * Bologna 2004
Study population
Variable Parameter Cases ControlsAge ofparticipants(years)
nM
SD
4575,8
4,7
8375,5
4,4
Age ofspouse(years)
nM
SD
4281,3
6,4
8377,3
6,2
Duration ofpartnership(years)
nM
SD
4445,512,0
8248,9
8,7
M: Mean SD: Standard deviation
M. Dreier * ESHMS - SISS International Joint Congress * Bologna 2004
4478 4583N =
Mental quality of life
casescontrols
SF
-12
, m
en
tal c
om
po
ne
nt
sum
ma
ry s
core
80
70
60
50
40
30
20
10
t 0
t 1
Results I: Mental health
Mean of German standard sample
> 70 years
t 0: p<0,01 t 1: p=0,05(Mann-Withney-U-Test)
M. Dreier * ESHMS - SISS International Joint Congress * Bologna 2004
4478 4583N =
Mental quality of life
casescontrols
SF
-12
, m
en
tal c
om
po
ne
nt
sum
ma
ry s
core
80
70
60
50
40
30
20
10
t 0
t 1
Results I: Mental health
Mean of German standard sample
> 70 years
t 0: p<0,01 t 1: p=0,05(Mann-Withney-U-Test)
M. Dreier * ESHMS - SISS International Joint Congress * Bologna 2004
1133 1233N =
Mental quality of life, modified by hope/optimism
low degreehigh degreeS
F-1
2,
me
nta
l co
mp
on
en
t su
mm
ary
sco
re
80
70
60
50
40
30
20
10
t 0
t 1
4478 4583N =
Mental quality of life
casescontrols
SF
-12
, m
en
tal c
om
po
ne
nt
sum
ma
ry s
core
80
70
60
50
40
30
20
10
t 0
t 1
Results I: Mental health, modified by hope/optimism
Mean of German standard sample
> 70 years
Mean of German standard sample
> 70 years
t 0: p<0,01 t 1: p=0,05(Mann-Withney-U-Test)
t 0: p=0,08 t 1: p<0,05(Mann-Withney-U-Test)
M. Dreier * ESHMS - SISS International Joint Congress * Bologna 2004
3212 3312N =
Mental quality of life, modified by self-blame
low degreehigh degreeS
F-1
2,
me
nta
l co
mp
on
en
t su
mm
ary
sco
re
80
70
60
50
40
30
20
10
t 0
t 1
4478 4583N =
Mental quality of life
casescontrols
SF
-12
, m
en
tal c
om
po
ne
nt
sum
ma
ry s
core
80
70
60
50
40
30
20
10
t 0
t 1
Results I: Mental health, modified by self-blame
Mean of German standard sample
> 70 years
Mean of German standard sample
> 70 years
t 0: p<0,01 t 1: p=0,05(Mann-Withney-U-Test)
t 0: p<0,01 t 1: p<0,05(Mann-Withney-U-Test)
M. Dreier * ESHMS - SISS International Joint Congress * Bologna 2004
4478 4483N =
Screening for depression
casescontrols
Ge
ria
tric
de
pre
ssio
n s
cale
, sc
ore
15
14
13
12
11
10
9
8
7
6
5
4
3
2
10
t 0
t 1
Results II: Symptoms of depression
t 0: p<0,01 t 1: n.s.(Mann-Withney-U-Test)
M. Dreier * ESHMS - SISS International Joint Congress * Bologna 2004
4478 4483N =
Screening for depression
casescontrols
Ge
ria
tric
de
pre
ssio
n s
cale
, sc
ore
15
14
13
12
11
10
9
8
7
6
5
4
3
2
10
t 0
t 1
Results II: Symptoms of depression
t 0: p<0,01 t 1: n.s.(Mann-Withney-U-Test)
M. Dreier * ESHMS - SISS International Joint Congress * Bologna 2004
1133 1232N =
Screening for depression, modif. by hope/optimism
low degreehigh degreeG
eri
atr
ic d
ep
ress
ion
sca
le,
sco
re
15
14
13
12
11
10
9
8
7
6
5
4
3
2
10
t 0
t 1
4478 4483N =
Screening for depression
casescontrols
Ge
ria
tric
de
pre
ssio
n s
cale
, sc
ore
15
14
13
12
11
10
9
8
7
6
5
4
3
2
10
t 0
t 1
Results II: Symptoms of depression, modified by hope/optimism
t 0: p<0,01 t 1: n.s.(Mann-Withney-U-Test)
t 0: n.s. t 1: n.s.(Mann-Withney-U-Test)
M. Dreier * ESHMS - SISS International Joint Congress * Bologna 2004
3212 3212N =
Screening for depression, modified by self-blame
low degreehigh degreeG
eri
atr
ic d
ep
ress
ion
sca
le,
sco
re
15
14
13
12
11
10
9
8
7
6
5
4
3
2
10
t 0
t 1
4478 4483N =
Screening for depression
casescontrols
Ge
ria
tric
de
pre
ssio
n s
cale
, sc
ore
15
14
13
12
11
10
9
8
7
6
5
4
3
2
10
t 0
t 1
Results II: Symptoms of depression, modified by self-blame
t 0: p<0,01 t 1: n.s.(Mann-Withney-U-Test)
t 0: n.s. t 1: p=0,06(Mann-Withney-U-Test)
M. Dreier * ESHMS - SISS International Joint Congress * Bologna 2004
Results III: Antidepressants
Prescription of Antidepressants
CasesControls
Pe
rce
nta
ge
s
50
40
30
20
10
0
1. quarter *
2. quarter *
3. quarter *
4. quarter *
9
3
14
3
20
4
18
4
* In controls quarterly periods after the first interview, in cases quarterly periods after death of spouse.
1.-3. quarter: p<0,05 4. quarter: n.s.(Mann-Withney-U-Test)
M. Dreier * ESHMS - SISS International Joint Congress * Bologna 2004
Results III: Antidepressants
Prescription of Antidepressants
CasesControls
Pe
rce
nta
ge
s
50
40
30
20
10
0
1. quarter *
2. quarter *
3. quarter *
4. quarter *
9
3
14
3
20
4
18
4
* In controls quarterly periods after the first interview, in cases quarterly periods after death of spouse.
1.-3. quarter: p<0,05 4. quarter: n.s.(Mann-Withney-U-Test)
M. Dreier * ESHMS - SISS International Joint Congress * Bologna 2004
Results III: Antidepressants, modified by hope/optimism
Prescription of Antidepressants
CasesControls
Pe
rce
nta
ge
s
50
40
30
20
10
0
1. quarter *
2. quarter *
3. quarter *
4. quarter *
9
3
14
3
20
4
18
4
Prescr.of Antidepressants, modif. by hope/optimism
low degree of hopehigh degree of hopeP
erc
en
tag
es
50
40
30
20
10
0
1. quarter *
2. quarter *
3. quarter *
4. quarter *
99
18
12
27
18
36
12
* In controls quarterly periods after the first interview, in cases quarterly periods after death of spouse.
1.-3. quarter: p<0,05 4. quarter: n.s.(Mann-Withney-U-Test)
1.-4. quarter: n.s. (Mann-Withney-U-Test)
M. Dreier * ESHMS - SISS International Joint Congress * Bologna 2004
Presc. of Antidepressants, modified by self-blame
low degreehigh degreeP
erc
en
tag
e
50
40
30
20
10
0
1. quarter *
2. quarter *
3. quarter *
4. quarter *
98 9
25
15
33
15
25
Results III: Antidepressants, modified by self-blame
Prescription of Antidepressants
CasesControls
Pe
rce
nta
ge
s
50
40
30
20
10
0
1. quarter *
2. quarter *
3. quarter *
4. quarter *
9
3
14
3
20
4
18
4
* In controls quarterly periods after the first interview, in cases quarterly periods after death of spouse.
1.-3. quarter: p<0,05 4. quarter: n.s.(Mann-Withney-U-Test)
1.-4. quarter: n.s. (Mann-Withney-U-Test)
M. Dreier * ESHMS - SISS International Joint Congress * Bologna 2004
Summary
• Loss of spouse in elderly women is followed by impairment of mental health
• One year after loss improvements in mental health have occurred
• Hope/optimism and self-blame may moderate the degree of mental impairment
M. Dreier * ESHMS - SISS International Joint Congress * Bologna 2004
Further directions
• Long-term follow-up: morbidity and mortality
• Examination of the role of social support