Bereavement after caregiving or unexpected death: effects on elderly spouses.

Responses to bereavement have been shown to vary depending on whether death is expected or unexpected, and on the nature of family caregiving experiences, but little previous research has examined these factors simultaneously. To address these issues, we utilized prospective data on bereavement from 193 participants in the Changing Lives of Older Couples (CLOC) study, who were assessed both before their loss and at six and 18 months after the death. Participants who experienced either unexpected loss, or expected loss without caregiving, with low-stress caregiving, or with high-stress caregiving completed measures of psychological, social, and health functioning on each occasion. Results showed that unexpected death was associated with marked increases in depression, while the nature of caregiving did not affect the trajectory of any of the psychological well-being measures. All groups except highly stressed caregivers showed improvements in social activity and support after bereavement, suggesting that highly stressed caregivers may be at an increased risk for social isolation during bereavement. Thus experiencing an unexpected death may put bereaved spouses at risk for depression, while high-stress caregiving may lead to problems with social isolation.