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

Abstract

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 reported 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.