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Article Excerpt
The current study assessed 125 conjugally bereaved persons using multiple self-report measures as indicators of personal adjustment and bereavement distress across three times of testing (initial, 6-month, and 3-year follow-up). Cross-lagged panel analyses were conducted to examine the potentially causal relationships between indicators of both adjustment and bereavement distress. Across nearly all measures of general adjustment and bereavement distress, adjustment was significantly more predictive of bereavement distress than bereavement distress was predictive of adjustment from both Time 1 to Time 3 and Time 2 to Time 3. These findings suggest that difficulties in general adjustment may exacerbate bereavement distress and emphasize the importance of interventions targeting the acquisition of adaptive coping skills in conjugally bereaved persons.
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While empirical literature has lent considerable time and space to the identification of problems related to widowhood (e.g., Atchley, 1975; Raphael, 1983), a growing amount of information is available concerning the successful adjustment of grieving persons (Folkman, 1997; Lindstrom, 1997). Indeed, there exists a wealth of work explicating models of bereavement (Atchley; Bowlby, 1980; Moos, 1995; Parkes, 1988; Pollock, 1987), grief-coping processes (Jacobs, Kasi, Schaefer, & Ostfeld, 1994; Lindstrom, 1999; Maxwell, 1995; Stroebe & Schut, 1999), and their relationship to adjustment (Parkes; Schut, Stroebe, van den Bout, & Keyser, 1997; Stein, Folkman, Trabasso, & Richards, 1997).
THEORETICAL APPROACHES TO BEREAVEMENT
Many theories have spoken to the nature of grief and its course, stressing the importance of one's relationship to the deceased as well as the fluctuating nature of one's response to loss over time, the latter of which may, in part, be explained in terms of more generalized responses to change, leading to not only more problematic grieving, but also to a loss of support from others. Indeed, many theoretical approaches to grieving implicitly suggest the possibility of a relationship between generalized adjustment and bereavement-specific distress. For example, psychoanalytic models call attention to relationship issues between bereaved and deceased persons prior to death, suggesting the quality of the relationship to greatly influence the subsequent experience of loss by the survivor, with poorly established interpersonal bonds leading to a more problematic grieving process (Freud, 1959; Schultz, 1978). Attachment theory (Bowlby, 1969, 1980) likewise stresses the constructs of grief work and general adaptation, emphasizing the nature of one's relationship to an attachment figure and the subsequent loss of these bonds. Such work implies that relationship factors and perhaps overall adjustment prior to a death greatly impact the bereavement process.
Indeed, Klass and Walter (2001) stress the importance of one's continuing relationship with the deceased person, which might be understood as an extension of that relationship prior to death, and more specifically as a function of how persons cope more generally with their lives. This is the central tenet of the Two-Track model of bereavement espoused by Rubin (1981). Likewise, Cognitive Stress Theory (Folkman, 2001; see also discussion by Stroebe and Schut, 2001) stresses the parallels between one's responses to loss and one's responses to other stressful life events, emphasizing cognitive appraisal of both sets of events and the availability of resources to deal with stressful life events as important in both contexts. Emotion theory (Shaver & Tancredy, 2001) stresses the positive and negative quality of emotions and their regulation in coping with both "personally important changes" and bereavement. In this context, after the death of a spouse, individuals can use problem-solving skills and cognitive restructuring to help them cope with their feelings and changes in their identity as well as the practical obstacles of everyday living (Hansson, Remondet, & Galusha, 1993; Wortman, Silver, & Kessler, 1993). The ability of individuals to experience and manage their emotions, maintain adequate vocational and social functioning, fulfill personal responsibilities, and incorporate their experiences into a satisfying life are recognized indicators of adjustment to most life changes, which may or may not generalize to loss (Folkman, Lazarus, Gruen, & DeLongis, 1986; Maxwell, 1995; Moos, 1995; Stroebe & Stroebe, 1983). Recently, Moos presented an integrative model of grief, illustrating the roles of individual perceptions in the context of family processes in shaping individual and familial responses to bereavement. From a systemic perspective, Moos proposes family members, each with his or her own interpretation of the death, will interact with one another to determine the course of grief in the family and coping strategies adopted, creating new styles of relating, communicating, adapting, and coping with stress and difficult emotions.
A recent approach to the relationship between adjustment and bereavement distress has been espoused by the Dual Process Model of Coping with Bereavement proposed by Stroebe and Schut (1999). This model explores the idea of "grief work" as the act of contemplating and processing the events, relationships, changes, and emotions associated with the loss. Coping within this system is described as a relationship between the dual processes of grief work and the initiation of new roles, life changes, and methods for avoiding the processing of bereavement experiences. In this respect, as do many other theories of grief and bereavement (see above), the Dual Process Model calls attention to the relationship between generalized adjustment processes, which transcend many types of stressful life events, and the difficulties in specific adjustments individuals may experience in response to the death of a loved one, which we operationalize here as indicative of bereavement distress.
INFLUENCES ON BEREAVEMENT DISTRESS:
Age and Gender
To create a comprehensive picture of the relationship between bereavement and adjustment distress, factors found to mediate the course of grief, such as age (Folkman, Lazarus, Pimley, & Novacek, 1987) and gender (Hayslip, Allen, & McCoy-Roberts, 2000), must be considered. For example, Folkman et al. proposed that members of different age cohorts often face qualitatively different stressors as a function of their unique upbringing, while also implementing coping mechanisms specific to their level of development. Moreover, research indicates that it is not unusual for men to have greater difficulty expressing emotion following spousal loss, to enter into romantic relationships more rapidly after the death, and to demonstrate more significant struggles accepting the loss (Schuchter & Zisook, 1993). Women typically report greater emotional distress, admit to feeling helpless, and express more significant changes in identity and social role (Allen & Hayslip, 2000).
Personality Processes
Personality characteristics (Meuser, Davies, & Marwit, 1994-1995) and preexisting psychological conditions (Gilewski, Farberow, Gallagher, & Thompson, 1991) may also mediate reactions to the loss of a spouse. Gilewski et al. found individuals who were moderately to severely depressed at the time of the death encountered significantly greater and more severe psychological and emotional problems following the loss of spouse. Their findings support the notion that problems with adjustment and adaptation prior to and during stressful events such as death loss strongly influence the course of bereavement and coping during the months and years following the loss. Perceived levels of control and competency also influence the distress related to bereavement and mediate the course of healing among the conjugally grieved (Allen & Hayslip, 2000; Lowenstein & Rosen, 1995). Furthermore, Hayslip et al. (2000) provide evidence to suggest the level of confidence with which a conjugally bereaved person approaches the tasks of grief and mourning influences successful coping. Across a 2-year period of time, Dimond and her colleagues Lund and Caserta (1987) determined that for bereaved persons, variables such as "perceived closeness" and "quality of interaction" within convoys of support were strongly correlated with measures of depressive symptoms and life satisfaction.
Coping Efficacy
Coping responses are important influences on physical health and psychological well being concerning bereaved persons (Lindstrom, 1997). Lindstrom found that ratings of "poor" coping were significantly related to problematic subjective health ratings, whereas "good" coping expectancies precipitated positive subjective health ratings during follow-up interviews. In this light, positive reappraisal, problem-focused goals, spiritual beliefs and practices, and drawing positive meaning from distressing events represent several coping approaches proposed to be efficacious when adjusting to bereavement (Folkman, 1997; Jacobs et al., 1994). Among men, while active approaches to "conquering" grief have demonstrated coping utility (Goodman, Black, & Rubinstein, 1996; Maxwell, 1995), women are often successful using social and emotion-based coping strategies (Lindstrom, 1999; Shapiro, 1996). Since the death of a loved one is too often viewed as a stressor or as a series of ongoing stressors, bereavement-coping strategies typically resemble those commonly adopted to manage life stressors in general (Folkman, 1997; Folkman et al., 1986). Therefore, level of adjustment and success of coping with stressful events prior to bereavement should predict the response to death loss and extent of experienced bereavement distress throughout the bereavement process.
Social Support and Cognitive Appraisal
Correlates of bereavement outcome have included social withdrawal and a lack of social support (Allen & Hayslip, 2000; Parkes, 1975; Vachon, Rogers, Lyall, Lancee, Sheldon, & Freeman, 1982), positive versus negative appraisals (Stein et al., 1997), and frequency of goal-oriented behavior (Kelly et al., 1999; Stein et al.). A review by Vachon and Stylianos (1988) found that strong and involved social support networks led to lower levels of distress following conjugal bereavement. Caregivers reporting more regular use of positive appraisals have been found to report less depressed mood, greater planning and goal-oriented behavior, and were more likely to express positive psychological functioning when compared to individuals reporting frequent use of negative appraisals (Stein et al.). After experiencing an unexpected loss, individuals demonstrating low internal locus of control, suggesting perceptions of vulnerability and a lack of personal control, have been identified as a high-risk group for bereavement distress (Stroebe, Stroebe, & Domittner, 1988).
The theories discussed above propose a variety of factors relating to personal adjustment, family environment, and problem-solving behavior that may actively mediate an individual's approach to stressful life...
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