This is to certify that the

dissertation entitled

THE EFFECT OF A LIFE MANAGEMENT
SKILLS PROGRAM ON DEPRESSION
AND GRIEF IN WIDOWS

presented by

 

JOYCE A. THOMAS

has been accepted towards fulfillment
of the requirements for

Ldegreein Curriculum and
Instruction

& ’Q%XQ:é¢g_/,

Major professor

 

Date May 18, 1982

MSU 1': an Affirmative Action/Equal Opportunity Institution 0-12771

 

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THE EFFECT OF A LIFE MANAGEMENT SKILLS
PROGRAM ON DEPRESSION AND
GRIEF IN WIDOWS

BY

Joyce Ann Thomas

A DISSERTATION

('\

a; // 7 {'5' ,

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Department of Curriculum and Instruction

I982

ABSTRACT

THE EFFECT OF A LIFE MANAGEMENT SKILLS
PROGRAM ON DEPRESSION AND
GRIEF IN WIDOWS

BY

Joyce Ann Thomas

The primary purpose of this study was to determine
the effect of a Life Management Skills Program on depression
and grief in recent widows.

The approach of the investigation involved administer-
ing a pre- and post—test of The Texas Revised Inventory of

Grief and The Measurement of Depression scale to all of the

 

participants.

The subjects were divided into two groups: Participants
(those who were involved in the six weeks Life Management
Skills Program) and Non—Participants (those who were in-
volved only in normal, social activities). There were nine
and eighteen widows in each group respectively.

The Life Management Skills Program included those
skills and information that would assist the widow in
dealing with and adjusting to the legal, financial and
psychological changes which had occurred as the result of
the death of her spouse.

Two research questions were formulated:

1. Are depression scores of widows who participated

in a Life Management Skills Program reduced more than those

who are non-participants in such a program?

2. Are grief scores of widows who participated in a
Life Management Skills Program reduced more than those who
are non—participants in such a program?

The statistical technique used for all tests of sig-
nificance was the t-test.

It was concluded that:

1. There was a significant difference in the decline
of depression in the participant group at the .05 level when
comparing the pre— and post-test scores of the two groups.

2. There was no significant change in the level of
grief when comparing the pre- and post-test grief scores

of the two groups.

Dedicated to
The Loving memory 05 my gnandmothen

ALICE ELLIOTT

ii

 

ACKNOWLEDGMENTS

The successful completion of this dissertation is
the cooperative efforts of many people. To some I want to
give special recognition.

Dr. Cas Heilman, Committee Chairman and friend with-
out whose guidance and encouragement, this project would
not have been completed.

Dr. Jane Oyer, Dr. Norman Kagan and Dr. Richard Gardner,
Committee Members, who each in their own way were a source of
motivation.

Mrs. Garnet Hauger, and Mr. Paul Bufkin, statisticians,
whose assistance was an absolute necessity.

Miss Kathy Hiler, typist, whose good humor and long
hours met the pressing deadlines.

Special thanks to 11 Sung Chung for his editorial
assistance, and Kelly for her contribution.

There were so many friends and colleagues who seemed
to know just when their love and friendship were needed.

My children, Teresa, Sheryl and Steven, my mother,

Jennie, and my sister, Jackie, for always believing in me.

iii

TABLE OF CONTENTS

LIST OF TABLES . . . . . . . . . . . . .
Chapter
I. INTRODUCTION. . . . . . . . . . .

II.

III.

IV.

Need for the Study . . . .
Statement of the Problem . .
Purpose of the Study . . . . .
Research Questions . . . . .
Limitations. . . . . . . . .
Definition of Terms.

REVIEW OF THE LITERATURE. . . .

Profile of the American Widow.
The Elderly Widow. . . . . .
Overview of Bereavement. . . .
Problems of the Widowed. . . .
Intervention & Support for the
Widow. . . . . . . . . . . .

RESEARCH METHODOLOGY. . . . . .

Research Questions . . . .
Selecting the Population .
Data Collection. . . . .

-Description of the Instruments

Program Description. . . . .

RESULTS . . . . . . . . . . . . .

Sample Descriptions. . . . . .
Research Questions . . . . . .
Treatment of Data. . . . . .

Depression Scale Results . . .
Grief Scale Results. . . . . .

DISCUSSION. . . . . . . . . . .

Summary. . . . . . . . . . . .
Findings . . . . . . . . . .
Conclusions. . . . . . . . .

Page
vi

l-‘

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11

ll
24
32
44

6O

69

69
69
7O
71
75

79

79
83
89
9O
91

93
93

95
96

TABLE OF CONTENTS--Continued

APPENDIX

APPENDIX

APPENDIX

APPENDIX

APPENDIX

APPENDIX

E

F

BIBLIOGRAPHY

Limitations. . . . . . .
Implications for Further

Research.

97
97

100
101
102
103
104
106

107

LIST OF TABLES

Table Page

I. Characteristics of Widows . . . . . . . . . . 13

II. Expectation of Life at Birth in the United
States . . . . . . . . . . . . . . . . . . 16

III. Expectation of Life at Various Stages in the
United States 1976 . . . . . . . . . . . . 17

IV. Percentage of Women 65+ Who Are Widows. . . . 26

V. Stages of Grief . . . . . . . . . . . . . . . 33
VI. Prevalence of Health Deterioration. . . . . . 51
VII. Ratios of Men's to Women's Frequencies of

Suicide By Age and Marital Status. . . . . 59
VIII. Frequency of Depression Among 280 Ages,

Widowed and Married Persons With and

Without a Confidant. . . . . . . . . . . . 6l

IX. Age Distribution of Participant and Non—
Participant Groups . . . . . . . . . . . . 79

X. Duration of Widowhood of the Participant
and Non-Participant Groups . . . . . . . . 80

XI. Educational Level of the Participant and Non-
Participant Groups . . . . . . . . . . . . 8O

XII. Monthly Income Before and After Widowhood of
Participant and Non—Participant Groups . . 81

XIII. Number of Children in the Participant and
Non-Participant Groups . . . . . . . . . . 8l

XIV. Self Rating Depression Scale Participant
Group . . . . . . . . . . . . . . . . . . . 85

XV. Self Rating Depression Scale Non—Participant
Group . . . . . . . . . . . . . . . . . . . 86

vi

Table

XVI.

XVII.

XVIII.

XIX.

XX.

Participant Pre and Post-test Grief Scores
Non-Participant Pre and Post—test Grief Scores
Self Rating Depression Scale (SDS)

Texas Inventory of Grief

Tests of Signifiance .

vii

Page

. 88

CHAPTER I
INTRODUCTION

Death has made millions of Americans single again.
The number of widows in the United States reached 10.7
million in 1976, an increase of more than one million since
1970. Currently one of every eight women fourteen years or
older is widowed. (MetrOpolitan Life Insurance Company, 1977).

The economic, social, intellectual, psychological and
physiological profile of the American widow indicates that
the newly widowed have: more physical illness, more mental
illness, more hospitalization, and more chances of dying
than their married, female counterpart.

They feel lonely, frightened, isolated and alienated.
They have problems with children, jobs, finances, housing
and socializing. The loss of a spouse through death con-
stitutes one of the most traumatic of human experiences.

The initial days of Widowhood are rough, but bearable.
There are memories to share, decisions to make, and most
important, people to be with. But after the first few weeks
of the loss, the minister pays the final visit, relatives and
friends resume their normal routines, and the widow is left
alone to learn a different way of life, a new and unwanted

role, to adjust to changed economic circumstances, and to

cope with a maze of feelings: loneliness, anger, relief,
guilt, hopelessness, panic, self-pity and depression; feel-
ings that family and friends--however loving—~cannot fully
understand.

Widowhood is a demanding, transitional role. A study
of 1,744 widows, done in 1969 by the Life Insurance Agency
Management Associations, revealed that widows whose husbands
died before their 65th birthday need:

a. help to acclimate to their new status;

b. help to deal with legal, financial, economic
and employment adjustments and,

c. family, friends and clergy, even though these
persons are not the primary source of help in
long-term adjustment.

The average period of Widowhood is 13.5 years (Carter
and Glick, 1970) but the average widow whose husband dies of
natural causes will spend eighteen and one-half years as a
widow (Lopata, 1973).

Maintaining a separate household is a financial hard-
ship for most widows but to think of living any other way
for many entails a loss of privacy as well as a loss of
independence (Chevan and Korson, 1972).

In 1976 there were 1.3 million children under eighteen
in families headed by a widowed mother. One-sixth of these
children were less than six years old (Metropolitan Life
Insurance Company, 1977).

Virtually every study of widows reports the difficult

financial situation of the woman as a result of her husband's

death. The median income of widowed heads of households in
the United States in 1975 was $4,312.00 (Metropolitan Life
Insurance Company, 1977).

The most frequently reported problem of the widow is
loneliness (Barrett, 1974).

Maddison (1968) says the period of widowhood requires
a reorganization and reintegration of social roles suitable
to a totally new status.

In a study of 375 widows done by Maddison, (1968) in
Boston, one-fourth of the young widows reported a significant
deterioration in health in the first thirteen months.

In a study done by Glick, Weiss and Parkes, (1974)
they found that the widows had three times as many hospital-
izations and spent considerable more time sick in bed than
the control group.

Cox and Ford (1964) studied 60,000 widows under 70
years of age and found mortality in widows was higher than
usual in the second year after widowhood and Rees and Lutkins
(1967) followed all the close relatives of all members of a
small community in Wales who died in a six year period.
During this time 4.8 percent of them died within one year of
bereavement compared with only 0.7 percent of a comparable
group of non—bereaved people of the same age, living in the
same area.

Parkes (1964) compared the medical records of forty-
five London widows for two years before and eighteen months

after bereavement and found that for widows under the age

of sixty~five a consultation rate for psychiatric symptoms
more than tripled during the first six months after bereave-
ment, and the amount of sedation prescribed to widows was
seven times greater during the eighteen month period after
the bereavement.

In subsequent studies (1964, 1975), Parkes found that
” of 3,245 patients admitted to psychiatric units in a two
year period, 94 developed their illness within six months of
the death of a spouse or parent. This number was six times
greater than the expected rate of bereavement in the general
population.

From various samples of psychiatric hospital admissions,
the percentage whose primary difficulty was diagnosed as un-
resolved grief was: 9 percent (Jackson, 1957), 10 percent
(Bachmann, 1964), and 15 percent (Lazare, 1976).

The high rate of suicide among the widowed has also
been well documented. Sainsbury (1955) showed that suicides
were more common among the widowed than the single, and that
the rate was lowest among the married. Segal (1969) con~
firmed the suicide rates of the divorced, separated and
widowed to be regularly higher than the married. Bunch ( 1972)
studied suicide mortality and found that in a five year period
preceding the suicide, 36 percent of the sample had been be-
reaved of a parent or spouse and that more widows than
widowers killed themselves.

Additional studies showing the relationship between

suicide and widowhood have been conducted by Durkheim (1951),

 

Rushing (l968) , Resnik and Cantor (1970), Marris (1969) and
others.

There has been a growth recently in programs concerned
with assistance for the widowed. The purpose of these pro—
grams is to provide assistance in the form of listening,
to help with adjustments that follow death and to provide
friendships and companionship.

Since funeral directors are now receiving an increasing
number of requests to perform bereavement services, "The
National Funeral Directors' Association was pressed to make
available a manual that would assist in the establishment
of such programs." The product developed by a committee,

headed by Dr. Donald Steele, was The Funeral Director's

 

Guide to Designing and Implementing Programs for the Widowed

 

(1975).

Many intervention models have been implemented, with
the most well-known being the Widow to Widow programs of
Phyllis Silverman. This organization received a develop-
mental grant from the National Funeral Directors Association
for the initial research and implementation. Basically,
it provided a systematic effort of re—engaging the newly
bereaved individual with the widow as the primary care—
giver (1970).

Barrett (1974) also developed a very significant group
intervention program for widows using three distinct for—
mats including: self~help groups, women's consciousness

raising groups and "confidant" groups based on the model

of Lowenthal and Haven's research (1968) on the relationship

« ‘ 1.1 14. J—lne post—test, SUb-

y higher self

ed widowed to

have been success—

;inctly social
lat they provide

12/ through a variety

mat for helping

ts of her loss and
re experiences and
cial matters, etc.
5" have been used

h the bereaved.

 

helpful in pro—

NAIM and Post—Cana,
I a non—demoninational
Each Other Spirit-
nerican Association
iltation Center in
Eective agencies

ed.

 

of Lowenthal and Haven's research (1968) on the relationship
between intimacy and mental health. At the post-test, sub-
jects in all three groups had significantly higher self
esteem.

In addition to the two above mentioned widowed to
widowed programs, other types of programs have been success—
ful.

Some widowed persons have begun distinctly social
groups. The benefit of such a group is that they provide
opportunities to become socially involved through a variety
of planned groups.

Workshops are also an excellent format for helping
the widow learn about the emotional aspects of her loss and
the management of feelings as well as share experiences and
concerns over children, dating, and financial matters, etc.

Telephone intervention of "Hot Lines" have been used
successfully as a therapeutic contact with the bereaved.

Other organizations which have been helpful in pro-
viding services for the widowed include: NAIM and Post-Cana,
organizations of the Catholic church, and a non-demoninational
religious group called THEOS (They Help Each Other Spirit—
ually). Parents Without Partners, The American Association
of Retired Persons, and The Widowed Consultation Center in
New York City are also among the more effective agencies

providing services to the recently widowed.

 

Statement of the Problem

 

This research was an exploratory study attempting
to determine the influence of a Life Management Skills Prog-
ram on the levels of depression and grief in recent widows.
It was entered into as a pilot study.

Purpose of the Study

 

Specifically, this study sought to test the effects
of a Life Management Skills Program of systematic inter—
vention on depression and grief in recent widows.

The organization of such a group was based on the
principle that people communicate most sensitively with
others who share their experiences, through exchanging
ideas, sharing feelings and emotions, and given the
Opportunity to gain information and make new friends,
progress more easily throughout the grieving process with
less depression.

More specifically, the content of this Life Management
Skills Program of intervention included:

1. Assisting recent widows in understanding the
nature and process of grief.

2. Giving practical financial and legal information
and skills needed in making adjustments and
transitions in their lifestyle.

3. Giving information and skill acquisition
opportunities in:
values clarification, decision making,
goal setting, budgeting, and coping with
stress.

The first goal of this exploration would be to create

an environment where participants would feel comfortable

“3‘ 3_‘_._' WWW-

1earning these skills.

The intent of the group process was to offer system-
atic intervention in the form of practical information and
acquisition of skills that would assist the widow in handling
her depression and grief.

It was assumed that it would be "safer" for the grieving
widow to deal with these feelings in a structured environment
where the primary focus was on the acquisition of skills
and adjustment information of a concrete nature.

It was further felt that the participants would serve
as a support group to the others in similar circumstances.

The context in which self help groups have experienced
a current surge of growth is given the following perspective
by Sidel and Sidel (1976).

"The self help and mutual aid movement is a re—
sponse to a number of different factors in our society
which made human services unavailable or unresponsive
to those who need them: the complexity and size of
institutions and communities, with their accompanying
depersonalization and dehumanization, the alienation
of people from one another, from their communities
and institutions and even from themselves; and the
professionalism of much which in the past was done by
individuals for themselves or for one another. Self
help groups have made major contributions toward deal-
ing with problems which cannot be dealt with by other
institutions in the society, and at the same time have
provided people with opportunities for helping roles,
roles which have become increasingly difficult to find
in our society as more and more helping has been taken
over by professionals. Self help or mutual aid groups
provide a mechanism whereby individuals, in a collective
setting with others who face similar life situations,
can assume responsibility for their own bodies, psyches,
and behavior and can help others do the same. They
are the grass roots answer to our hierarchical, pro-
fessionalized society--to a society which attempts,
in so many ways, to render impotent the individual,
the family, the neighbor. Not only are self help

"m— a...‘ «Ha—.ALTA'S. t... _:

groups providing deSperately needed services, but

they are returning to the individual a feeling of

competence.and self reSpect and they are forging

new lines, new connections among people."

The overriding purpose of this group was to provide
life management skills in a therapeutic environment.

Researchyguestions

 

Question 1: Are depression scores of widows who

v

 

participated in a Life Management Skills Program reduced
more than those who are non-participants in such a program?

Question 2: Are grief scores of widows who partici—

 

pated in a Life Management Skills Program reduced more than
those who are nonmparticipants in such a program?

Delimitations

 

This study is of twenty-seven widows living in Shia-
wassee County, between the ages of 31 and 73, who partici-
pated in a series of six weekly sessions of three hours per
session. A Life Management Skills Program was presented
with the outcomes of such a program reported on the selected
tests.

Definition of Terms

 

Depression: Depression is defined operationally as

 

a “syndrome comprised of co—existing signs and symptoms
which signify the presence of pathological disturbances or
changes in four areas: somatic, psychological, psychomotor
and mood" (Zung, 1974).

The model of depression which most closely fits the

subjects in this study is the learned helplessness theory

 

 

10

as proposed by Seligman (1975). Briefly, the theory holds
that depression results from the perception that one has
little power to change aversive situations, thus producing
an apathetic and negative outlook.

Grief: As with depression, there are a variety of
definitions for grief. The most pertinent for this study
is by Doss who describes it as an experience which is a
result of deprivation: ”Grief, an important, normal re-
sponse to death, is essentially a deprivation experience
manifesting itself physically and emotionally" (1974).

This definition includes the important components of
grief: (1) normalcy, (2) deprivation as its cause, (3)
physical manifestations, and (4) emotional manifestations.

Life Management Skills: Life management skills are

 

those skills and information designed to assist the widow
in dealing with and adjusting to the legal, financial and
psychological changes which have occurred as a result of

the death of her spouse.

CHAPTER II

REVIEW OF THE LITERATURE

PROFILE OF THE AMERICAN WIDOW

The profile of the American widow that follows is taken
predominantly from the U.S. Census Reports, a comprehensive
study done by Robert C. Nuckols for the Life Insurance Agency
Management Association of Hartford, Connecticut (1973), and
a similar study done by the Metropolitan Life Insurance Com-
pany (1977).

FREQUENCY

 

The number of widows in the United States reached 10.7
million in 1976 (Metropolitan Life Insurance Company, 1977),
an increase of more than one million since 1970. The rising
number of widows is accounted for mainly by the increase in
the number of women at the older ages and to a lesser degree
by the likelihood that a wife will outlive her spouse.

The increase in the number of widows in the 1966—76
period resulted almost entirely from an increase in the number
of widows over age 55. In 1976, nine out of every ten widows
were at least 55 years old and almost four out of every ten
were at least 75 years old. The median age of widows rose
to 71.1 years, an increase of 1.8 years between 1970 and 1976,

compared with a decrease of 1.1 years in the median age of all

11

 

 

12

women aged 14 and over to 39.3 years. During the same period,
the number of younger widows decreased substantially; by 1976
less than four percent of all widows were under 45 years of
age and only one percent were under 35.

z_xg_E_

Widows now outnumber widowers by more than 5 to l and
at ages under 45 by more than 7 to 1. This margin reflects
the lower mortality among women than among men, as well as
the fact that a wife is generally younger than her husband
at the time of marriage.

Currently one out of every eight women 14 years or older
is widowed. The proportion at the younger ages is low, but
increases sharply with advance in age. Widows constituted
only three percent of the female population under age 35 in
1976, but represented one—fifth of all women at ages 55—64.
The proportion doubled at ages 65-74, and at ages 75 and over
nearly three-fourth of all women were widowed (See Table I)
(Metropolitan Life Insurance Company, 1977).

RACE

 

Widowhood is less frequent among white women than among
the non—white at every age, but the widest variance is at the
younger ages. Under age 35 and at ages 45—54 the proportion
of widows among non-whites was about twice that among white
women. In the 35-44 age group, the ratio was as much as 4
to 1. At the older ages the proportion ranged from 6 to 9
percentage points higher for non-white women than for white

women. (Bureau of the Census, 1970)

 

 

 

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15

LIFE EXPECTATION

 

The gain in life expectancy for women since the turn
of the century has been greater than for men at nearly all
ages. Since 1900, female life expectancy at birth has in—
creased by 28.4 years, while male life expectancy has in—
creased by 22.7 years. The difference in the average length
of life between men and women has also increased. Life ex—
pectancy at age 40 was about 1.4 years longer for a woman
than for a man at the turn of the century; it is now 6.3
years longer. (See Table II)

In contrast, the difference in life expectancy between
white and non-white Americans has been greatly reduced in
this century. Generally, the gain for non-white males has
exceeded that for white males at all ages. Non-white females
showed the greatest gains at the younger and older ages. For
white females, life expectancy increased most between the
ages of about 45 and 65.

In 1976, the difference in life expectancy between white
and non—white persons at birth was 4.7 years for females and
5.6 years for males, and this difference decreased with age.
(See Table III)

LENGTH OF WIDOWHOOD

 

The average period of widowhood is 13.5 years (Carter
and Glick, 1970) but the average widow whose husband died of
natural causes will spend eighteen and one-half years as a
widow (Lopata, 1973). 68 percent of Lopata's Chicago sample

of widows over age 50 were widowed five or more years ago.

16

 

 

 

 

 

 

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18

REMARRIAGE

Marriage may be seen as a solution to the loneliness
of widowhood. However, the widowed remarry less often than
the divorced. While 75 percent of all divorcees will be
married within five years, only 25 percent of widows remarry
in that length of time. The likelihood of remarriage de—
creases sharply with increasing age (Bernard, 1956).

Remarriage rates are also substantially lower among
women than among men (Metropolitan Life Insurance, 1977).
One—fourth of the widows remarry within five years compared
to one-half of the widowers and three-fourths of all divorced.
The likelihood of remarriage decreases with age more sharply
for the widow than for the widower (Bernard, 1956).

Several studies show that many widows do not want to
remarry (Cosneck, 1966). In this connection, Marris (1958)
has pointed out that there is guilt associated with the grief
and a sense of loyalty to the deceased spouse as an obstacle
to remarriage, while Marsden (1969) observes that remarriage
may be a financial risk for the widow who might lose her
government benefits. The widow's seeming lack of interest
in marrying may not be a true indication of her desires,
however, it may be lack of opportunity; men die seven to
eight years sooner than women and grooms are usually older
than the women they marry.

HOUSING
Many surveys have shown that older people prefer to

live apart from their children, preferably in their own homes

19

and the tendency for widows to maintain their own households
seems to be growing. In 1976 more than 87 percent of all
widows under age 65 headed households, while 84 percent of
those aged 65—74 and 63 percent of those aged 75 and over

did so. Four—fifths of all widows at age 35-44 headed a family
unit and for those under age 55 as a group the proportion was
more than three—fifths.

Maintaining an independent household is more prevalent
among older widows with about three—fifths of all widows at
these ages living alone or with non—relatives. Most other
widows live in the homes of relatives. Relatively few widows
reside in institutions; of those who do, 80 percent are 75
years of age or older (Metropolitan Life, 1977).

"In a Chicago sample, 49 percent of widows over
50 years of age live alone (Lopata, 1971): 29 percent
share their residence with one other person; 12 per-
cent with two others; and 10 percent with more than
two. Most (69%) of the widows who share their house-
holds are the heads of the household; unmarried
children are still there. Only 10 percent of the
total sample live in a household headed by their
children or children's spouse.

Half the widows living alone and two-thirds of
widows who head larger households in Chicago are
still living in the same house where they lived
prior to becoming a widow.

Five percent live in institutions. About 75,000
persons or 15 percent of the institutionalized group
reside in mental hospitals." (Barrett, 1974)

Lopata (1973) observes that older widows expect problems
in living with married children or are enjoying the ease and
independence of living alone sufficiently to offset its dis—
advantages. Widows sharing a residence tend to be with un—

married children or those undergoing a disorganization of

their marriage and many times the widow emerges as the head

20

of such a household.

Maintenance of an independent household is for many of
the widowed the symbolic bastion within which they define
their roles. To think of living any other way entails a loss
of privacy as well as independence (Chevan and Korson, 1972).
However, the research data obtained so far dispels any sense
of uniformity in the type of housing of the widowed.

"No single representation can suffice for all
segments of the widowed population. Characterizing

the widowed population as isolated and alone is as

unjustified as picturing the widowed surrounded by

kin in three-generation households." (Chevan &

Korson, 1972).

CHILDREN

Many younger widows have the responsibility of support-
ing children. In 1976 there were 1.3 million children under
18 in families headed by a widowed mother. Almost all families
with a widow, under age 35 as head of the household included
at least one child; in two-fifths of the families, there were
three or more children. Half of these families included
children under six years of age. At ages 35-44 the proportion
of widowed mothers with dependent children was still fairly
high - almost 90 percent had children under 18 years of age
and one-sixth of the families included children less than six
years old. Among widows at ages 45 and over, however, the
proportion dropped sharply; there were children under 18 in
only one-third of the families headed by a widow aged 45-64
and in fewer than two percent of the families headed by a

widow aged 65 or over (Metropolitan Life Insurance Company,

1977).

21

EMPLOYMENT

 

Many more widows are to be found in the work force than
their married counterparts of the same age. Carter and Glick
(1970) reported that 26.9% of white widows and 35.5% of non-
white widows were employed.

In 1976, more than half of the widows who were less
than 65 years of age were in the labor force, although the
proportion of all ages combined who were employed or seeking
work was only 22 percent. The great preponderance of widows
at ages 65 and over, less than 8 percent of whom were in the
labor force, accounted for the low participation rate at all
ages combined. Widows under age 65 were found to have a
higher labor force participation rate than married women and
the lowest unemployment rate of all women. Unemployment
averaged about 6 percent for all widows and about 5 percent
for widows under age 65 (Nuckols, 1973).

OCCUPATIONS

 

The occupations of employed widows under age 65 vary
only slightly with age. According to the 1970 census, about
one-fourth were employed as clerical workers, one-fourth as
service workers, one-sixth as operatives, and one-eighth as
professional and technical workers. Among young widows
relatively more were employed as craftswomen and laborers,
as professionals and technical workers and as operatives
(semi-skilled workers). On the other hand, private household
and other service workers constituted a relatively smaller

proportion of employed young widows.

22

An occupational analysis of women ages 45-54 (Carter
and Glick, 1970) concurred that there was a preponderance of
widows in professional jobs. One—half of the employed non-
white widows ages 45—54 were employed for private household
work and one-half the employed white widows were in white-
collar jobs.

INCOME

Virtually every study of widows reports the difficult
financial situation of the woman as a result of her husband's
death.

In his study on 1,774 women who had been widowed nearly
two years and whose husbands died before 65 years of age,
Nuckols (1973) found that family incomes were significantly
decreased. The change showed a four percent increase for
families formerly receiving less than $3,000.00 to a 57 per—
cent decrease among families with incomes formerly over
$15,000.00

There is a loss of income from the husband's job,
possible freeze on bank accounts, large bills from prolonged
illnesses and high funeral costs. According to Nuckol's
Study (1973):

"The median or 'typical' widow was faced with
final expenses amounting to $2,860.00. The average

(mean) final expense was $3,900.00, of which

$1,740.00 represented medical bills, $1,510.00

funeral expenses, and $650.00 for taxes, estate

administration, and miscellaneous items."

Ninety-two percent of the widows said that their husbands had

had some form of life insurance, and ninety-one percent

23

received monthly benefit payments from income options or
annuities.

The most common manifestation of a lowered standard of
living was a pervasive sense of concern about money, e.g. of
the need to cut back all unnecessary spending for fear of
acquiring debts. Clothing, social and recreational activities,
and food were the specific areas in which cutbacks were most
often reported (Nuckols, 1973).

The median income of widowed heads-of—households in
the United States in 1975 was $4,312.00 (Metropolitan Life,
1977). Almost one—half of the widows heading households had
incomes of less than $4,000.00 and one-fifth had incomes
between $4,000.00 and $7,000.00 and one-eighth had incomes
between $7,000.00 and $10,000.00. An additional one-sixth
received more than $10,000.00.

In 1963 Palmore discovered that the average earnings
of employed widows were only about three-fourths the average
earned by all female workers. Twenty-five percent of these
families had income below the Social Security Administration
poverty level. The highest source of income was the widow's
own earnings (40 percent). Forty—seven percent of these
widows were working prior to death and 56 percent after the
death.

In a study of 849 widowed compared to 702 married per-
sons in small towns of Missouri in 1966, Pihlblad, Adams and
Rosencranz concluded: l. Widowers' incomes are about half

the incomes of their married counterparts and widows' incomes

24

are about three—fourths the Widowers' incomes. 2. There is
a tendency for widows to adjust to lower incomes by seeking
employment, whereas widowers tend to reduce expenditures.

3. Residence with and dependence upon children tends to be
the last resort to socio-economic adjustment. 4. Almost
never do friends become a source of dependence.

BENEFITS

Currently, widows without dependent children are not
aided by the Federal Government before age 62 and then only
if the widow or her husband were insured under Social Security.
There are approximately 2 million such underage widows with-
out dependents (Barrett, 1974).

In 1962 (Palmore, et. a1.) made a study of widows and
children who met eligibility requirements for survivor bene-
fits. The median total income of eligible families was
$3,570.00. Old age, Survivors, Disability and Health In—
surance were the major sources of income for nearly two-thirds
of the families. Other assistance included investment returns,
help from friends and relatives, employment, Veteran's bene—
fits, insurance and federal employee survivor benefits.

The average per capita monthly income payment from all
sources was $155.00. Seventy—one percent of the husbands did
not have a will and 25 percent had programmed life insurance

(Nuckols, 1973).

THE ELDERLY WIDOW

 

Elderly widows (65+) comprise a group of special interest

because their low financial status and high rate of residential

25

isolation expose them to greater social and economic risks
than other segments of the elderly population. Also, because
they have many problems unique to them, the following profile
is presented separately.

According to the Bureau of Census (1970), there were
6.5 million elderly (65+) widows residing in U.S. households
in March 1975. These 6.5 millions widows, reports G. Fowles
in his "Data Analysis and Dissemination on Division of the
Department of Health, Education and Welfare", constituted
nearly one—third (31 percent) of all persons 65+ years old
and over one-half (53 percent) of all elderly women.

The principal reason for such a large number of elderly
widows is higher mortality rates for males at all ages result-
ing in an estimated average life expectancy of 68.2 years in
1974, about eight years less than for females. If these
mortality rates were held constant in the future, only two-
thirds of all males born in 1974 would survive to age 65,
compared to over four—fifths for females. Mortality rates
for females rise more rapidly after age 65 than for males,
but the average life expectancy for 65 year old females is
four years greater than for males (17.5, compared to 13.4).
This mortality differential is a major contributor to the
number of widows in America.

Another major factor contributing to widowhood is the
average disparity in ages between husbands and wives.
According to the 1970 Census, three-fourths of all husbands

were older than their wives. The median difference in ages

 

26

was 2.4 years. For older husbands (65+), the disparity was
even more striking. About 81 percent were older than their
spouses and the average age difference was over four years.
Even if there were no difference in life expectancy between
the sexes, the fact that men generally marry younger women
would insure a larger number of widows.

Remarriage for the elderly widow is quite limited,
due to the small number of eligible males in this age group.
Elderly females who are eligible for marriage outnumber eli—
gible males by a ratio of 4 to 1. In addition, males who
marry after the age of 65 tend to marry women from younger
age groups. Data for 1974 show that the number of men 65
years and over who married during the year was twice as high
as the number of elderly brides. Even though most of the
elderly brides probably married men over 65, over half of
the elderly grooms married females under 65.

Age and Race

 

The proportion of elderly women who are widowed in-
creases with age because of the cumulative effect of the
above mentioned factors. About four of every ten women,
according to Fowles (1976) 65 to 74 years are widows, but

seven out of every ten women 75 years and older are widows.

TABLE IV
PERCENT OF WOMEN 65+ WHO ARE WIDOWS

Bureau of Census

 

 

 

AGE ALL RACES WHITE BLACK
65+ ............ 52.5 51.8 60.2
65 to 74 ....... 41.9 40.8 52.6

75+... ......... 69.4 68.9 73.9

 

27

Elderly black women are more likely to be widowed than
their white counterparts, because of higher mortality rates
for blacks and the age differences between black husbands
and their wives is greater than for whites, particularly
in the 65+ age groups. About three of every four black
females 75 years old and over are widows (Fowles, 1976).

Living Arrangements

 

Data from the 1960 and 1970 decennial censuses show
that the number of three and four generation families de-
creased by ten percent during the 1960's while the total
number of families grew by 13 percent. The multi-generation
families represented only four percent of all families in
1970.

Elderly married couples tend to live by themselves.

For most widows, the choice is to continue residing in a
separate household when the spouse dies. About 62 percent

of all widows who were 69 years and older were living alone
in 1975. This proportion was slightly higher for widows 65
to 74 and slightly lower for the 75 and older group. This
group often has more physical difficulties that necessitate
moving to a nursing home or the home of a relative. Among
all elderly women, about 59 percent reside with their hus-
bands or other family members, but only 35 percent of elderly
live with relatives (Bureau of Census, 1970).

Employment

 

A somewhat different occupational distribution existed

among widows over age 65. Fewer were employed as clerical

28

workers and operatives while a greater proportion worked in
private households and as sales personnel. On the whole,
widows comprised a relatively larger proportion of those
employed in management and service occupations and a smaller
proportion of those in professional and clerical positions
than was true for the total female work force.

Income

The information from the Bureau of Census data on cash
income in 1974 show that the median income for all elderly
women (65+) was $2,375.00.

Black females 65+ reported incomes 25 percent lower
than their white counterparts. Among those without husbands,
blacks received a median income of only $1,838.00, about 30
percent less than whites.

According to the federal government's official statisti-
cal measure of poverty, the "poverty index", about 18 percent
of all elderly women were below the poverty level in 1974.
Only eight percent of those elderly women who were living
with their husbands reported joint incomes below this level,
as compared to 24 percent for widows. There were about 1.6
million widows who fell in this category. Among all elderly
women who live alone about one out of every three was poor.

The rate of poverty for black women was about twice as
high than for whites. More than four of every ten elderly

black widows were below the poverty level.

29

Housing

Housing characteristics taken from the 1970 Census are
published for all elderly women who lived alone, of which 85
percent were widows.

Over three—fourths of all elderly couples (husband-wife
families with a husband 65+ years old) resided in a home they
owned compared to slightly over one—half for elderly women
living alone. However, some of this is done by choice. Many
elderly persons choose to move to apartments.

The housing of elderly women living alone tended to be
older and of lower market value than that of elderly couples.
The median value of homes owned by elderly females was $11,000
in 1970 and 63 percent were built before World War II. For
women 75 years old and over, an even higher proportion (68
percent) of their homes were built during this pre-war period.
The homes owned by elderly couples were valued about 26 per-
cent higher than those of elderly females and about half were
built prior to 1940.

The median rent paid by elderly couples was $20.00
higher than for females living alone ($102 vs. $82), but the
units occupied by couples was one room larger. Over two-
thirds (69 percent) of the female individuals paid 35 percent
or more of their annual income for housing costs, compared to
30 percent for elderly couples.

Elderly females living alone are more likely to live in
units lacking complete plumbing than elderly couples. Complete

plumbing defined by the Bureau of the Census, consists of hot

30

and cold piped water, flush toilets, and tub or shower.

Availability of Services to the Elderly Widowed

 

The higher frequency of illness and disability, de-
creased financial resources and increased social isolation
of the elderly often require a wide variety of supportive
services. Some of these services are provided in the home,
but many services in the medical, educational, recreational
and nutritional centers are provided outside the home, often
at some distance. Therefore, the availability of an auto-
mobile or transportation services can be a crucial factor in
access to these services.

The 1970 Census data indicate that most elderly females
living alone do not own or have regular use of a private
automobile. Only two of every five females 65 to 74 years
of age had use of an automobile, and this dropped to one of
every five women for women 75+. By contrast, over 80 percent
of all elderly couples owned or had regular use of an automobile.

Many elderly widows chose not to own or drive a car
because of the financial expenses in maintaining and operating
a vehicle and because of physical disabilities such as failing
eyesight. Many elderly married women never learned to drive
and are unwilling to assume this role when their husband dies.
Summary

Current data on various characteristics of the nation's
6.5 million elderly widows not living in institutions indicate
that the conditions of their existence are considerably differ-

ent from the elderly population in general. Most widows live

 

31

alone on relatively low incomes. One-fourth rely on cash
incomes below the federal government's poverty index. Many
have given up their homes and moved to smaller apartments,
but housing costs consume a large share of their income.
Most do not have automobiles and must rely on other sources
of transportation.

These data do not measure the quality of the total
life situation of the elderly widow. The extent to which
the widow's kinship and friendship networks provide emotional,
physical, and economic support is not measured. The benefits
from many of the existing public and private programs de-
signed to assist the elderly is also a positive input into
the elderly widow. Also, direct financial assistance, such
as supplemental security income payments and subsidized
housing, are of great benefit. Still, however, there is a
very prominent need for supportive services among the nation's

elderly widow.

OVE RVI EW OF BE REAVEMENT

 

Our society, in general, encourages the repression of
grief. But often it is the case that the ”strong, silent
ones" are far more likely to get into serious emotional
problems than the seemingly "weak" grievers who express
openly all their feelings. Because the grief situation does
not readily lend itself to experimental and quantitative
manipulation of the usual forms of controlled observation,
the subject of grief has been ignored by academic psychologists.

Grief is a universal deprivation experience which causes
emotional and psychological reactions in the griever. As
Bowlby (1961) points out, the loss of a loved object often
leads to behavioral sequences, which, varied as they might
be, are in some degree predictable. These behavioral se-
quences are associated with subjective experiences which begin
with anxiety and anger, and proceed to pain and despair and,
if all goes well, end with hope. Both the behavior and sub-
jective experiences oscillate turbulently with yearning,
protest, rage, alternating with blank, mute despair. This
entire experience is referred to as "grief" by Bowlby. Many
authors have made attempts at charting the normal process of
grief (See Table V).

Grief is not particularly a negative reaction, and this

32

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34

is well explained when Peter Marris (1958) describes it as:

"the expression of a profound conflict between
contradictory impulses--to consolidate all that

is still valuable and important in the past, and
preserve it from loss; and at the same time, to
re—establish a meaningful pattern of relationships,
in which the loss is accepted."

According to Freud, who was one of the first to explore
this process, the grief reaction in victims of bereavement
is something normal, not to be treated medically, but simply
allowed to run its natural course. In his famous article,
"Mourning and Melancholia", he writes:

"Although grief involves grave departures from the

normal attitude to life, it never occurs to us to

regard it as a morbid condition and hand the mourner
over to medical treatment. We rest assured that
after a lapse of time it will be overcome, and we
look upon any interference with it as inadvisable
or even harmful." (1917)

Grief is not a disease to be treated, but a process to be

experienced, according to Freud.

GRIEF PROCESS

 

At the moment of his death (1949), the Prince Andrei

Bolkonsky of War and Peace, reflects: "When it is a beloved

 

and intimate human being that is dying, besides the horror

at the extinction of life there is a severance, a spiritual
wound, which like a physical wound is sometimes fatal and
sometimes heals..." (Book XV, Chapter I). The process of
grief ideally protects this open wound from rough and painful
contact and leads at last to healing (Siggens, 1967).

The normal grief process is a multi-faced experience:

 

35

"Grief work", explained by Freud (1917) is the task
of mourning. And it is work--hard, long, painful,
slow, repetitive, a suffering through of the same
effort over and over. It's a matter of re-thinking,
re-feeling, re-working the same longpast fields, the
same old emotional material, over and over breaking
through the denial and disbelief that the past and
the deceased are both dead; re-examining one's past
life repeatedly and seeing each through, each inti-
mate experience, with and without the deceased,
looking at everything that has gone before from a
thousand or more points of View until finally the
past, like the deceased, is ready to be buried."

Also, grief varies widely from one person to another.
Elizabeth Kubler-Ross (1969) suggests the following

stages of grief.

l. denial and isolation
2. anger

3. bargaining

4. depression

5. acceptance

Other normal traits in the grief process include:
denial, obsessional review, identification with the deceased,
idealization, rationalization, substitution, alter perceptions,
and physical manifestations, (crying, sleep disturbances,
restlessness, appetite changes, change in sexual desires,
emotional manifestations, fear, anger, depression, guilt).
Physical distress and worsened health, an inability to sur-
render the past, brooding over memories, sensing the presence
of the dead, clinging to possessions, being unable to com—
prehend the loss, feelings of the unreality, and withdrawal
into apathy and hostility against others, against fate or
turned upon onself are also common reactions.

One of the foundational works on the process of grief

is Lindemann's study on acute grief (1944), which, interviewing

36

101 grieving persons, describes symptoms and behavior
patterns of normal grief and also "morbid grief reactions"
and develops a system for the management of grief. He gave
three tasks to be accomplished as a part of grief work;

1. emancipation from the bondage to the deceased;

2. readjustment to the environment in which the

deceased is missing; and

3. the formulation of new relationships.

Lindemann observed from this study that the character—
istic signs of grief were somatic distress, pre-occupation
with the image of the dead, guilt, hostile reactions and
loss of patterns of conduct.

Most human behavior occurs on a normal-abnormal con-
tinuum, and it is difficult to separate normal and patholo-
gical grief. This is particularly true because many of the
components of normal grief (intense anger, somatic distress
and denial) would be viewed as abnormal under most other
circumstances. Nevertheless, there is the basic difference
between normal and inadequate grief. The latter is the
mourning that leaves the survivor unable to cope properly
with ordinary life.

"A turning—point comes when the pathological processes

of the illness can be seen as intensifications, de-

viations, or prolongations of processes that occur in

health." (Bowlby, 1961)

Recently, the medical profession is beginning to pay
serious attention to pathological, or morbid grief, and the

physical and psychological implication of ignoring "grief

work".

37

"Pathological grief" is, according to Freese (1977),

". . . the inadequate or uncompleted mourning. Here
the bereaved goes on living in the old emotional
bondage which like all forms of peonage keeps its
vassals in perpetual slavery . . . one loses the
opportunity to mature and change, is left to go
through life permanently shackled to the long age."

Pathological grief represents the nonconclusion of the grief
work.

Parkes (1972) gives the following picture of a "typical"
pathological griever:

"From the evidence available, which comes mostly from
studies of bereaved women rather than bereaved men,

our high—risk case would be a young widow with children
living at home and no close relatives nearby. She
would be a timid, clinging person who had reacted bad-
ly to separation in the past and had a previous history
of depressive illness. Closely bound up with her hus-
band in an over—reliant or ambivalent relationship,

she would not have prepared herself for his unexpected
and untimely death. Cultural and familial tradition
would prevent her from expressing the feelings that
then threatened to emerge. Other stresses occuring
before or after the bereavement such as loss of income,
changes of home, and difficulties with children would
increase her burden. Although she may at first appear
to be coping well, intense pining would subsequently
emerge, together with evidence of pronounced self-
reproach and/or anger. These feelings, instead of
declining as one might expect, would tend to persist."

Thus, we term "pathological" the griever that does not
successfully complete the tasks of grief work: release of
grief, structuring, acceptance of reality, making the
decision for life, expressing socially unacceptable emotions
and experiences, evaluation of the loss, incorporation of
the dead, and a new-life orientation.

Lindemann (1944) determined that the following were

the forms of pathological grief:

38

Distorted reaction where there are major changes

in the behavior pattern such as:

a. Overactivity with no sense of loss.

b. Major alterations in the social life, especially
isolation.

c. Acquisition of symptoms belonging to the
deceased or that caused the death.

d. A physiological disease such as ulcerative
colitis, rheumatoid arthritis or asthma.

e. Blatant states of agitated depression.

f. Activities which are detrimental and self-
punitive without awareness of guilt.

g. Lasting loss of patterns of interactions
with others.

h. Hiding of feelings by becoming "wooden", or
schizophrenic-like.

1. Furious hostility against specific persons.

Delay of a grief reaction where the grief may be

unresolved for many years. The grief may finally

be activated by a less significant event.

According to Parkes (1964), there are three types of

morbid grief:

1.

Inhibited type of grief--where the bereaved feels
nothing and does not express the feelings of loss.
It may take the form of neurotic or psychomatic

disorders. Symptoms are often present. Some say

that most cases of depression are due to unexpressed

39

grief. This inhibited grief is often found in
children and in the old.

2. Chronic types of grief-—where there is a pro-
longation of grief with intense anxiety attacks,
depression and searching behavior.

3. The delayed type of grief--the expression of
grief is put off for weeks, months or years. Some
day the major loss will be felt, perhaps when a
person finds himself grieving for a minor loss.

Parkes (1972) states:

"Although there is no clear ending to grief, it is

common for widows to describe one or several "turning

points: that is, events associated with a major re—
vision of their feelings, attitudes, and behavior.

Such turning points may occur, for instance, when a

widow goes away on a holiday, takes a job, goes out

with a man for the first time since her bereavement,
or redecorates her house. They both reflect and
engender an abandonment of the old modes of thinking
and living."

Relating normal and pathological grief to the widowed
population, Glick et. a1 (1974) have conducted a study of
bereaved widows who were having adjustment difficulties
after one year. Twenty-eight percent agreed at the end
of the first year with the statement, "I would not care
if I died tomorrow." A few reported that their grief had
continued unabated and was as intense at the end of the
year as it has been at the beginning. Still other widows,
though they claimed partial recovery, seemed compelled to

dissipate in frenetic activity feelings that might otherwise

have been expressed as fear, anxiety or intense sorrow.

4O

Glick et. a1 (1974) felt that disposing of the personal
belongings of the deceased may demonstrate a critical turning
point in the grief process.

"The first determined movement of a widow toward

acceptance of her separation often was going through

her husband's belongings, putting aside what was to

be kept and giving away or throwing away the remainder.

. Most widows waited several weeks or even months be-
fore moving their husband's belongings from their
bureaus and closets. Often this was a painful task,
accompanied by reminiscence and tears. But when it

was completed it became a statement that one era of

the widow's life had ended and that another was

beginning."

The ultimate goal of grief work is to be able to
remember without pain, and to be able to reinvest the emo—
tional surplus. Volkan (1972) summarizes five factors which
will affect the success of the grief process:

"1. Whether or not the death had been anticipated.

2. The mourner's rapport with the one who had died.

3. The mourner's emotional make—up.

4. Whether death was caused by self—destruction or

violence, or came about through illness.

5. Whether or not the death has brought about changes

in the real world for those left behind."

PREDICTORS OF UNFAVORABLE BEREAVEMENT OUTCOME

 

Maddison (1968) attempted to determine parameters pre—
dictive of an unfavorable resolution (defined by the presence
of physical and emotional difficulties that precipitate a
deterioration in health) of the bereavement crisis. The
evidence available thus far comes predominantly from studies

of bereaved women, rather than bereaved men.

41

The widow who turned out to be a “bad-outcome" subject
was dissatisfied with the help available to her during the
crisis. She perceived a high frequence of unhelpful inter-
actions with persons within her social network during the
first three months following the death of her spouse. She
considered persons around her to be actively or passively
opposing her wish to review past memories and be experienced
with the deceased spouse. Not only were significant others
(including family, friends, clergy and physicians) minimally
helpful in assisting the widow in ventilating her feelings,
but the people often encouraged development of new activities
and new romantic relationships at times when the widow was
not prepared emotionally for such suggestions. Such attempts
were met with great anger and bitterness.

According to Maddison the best single predictor of phy—
sical and psychological symptoms was the widow's perceptions
of her environment as failing to meet her needs during the
crisis. "Good—outcome" widows reported that they received
permissive support from the environment and that was seen as
helpful.

Parkes also did a study on determinants of outcome
following bereavement (1975) with sixty-eight widows and
widowers which were interviewed shortly after bereavement
and again a year later. Factors which at the early interviews
predicted poor outcome included: "low socio—economic status,
short terminal illness with little warning of impending death,

multiple life crises (particularly those involving disturbance

42

of marital relationship) and reactions to bereavement of
severe distress, yearning, anger or self-reproach."

Lindemann (1944) stated that ambivalent relationships
of the deceased and survivor often lead to severe grief
reactions.

Also, Lopata (1972) found that disorganization suffered
by widows depended on the wife's role, the psychological and
social dependencies of the woman upon being the wife of that
specific man, and the extent to which the couple operated as
a team.

Other significant facts (other than inadequate and in-
effectual environmental support) contributing to bad outcome
were: (1) age of widow less than 45 with dependent children;
(2) evidence of pre—existing marital difficulties; (3) pro-
tracted death (associated with severe suffering and disfigure-
ment) maximizing pre-existing ambivalence, leading to feelings
of guilt and inadequacy; (4) prior history of severe reaction
to death of another family member; (5) additional stresses or
crises in close temporal relationship to bereavement; (6)
deliberate avoidance of affective expression, especially con—
trolling hostile and angry feelings; (8) continued reaction
formation against dependence; (8) poor interpersonal relation-
ship with own mother or husband's family.

Epstein et. a1 (1975) agrees very closely with Parkes
(1972) that a high risk case tends to be a young widow with
children living at home and no close relatives living nearby.

Cultural and familial norms prevent her from expressing feelings

43

of anger, ambivalence, and guilt. Other stresses occurring
before or after the bereavement, such as a loss of income,
change in residence, and difficulties with children also

increase the widow's burden.

44

PROBLEMS OF THE WIDOWED

 

Transition

 

Loss of a spouse requires the widow to change roles.
She is no longer wife, but widow. This involves a search
for a new definition of self as a single person. Without
the benefit of a marital relationship which once framed and
focused her daily life, the widowed person must learn to
live with loneliness and still find new purpose. This
transition may turn out to be most difficult.

Also, the loss of a spouse involves significant changes
in the "every-dayness" of the person's remaining. A widow
may need to learn to drive, fill out tax forms, do minor
household repairs and make decisions never asked of her pre—
viously. This happens when her friends and family are also
struggling with their own grief after the loss, thus making
them less able to be supportive of her.

Despite her grief, her sense of loss, and the lack of
preparation for her new role, the widow must attend to many
practical matters in the hours and weeks following her hus—
band's death. The funeral must be arranged, death certifi-
cates obtained, insurance claims filed, social security
benefits applied for, and many other legal and financial
matters attended to. In this context, Nuckol's study (1973)

with widows has estimated the helpfulness of the persons

45

they encounter. According to the study, widows reported
family and close relatives as most helpful with attorney
following. When reporting the most helpful persons among
those they contacted, they reported again family and close
relatives, followed by attorney.

It is impossible for a wife of any age to be completely
prepared for the grief and loneliness that will follow the
loss of her husband. However, there are steps that can be
taken, either in direct anticipation of death or in the course
of daily living, to make it easier for her to adjust to her
new responsibilities as head of the household. Income needs
may be anticipated and a program of life insurance developed;
a will can be prepared; social security and employee benefits
can be discussed; papers can be put in order and their loca-
tions made known; and she may gain experience in money
management by handling the day to day finances of the house-
hold (Nuckols, 1973). If she is in good health, the widow
may be able to earn an income. She will have the proceeds
from her husband's life insurance; she will also have social
security while the children are growing up and after she
reaches retirement age. But these resources are probably
not enough to maintain a semblance of her former standard of
living.

The most frequently reported problem of the widow is
loneliness (Barrett, 1974). The more recent the death of a
spouse, the greater the likelihood of reported loneliness

(Townsend, 1957). Lopata (1969) examined the forms and

46

and components of the sentiment of loneliness as experienced
by 300 Chicago area widows. The forms include: loneliness
for the deceased husband as an individual, an object of love,
the person making the woman an object of love, a companion,
someone whose presence organizes time and work, a partner

in the division of labor, a source of status, and a source

of life style. Loneliness is also experienced by widows
because of strains in relations with married friends and an
inability to convert secondary relations into ones of greater
depth. The very lonely are women who were socialized into
passive membership in automatically encompassing groups, who
now lack such relations. In general, however, most widows
continue some close relations or build new life styles solving
many of the problems of loneliness. Next to loneliness,
widows list finance and rearing children as the most serious
problems (Nuckols, 1973).

Lopata (1973) holds that participation and adjustment
following widowhood is primarily a function of personality,
attitudinal, and ethnic factors. Until recently, however,
the status of widowhood has largely been colored by economic
considerations. Pressing material needs in homes broken
through the death of the breadwinner have assumed a paramount
position and have overshadowed real understanding of the
social and psychological problems the widow must face.

Single Parenthood

 

While the big problem facing divorced or separated

parents is how to get along with an ex-spouse, the chief

47

concerns of widows and widowers is how to get along without
one. This is the main difference that distinguishes almost
all the special problems of single parents who have been
widowed.

Some feel widows with children are fortunate because
the children's needs may help the widow achieve perspective
on her own grief, and because children provide an antidote
to the awful silence that widows without children experience.
But as mothers, among other things, they worry about psycho-
logical problems for kids raised without a father. The be—
reaved child has a higher than chance risk of developing
serious problems as an adult and, especially, Brown (1966)
and Birtchnell (1970) found a clear relationship between
adult depression and early childhood bereavement.

In fact, several studies have noted that the high rate
of parental loss experienced by delinquent populations
(Gleuck and Gleuck, (1950), Gregory (1965), found that al-
though delinquence was more a consequence of divorce than
death, both boys and girls that had lost a parent by death
dropped out of high school prematurely. And, Bonnard (1961)
claimed that much anti—social or delinquent behavior is a
consequence of bereavement.

According to Newman and Denman (1971), white males
who had lost their fathers prior to age 18 are more likely
to be involved in criminal behavior. Greer (1964) has also

shown that individuals with sociopathic symptoms had ex-

perienced greater paternal death.

48

It is an interesting sideline to note Woodward's (1974)
finding that scientific genuis is positively associated with
parental loss to death in childhood. Amongst eminent scien—
tists, two out of five have lost a parent during their child-
hood.

Without question, however, the widow with young children
faces a task with many inherent psychological risks.

Social Adjustments

 

Widowhood is a major crisis in a women's life which
requires new social adjustments for the family, as well as
for herself. It requires the development of alternative
patterns of behavior if the individual is to maintain satis-
factory relations with the family, the kin group, and the
community and if she is to sustain a minimum level of per-
sonal equilibrium.

As Madison (1968) says, the period of widowhood requires
a reorganization and reintegration of social roles suitable
to a new status. Suddenly a women is no longer a wife, she
is a widow, "We" becomes "I", "ours" becomes "mine". She
sees far less of her husband's relatives than before his
death (Lopata, 1970; Marris 1958), while contact with widows'
own relatives is basically unchanged (Marris, 1958). Family
and friends are quite tolerant to the initial bereavement
response, but if prolonged, they quickly tire of it and may
isolate the individual.

The single world is a difficult place for the typical

widow to adapt. She finds it hard to accept sexual

49

changes in recent years. Also, the widow often finds herself
ostracized by her female friends. Much to her surprise, she
may be seen as a rival for a hhsband. Thus, she has to
develop a new social matrix which may be difficult during

the period of bereavement.

Widows are often approached by friends of her husbands,
but sexual complications hinder relationships and conflicts
may arise because they feel still married to their husbands.
In the present couple-oriented society, further, a widow is
no longer socially desirable as before and this leads her to
feel angry and isolated. Also, she may be unable to form
new relationships because she has previously assumed a
passive role in making new contacts.

In general, the bereaved tend to devalue all relation—
ships except the one that has been lost. This makes it
difficult for others to help the widow. Maddison (1968)
suggests two tasks: to detach herself from the lost spouse
in order to permit the continuance of other relationships
and the development of new ones, and to develop a new role
conception as an adult woman without a partner.

In spite of the many social problems, most widows do
adjust to the change in status and some enjoy their new life.
In a study of 300 widows in Chicago, Lopata (1972) found
that many believed themselves to be more independent, com—
petent, active and freer than when their husbands were

living.

50

"In general, the more functional the husband-wife
relation is to the wife's role, and the more multi-
dimensional the involvement of her husband in a women's
life, the more disorganized becomes her other social
relations with her husband's death.
Lopata further states: "The major factor in the amount
of disengagement experienced by a woman upon the death
of her husband is the degree to which her various social
roles were dependent upon him."
The impact of adjustment of a decrease in social inter-
action, or a loss of social roles, is considerably softened
if the individual has a close personal relationship (Lowenthal
and Haven, 1968). Also, religion plays an important role in
the process of adapting to widowhood, especially in the case
of females. Whereas widowers were the least likely to attend
religious services, widows were the most likely to attend

(Berando, 1967).

Educational Level

 

Cosneck (1966) has shown that the widow's educational
level is related to her subsequent adjustment to her new
social roles; the greatest social isolation occurs among
women with the least education. According to Lopata's
(1973) survey, the lower a woman's education, the less like-
ly she is to rank the role of wife in first place in the
hierarchy of roles for women. Instead, she places the role
of mother first. The less-educated woman feels that she has
no share in her husband's world. This is especially true of
black women. They were twice as likely as white widows to
say that they shared only a few activities with their hus-
bands and they were more used to making decisions on their

own .

51

Physical Health

 

The grief precipitated by the death is almost certainly
associated with changes in the function of the endocrine and
central nervous system. In turn the effects of this have
secondary consequences for resistance to various illnesses.

The health of 375 widows, thirteen months after their
bereavement, was evaluated in Boston, Massachusetts and Syd-
ney, Australia (Maddison, 1968). The reported health of
matched, non-bereaved controls was evaluated over the same
period.

In Boston, 21.2 percent of the widows sustained a
marked health deterioration, with the control group being
at 7.2 percent. In Sydney, the figures were 32.1 percent
for widows and 2.0 percent for the controls. In the Boston
widows, Maddison found that young age was associated more
frequently with higher illness scores than older age, but
this was not replicated in the Australian sample. One-
fourth of the young widows reported a significant deteriora-

tion in health in the first thirteen months.

 

 

 

TABLE VI
PREVALENCE OF HEALTH DETERIORATION

No. of Degree of Deterioration—%

Subjects Marked Moderate Nil
Boston widows 132 21.2 35.6 43.2
Sydney widows 243 32.1 36.2 31.7
Boston controls 98 7.2 31.6 61.2
Sydney controls 101 2.0 28.7 69.3
Total widows 375 28.0 36.3 35.7
Total controls 199 4.5 30.2 65.3

 

A score of 16 or above represented a marked deterioration

52

in health and a score of four or less did not seem to involve
any significant health deterioration.

In 1968 and 1969, 109 white widows and widowers were
interviewed (Clayton et. a1, 1971) about the physical and
mental health of the survivor as well as questions attempt-
ing to assess the marriage and the social network of the
survivor.

Among other results, they discovered that crying,
depressed mood and sleep disturbance are the cardinal
symptoms of the bereavement reaction. Fifty-two percent
of these persons took sleep or nerve medicines.

Parkes (1970) also published a report of 22 London
widows under the age of 65 who were seen at one, three,
six, nine and thirteen months after the deaths of their
husbands. At 13 months there were six widows (27 percent)
whose health was definitely worse.

Further, in a sample of 49 widows under 45, Glick,
Weiss and Parkes (1974) found that within eight weeks after
the death of their husbands, 40 percent of the widows had
consulted their physicians because of headaches, dizziness,
muscular aches, menstrual irregularities, loss of appetite
and sleeplessness. In the year following bereavement, they
had three times as many hospitalizations and spend consider-
ably more time sick in bed than did a control group.

There is a higher rate of disabling illness among un-
married females (primarily widows) than among married females

(Woolsey, 1952). Also, a greater number of disability days

53

per person and a higher frequency and duration of hospitali-
zation shows up in widowed, divorced or separated women than
married women.

In one of the latest investigations, new widows report
significantly more physical symptoms and psychological stress

as measured by the Goldberg General Health Questionnaire . . .

 

than did a comparable group of women with newly diagnosed
breast cancer (Vachon, 1975).

Mortality

 

In the final analysis, mOrtality is due to a physical
phenomenon. However, the social processes play a significant
role in the etiology of many disorders that lead to death
and frequently determine how promptly and persistently one
seeks treatment. And, of course, with some types of mortal-
ity, such as suicide, the role of social factors is obvious.

With regard to the relationship between marital
status and mortality for men.and women, the married
have lower mortality rates than the unmarried and

the differences between being married and being

single, widowed, or divorced are greater for men

than for women. These differences are particularly

marked among these types of mortality where one's

psychological state would appear to affect one's

life chances." (Gove, 1979).

Using mortality statistics, Kraus and Lilienfield
(1959) found an increase in mortality rates of forty per-
cent for widowers in the first six months following bereave-
ment. The greatest increase was found in those dying from
coronary thrombosis and other arteriosclerotic and degenera-

tive heart diseases and vascular lesions of the central

nervous system.

54

Cox and Ford (1964) studied durational mortality
statistics of 60,000 widows under 70 years of age and found
the mortality in widows was higher than usual in the second
year after widowhood and Rees and Lutkins (1967) followed
all the close relatives of all members of a small community
in Wales who died in a six year period. Nine hundred and
three close relatives of 371 residents who died during 1960-
65 showed that a 4.8 percent of them died within one year
of bereavement compared with only 0.7 percent of a comparable
group of non-bereaved people of the same age, living in the
same area. The mortality rate was particularly high for
widows and widowers, twelve percent of whom died during the
same period.

Psychological Adjustments

 

Numerous researchers have attempted to measure be-
reavement reactions by using indicators such as rates of
physical and mental illness and mortality statistics. Parkes
has probably done more in this field than any other single
author. In his initial study (1964) he compared the medical
records of forty—five London widows for two years before and
eighteen months after bereavement.

He found that: (l) for widows under the age of 65 a
consultation rate of psychiatric symptoms (anxiety, de—
pression, insomnia, tiredness, run down, attendance for
tonics and sedation) more than tripled during the first
six months after the bereavement. The amount of sedation

prescribed to widows under the age of 65 was seven times

55

greater during the 18 month period after the bereavement
than it has been in the control period; (2) no such changes
for psychiatric symptoms and sedatives were found among
widows over 65; and (3) the consultation rate for non—
psychiatric symptoms was not significantly increased in
the younger group. (4) There was a significant increase
in this rate for older women.

In the subsequent studies, (1964, 1975) Parkes found
that of 3,245 patients admitted to psychiatric units in a
two year period, 94 developed their illness within six months
of the death of a spouse or parent. This number was six
times greater than the expected rate of bereavement in the
general population. In another study, Parkes compared a
group of bereaved patients with a group of non-patient widows.
He found that in the bereaved group, there was greater diffi—
culty in accepting the loss, and feelings of self—blame were
more intense.

A group of thirty-five grievers were studied by Parkes
(1972) that were referred to professionals for help.

"Twenty-six were referred for depression, six

for alcoholism, five for hypochondrical symptoms,

and four for phobic symptoms and there were smaller

numbers with panic attacks, asthma, loss of hair,

depersonalization, insomnia, fainting, or headaches.

In addition, there were two cases of frank psychosis

with hallucinations peculiar to bereavement."

In a study by Parkes and Brown (1972) of 40 widows and
19 widowers under 45 who had been bereaved 14 months, the

bereaved sample showed greater evidence of depression and

general emotional difficulty, as reflected by recent

56

disturbances, sleep, appetite and weight fluctuation, lone—
iness, restlessness, indecisiveness, poor memory, and an
increased consumption of tranquilizers, alcohol and tobacco.
Survivors were four times as likely as controls to have been
hospitalized in the preceding year (general medical and
psychiatric). Members of the widowed group more often than
controls sought advice for emotional problems from physicians
and clergy.

From various samples of psychiatric hospital admissions,
the percentage whose primary difficulty was unresolved grief
was: nine percent (Jackson, 1957), ten percent (Bachmann,
1964), and fifteen percent (Lazare, 1976).

Stein and Susser (1968) concluded in their study of
mental illness and widowhood that recent widowhood precipi—
tates the seeking of psychiatric care and, presumptively,
the inception of mental illness. Widowhood is not associated
with chronic disablement arising from mental illness, how—
ever. These actions follow closely on the event of bereave-
ment more often than expected by chance.

In a study of 109 widows and widowers, Bornstein, et.
a1 (1973) found that the best single predictor of depression
at thirteen months after the loss was depression at one
month. These depressed subjects differed from other be—
reaved in that they had fewer children living nearby, did
not live with other family members and had less financial
and religious support. The depressed subjects also had

few, if any, previous bereavement experiences; thus it

57

would seem that coping with a prior bereavement experience
facilitates adjustment to the death of a spouse, as confirmed
by Huston (1971).

Clayton et. a1 (1972) evaluated a group of widows,
average age 61, one month after the death of their spouses.
Thirty-five percent of them had a collection of depressive
symptoms similar to those common in psychiatric depressed
patients.

One social variable was significant and showed that
fewer of the group with reactive depression had children in
the area they considered close. Thus one means of support
emotional, physical or financial was not available to them.

Those at greatest risk following death of spouse in-
clude widows:

1. with poor social support;

2. under 45, whose spouse died suddenly or over 65

whose spouse had an illness of six months or more;

3. who had experienced an ambivalent marital relation-
ship;
4. who had a minimal funeral ceremony associated with

denial; or
5. with previous psychiatric history (Vachon, 1976).
Marital status and mental disorders among aged were
studied by Bellin and Hardt (1958) with 1803 persons aged
65 and over residing in six census tracts in an upstate New
York urban community.

The ordering of mental disorder rates among the married,

58

widowed, separated, or divorced and single is identical for
each sex: the separated—divorced have the highest rates,
followed in order by the widowed, single and married. On a
gross basis, mental disorder rates for the widowed are sig-
nificantly higher than those of the married (Bellen and
Hardt, 1958).
Suicide

The loss of a marital partner, which causes the dis—
ruption of social relationships on the part of the victim,
has been seen as one of the most significant factors pre-
cipitating self—destruction, and the high rate of suicide
among the widowed has been well—documented.

Durkheim (1951) states:

"The suicides, occurring at the crisis of
widowhood. . . are really due to domestic amomaly,
resulting from the death of a husband. A family
catastrophe occurs which affects the survivor. He
has not adapted to the new situation in which he
finds himself and accordingly offers less resistance
to suicide."

Many studies confirm that suicide, attempted or actual, is
often preceded by the disruption of significant social
interaction and reciprocal role relationships through the
loss of a mate (Rushing, 1968). Sainsbury (1955) showed
that suicides (causing over 5,000 deaths a year, not far

off the number who die in road accidents) were more common
among the widowed than the single, and that the rate was
lowest among the married. Between 1955 and 1967 Segal (1969)

studied the New Hampshire suicide rates by age, sex and

59

marital status. He discovered the suicide rates of the
divorced, separated and widowed to be regularly higher than
the married.

TABLE VII

RATIO'S OF MEN'S TO WOMEN'S FREQUENCIES OF SUICIDE
BY AGE & MARITAL STATUS

 

 

 

 

By Age By Marital Status
Age Group Ratio Status Group Ratio
0 - 24 5:1 Married 2.9:1
25 ~ 44 2.4:1 Never Married 4.1:1
45 - 64 2.4:1 Widowed 2.5:1
65 & More 4.8:1 Separated—Divorced 2.6:1

 

In regard to the mortality risk of the bereaved, Bunch
(1972) studied suicide mortality and found that in the five
year period preceding the suicide, 36 percent of the sample
had been bereaved of a parent or spouse and that more widows
than widowers killed themselves. She suggests that the risk
to the widowed is of longer duration than is usually believed.

Berardo (1967) depicted widowhood among the aged as a
critical situation involving social and personal disorganiza—
tion. Old statuses and roles are lost and new relationships
must be made for a satisfactory adjustment. However, nebulous
and contradictory expectations become the social context of
the new status confronting the aged survivor. The relation—
ship between suicide and widowhood has been documented by
Durkheim (1951), Rushing (l968), Resnik and Cantor (1970),

Marris (1969), and others.

60

INTERVENTION AND SUPPORT FOR THE WIDOW

 

Widowhood emerges as a rather dismal picture. Clearly,
the majority of women survivors generally have to face many
personal and family adjustment problems while concurrently
attempting to establish a satisfactory adaptation to a new
and relatively undefined social role. Their economic situa-
tion is likely to be unstable; more often than not they will
need to get a job. Moreover, as already pointed out, in
comparison to the still married, they face the possibility
of an early mortality, and have more than an average proba-
bility that they will develop some mental disorder or commit
suicide.

As Lowenthal and Haven (1968) reported, the presence
of an intimate relationship serves as a buffer both against
gradual social losses in role and interaction and against
the more traumatic losses accompanying widowhood and re-
tirement. This is confirmed by Barrett and Becker's study
(1978): those widows who, as wives, had friends who were
widows scored higher in preparation for widowhood. The best
prepared were the widows of men who died of long illnesses.
Those living alone reported better preparation than those
living with children or others. Age, long marriages and

marital happiness had no bearing on preparation.

61

TABLE VIII
FREQUENCY OF DEPRESSION AMONG 280 AGED,
WIDOWED AND MARRIED PERSONS WITH AND
WITHOUT A CONFIDANT

 

 

 

Percent Percent
Satisfied Depressed
Widowed within 7 years
Has confidant 55 45
No confidant 27 73
Married
Has confidant 65 35
No confidant 47 53

 

Lowenthal and Haven (1968)

RELIGIOUS FAITH

Very often people turn to religious beliefs to give
support in the transition from wife to widow. However,
studies done by various researchers have provided little
in way of conclusive evidence on the role of faith in the
widowed.

In the 1974 Boston widows' study done by Glick, Weiss
and Parkes, the role of the clergy is seen as limited.

"In truth, few widows seemed to want closer
contact with clergy than they had. They had little
enough energy for anyone outside their intimate
family and friends, and they might have felt
especially reluctant to play hostess for a
courtesy call from a priest or minister they
previously had met only on Sunday mornings."

According to their study, experiencing widowhood may be
destructive to one's faith.

"The death of their husband damaged the reli—
gious faith of some widows. Although seventy—three
percent of our sample said that the death had not
affected their religious beliefs, a significant

minority said in an early interview that their
faith had been shaken, and one in eight said she

62

was angry with God or fate for having permitted
her loss."

Parkes (1972) offers the following on the ambivalent
role of one's faith in relationship to bereavement:

"A month after bereavement thirteen widows out of
eighteen in the London Study who expressed belief
in God said that their faith had helped them. The
relationship between religion and adjustment, how-
ever, is not simple. There was some evidence that
those whose religious beliefs helped them to place
the bereavement in a meaningful perspective coped
better with bereavement than those who had no such
faith, but it was also true that several of the
regular church-attenders did not make out well.
The view of God as a protecting, loving father

was hard to maintain in the face of untimely be—
reavement, and the possibility of reunion in days
to come did not help the widow to tolerate the
absence of her husband now."

For some widows religious beliefs has the possibility
of giving meaning to their grief and loss. However, as
Glick, Weiss and Parkes (1974) observed,

"It seems to make little difference whether a widow
held a fatalistic view of death, believed in pre-
desination, or held that life, and death were in
the hands of God. Whatever her beliefs, the review
process, the exploration of alternative outcomes,
and the fleeting fantasies of undoing the fatal
outcome were pursued."

SUPPORT SYSTEMS

 

Lopata (1970) points to the lack of facilities for
helping people who are socially disengaged to find new ways
of re-engaging in society. She also notes that if people
need assistance with this they are often viewed as different
or defective. It is reported that mental health agencies in
the United States are underutilized by widows. Their services

are not oriented to the needs of this group (Silverman, 1970).

63

However, there are some organizations that have been
helpful, including:

1. A Catholic Church organization called NAIM and
another, Post-Cana. Also, a non-demonination
religious group THEOS (They Help Each Other
Spiritually) (Decker and Kooman, 1973).

2. Parents Without Partners started in 1957, is a
group for widowed, separated and divorced persons
with dependent children (Eagleson & Eagleson, 1961).

3. The American Association of Retired Persons offers
services for the widowed (Loewinsohn, 1977).

4. The Widowed Consultation Center in New York City,
staffed by professionals, including social workers,
psychiatrists and legal and financial advisors,
has served thousands of widows.

SELF HELP GROUPS

 

Most often groupings develop around "critical transitions
in a person's life, when other solutions are unavailable or
ineffective. In mutual help groups the individual is not de-
fined as a deviant or a patient, but as someone undergoing a
natural and normal experience, such as bereavement, childbirth
or divorce.

Mutual help groups are defined as those organizations
that limit their membership to individuals with common pro-
blems. The purpose of such organizations is to help the
members and others with the same difficulties solve their
mutual problems. In time, recipients of help will move to
become helpers.

Several conditions give rise to such organizations;
they develop when the professional caregiver fails to deal

successfully with the problem, when this caregiver solves a

 

64

problem, but does not understand or attend to the problems
that are created by the solutions. At times of rapid social
change, mutual help groups develop when there is a lacuna
between existing social patterns and the requirements of

new situations.

Programs for the widowed grew out of the latter situa-
tion. Social mobility, changing death rates, changing patterns
of behavior and role sets in the family, as well as enormous
changes in religious behavior, left a vacuum, so that patterns
for grieving were not passed on by one member of the family
to another. Communities are more homogeneous so that the new
widow, for example, might be unique in her community. Families
move around so that their support and guidance are not readily
available, nor do the patterns of previous times always seem
relevant to the present situation. In a mutual help program,
help can be offered spontaneously as neighbor reaches out to
neighbor, thus expanding the helping network in which a person
participates.

The purpose of any program of preventive intervention
is to prevent emotional breakdown in a vulnerable population.
Caplan (1964) describes the characteristics of an effective
preventive intervention program: the service should be
available immediately or soon after the critical event occurs.
It should be able to reach every exposed person, that is,
each individual in the population at risk. It must have a
legitimate access to the population, that is, some mandate

from the community. Finally, it must be able to provide a

65

maximum benefit with minimal cost.

The Widow to Widow program provides a systematic effort
at re-engaging the bereaved individual in a new but acceptable
role. The primary caregiver is a widow. A widow caregiver
bears no stigma of illness, or disability. To take help from
such a person does not reflect negatively on the individual's
own competence. As a teacher, a role model, as a bridge
person, she helps make order out of the chaos of grief and
provides the widow direction in the role transition. This
is the essence of prevention.

The social situation is different. The woman is no
longer a wife. She must search for a new definition of self
as a single person. She must learn to live with loneliness
and yet find new purpose. The transition of learning to be
a widow is difficult and many need help to be successful.

If she finds help only from a mental health specialist
she becomes a deviant, her problem is pathological. The
newly bereaved are not able to ask for help; they do not
know what they need. Neither are they well organized enough
to seek out anyone.

Also, the widows served can move into the role of care-
giver. This is then one of the new roles available to them
as they move to redefine their lives without a spouse. The
caregiver in turn is helped. This is another aspect of self
help efforts that the person helping is also being helped by
the activity.

These widow—caregivers are a very specialized group

 

 

66

of "experts". They have lived through the crises, they have
recovered, and they teach others that it can be done and how
to do it.

Carol Barrett (1974) developed a group intervention
program for widows using three distinct formats, including:
self—help groups, women's consciousness—raising groups for
widows, and "confidant" groups based on the model of Lowen-
thal and Haven's research of the relationship between intimacy
and mental health in old age (1968). At post-test, subjects
in all three groups had significantly higher self—esteem.

The women's consciousness-raising participants gave the
program the highest helpfulness ratings. They also reported
the most positive life changes during the six month follow-up
period.

Parkes (1972) cautions that groups of the bereaved can
become self-defeating and ingrown at times. Social activi—
ties with other widows should be seen as steps towards other
forms of activity, rather than as ends in themselves. Other-
wise there is a danger that inward—looking cliques will de-
velop, whose members succeed only in reinforcing one another's
fears of the outside world as hostile and dangerous.

However, the extensive work of Silverman (1970, 1972,
1974 and 1975), Barrett (1973, 1974, 1977, 1978), and Lopata
(1969, 1970, 1971, 1972, 1973, 1975) clearly demonstrates
the value of such structures for recent widows.

In asking widows what kind of help they needed (Barrett

1977, 1978), two suggestions were paramount: one was related

67

to financial preparation and the other emotional preparation
for widowhood. They urged all women to learn financial man—
agement and become familiar with all financial documents and
transactions, to give attention to life insurance, making of
wills and savings of money, and to develop a marketable skill.

In the second area, they suggest developing independent
interests and resources. Barrett cites Lopata's prediction:
"the more areas of one's life which are dependent on the
spouse's participation, the greater the role discontinuity
at widowhood." Their roles as wives shape the boundaries
of their roles as widowed women (Lopata 1971, 1973).

An additional theme was specific planning for widow-
hood. Talking with their husbands ahead of time and finding
an advisor from among family associates or relatives. Finally,
explicit emotional preparation: know and understand all the
possible emotional reactions to bereavement; appreciate your
husband and live to the fullest while your husbands are alive.

Advice given by widows, reported by Nuckols (1973)
encouraged the potential widow to: "be active, have faith",
be open with relatives and friends, take advantage of special
support services and make necessary preparations to ensure
the transition with as much ease as possible.

From interviewing 150 persons, Clayton et. a1 (1971)
confirmed that the bereaved have difficulty making decisions.
Perhaps this is why the lawyer and undertaker are viewed as
helpful and aid the widow in making immediate decisions.

Without exception, professionals encouraged life-planning

68

behavior.

The purpose of talking about feelings should be to
free the person to act. Offering help with feelings alone
when a person does not know how to act does not in fact
move the situation ahead. In helping the widowed, this is
especially true, since a role lacuna often exists and the
new widow needs a role model from whom to learn how to be
a widow. Some widows do need a place or relationship in
which they can express their feelings, but most need help
with concrete, specific difficulties.

Two basic problems facing a widow need to be examined:
the first is that of facing the fact of widowhood; that is,
accepting their changed marital status and all this involves.
The second is to learn to manage their own lives, and to
demonstrate to themselves and others that they can be and
are independent (Silverman, 1972).

Self help has a peer status to achieve therapeutic
goals. Peers must and do reveal themselves to each other.
All have experienced the problem or behavior which defines
them as peers. They are totally involved in a fellowship
and each experience is part of therapy (Hurvitz, 1970).

They are therapists because of their ability to disclose
themselves, create empathy and encourage and support others'

efforts to change.

CHAPTER III

RESEARCH METHODOLOGY

The purpose of this study was to test the effects of
a Life Management Skills Program of systematic intervention
on depression and grief in widows.

In order to test the following research questions,
a participant group of widows that were involved in a six
week Life Management Skills Program was compared to a non-
participant group of widows on pre— and post-, self-reporting
scales of depression and grief.

Research Questions

 

Question 1: Are depression scores of widows who

 

participate in a Life Management Skills Program reduced more
than those who are non-participants in such a program?

Question 2: Are grief scores of widows who partici-

 

pate in a Life Management Skills Program reduced more than
those who are non—participants in such a program?

Selecting the Population

 

The population of this study were widows predominantly
from Shiawassee County, Michigan.

The population was divided into two groups (referred
to as participants and non—participants). Both groups
consisted of volunteers from an on-going county Widow to

69

 

7O

Widow program that was meeting on a monthly basis.

The participant group consisted of nine widows who
volunteered to participate in a weekly Life Management
Skills Program for six consecutive weeks.

The non—participant group consisted of eighteen widows
who volunteered to be part of the study.

The participant group consisted of nine participants
yielding the demographic data shown in Appendix F.

The non-participant group consisted of eighteen parti-
cipants with demographic data also displayed in Appendix F.

Demographic variables included: age, months widowed,
income level, number of children, children at home, per—
sonal health, level of education, and intensity of religious
belief.

There were certain uncontrolled variables that might
have affected the grief and depression levels of the widows,
including: the passage of time, participation in other
social activities and other outside support systems.

There was no formal attempt made to control the impact
of these variables.

Data Collection

 

All members of the participant and non-participant

groups completed the Confidential Information Sheet, The

 

Texas Revised Inventory of Grief and The Measurement of

 

 

Depression scale at the onset of the program. The non-

 

participant group was given these pieces with an accompany-

ing letter of instructions at the monthly widow to widow

 

 

 

71

meeting and the participant group completed the forms at

the first meeting.

At the end of the six weeks The Texas Revised Inventory

 

of Grief and The Measurement of Depression scale were ad-

 

ministered. The participant group completed the two scales
at the last group meeting and the non-participant group
were sent the scales in the mail with instructions for com-
pleting and returning them to the group leader.

Pre- and post- test scores for both tests on popula—
tions in the participant and non—participant groups were
compiled and contrasted. The t—test was used for all tests
of significance. The .05 level of significance was deter-

mined to be the level for rejection of the null hypothesis.

Description of the Instruments

 

The Confidential Information Sheet

 

A short questionnaire was designed to gather basic,
demographic information regarding the subjects. This in—
cluded: income, number and ages of children, age widowed,
length of illness, living conditions, health, church
affiliation, employment history, current problems and
support systems (See Appendix A).

Summary tables of this information are included for
both the participant and non-participant groups (See Ap-
pendix F).

The Measurement of Depression

 

This is a self—rating depression scale (SDS) developed

 

 

72

by William WLK. Zung, M.D. for the quantitative measurement
of depression as an emotional disorder based upon the
operational definition, "depression is a syndrome comprised
of co-existing signs and symptoms which signify the presence
of pathological disturbances or changes in four areas:
somatic, psychological, psychomotor and mood."

The test contains twenty items each with a "depression"
value of 1 to 4 with 1 indicating little or no depression
and four indicating much depression. A respondent with a
score of 20 displays no measurable amount of depression,
while a respondent with a score of 80 displays a consider—
able amount of depression. The total score is scaled so
that a score of 20 matches an SDS (Self—rating Depression
Scale) Index of 25, while a score of 80 is associated with
an SDS index of 100.

Individual item scores tell what specific sign or
symptom the individual is manifesting, while aggregate
scores of several items tell what area(s) the individual
is having the mcst difficulty with.

The SDS is intended to rate depression as a disorder.
However, it is not intended to differentiate the different
types of depression. It serves rather to quantitatively
measure the intensity of depression regardless of the
diagnostic label used.

Certain safeguards are incorporated in the construction
of this rating scale. An individual is unable to discern a

trend in their answers because half of the statements are

 

 

73

worded symptomatically positively and half are worded
symptomatically negative. Additionally, an even rather
than an odd number of columns is used to offset any possi-
bility of an individual checking middle colums in order
to look average.
The SDS Index can be interpreted as follows:

Below 50 Within normal range, no psychopathology

50 - 59 Presence of minimal to mild depression

60 - 60 Presence of moderate to marked depression

70 7 over Presence of severe to most extremely
depressed

The above interpretations are based upon data which
compares depressed versus non-depressed individuals, and
depressed versus normal subjects in the 20 - 64 year old
range. High scores are not in themselves diagnostic, but
indicate the presence of symptoms which may be of clinical

significance.

 

The SDS instrument, the Diagnostic Criteria for De-

pressive Disorders, and the Table for Converting Raw Scores

 

to the SDS Index can be found in Appendixes B, C, and D

 

respectively.
The Texas Revised Inventory of Grief

The Texas Revised Inventory of Grief, (1978) is a
self report measure composed of three parts developed by
Thomas Faschingbauer, Richard DeVaul, and Sidney Zisook.

The TRIG is a two scale Likert—type measure of grief

 

 

74

following bereavement. It was developed using factor analysis.

Demographic/Psychographic Data

 

The TRIG answer sheet begins by inquiring about the
bereaved person (name, age, sex, race, education, and religion).
Next is a series of questions about the deceased person's age,
duration since they died, their relationship to the bereaved,
how close that relationship was, and how suddenly and unexpect-
edly they died.

Part I consists of eight items which have a median corre-
lation with their total score minus each particular item of
+.67. The alpha coefficient of reliability is +.81.

Construct validity was assessed for Part I by hypothe-
sizing that the deaths of persons active and important in the
daily life affairs of the bereaved would produce greater levels
of life disruption than those less actively involved.

These items all attempt to measure the amount of life
disruption incurred consequent to bereavement. Completely
true answers are scored 5, completely false items 1, and those
between 4, 3, and 2.

Part II consists of thirteen items which have a median
correlation with their total score minus each particular item
of +.69. The alpha coefficient of reliability is +.86, and
the split half reliability was .88. These items are also
scored from 5 to l in the same direction as those in Part I.
The total score here reflects the present level of unresolved
grief.

These two parts contain a total of 21 items with a

 

75

"grief" value of 1 to 5 with 1 indicating little or no grief
and 5 indicating much grief. A respondent with a score of
21 has no measurable grief, while a respondent with a score
of 105 displays a considerable amount of grief.

Combining Parts I and II

 

In addition to measuring both past adjustments and
present feelings, the TRIG appears to provide information
regarding a person's progress through the various stages of
grief by combining Parts I and II. It was hoped that two
orthogonal measures of grief might function much as do the
measure of barometric pressure and temperature in delineating
seasonal weather changes.

Part III consists of five items, true and false, of
related facts that might be important clinically. However,
these items did not load highly enough to be included in
Part I or II (See Appendix E).

Program Description

 

The Life Management Skills Program was a six week
program that took place in one of the family rooms at the
Knapp and Smith Funeral Home on a weekly basis from 7:00—
9:00 P.M. weekly.

The program was content specific and product oriented.
The technique used was a dialogue-interactive mode with
every meeting having some "hands—on", substantive material
to deal with. It was felt that the participants would be
more comfortable if they could externalize the grief on some

concrete issue.

76

This group was begun on March 29th and continued for

six consecutive Monday evenings.

Following is a schedule of events for each session:

Session I

 

Ulrbwwl-J

In

Consent Form

Confidential Data Sheet

Texas Revised Inventory of Grief

Depression Scale

Key Differences Between Grieving and Depression

addition to completing the above instruments and

forms the researcher gave a short lecture on, "The Normal

Process of Grief". Then, each of the participants were in-

vited to share whatever they felt comfortable with about

their own particular loss.

Session II

 

Self Assessment Inventory

Living Your Loneliness

Check sheet for financial, legal, mental, physical,
psychological, social and philosophical well being.
What Do I Value in Life?

A short lecture was presented on "Managing Our Loneli—

ness" and also on "Values Development and Clarification" by

the group leader. In each session the participants were free

to ask questions and contribute in any way.

Session III

 

(fishbowl-4

In

our time

Time Diary

Record of Important Family Papers

Documents You Will Need to Handle Business Matters
Let's Talk About Money

The Money Manager

this session the focus was on the good management of

and financial resources. Each participant was given

the assignment of keeping track of how they spent their time

77

and were asked to make out a budget of how they spent their
money. In addition, the discussion covered the many documents
that a widow would need to have in order to efficiently manage
their legal and financial matters.

Session IV

 

1. Holmes-Rahe Stress Test

2. Personality and Disease Predisposition

3. Stress and the Family

This session was given entirely to stress management.
The stress instrument was administered and a discussion followed.
Next, we discussed the relationship between individual person-
alities and their predisposition to certain illnesses; more
generally referred to as type A and type B personalities.
Then several articles were distributed for home reading from
the Family Living Series on Stress and the Family which was
developed by the Michigan State University Cooperative Ex—

tension Service.

Session V

 

1. Decision Making

2. Nutrition

3. Exercise

Session V dealt with the ability and components of good
decision making skills. Each participant was asked to share
a decision she was trying to make at that time.

A short lecture was given on the value of good nutrition
and exercise in order to feel more physically fit. Also, the
effects of poor diet on depression. Participants shared the

problems of cooking for one person and were asked to each

bring a recipe for one that they especially enjoyed.

78

Session VI

 

General Goal Setting

Short Term Goal Setting

Long Range Goal Setting

. Competency Assessment

Texas Revised Inventory of Grief
Depression Scale

ambWNl-J

This final session was given to setting personal goals
for each individual and making a personal assessment of where
they felt they were with their own life management skills.
The two research instruments were given to all the participants.
Phone numbers were given for support systems if they felt
they needed additional assistance. Only one of the group mem-
bers kept in touch by telephone and that on an infrequent

basis.

 

CHAPTER IV

RESULTS

Sample Descriptions

 

The purpose of this chapter is to give a detailed de-
scription of the samples and present the results of the
statistical treatment of the data.

The population of this study were widows predominantly
from Shiawassee County, Michigan. The population was di-
vided into two groups referred to as participants and non-

participants with nine and eighteen members respectively.

Participants
The sample of the participant group ranged in age from
31 to 64, with a mean age of 50.9 and a standard deviation
of 14.3 years.
TABLE IX

AGE DISTRIBUTION OF PARTICIPANT
AND NON-PARTICIPANT GROUPS

 

 

 

Age Participant Non—Participant
Range Frequency Frequency
31—40 3 l
4l-50 0 3
51—60 3 7
6l-70 3 6
7l—73 O l

n = 9 n = 18
§ = 50.9 i = 56.6
SD = 14 3 SD = 10.2

 

 

 

 

 

80

The duration of widowhood among the subjects ranged
from three months to four years and one month, with a mean
duration of eighteen months and a standard deviation of
sixteen months.

TABLE X

DURATION OF WIDOWHOOD OF THE PARTICIPANT
AND NON-PARTICIPANT GROUPS

 

 

 

Number of Participant Non-Participant
Months Widowed Frequency Frequency

1-12 4 5
13-24 2 7
25-36 2 1
37-60 1 2
61-84 0 2
85-101 0 l

n = 9 n = 18

x = 18.9 x = 30.7

SD = 14.7 SD = 28.8

 

The educational level of the participants ranged from
five completing high school to two completing two years of
college. The mean years of education was 13.3 with a
standard deviation of 1.7 years.

TABLE XI

EDUCATIONAL LEVEL OF THE PARTICIPANT
AND NON-PARTICIPANT GROUPS

 

 

 

Years Participant Non-Participant
Completed Frequency Frequency
8-11 0 5
12 5 10
13-17 4 2
n = 9 E = 17*
x = 13.3 x = 11.5
SD = 1.7 SD = 2.1

*one non—participant did not respond
The mean monthly income of the participant group

prior to the death of the spouse was $1,000 and following

81

the death $853, the range prior to the spouse's death was

$600 to $1600 and 0 to $1667 after. Approximately fifty
percent of the sample worked prior to and following the

death. Table XII compares the current and marital incomes.

TABLE XII

MONTHLY INCOME BEFORE AND AFTER WIDOWHOOD
OF PARTICIPANT AND NON-PARTICIPANT GROUPS

 

 

 

 

 

 

 

 

 

 

 

Monthly Participant Non-Participant
Income Range Frequency Frequency
Before After Before After
O-$500 0 2 2 6
600-1000 4 2 3 3
1100-1500 1 1 4 0
1600-2000 1 1 0 0
_ n=6* _n=6 _n=9 _n=9**
x=$1000 x=$853 x=$854 x=$470
SD=$365 SD=$589 SD=$443 SD=$261
* 3 participants did not respond
**9 non-participants did not respond

 

 

The participant sample had a mean of 2.25 children

with the range from 1 to 4. Only four of the subjects had

children living at home after the death of the spouse.

TABLE XIII

NUMBER OF CHILDREN IN THE PARTICIPANT
AND NON-PARTICIPANT GROUPS

 

 

 

 

 

 

 

Number Participant Non-Participant
of Children Frequency Frequency
0-1 1 4
2-3 7 8
4—5 0 5
6—7 0 1

n=8* 3:18
x=2k x=2.9
SD=1 SD=1.6
* one participant did not respond
4

 

 

82

On a scale ranging from 1 to 6 measuring religious
intensity (one being low intensity and six high intensity)
the self—reported mean was 5. Of the sample only one was
Catholic with the remainder being Protestant.

Participants reported their physical condition on a
four point scale: poor, fair, good and excellent, the mean
prior to and following the death was good to fair physical
health. Appendix F.

Non-Participants

 

Analysis of the non-participant group yielded the
following demographic details. The age range of this group
was 33 to 71 years with the mean age 56.6 and the standard
deviation 10.2 years.

The mean number of years widowed was 2 years and 6.7
months with the range of 0 (less than one year) to 8 years
with a standard deviation of 28.8 months.

The non—participant range of education was 8 to 17
years with the mean level at 11% years and a standard
deviation of 2.1 years.

This group had a lower mean monthly income before
and after the death than the participant group. Prior to
widowhood the range was $69.00 to $1400 per month with a
mean of $470 per month. The standard deviation was $443
and $261 respectively. Approximately one third of these
widows worked before and after the death of their spouse.

The issue of money appeared to be a very sensitive one.

83

Both the participant and non-participant groups were
reluctant to report their financial condition.

The non-participant sample had a mean of 2.9 children
with a range from 0 to 8 children and five of these had
children currently living at home.

To the question of religious intensity the mean
response of this group was 5.24 on a six point scale with
a distribution between Catholic and Protestant being 12
and 6 respectively.

Responses regarding physical health for this group
yielded a mean response of "good" prior to widowhood and
"fair to good" following widowhood.

Individual scores and responses for each participant
are recorded in Appendix F.

Research Questions

 

The data were collected and treated as outlined in
Chapter III.

Two research questions were explored. The first
related to changes in depression scores and the second
related to changes in grief scores.

Question 1

 

Are depression scores of widows who participate in
a Life Management Skills Program reduced more than those
who are non-participants in such a program?

Question 1 was tested using change scores from the

depression scale, The Measurement of Depression Scale

 

(Zung, 1975).

84

All nine respondents in the participant group com-
pleted the pre and post depression inventories. The
results are shown in Table XIV.

Seventeen respondents in the non-participant group
completed the pre and post depression inventories (there
was one non-usable pre-test). See Table XV for the results.

Question 2

 

Are grief scores of widows who participate in a Life
Management Skills Program reduced more than those who are
non—participants in such a program?

Question 2 was tested using change scores from the

grief scale, The Texas Revised Inventory of Grief (Fasching-

 

bauer, 1978).

Six respondents in the participant group completed
pre and post grief inventories (there were two non—usable
pre-tests and one non—usable post-test). The results are
shown in Table XVI.

Sixteen respondents in the non-participant group
completed the pre and post grief inventories (there were
two non-usable pre and post-tests). The results are
shown in Table XVII.

In every case the scores of persons were not used
unless they completed both pre and post-tests on the

individual instrument.

 

85

TABLE XIV

SELF RATING DEPRESSION SCALE
PARTICIPANT GROUP

 

 

 

 

 

 

 

 

 

 

POPULATION PRE-TEST PRE-TEST POST-TEST POST-TEST DIFF.**
PARTICIPANT RAW SCORE SDS INDEX RAW SCORE 888 INDEX (PRE~POST)

1 47 59 40 50 9

2 48 60 49 61 -1

3 45 56 4o 50 6

4 44 55 45 56 -1

5 37 46 36 45

6 55 69 52 65

7 44 55 44 55

8 55 69 36 45 24

9 45 56 24 3o 26

n = 9 £1 = 58.33 £2 = 50.78 I1 = 7.56
51 = 7.21 52 = 10.32 sy = 10.45

**A positive value here indicates a lowerlscore on
the post-test than on the pre-test and represents
a decline in depression. A negative value here
indicates a larger score on the post—test than on
the pre-test and represents an increase in depression.
yl indicates an average decline in depression of 7.56
S.D.S. units.

 

 

86

TABLE XV

SELF RATING DEPRESSION SCALE
NON-PARTICIPANT GROUP

 

 

 

 

 

 

 

 

 

 

NON-PARTI- PRE-TEST PRE-TEST POST-TEST POST-TEST DIFF.**
CIPANT RAW SCORE SDS INDEX RAW SCORE SDS INDEX (PRE-POST)
l 32 40 32 40 0
2 34 43 26 33 10
3 48 6O 43 54 6
4 48 60 38 48 12
5 36 45 28 35 10
6 26 33 35 44 ~11
7 42 53 37 46 7
8 48 60 31 39 21
9 28 35 41 51 -16
10 26 33 27 34 -1
ll 38 48 45 56 -8
12 33 41 28 35 6
13 4O 50 48 6O -10
14 30 38 37 46 -8
15 32 40 39 49 -9
16 41 51 40 50 1
17 29 36 33 41 -5
n = 17 i3 = 45.05 £4 = 44.76 y2 = .29
s3 = 9.43 54 = 8.13 sy2 = 10.05
*FORMULA= Index = 3211.328: E‘f’t‘é‘é X 100 = Siéiiiiiiting

Scale Index

**A positive value here indicates a lower score on the
post-test than on the pre—test and represents a decline
in depression. A negative value here indicates a larger
score on the post—test than on the pre—test and repre—
sents an increase in depression. y indicates an average
decline in depression of .29 S.D.S. units.

 

 

 

 

87

TABLE XVI

PARTICIPANT GROUP
PRE AND POST TEST GRIEF SCORES

 

 

 

 

 

 

 

 

 

 

 

POPULATION PRE-TEST POST-TEST
PARTICIPANT PART I PART II PART III PART I PART II PART III
1 26 44 l 26 43 l
2 16 51 2 21 48 3
3 31 56 3 34 50 5
4 24 45 l 23 42 l
5 25 47 2 36 49 2
6 32 23 2 32 23 2
PART I = Amount of life disruption incurred consequent to

bereavement. 5 = completely true; 1 = completely
false.

 

 

 

 

 

 

 

 

 

 

PART II = Present level of unresolved grief.
PART III = Related Clinical Facts, T = 1, F = 1.
PRE-TEST POST-TEST
PARTICIPANT TOTAL SCORE TOTAL SCORE DIFFERENCE
1 70 69 l
2 67 69 -2
3 87 84
4 69 65
5 72 75 -3
6 55 55 0
£1 = 70.00 £2 = 69.50 §l — .5
s1 = 10.28 32 = 9.71 sYl = 2.74
n = 6 n = 6 n = 6

**A positive value here indicates a lower score on the
post-test than on the pre—test and represents a decline
in grief. A negative score here indicates a higher
score on the post-test than on the pre-test and re—
presents an increase in grief. yl indicates an average
decline in grief of .5 units.

 

88

TABLE XVII

NON-PARTICIPANT GROUP
PRE AND POST TEST GRIEF SCORES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

POPULATION PRE-TEST POST-TEST
PARTICIPANT PART I PART II PART III PART I PART II PART III
1 18 30 3 17 34 2
2 24 24 l 20 25 3
3 22 44 l 24 41 3
4 26 47 l 19 42 1
5 24 37 1 29 33 3
6 22 35 2 23 44 3
7 24 46 3 23 40 2
8 16 38 2 13 25 3
9 21 27 3 18 26 3
10 15 43 3 13 41 3
ll 24 57 1 17 58 l
12 29 35 3 23 30 3
13 17 30 1 23 32 1
14 21 48 1 23 49 l
15 17 33 3 12 39 l
16 13 43 l 13 37 l
PRE-TEST POST-TEST
PARTICIPANT TOTAL SCORE TOTAL SCORE DIFFERENCE*
1 48 51 -3
2 48 45 3
3 66 65 l
4 73 61 13
5 61 62 —1
6 57 67 -10
7 70 63 7
8 54 38 16
9 48 44 4
10 58 54 4
ll 81 75 6
12 64 53 11
13 47 55 -8
14 69 72 -3
15 50 51 -l
16 56 50 6
n = 16 x3 = 59.38 x4 = 56.63 y2 = 2.75
s = 10.34 s = 10.37 s = 7.06
3 4 y2

*A positive value here indicates a lower score on the
post-test than on the pre-test and represents a decline
A negative value here indicates a higher
score on the post-test than on the pre-test and re-

in grief.

presents an increase in grief.

decline in grief of 2.75 units.

y2 indicates an average

 

 

 

89

Treatment of Data

 

The t—test was used for all tests of significance.
This test is especially designed for small sample sizes
and was appropriate for this study.
The following tests of significance were run:
1. Non-participant group pre-test vs. non—participant
group post-test scores on
a. depression
b. grief
2. Participant group pre-test vs. participant group
post—test scores on
a. depression
b. grief
3. Non-participant group vs. participant group pre
and post—test scores on
a. depression
b. grief

Depression Scale Results

 

When comparing the pre and post-test scores of the
participant group on the depression scale, the results
indicated a significant difference (a =.05) between the
pre-test and post-test reporting of depression in the
participant group. See Table XIV.

When comparing the pre and post-test scores of the
non-participant group on the depression scale, the results

were not significant at the .05 level. See Table XV.

 

 

90

When testing the differences in decline of depression
between the participant and non-participant groups, the
difference was significant at the .05 level.

Therefore it can be stated that the participants in
the six weeks Life Management Skills Program for widows did
have a decrease in depression.

TABLE XVIII
SELF RATING DEPRESSION SCALE (SDS)

 

 

PartiCiPant Group Non-Participant Group
H = 9 n = 17
X1 = 58.33 x3 = 45'05 Average Pre-
(s = 7.21) (s = 9 43) Test Score
1 3
X2 = 50.78 x4 = 44.76 Average Post-
(S : 10°32.(S = 8.13) TeSt Score
2 4
yl = 7.56 y2 = '29 Average Diff.
- _ Between Pre-
(Syl — 10.45) (5Y2 _ 10°05) Test & Post-

Test Scores

 

Grief Scale Results

 

The results comparing the participants pre— and post—
test scores on the grief inventory were not significant at
the .05 level. Thus, the treatment program was not effective
in reducing the level of grief. See Table XVI.

When comparing the non-participants pre- and post-test
scores on the grief inventory there was no significant differ-
ence at the .05 level. See Table XVII.

T-tests run on the comparative grief scores of the

participants and non-participants demonstrated no

 

 

91

significant differences in the decline of grief between the
participants and non-participants.

TABLE XIX
TEXAS INVENTORY OF GRIEF

 

 

Participant Group Non-Participant Group
n = 6 n = 16
i = 70.00 I = 59.38
1 3 Average Pre-
(31 = 10'28) (E3 = 10'34) Test Score
x2 = 69.50 x4 = 56.63
_ = Average Post-
(i2 _ 9°71) (54 10°37) Test Score
y1 = '5 y2 = 2‘75 Average Diff.
(s = 2.74) (s = 7.06) Between Pre-
y1 y2 and Post-
Test Scores

 

 

 

 

Therefore it can be concluded that the treatment
program was not effective in reducing the levels of grief.
To summarize, the following table of tests of signi-

ficance was constructed.

TABLE XX
TESTS OF SIGNIFICANCE

 

 

Depression Grief
Non-participant Test not Test not
pre-test average significant significant

vs.
Non-participant
post—test average

at .05 level

at .05 level

 

Participant
pre-test average
vs.
Participant
post-test average

Significant
at .05 level

Test not
significant
at .05 level

 

 

Non-participant
vs.
Participant

 

Significant
at .05 level

 

Test not
significant
at .05 level

 

 

 

92

It appears that without any deliberate attempt to
deal with depression and grief in the non-participant group,
there was no significant changes in the levels of these two
factors during the six weeks period of testing.

However, the test results demonstrate that within the
participant group involved in the six weeks Life Management
Skills Program, there was no significant decline in grief,
but a significant decline in depression at the .05 level.

Therefore, it can be concluded that participants in
the Life Management Skills Program for widows did show a

decrease in depression.

 

 

CHAPTER V
DISCUSSION
Summary

The primary purpose of this study was to test the
effects of a Life Management Skills Program of systematic
intervention on the levels of depression and grief in widows.

This was an exploratory study to determine if a full
scale study was warranted.

The approach of the investigation involved administer-
ing pre and post-test self-reporting depression and grief
instruments to all the persons involved in the study.

The population of this study were volunteers who were
widows, predominantly from Shiawassee County, Michigan. The
population was divided into groups of their choosing ref-
erred to as participants and nonuparticipants. There were
nine and eighteen widows in each group respectively. The
non~participants did not receive any specialized treatment.

The instruments that were used in the study were Thg

Texas Revised Inventory of Grief and The Measurement of

 

 

Depression scale. In addition, all of the population filled

 

out the Confidential Information Sheet.

 

To achieve the purpose of the study, two research

questions were formulated;

93

 

94

The results indicated that the participant group began
with significantly higher depression and grief levels

than the non-participant group, but that the participant
group made larger gains in recovering from depression.
Although it is true that the two groups started at differ-
ent places with respect to both depression and grief, the
tests of significance still validate that the participant
group made the greatest positive change with respect to
depression. Tables XIV, XV, and XVIII.

One additional observation was explored in relation
to the stability in the level of grief in the participant
and non-participant groups as measured by the grief
inventory.

The change in grief for the participant group (§l =
.5; syl = 2.74) does appear to be less than the change in
grief for the non-participant group (§2 = 2.75; sy2 = 7.06).
(yz and yl represent average changes in grief). It appears
that the non-participant group experienced a larger change
in grief than the participant group. This would lead one
to suspect that the grief of the participant group was
more stable than that of the non-participant group. In
testing the difference in variation (variance) between the
change in grief of the non-participant group and the change
of the participant group, the results indicated that the
non-participants group experienced significantly (a = .05)

more variation in grief than the participant group. This

95

Question 1: Are depression scores of widows who

 

participated in a Life Management Skills Program reduced
more than those who are non—participants in such a program?

Question 2: Are grief scores of widows who partici-

 

pated in a Life Management Skills Program reduced more
than those who are non—participants in such a program?

The statistical technique used for all tests of sig-
nificance was the t-test. The findings of the investigation
were presented statistically in Chapter IV.

Findings

 

In testing Question 1, it was found that there was
a significant difference in the decline of depression in
the participant group at thecx.05 level when comparing
the pre and post—test scores of the participant and non—
participant groups.

The results of testing Question 2 showed that there
was no significant change in the level of grief when com-
paring the pre and post-test grief scores of the partici-
pant and non-participant groups.

Other Findihgs

 

The data were exploited for information other than
that directly related to the research questions.

T—tests were run on the sample means of the partici—
pant group pre-tests compared to the sample means of the
non-participant group pre-tests to determine if the two

groups started at different grief and depression levels.

96

would lead one to conclude that the grief of the partici-
pant group was more stable than the grief of the non—
participant group.

Conclusions

 

On the basis of the findings of this study the
following conclusions can be drawn:

A Life Management Skills Program of systematic
intervention for recent widows does not have a reduction
effect on the grief level of the widow involved. However,
the grief of the participant group remained more stable
than that of the non-participant group. This appears to
imply that the effect of a support group kept the parti-
cipants from the radical fluctuations in their grief levels.
The fact that the program did not reduce grief also seems
to confirm the classical research of Freud (1917) when he
stated in his famous article, "Mourning and Melancholia",

"Although grief involves grave departures from the

normal attitude to life, it never occurs to us to

regard it as a morbid condition and hand the mourner
over to medical treatment. We rest assured that
after a lapse of time it will be overcome, and we
look upon any interference with it as inadvisable

or even harmful."

He further stated that grief is not a disease to be
healed, but a process to be experienced.

An additional observation can be made that if the
person has an understanding of the "normal" parameters of

this experience, it will make the process less painful.

The second major conclusion drawn is that a Life

 

97

Management Skills Program of systematic intervention was
effective in reducing the leVels of depression for parti—
cipants in such a program.

Delimitations

 

The sample allowed for certain uncontrolled variables
that may have had some effect on the outcomes including:
the passage of time, participation in other social activi-
ties and the impact of other family and community support
systems. Two additional limitations may have been the small
number of subjects and the length of the program period.

There is also the possibility that the effect of
simply being in a group in a therapeutic environment with
others who face a similar painful life situation had as
much to do with their decrease in depression as did the
content of the Life Management Skills Program. This type
of positive group effect is validated in the research
findings of Sidel, Silverman, and Barrett as described
in Chapter II.

More specifically the results can be applied to
widows living in Shiawassee County, between the ages of
31 and 73, who participated in a six weeks Life Management
Skills Program, with the outcomes reported on the selected
tests of measurement.

Implications for Further Research

 

The suggestions for future research closely parallel

the limitations of this study. There is a clear need to

 

98

repeat this program with a larger population. The sample
should be randomized and the program expanded for a longer
period of time than six weeks. A statistical analysis

should also be done to determine a carefully controlled study
with matched pairs and more elaborate statistical procedures.

Additional variables to be given specific attention
would be the impact of educational level, income, age, num—
ber of children, social class and length of widowhood on
the levels of depression.

A similar study should also be conducted on widowers.

It would be appropriate for these groups to be off—
ered in a variety of community agencies including mental
health centers, churches, colleges and universities and
funeral homes.

The researcher suggests that additional Life Man-
agement Skills Programs make no overt attempt to address
grief but rather only assess the pre-post levels of this
process.

The results of this study give strong support that
the program of intervention is worthwhile, and that widows
who are competent in managing their lives have less dep"
ression when they lose their spouse. A feeling of mastery
of these skills may then lead to an attitudinal change
that may generalize to other areas of their lives.

The findings of this study warrant a full scale

study. This statistical analysis gives a guide for a

 

99

future, controlled study.
An additional task is the structuring of the train-

ing procedure so it could be replicated by others.

APPENDICES

 

 

 

 

 

 

 

APPENDIX A

THE CONFIDENTIAL

 

INFORMATION SHEET

 

APPENDIX A

INFORMATION SHEET

CONFIDENTIAL

All information which you fill in is strictly confidential.

 

 

 

 

 

 

 

NAME AGE

ADDRESS TELEPHONE

1. How long have you been widowed: years months.

2. At at which you were widowed . Race

3. Length of illness of spouse . Cause of death .

4. Number of children Ages Children at home

5. Do you live alone ______With someone With whom

6. Highest grade completed .___l-12 grades ____2 yrs. college ___ B.A.

Degree

___ M.A. Degree ___ Ph.D./M.D. Degree

7.

Other: specify

What was the state of your health prior to the death of your spouse:
Excellent Good Fair Poor

8. What is the state of your health now?

10.

ll.

12.

13.

14.

 

 

 

Excellent Good Fair Poor

Family, monthly income before widowed . After widowed .
Previously employed Currently employed Hours per week
Occupation
Religious Affiliation How important is religion in
your life?

Not at all Extremely

l 2 3 4 5 6

What are your most pressing problems/concerns?

What other major life stresses have occured during the last year?

From what person, group or organization do you receive the most
emotional support?

Joyce A. Thomas, Director
KNAPP AND SMITH FUNERAL HOMES
Bereavement Outreach Program

100

 

APPENDIX B

THE MEASUREMENT

 

OF DEPRESSION

 

APPENDIX B

THE MEASUREMENT OF DEPRESSION

Self-rating Depression Scale

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

None OR a Some of Good Part Most Or
Name little of the of the All of
the Time Time Time the Time

Age Sex Date
1. I feel down-hearted, blue

and sad
2. Morning is when I feel the

best
3. I have crying spells or

feel like it
4. I have trouble sleeping

through the night
5. I eat as much as I used to
6. I enjoy looking at, talking

to and being with attractive

women/men

I notice that I am losing

weight
8. I have trouble with

constipation
9. My heart beats faster

than usual
10. I get tired for no

reason
11. My mind is as clear as it

used to be
12. I find it easy to do the

things I used to do
13. I am restless and can't

keep still
14. I feel hopeful about the
; future I
ES. I am more irritable than I
E usual 1
U6. I find it easy to make , I
' decisions J 3
17. I feel that I am useful I E
E and needed - i 1
:18. My life is pretty full I F g T
l i ! I 1 i
:19. I feel that others would I I Y I I
f ‘ : - t ’ t ' P
e be better off if I were r . l n ,
. I y . I .
; dead . .7 + n L J
.20, I still enjoy the things I l I 1 . I

used to do I i I K Al

 

101

 

 

APPENDIX C

DIAGNOSTIC CRITERIA FOR

 

DEPRESSIVE DISORDERS AND

 

RELATION TO SDS ITEMS

 

 

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who was .o_mom on» CA

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U xgczmzm<

102

 

APPENDIX D

CONVERSION OF RAW

 

SCORES TO THE SDS INDEX

 

 

 

 

 

 

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mm we mm mm mv mm
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mm on on om mv on
v@ me mm mm vv mm
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mm 00 Om 0? mm ON
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83 x

 

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HQUOP OHCUW 361

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XOUCHV

103

APPENDIX E

TEXAS REVISED

 

INVENTORY OF GRIEF

 

 

 

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104

105

 

 

 

 

 

 

 

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APPENDIX F

COMPOSITE OF STATISTICAL

 

AND DEMOGRAPHIC

 

PROFILE DATA

 

 

 

 

 

 

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106

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