Predicting bereavement outcome: Marital factors (original) (raw)

1983, Family Systems Medicine

This paper describes system variables in the marital relationship that portend problems in the bereavement period for spouse survivors and that can be assessed prior to the death of the spouse. Marital relationships that are characterized by skewed decision-making processes, control and dominance of one member over the other, non-negotiation of decisions, inflexibility, lack of sensitivity to feelings, and constricted expression of affect place survivors at risk for problems in the bereavement period. Case material collected at a facility for the care of the terminally ill involved predeath marital evaluation and follow-up in the bereavement period. There is general agreement in the literature that the outcome of bereavement for spouse survivors is one of increased mortality as well as morbidity, including poor emotional and physical health (2, 3, 9, 14, 19, 22, 25, 26). Indeed, the problems of the bereavement period are of such significant proportions as to be a major public health concern. Thus, it is important to be able to predict who will be at risk. This paper will describe system variables in the marital relationship that portend problems in the bereavement period for the spouse survivor that can be assessed prior to the death of the spouse (25). Illustrative case material will be drawn from case consultation with spouses of terminally ill patients cared for at a hospice in the pre-death and the bereavement period. OUTCOME OF BEREAVEMENT There are many excellent reviews of bereavement and some are quite current (2,3, 9,14,19,22,26). Almost all the studies of individuals in the bereavement period are undertaken after the death of the loved one and many are of widows. The following description of the outcome of bereavement will be brief. For more detail, the reader is referred to the reviews.