M. Dreier * ESHMS - SISS International Joint Congress * Bologna 2004 Health and the Life Event...

M. Dreier * ESHMS - SISS International Joint Congress * Bologna 2004

Health and the Life Event ´Death of Spouse´ in Elderly Women

Maren Dreier, Heike Koch-Gießelmann, Siegfried Geyer

Hannover Medical School, HannoverHannover Medical School, Hannover

Department of General Medicine and Medical Sociology


IntroductionTwo-factor-model (Geyer,1999, based on Brown & Harris, 1978):

The association between life events and the development of illness

Changes in health status

Provoking agents

Vulnerability factors

Life events

Chronic difficulties

biological

mental/social vulnerability

Subject

environmental

Loss

Threat

Personal factors

Early loss events

Mat. ressources

Social support

aquired

congenital


AimTwo-factor-model (Geyer,1999, based on Brown & Harris, 1978):



Provoking agents


Life events


biological


Subject

environmental

Loss

Threat

Personal factors

Early loss events

Mat. ressources

Social support

aquired

congenital





Provoking agents


Life events


biological


Subject

environmental

Loss

Threat

Personal factors

Early loss events

Mat. ressources

Social support

acquired

congenital

Death of spouse





Provoking agents


Life events


biological


Subject

environmental

Loss

Threat

Personal factors

Early loss events

Mat. ressources

Social support

aquired

congenital

Death of spouse

Coping dimension:• hope/optimism• self-blame





Provoking agents


Life events


biological


Subject

environmental

Loss

Threat

Personal factors

Early loss events

Mat. ressources

Social support

aquired

congenital

Death of spouse

Coping dimension:• hope/optimism• self-blame

Mental health


Design

Case-control-study 3/02-3/04:• cases: bereaved women, age >= 70 years,

bereaved for 2-5 months controls: married women, age >= 70 years

• interviews at home: standardized instruments, a qualitative semi-structured interview (tape-recorded); medical questionnaire completed by the family doctor

• t0 : cases/controls n= 45/83

t1 : cases/controls n= 44/78

• loss to follow-up: 4,7%


Measures

Outcome: Mental health• Health-related Quality of Life: SF-12, mental component

summary (Bullinger M, Kirchberger I, 1998) • Screening for Depression: Geriatric Depression Scale GDS-15

(Yesavage JA et al, 1983)

• Antidepressive medication: prescription of antidepressants by general practioners

Coping:• Bedford College Coping Inventory COPI (Bifulco A, Brown GW, 1996) • Life Events and Difficulties Schedule LEDS (Brown GW, Harris T,

1978)


Study population

Variable Parameter Cases ControlsAge ofparticipants(years)

nM

SD

4575,8

4,7

8375,5

4,4

Age ofspouse(years)

nM

SD

4281,3

6,4

8377,3

6,2

Duration ofpartnership(years)

nM

SD

4445,512,0

8248,9

8,7

M: Mean SD: Standard deviation


4478 4583N =

Mental quality of life

casescontrols

SF

-12

, m

en

tal c

om

po

ne

nt

sum

ma

ry s

core

80

70

60

50

40

30

20

10

t 0

t 1

Results I: Mental health

Mean of German standard sample

> 70 years

t 0: p<0,01 t 1: p=0,05(Mann-Withney-U-Test)


4478 4583N =


casescontrols

SF

-12

, m

en

tal c

om

po

ne

nt

sum

ma

ry s

core

80

70

60

50

40

30

20

10

t 0

t 1

Results I: Mental health


> 70 years



1133 1233N =

Mental quality of life, modified by hope/optimism

low degreehigh degreeS

F-1

2,

me

nta

l co

mp

on

en

t su

mm

ary

sco

re

80

70

60

50

40

30

20

10

t 0

t 1

4478 4583N =


casescontrols

SF

-12

, m

en

tal c

om

po

ne

nt

sum

ma

ry s

core

80

70

60

50

40

30

20

10

t 0

t 1

Results I: Mental health, modified by hope/optimism


> 70 years


> 70 years


t 0: p=0,08 t 1: p<0,05(Mann-Withney-U-Test)


3212 3312N =

Mental quality of life, modified by self-blame

low degreehigh degreeS

F-1

2,

me

nta

l co

mp

on

en

t su

mm

ary

sco

re

80

70

60

50

40

30

20

10

t 0

t 1

4478 4583N =


casescontrols

SF

-12

, m

en

tal c

om

po

ne

nt

sum

ma

ry s

core

80

70

60

50

40

30

20

10

t 0

t 1

Results I: Mental health, modified by self-blame


> 70 years


> 70 years


t 0: p<0,01 t 1: p<0,05(Mann-Withney-U-Test)


4478 4483N =

Screening for depression

casescontrols

Ge

ria

tric

de

pre

ssio

n s

cale

, sc

ore

15

14

13

12

11

10

9

8

7

6

5

4

3

2

10

t 0

t 1

Results II: Symptoms of depression

t 0: p<0,01 t 1: n.s.(Mann-Withney-U-Test)


4478 4483N =


casescontrols

Ge

ria

tric

de

pre

ssio

n s

cale

, sc

ore

15

14

13

12

11

10

9

8

7

6

5

4

3

2

10

t 0

t 1

Results II: Symptoms of depression



1133 1232N =

Screening for depression, modif. by hope/optimism

low degreehigh degreeG

eri

atr

ic d

ep

ress

ion

sca

le,

sco

re

15

14

13

12

11

10

9

8

7

6

5

4

3

2

10

t 0

t 1

4478 4483N =


casescontrols

Ge

ria

tric

de

pre

ssio

n s

cale

, sc

ore

15

14

13

12

11

10

9

8

7

6

5

4

3

2

10

t 0

t 1

Results II: Symptoms of depression, modified by hope/optimism


t 0: n.s. t 1: n.s.(Mann-Withney-U-Test)


3212 3212N =

Screening for depression, modified by self-blame

low degreehigh degreeG

eri

atr

ic d

ep

ress

ion

sca

le,

sco

re

15

14

13

12

11

10

9

8

7

6

5

4

3

2

10

t 0

t 1

4478 4483N =


casescontrols

Ge

ria

tric

de

pre

ssio

n s

cale

, sc

ore

15

14

13

12

11

10

9

8

7

6

5

4

3

2

10

t 0

t 1

Results II: Symptoms of depression, modified by self-blame


t 0: n.s. t 1: p=0,06(Mann-Withney-U-Test)


Results III: Antidepressants

Prescription of Antidepressants

CasesControls

Pe

rce

nta

ge

s

50

40

30

20

10

0

1. quarter *

2. quarter *

3. quarter *

4. quarter *

9

3

14

3

20

4

18

4

* In controls quarterly periods after the first interview, in cases quarterly periods after death of spouse.

1.-3. quarter: p<0,05 4. quarter: n.s.(Mann-Withney-U-Test)


Results III: Antidepressants


CasesControls

Pe

rce

nta

ge

s

50

40

30

20

10

0

1. quarter *

2. quarter *

3. quarter *

4. quarter *

9

3

14

3

20

4

18

4




Results III: Antidepressants, modified by hope/optimism


CasesControls

Pe

rce

nta

ge

s

50

40

30

20

10

0

1. quarter *

2. quarter *

3. quarter *

4. quarter *

9

3

14

3

20

4

18

4

Prescr.of Antidepressants, modif. by hope/optimism

low degree of hopehigh degree of hopeP

erc

en

tag

es

50

40

30

20

10

0

1. quarter *

2. quarter *

3. quarter *

4. quarter *

99

18

12

27

18

36

12



1.-4. quarter: n.s. (Mann-Withney-U-Test)


Presc. of Antidepressants, modified by self-blame

low degreehigh degreeP

erc

en

tag

e

50

40

30

20

10

0

1. quarter *

2. quarter *

3. quarter *

4. quarter *

98 9

25

15

33

15

25

Results III: Antidepressants, modified by self-blame


CasesControls

Pe

rce

nta

ge

s

50

40

30

20

10

0

1. quarter *

2. quarter *

3. quarter *

4. quarter *

9

3

14

3

20

4

18

4



1.-4. quarter: n.s. (Mann-Withney-U-Test)


Summary

• Loss of spouse in elderly women is followed by impairment of mental health

• One year after loss improvements in mental health have occurred

• Hope/optimism and self-blame may moderate the degree of mental impairment


Further directions

• Long-term follow-up: morbidity and mortality

• Examination of the role of social support

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