The psychological aftermath of bereavement : Risk factors, mediating processes, and intervention

Abstract

In this dissertation some of the major facets associated with the psychological effects of bereavement were the subject of investigation: risk factors, mediating processes and intervention. Previous research on risk factors is limited because of a number of methodological shortcomings: a focus on only one or a few factors (which increases the chances of reporting spurious results) and reliance on use of a single measure of bereavement outcome. We avoided these pitfalls by simultaneously examining the impact of a large set of potential risk factors on multiple outcome measures (grief, depressive symptoms, emotional loneliness, and positive mood). We found that (un)expectedness of the death, type of loss, gender, attachment style, neuroticism, spirituality, social support, and aspects having to do with the financial situation of the bereaved person uniquely predicted bereavement outcome. Risk factors were differentially related to different outcome measures. Although knowledge about risk factors is valuable, it does not inform one about pathways through which these predictors become impactful. In a subsequent study we therefore examined the degree to which three potentially critical processes (rumination, threatening grief interpretations and deliberate grief avoidance) mediated the relationship between the risk factors and outcome measures identified earlier. Results showed that rumination and – to a somewhat lesser extent - threatening grief interpretations played an important role in mediating the effects of various risk factors on outcomes. However, the contribution of these two mediators was dependent on the specific risk factor and outcome measure under consideration. An effective paradigm for relieving the impact of stressful events is the disclosure technique developed by Pennebaker and colleagues. However, there is little evidence that written disclosure facilitates recovery from bereavement. We assumed that written disclosure may only benefit those bereaved who are at risk for developing problems or who are experiencing significant psychological problems as a result of their loss, and only when appropriate writing instructions are used. We developed a new writing intervention to test these assumptions. Bereaved individuals were randomly assigned to the intervention condition (n=460) or a waiting list control condition (n=297). Both groups filled in questionnaires online at baseline, and 3 and 6 months later. The intervention was administered via e-mail immediately after baseline measurement. Results showed that writing decreased feelings of emotional loneliness and increased positive mood, in part through its effect on rumination. However, writing did not affect grief or depressive symptoms. Contrary to expectations, effects did not depend on participants’ risk profile or baseline distress level. Another type of intervention - that appears to be growing - is online mutual bereavement support. We designed a study to increase our understanding of the people who use this type of support and of its effect. Our findings showed that people who draw on this type of support are more likely to be female, younger, to have lost a child, and are less likely to be part of a religious community. Using this type of support did not predict changes in mental health over time.