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a Graduate Program in Psychology, Trinity Western University, Langley, British Columbia, Canada
Correspondence: P. S. Fry, PhD, Graduate Program in Psychology, Trinity Western University, 7600 Glover Road, Langley, British Columbia, Canada, V2Y 1Y1. E-mail: Fry{at}Twu.ca.
Decision Editor: Laurence G. Branch, PhD
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Abstract |
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Key Words: Spousal loss • Psychological well-being • Personal meaning • Religiosity • Spirituality
Spousal loss in late life is widely accepted as being a stressful experience, accompanied by changes in individuals' perceptions of their overall psychosocial functioning and mental outlook (Caserta, Lund, and Rice 1999
; Fry 1998). The death of a spouse can, in fact, permeate all aspects of the surviving spouse's present and future functioning and be severely disruptive to psychological health and balance (Campbell and Silverman 1999; Gallagher-Thompson, Futterman, Faberow, Thompson, & Peterson, 1993; Morgan 1994). Although some recent longitudinal studies (e.g., Fry 1998; McCrae and Costa 1993; Wortman and Silver 1990) document evidence of considerable psychological resilience among widows and widowers and show positive gains and growth in psychosocial functioning in postbereavement years, the bulk of previous research studies (e.g., Gallagher-Thompson et al. 1993; Mendes de Leon, Kasl, and Jacobs 1994; Middleton, Raphael, Martinek, and Misso 1993; Raphael, Middleton, Martinek, and Misso 1993) has documented the negative sequelae associated with the death of the spouse and its serious debilitating effects on the widowed individuals' resilience and capacity to recover from adverse physical and mental health effects of grief and bereavement (Gallagher-Thompson et al. 1993). Most cross-sectional studies of widowed individuals (e.g., Osterweis, Solomon, and Green 1984; Siegel and Kuykendall 1990) note that following spousal loss, psychological health and well-being of individuals declines considerably, especially in terms of increased depression and anxiety, absence of happy affect, and decline in self-esteem, autonomy, and control (Lund, Caserta, Dimond, and Shaffer 1989).
The psychosocial model of mental health counseling (see Raphael et al. 1993; Siegel and Kuykendall 1990; Stroebe and Stroebe 1987) posits that decline in psychosocial functioning following spousal loss arises from loss of meaningful spousal roles and functions, loss of significant relationships, social support, contacts, and frequently diminished income following the death of the spouse. Following spousal loss, so much emotional energy is depleted in dealing with the stress of the loss that little energy remains for productive "grief work" (Worden 1991). In an attempt to teach surviving spouses how to cope with loneliness and distress, counselors have frequently used the stress/coping paradigm of grief therapy in which the focus has been on (a) exploring with clients the stress in their daily lives and their financial strains; (b) reappraising cognitively their negative life events; and (c) learning adaptive coping mechanisms for dealing with loss of social and economic resources and with physical health problems (see discussions by Moos and Schaefer 1986; Raphael et al. 1993; Stroebe and Stroebe 1987). For researchers, the psychosocial stress model of well-being suggests that stressors arising from the loss of highly valued roles and secondary strains, compromise well-being of bereaved spouses. A number of studies have therefore looked at the stress-buffering effects of social support as a stress-mediating factor in psychological well-being of bereaved spouses (see Litwin 1999). Although much has been learned from the existing literature about the determinants and predictors of psychological well-being within a stress/coping paradigm, we have little understanding of existential factors that help some widows and widowers to transcend their grief and to cope successfully with the transition to widow(er)hood (Worden 1991).
More recently, researchers have begun to appreciate the usefulness of an existential paradigm for understanding the dynamics of the effects of spousal loss on the psychological well-being of surviving spouses. Thus, within the context of an existential paradigm or framework, the focus is on the uniqueness of the human experience of suffering and loss as expressed phenomenologically. Raphael and colleagues 1993 reported a loss of purpose for living. Dershimer 1989 discussed the intensity of existential confusion and incoherence immediately after the loss. The existential framework of mental health posits that humans are not merely biological, social, or emotional beings, but beings able to rise above their stresses to achieve a higher level of existential awareness (Farran 1997). Recently, many psychologists and practitioners (e.g., Cole and Pargament 1999; Miller 1999; St. John 1999; Thorson 1999; Tonigan, Toscova, and Connors 1999) have made a strong appeal for considering grief and bereavement within the context of an existential paradigm. Several of these authors argue that the dynamics of spousal loss can best be understood or captured within an existential framework concerned with assessing the extent to which "ultimate concerns" of human beings' existence such as isolation, meaninglessness, loss of hope, choice, and meaning for life (Frankl 1984; Yalom 1980) contribute to the prediction of psychological well-being among elderly widows and widowers. As applied to the mental health and psychological well-being of widows and widowers, our understanding of their distress, depression, or grief may be more enhanced or enriched in a context that takes into account the existential needs or life concerns of the respondents. This is not to deny the significance of the role that demographic factors such as age, income, and gender play in coping with the stress of spousal loss, or to underestimate the important contribution that social resources, negative events, or physical health make toward psychological well-being (see Siegel and Kuykendall 1990; Stroebe and Stroebe 1983).
In keeping with this line of thinking, the purpose of this study was to examine the unique and combined contribution of several existential variables (meaning for life, optimism, choice, religious involvement, and spirituality), traditional measures of social resources, negative life events, and physical health, and demographic factors (sex, age, income, education) in predicting psychological well-being in a community-residing sample of recently bereaved widows and widowers.
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Psychological Well-Being: The Construct and Components |
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; Ellison 1994; Koenig et al. 1997; Levin and Chatters 1998; Okun 1995), psychological well-being is an umbrella construct of psychological health constituting an amalgam of various affective, experiential, and cognitive components that act and interact with one another in complex ways and are influenced, in turn, both directly and indirectly, by other variables of health, positive outlook, and social and emotional resources. Interactions of these variables may contribute significantly to psychological well-being. As used in this study, the construct is multifaceted and refers to a combination of various psychological dimensions, including components of morbidity, anxiety, mood, self-esteem, emotional adjustment, and autonomy. This conceptualization of psychological well-being is consistent with ones advanced by a number of earlier researchers (e.g., Ainlay and Smith 1984; Bradburn 1969; Holohan 1988; Miller 1976; Ryff 1995). More recently, gerontologists concerned with predicting successful aging also agree that psychological states of morbidity, anxiety, self-esteem, and autonomy are more valid indicators of subjective well-being in later life (see discussion by Holohan and Sears 1995; Levin and Chatters 1998) than previously included indices of self-mastery and environmental mastery. Levin and Tobin 1995, in their review, noted that in bereavement and widowhood studies, negative change in psychological well-being was most in evidence on dimensions of happy affect, self-esteem, emotional adjustment, and autonomy.
There is an increasing acceptance in the broader psychological literature of the notion that indices of affect, mood, self-esteem, and autonomy contribute significantly to well-being in individuals past age 75 (American Psychological Association 1993) in both advantaged and disadvantaged circumstances. Also, there is a paucity of information on any one or more standardized measures of psychological well-being that are reliable and valid for use with individuals who are both old, frail, and disadvantaged (American Psychological Association 1993). Thus, for purposes of this study we developed a measure of well-being that included primary psychological dimensions of mood, affect, self-esteem, and autonomy alongside other sociodemographic indicators of psychological well-being that have been used in previous studies of bereavement and widowhood (e.g., Osterweis, Solomon, and Green 1984; Siegel and Kuykendall 1990).
The present study was predicated on the assumption that existential factors such as meaning for life, purpose, choice, optimism, and spiritual and religious involvement are more powerful predictors of well-being following spousal loss than previously postulated factors of demographics and stressors such as loss of social resources, physical health, and negative events. These assumptions are in line with the thinking of some bereavement theorists (e.g., Cassem 1975; Jaffe 1985; Moustakas 1977; Schneider 1989), who contend that personal meaning, defined as having a purpose in life, gives the surviving spouse a sense of order and a reason for existence. With regard to mental health, dispositional optimism and the degree to which the individual perceives having personal agency (choice/responsibleness) have been shown to be related to a number of measures of psychological and physical well-being (see Reker, Peacock, and Wong 1987; Zika and Chamberlain 1992). Thus, optimism and choice, as positive attitudinal factors contributing to self-esteem, life satisfaction, and personal growth in the face of losses and distress, are postulated to be important variables in understanding the mental health and psychological well-being of grieving widow(er)s. In a variety of life spheres, religious involvement and spirituality are increasingly recognized to be a solid basis for providing faith, hope, and psychological well-being even in the face of horrendous external conditions over which an individual may have no control (Koenig and Futterman 1994; Levin 1995; Maton and Wells 1995). Thus, it seems reasonable to postulate that, after spousal loss, individuals who perceive their own lives to be meaningful, and who have a clear sense of choice and a positive religious and spiritual outlook on life, will be less vulnerable to the debilitating effects of grief and coping with the loneliness, self-doubts, and uncertainty that generally accompany bereavement.
The major goal of this study was to investigate, in depth, the possibility alluded to by existential and humanistic theorists (e.g., Conant 1996; Maslow 1955; Wortman and Silver 1990) that following major loss, existential variables of meaningfulness, optimism, and spirituality/religiosity may play an even greater role in the maintenance of stable psychological well-being than previously recognized demographic factors or social support factors. It is important to note that while the influence of traditional variables such as social support, physical health, and negative life events have been examined in a few previous studies of elderly persons (e.g., Heaney and Israel 1997; Krause 1986, Krause 1987; Krause and Borowski-Clark 1994), investigations of the unique contribution of existential variables to psychological well-being have rarely been considered in the context of bereavement. Substantive issues, such as the quality of one's inner life, meaning for life, spiritual development, and religious involvement have not, until recently, been conceived as salient influences on the well-being of older adults who experienced diverse losses (McFadden 1996).
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Hypotheses |
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First, based on earlier findings providing suggestive indications of the salutory influence of religion and spirituality in the lives of distressed individuals (Ainlay, Singleton, and Swigert 1992; Idler and Kasl 1992; Pressman, Lyons, Larson, and Strain 1990), it was proposed that existential dimensions would be more potent predictors of the psychological well-being of bereaved spouses than would be the demographic and traditional variables of social support, negative events, and physical health. Second, it was proposed that existential variables such as personal meaning, religious involvement, spirituality, optimism, and choice would contribute more significantly to the prediction of psychological well-being of widows compared to their counterparts, the widowers. The latter hypothesis is predicated on previous research suggesting greater social isolation among the bereaved widowers and more limited psychological resources available to them (Campbell and Silverman 1999; Davidson, Feldman, and Crawford 1994; Lieberman 1996; Murrell and Himmelfarb 1989).
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Methods |
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). Community-residing widows and widowers were recruited through local community newsletters and posters circulated in social service agencies, and by word of mouth, in three mid-sized cities in Southern Alberta. The help of family members, caregivers, and pastoral and chaplains' staff was also solicited to encourage the participation of bereaved spouses. As an incentive to participate, individuals who were receptive to an initial phone call were invited to participate in two didactic group sessions of bereavement counseling headed by a professional counselor.
Eligibility criteria included spousal loss within the previous 24 months, but not more recently than the last 6 months. For ethical considerations, it was decided not to include persons whose loss had occurred more recently than 6 months previous (see discussion by Parkes 1995). Other eligibility criteria were that the participants must be English-speaking, residing in the community (i.e., not in an institution, hospital, or nursing home), and not having physical or cognitive impairments that would preclude taking paper-and-pencil tests. The final sample was a representative cross-section of various sociodemographic communities. Sociodemographic information on the samples of widows and widowers is presented in Table 1 .
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, Bradburn 1969, Holohan 1988, Miller 1976, and Ryff 1995, a composite measure of psychological well-being was developed as follows: (a) Depressed mood was assessed on a 9-point scale (reverse scored with a higher score reflecting less depression), with the extremes labeled depressed (score = 1) and cheerful (score = 9). (b) Anxious mood was assessed on a 9-point scale (reverse scored with a higher score reflecting less anxiety), with the extremes labeled anxiety (score = 1) and calmness (score = 9). (c) Happy mood was assessed on a 9-point scale (reverse scored with a higher score reflecting more happiness), with the extremes labeled very unhappy (score = 1) to very happy (score = 9). In rating their depressive, anxious, and happy moods, participants were asked to report their mood during the last four months or so. (d) Autonomy was measured by means of a 5-item subscale of autonomy adapted from Ryff 1989 measure of psychological well-being (reverse scored with a higher score reflecting high autonomy). After reversing some items, scores on this measure can range from 1 to 25. (e) Self-esteem was assessed on a 9-point rating of self-esteem scale items (Rosenberg 1965; reverse scored with a higher score reflecting high self-esteem). (f) Adaptation to widowhood was measured using a five-item Ease of Role Transition Scale (ERTS) adapted from Miller 1976. The objective was to get the respondent to give a summary self-assessment of whether the adaptation to widowhood had been extremely difficult (score = 1) or relatively easy (score = 5). Items were reverse scored with a lower score denoting greater difficulty in adaptation. Scores on this submeasure of psychological well-being can range between 5 and 25, with a high score denoting greater ease of transition to widow(er) role. Miller 1976 reported an alpha reliability of .75 for this submeasure of psychological well-being, and noted that he had no problems using this scale with older adults. Alpha coefficients were .79 and .84 for widows and widowers, respectively. Scores on the three mood items (depression, anxiety, unhappiness), the Self-esteem items, Autonomy items, and the Ease of Role Transition were then summed to form a composite measure of psychological well-being, with a higher score reflecting more positive well-being. Alpha coefficients for the composite measure were .74 and .82 for widows and widowers, respectively, demonstrating high levels of internal consistency for all measures.
Social Support and Access to Social Resources.
These were measured by the Multidimensional Scale of Perceived Social Support (MSPSS; Zimet, Dahlem, Zimet, and Farley 1988). This scale has been used with different populations and age groups, and with both clinical and nonclinical samples in studies of depression, suicide, and such. Zimet and colleagues reported excellent psychometric properties, reliability, and validity with different populations, especially considering the limited number of items in the scale. Internal reliability (alpha coefficient) was .88 and test–retest reliability was .85 for the total scale. Construct validity was established by an inverse correlation with depression and anxiety scores (r = –.25). Three sources of support were measured through three subscales (Family, Friends, and Significant Others) with a composite higher score corresponding to higher support from the three sources. Cronbach's coefficients were between .89 and .93 for the factors of Friends, Family, and Significant Others. Alpha coefficients were .69 to .75 for widows and widowers, respectively.
Physical Health Problems.
These were measured by a 26-item physical health checklist of illnesses (OARS; Duke University Center for the Study of Aging and Human Development 1978) most commonly encountered by elderly persons. Participants responded Yes/No to the question, "Do you have any of the following illnesses at the present time?" A high score of Yes responses reflects a large number of physical health problems. Alpha coefficients were .62 and .72 for widows and widowers, respectively.
Frequency of Negative Events.
This was measured by means of one question: How frequently do you encounter negative life events (i.e., events that upset you, cause you to become angry with yourself or others, or events that make you sad and depressed)? Choices were: on a daily basis (6) to rarely (1).
Personal Meaning.
This was measured by a composite index of the Life Purpose (life goals, mission in life, sense of direction), Will to Meaning (sense of order, reason for existence, clear sense of identity), and Future Meaning (future potentialities, fulfillment, and positive expectations concerning one's future life) subscales of the Life Attitude Profile (LAP; Reker and Peacock 1981). The subscales of the LAP were reported by its authors as having significant positive correlations with measures of both psychological and physical well-being of older adults. Also, high alpha coefficients demonstrated the internal consistency among the subscales (Reker et al. 1987). Scores for each subscale (7-point) are expressed as a mean and summed across subscales. Scores can range from 3 to 21. Alpha coefficients were .83 and .79 for the widows and widowers, respectively.
Measure of Religious Involvement.
In order to measure respondents' extent of participation in formally organized religious activity, a five-item index of organizational religiosity was adapted from Chatters, Levin, and Taylor 1992. Item 1 measured: Taking all things into account, how important is religion to you in your daily life? (from very much = 6 to not at all = 1). Item 2 measured frequency of attendance at church, synagogue, or other formal places of worship: How frequently do you attend religious services or religious activities? (from daily = 6 to never = 1). Item 3 measured intensity of religious involvement in church, synagogue membership, and related activity from deeply involved = 6 to marginally involved = 1. Item 4 measured respondents' involvement in diverse forms of informal religious activity: How frequently do you participate in informal religious services, for example, listen to or watch religious talk shows on TV and radio, sing hymns or church music, or read the Bible? (from daily = 6 to seldom = 1). Item 5 measured respondents' degree of comfort derived from religion in times of suffering and distress (from very much = 6 to none at all = 1). A higher score denotes a high degree of comfort from religion and religious participation.
Measure of Accessibility to Religious Support Services.
This measure had one question: How easy or difficult is it to get the help of your pastor, minister, religious mentor, or church and synagogue members in a time of need? The choices were very easy = 6 to very difficult = 1.
Index of Spirituality.
Spirituality was assessed with Howden 1992 Spirituality Assessment Scale (SAS), which is a 28-item Likert-type scale covering four significant domains, including Purpose for Life, Inner Resources, Inner-connectedness, and Transcendence. The scale is concerned with assessing related constructs of personal contemplation, private prayer, and connectedness with self and a power higher than oneself. Howden reported inter-item consistency to be .92 for the total SAS. Significant reliability coefficients for the scale were reported also by Brennan 1999, who used the scale with older adults. In the current sample, reliabilities for the four domain subscales ranged from .69 to .81, and inter-item consistency of this measure was .81 for the total SAS.
The scores on the various items measuring organizational religiosity, spirituality, and accessibility to religious support services were summed to form a composite score for each of five indices of religiosity, spirituality, comfort from religion, peace with self, and accessibility to religious support. Higher scores reflected higher religious and spiritual involvement, higher degree of comfort derived from religion, higher degree of peace with self, and easier access to religious support. Alpha coefficients ranging from .71 to .76 and from .77 to .84 were found for the various composite indices of religious involvement, spirituality, and accessibility to religious support for the widows and widowers sample, respectively.
Optimism.
Optimism was measured by means of Scheier and Carver 1985 Measure of Dispositional Optimism (MDO). This is a 12-item measure rated on a 5-point rating scale ranging from strongly agree to strongly disagree. Scores may range from 12 to 60. Typical items include "In uncertain times, I usually expect the best"; "I am a believer in the idea that every cloud has a silver lining"; and "I can rarely count on good things happening to me." Scheier and Carver 1992 present extensive reliability and validity data of their optimism measure in various clinical and nonclinical samples, and demonstrate the links between optimism and physical and emotional health and well-being (Scheier and Carver 1985, Scheier and Carver 1992). Alpha coefficients for the dispositional optimism scale were .67 to .71 for widows and widowers, respectively.
It should be noted that all measures administered to the participants were formatted in terms of language and structure appropriate for adults having a 9th grade education. All paper-and-pencil tests and self-report measures used in the study were previously piloted on a volunteer group of 20 men and women aged 60 to 80. Subsequent modifications were made in the instructions and illustrations given for responding to the 6-point ratings of test items. This procedure was undertaken to ensure that even those participants who were elderly and had relatively limited education could validly complete the measures.
Design and Analysis of the Study
A stepwise hierarchical regression analysis model was used in this study, with the expectation that it would provide estimates of the percentage of variance in "psychological well-being" accounted for by the four blocks, respectively, of the sociodemographic variables (i.e., age, education, and income), traditional measures (i.e., social resources, negative life events, and physical health problems), existential measures (personal meaning, participation in organized religion, spiritual involvement, importance of religion, comfort from religion, sense of inner peace, accessibility to religious support, and optimistic outlook), and interactions of health and key existential variables. The regression is stepwise on the four sets or blocks of variables used and is hierarchical on the variables within each step. The regression model used is linear. The same stepwise linear hierarchical regression analysis was performed on the sample of widows and widowers in order to observe differences or similarities between predictors of psychological well-being for the two samples.
Independent of whether the differences in the final regression models for the widows' and widowers' samples were salient or trivial, an a priori decision was made to do a similar regression analysis on the combined sample of widows and widowers. The underlying rationale for studying the predictor variables in the combined sample was that the findings regarding predictors of psychological well-being would be generalizable to a heterogenous group of male and female elders who have experienced grief and bereavement.
In order to test for the unique, combined, and interactive contribution of the three demographic variables, three traditional variables, and eight existential variables to the prediction of psychological well-being, a four-step multiple hierarchical regression analysis was performed on the data for the sample of elderly widows, widowers, and combined sample.
In Step 1, the demographic variables were entered as a block followed by the three traditional measures (social resources, number of negative life events, and physical health problems) in Step 2. The eight existential variables were entered in Step 3, followed by the respective interactions of four key existential variables with physical health in Step 4.
The order of entry of the blocks was based on methodological, historical, and theoretical considerations in the literature on bereavement and well-being factors in general, and the corresponding literature on differences in men's and women's responses to grief (see Campbell and Silverman 1999; Conant 1996; Fry 1992; Gallagher-Thompson et al. 1993; Lund, Caserta and Dimond 1993; McCrae and Costa 1993; Siegel and Kuykendall 1990; Stroebe and Stroebe 1983). The demographics were entered first as a control for all study variables, followed by the three traditional variables of social support, physical health problems, and negative life events that have been investigated in previous studies of bereavement and spousal loss (e.g., Murrell and Himmelfarb 1989; Siegel and Kuykendall 1990). The block of eight existential variables was entered in a later step (Step 3) primarily because these predictor variables, with few exceptions (e.g., Ross 1988) had not been examined in prior studies of psychological well-being following bereavement. By entering the set of eight existential variables in Step 3, the expectation was that this would provide a more discriminating and robust test of their unique contribution to the psychological well-being of bereaved men and women, in general, and psychological well-being of elderly men and women who had experienced a specific form of bereavement, namely spousal loss. Finally, the interaction of a few key existential variables and physical health was studied last of all in Step 4. The Step 4 analysis was predicated on the premise that among individuals who are bereaved and at the same time in poor health, the contribution of key existential variables (personal meaning, importance of religion, optimism, and accessibility to religious support) might interact significantly with the traditional variable of Physical Health Problems (see Morgan 1994).
The order of entry of the independent variable blocks also took into account the general cautions concerning linear regression suggested by Cohen and Cohen 1983.
Procedure
Data for the study were collected as part of the author's longitudinal study on the adjustment and coping patterns of elderly widows and widowers (Fry 1998, Fry 1999a, Fry 1999b). Several participants in this study had previously participated in Fry 1998 study on coping with spousal loss. The present study reports only on a subset of 14 variables: Sociodemographics (3), Traditional Measures (3), and Existential Variables (8), which were hypothesized to be predictors of psychological well-being in both samples of widows and widowers. Participants completed the measures at their own pace, at home or in their place of work and study, and arranged to drop off the materials at prearranged pick-up centers. On average, respondents returned the completed measures within a 2-week period.
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Results |
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The bivariate correlations of psychological well-being with demographic variables and other traditional and existential predictor variables are presented in Table 3 . For widowers, none of the demographic variables were significantly related to psychological well-being; for widows, income showed a significantly stronger relationship to psychological well-being. With the exception of "comfort derived from religion" for the sample of widowers, all of the remaining psychosocial variables were significantly related to the psychological well-being of both widows and widowers. The overall pattern of associations between psychological well-being and psychosocial predictor variables was noticeably stronger for the sample of elderly widows.
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). For the sample of elderly widows, the intercorrelations ranged from –.16 to .36, median = .10; for the elderly widowers, the intercorrelations ranged from –.12 to .43, median = .12. Thus, multicollinearity does not appear to be a concern in this study. In the hierarchical regression model used in this research, the R2 change reveals information on the variance in psychological well-being explained by each block. Within each block of variables (Demographics, Traditional Measures, Existential Variables, and Interactions of Key Existential Variables with Physical Health), the standardized regression weights provide information on the relative contribution of individual variables. Results of the hierarchical regression analysis are provided in Table 4 .
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The Widowers Sample
A similar hierarchical analysis was performed for the sample of elderly widowers, and the analysis yielded similar patterns of predictors of psychological well-being. For the elderly widowers, the demographic variables accounted for 10% of the variance in psychological well-being, a significant contribution. Closer inspection showed that Education contributed significantly to the prediction of psychological well-being of widowers (Beta = .22, p < .05). The addition of the traditional measures of Social Resources, Negative Life Events, and Physical Health Problems in Step 2 resulted in a sizable and significant increase in the explained variance in psychological well-being (18%). Again, a closer inspection showed that Social Resources and Contacts (Beta = .42, p < .001) contributed most to the prediction of psychological well-being, while Physical Health Problems (Beta = –.27, p < .01) made a smaller yet significant contribution. After controlling for demographics and the traditional measures, the existential variables made a surprisingly sizable and significant contribution to the prediction of psychological well-being of widowers, accounting for 27% of the variance. Personal meaning emerged as the most potent existential predictor (Beta = .40, p < .001), followed by optimism, which was also a salient predictor (Beta = .29, p < .01). Importance of religion made a smaller yet significant contribution to the explained variance in psychological well-being (Beta = .16, p < .05). The existential variables of Personal Meaning, Importance of Religion, Optimism, and Accessibility to Religious Support by Health interactions failed to account for additional significant variance.
The Combined Sample
The hierarchical analysis on the combined sample of elderly widows and widowers showed that all key demographic variables, traditional measures, and existential variables contributed significantly to the prediction of psychological well-being. However, the Existential Variables by Health interactions failed to account for significant variance in psychological well-being. As seen in Table 4 , the demographic variables entered together accounted for 8% of the variance in psychological well-being. Among the demographic variables, two factors of Education (Beta = .21, p < .05) and Income (Beta = .19, p < .05) contributed significantly to the prediction of psychological well-being of widows and widowers combined. In other words, the indications are that having a high education and high income predicted higher psychological well-being. Among the traditional measures, all three variables of Social Resources and Contacts (Beta = .48, p < .001), Negative Life Events (Beta = –.29, p < .001) and Physical Health Problems (Beta = –.27, p < .001) emerged as salient predictors of psychological well-being. Entered together, the traditional measures accounted for a sizable significant increase in explained variance (18%) in psychological well-being of the combined sample of widows and widowers. As seen in Table 4 , when all existential variables were entered together for the combined sample, they accounted for a sizable and significant percentage (21%) of the explained variance in psychological well-being. Closer examination showed that among the existential variables, Personal Meaning (Beta = .24, p < .001) and Importance of Religion (Beta = .28, p < .001) emerged as the most salient predictors, while Spiritual Beliefs and Practices (Beta = .20, p < .05), Accessibility to Religious Support (Beta = .17, p < .05), and Optimism (Beta = .19, p < .05) made a smaller yet significant contribution to accounting for additional variance.
The existential variables of Personal Meaning, Importance of Religion, Optimism, and Accessibility to Religious Support by Health interactions failed to account for additional significant variance.
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Discussion |
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; Fry 1998; Fry 1999b; Jaffe 1985; Lund et al. 1993; Siegel and Kuykendall 1990). Consistent with indications from earlier research on bereavement (Idler and Kasl 1992; Koenig 1988; Young and Dowling 1987), the findings support the speculation that several specific dimensions of personal meaning for life, religiosity, and spirituality may alleviate the depression and anxiety of men and women following spousal loss, and provide hope and comfort. This is especially true for elderly widows in this study who, more clearly than widowers, indicated the comfort they derived from religion, from spiritual beliefs and practices, and from accessibility to religious support. For both elderly widows and widowers, the findings highlight the view that although health, income, education, social resources, and stress of negative life events continue to be reliable predictors of psychological well-being, several collective existential dimensions of personal meaning for life, optimism for the future, and aspects of religiosity and spirituality (which have not been measured explicitly in earlier studies) are, by far, sounder predictors of psychological well-being and coping with the distress of spousal loss. The eight existential constructs (e.g., Personal Meaning, Optimism, Importance of Religion, Accessibility to Religious Support) examined in the study accounted for 28%, 27%, and 21%, respectively, of the variance within the individual samples of widows and widowers, and the combined sample. This is after the various demographic and traditional variables were controlled and accounted for.
Implications for Practitioners
Although this study did not examine causal factors in psychological well-being of widows and widowers, the findings permit the speculation, if not the conclusion, that several existential constructs and dimensions of religiosity, comfort derived from prayer in a time of distress and loss, and spirituality and personal meaning are valid and reliable predictors of psychological well-being and adjustment to the role of widowhood. These variables may take on added meaning when placed in the context of grief and bereavement work with widowers, in particular.
The findings show clearly that psychological well-being of widowers, compared to widows, was at a lower level. In terms of mean ratings, postbereavement men had significantly fewer social, psychological, and religious/spiritual resources and contacts. These findings support the hypothesis for the study and are not at variance with the observations of practitioners concerned with organizing programs of self-care for widowed individuals (e.g., Caserta et al. 1999). Recently, a number of professionals in community services have stressed the urgent need to strengthen psychological resources of widowers who, compared to widows, are at greater risk for social isolation, depression, and physical health problems following spousal death. Campbell and Silverman 1999, who have worked extensively with widowers and observed their lack of emotional resources, also stress the need to integrate more religious involvement, spirituality, and shared interactive experiences into grief work for men. Yalom and Lieberman 1993 similarly discuss ways and means to stimulate and heighten existential involvement for individuals facing suffering and distress (see discussions by Miller 1999, and his associates, Tonigan, Toscova, and Connors 1999, Yahne and Miller 1999).
The general implication for counselors working with bereaved spouses is that they must find ways to stimulate and reinforce the "will to live" and stimulate personal meaning or purpose for life. If religiosity indicators are low, alternate strategies that rely on personal growth and spirituality may be explored to enhance meaning for life (St. John 1999).
Researchers, practitioners, and health providers must come to recognize that the phenomenon of spousal loss cannot be understood simply within the context of its accompanying stressors and secondary strains. Stress-coping paradigms and existential paradigms, when used in a complementary manner in research and in practical programs of grief work for bereaved spouses, are likely to yield greater insight into existential aspects of the distress, suffering, and adversity that accompany spousal loss. What social, personal, religious, and spiritual resources are needed to combat the stress and distress of spousal loss must also be understood from the frameworks of both the stress-coping model and the existential model.
A word of caution, however, is important. Given that evidence concerning the association of multidimensional measures of religiosity, spirituality, personal meaning, psychological well-being, and bereavement is still developing, interpretations and implications offered for grief work and therapy should be regarded as preliminary.
Limitations of the Study
A number of methodological issues may have affected the veracity of the findings and should be considered as limitations of this study. First, as with any study of such a sensitive nature as spousal loss and bereavement, the use of volunteer participants presents an important limitation that relates to the sampling framework. Second, it should be noted that almost 85% of the volunteer participants had experienced spousal loss in the last 12 to 16 months; the number of participants in the 6-month to 11-month postbereavement period, and in the 16-month and longer postbereavement period, was therefore extremely limited. Inadequate sample size at various postbereavement stages prohibited a separate analysis aimed at studying the relationship between length of postbereavement and psychological well-being. A study of participants who had experienced spousal loss more recently than 12 months ago, or after a postbereavement period longer than 16 months, may possibly have yielded different findings. Third, the present study is cross-sectional, and as is true of all cross-sectional analyses, we can only speculate at this time on the long-term salutory influence of existential factors (such as personal meaning, religiousness, and spirituality) on older adults' coping with loss.
In spite of these shortcomings, we hope the work reported here sparks further interest in the relationship of existential factors to psychological well-being of bereaved spouses. Given the increasing evidence that existential factors such as meaning, religion, and optimism for life serve certain health-protective functions (Ellison and Levin 1998), a more extensive understanding of these processes and how they are related to bereavement is essential.
Future Research
Future research pertaining to the psychological well-being of widows and widowers, with respect to predictors, should pursue supplementary qualitative data gathering to explore in detail the precise influence of religion, spirituality, comfort from religion, and religious meaning for life after spousal loss. Further qualitative research is necessary to explore the salience of existential involvement and how it serves as a buffer against the distress of loss and bereavement, especially in old age. A combination of qualitative and quantitative methodologies (triangulation) is strongly recommended, and such procedures may assist in the formulation of more specific hypotheses for future research and extended programs of bereavement counseling and therapy for widows and widowers.
Finally, researchers must consider the significance of using both stress/coping and existential paradigms in future research on adjustment to bereavement in late life functioning (see Fry 1998, Fry 1999a, Fry 1999b).
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Footnotes |
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Gratitude is extended to many older adults living in Calgary and the outlying districts of Airdrie, Cochrane, Crossfield, High River, Lethbridge, and Red Deer, in Southern Alberta, who responded to the call for subjects. The help of research assistants Evelyn Doyle and Anne Humanek in recruitment of subjects and data collection is especially appreciated. Diane Hussein and Patricia Parham assisted in tabulation and organization of data files, and Dr. Mark Kolodziej helped with the statistical procedures used in the quantitative data analysis.
An earlier version of this research was presented at the 107th Annual Convention of the American Psychological Association, Boston, MA, August 20–24, 1999.
Received for publication February 29, 2000. Accepted for publication September 22, 2000.
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