The temporal course of depressive symptoms and grief intensity in late‐life spousal bereavement

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Abstract
The temporal course of grief intensity and depressive symptoms associated with conjugal bereavement is described in depressed and nondepressed bereaved elders over a period spanning 18 months from spousal loss. Sixty elderly, recently bereaved participants were grouped by the presence (n = 33) or absence (n = 27) of syndromal major depression according to Research Diagnostic Criteria. Clinical ratings of depressive symptoms (Hamilton Depression Rating Scale) and grief intensity (Texas Revised Inventory of Grief) were obtained regularly over the first 18 months of bereavement. Data were averaged at 3‐month intervals and examined in: 1) repeated measures analyses of variance; 2) pairwise contrasts at each time interval; and 3) correlation matrices of change scores. In the group of subjects with syndromal major depression (24 of 33 received some form of treatment), Hamilton depression ratings declined an average of 61% but remained mildly elevated at 18 months. Grief intensity scores remained higher in depressed than in nondepressed subjects throughout the 18‐month observation period and showed little decline over time (18%). Changes in depression ratings accounted for only 11.6% of the variance of change in bereavement intensity. The absence of clinically significant reduction in grief intensity scores, despite attenuation of depressive symptoms, might indicate that persistent grief is a separate process from depression and one which may predict other adverse medical, psychiatric, or psychosocial outcomes. A competing hypothesis suggests that persistence of grief may not be pathological. The need for futher controlled prospective data is highlighted. Depression 1:45–49 (1993).