Effects of divorce and widowhood on subsequent health behaviours and outcomes in a sample of middle-aged and older Australian adults.

Marital disruption is a common life event with potential health implications. We examined the prospective association of divorce/widowhood with subsequent lifestyles, psychological, and overall health outcomes within short and longer terms using three waves of data from the 45 and Up Study in Australia (T1, 2006-09; T2, 2010; T3, 2012-16). Marital status and health-related outcomes were self-reported using validated questionnaires. Nine outcomes were examined including lifestyles (smoking, drinking, diet and physical activity), psychological outcomes (distress, anxiety and depression) and overall health/quality of life. Logistic regression was adjusted for sociodemographic characteristics and baseline health outcomes. Of the 33,184 participants who were married at T1 (mean age 59.5 ± 9.3 years), after 3.4 years, 2.9% became divorced and 2.4% widowed at T2. Recent divorce was positively associated with smoking, poor quality of life, high psychological distress, anxiety and depression at T2. Similar but weaker associations were observed for widowhood. However, these associations were much attenuated at T3 (5 years from T2). Marital disruption in midlife or at an older age can be detrimental to health, particularly psychological health in the short term. Public awareness of the health consequences of spousal loss should be raised. Resources, including professional support, should be allocated to help individuals navigate these difficult life transitions.

Communication, self-esteem and prolonged grief in parent-adolescent dyads, 1-4 years following the death of a parent to cancer.

PURPOSE: Talking and grieving together may be advantageous for maintaining belief in a meaningful future and can help bereaved adolescents and their parents to cope better with the situation. The aim of this study was to explore communication, self-esteem and prolonged grief in adolescent-parent dyads, following the death of a parent to cancer. METHOD: This study has a descriptive and comparative design. Twenty family dyads consisting of parentally bereaved adolescents (12-19 years) and their widowed parents completed the Parent and Adolescent Communication Scale, Rosenberg Self-Esteem Scale and Prolonged Grief-13, 1-4 years following the death of a parent. RESULTS: Twelve family dyads reported normal-high parent-adolescent communication, 11 dyads rated normal-high self-esteem. Two adolescents and three parents scored above the cut-off for possible prolonged grief disorder (≥35), none of these were in the same dyads. There was a difference (p < .05) between boys (mean 40.0) and girls (mean 41.9) with regard to open family communication, as assessed by parents. Girls reported lower self-esteem (mean 26.0) than boys (mean 34.1, p < .01). CONCLUSIONS: This study provides insights from parentally bereaved families which indicate that despite experiencing the often-traumatic life event of losing a parent or partner, most participants reported normal parent-adolescent communication, normal self-esteem and few symptoms of prolonged grief. The potential usefulness of identifying families who may need professional support in family communication following the death of a parent is discussed.

Health risk behaviors in elderly Brazilian widowers. / Comportamientos de riesgo para la salud en hombres mayores brasileños viudos.

The objective of this study was to compare the prevalence of health risk behaviors among elderly widowers with that of elderly partnered males, as well as single or divorced/separated men. Additionally, we set out to examine the prevalence of risk behaviors in elderly widowered men according to age, education level, and race/skin color. A cross-sectional study was conducted with elderly men (≥ 60 years) who were interviewed through the Surveillance System of Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel) in 2016 (n=5,384) and 2017 (n=5,801). The Vigitel survey includes representative samples of adults residing in the capitals of Brazilian states and the Federal District, and of those surveyed, 886 were widowers. Identified risk behaviors included physical inactivity during leisure time, irregular consumption of fruits, vegetables and legumes, smoking and alcohol abuse. The prevalence of smoking was lower among partnered elderly men [PR=0.68, CI95% (0.52-0.90)] than among widowers. There were no differences in the prevalence of other risk behaviors between widowers and other groups. When only widowers were taken into account, there was significant association of risk behaviors with age and educational level, but not with race/skin color.

Se buscó comparar la prevalencia de comportamientos de riesgo para la salud en hombres mayores viudos con las de hombres mayores con pareja, solteros y divorciados/separados, así como la prevalencia de comportamientos de riesgo en hombres mayores viudos según rango de edad, escolaridad y raza/color. Se realizó un estudio transversal con hombres mayores (≥ 60 años) entrevistados por el Sistema de Vigilancia de Factores de Riesgo y Protección para Enfermedades Crónicas por Encuesta Telefónica (Vigitel) en 2016 (n=5.384) y 2017 (n=5.801) que incluye muestras representativas de adultos de las capitales de los estados brasileños y del Distrito Federal. De ellos, 886 eran viudos. Los comportamientos de riesgo fueron: inactividad física en el tiempo libre, consumo irregular de frutas, verduras y legumbres, tabaquismo y consumo abusivo de alcohol. La prevalencia de tabaquismo fue menor entre los hombres mayores con pareja [RP = 0,68; IC95% (0,52-0,90)] que entre los viudos. En los demás comportamientos de riesgo no se observaron diferencias en la prevalencia de los viudos en relación a los demás grupos. Cuando se analizaron solamente los viudos, se observaron importantes asociaciones de los comportamientos de riesgo con las variables grupo de edad y escolaridad, pero no con raza/color.

Comportamientos de riesgo para la salud en hombres mayores brasileños viudos / Health risk behaviors in elderly Brazilian widowers

RESUMEN Se buscó comparar la prevalencia de comportamientos de riesgo para la salud en hombres mayores viudos con las de hombres mayores con pareja, solteros y divorciados/separados, así como la prevalencia de comportamientos de riesgo en hombres mayores viudos según rango de edad, escolaridad y raza/color. Se realizó un estudio transversal con hombres mayores (≥ 60 años) entrevistados por el Sistema de Vigilancia de Factores de Riesgo y Protección para Enfermedades Crónicas por Encuesta Telefónica (Vigitel) en 2016 (n=5.384) y 2017 (n=5.801) que incluye muestras representativas de adultos de las capitales de los estados brasileños y del Distrito Federal. De ellos, 886 eran viudos. Los comportamientos de riesgo fueron: inactividad física en el tiempo libre, consumo irregular de frutas, verduras y legumbres, tabaquismo y consumo abusivo de alcohol. La prevalencia de tabaquismo fue menor entre los hombres mayores con pareja [RP = 0,68; IC95% (0,52-0,90)] que entre los viudos. En los demás comportamientos de riesgo no se observaron diferencias en la prevalencia de los viudos en relación a los demás grupos. Cuando se analizaron solamente los viudos, se observaron importantes asociaciones de los comportamientos de riesgo con las variables grupo de edad y escolaridad, pero no con raza/color.

ABSTRACT The objective of this study was to compare the prevalence of health risk behaviors among elderly widowers with that of elderly partnered males, as well as single or divorced/separated men. Additionally, we set out to examine the prevalence of risk behaviors in elderly widowered men according to age, education level, and race/skin color. A cross-sectional study was conducted with elderly men (≥ 60 years) who were interviewed through the Surveillance System of Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel) in 2016 (n=5,384) and 2017 (n=5,801). The Vigitel survey includes representative samples of adults residing in the capitals of Brazilian states and the Federal District, and of those surveyed, 886 were widowers. Identified risk behaviors included physical inactivity during leisure time, irregular consumption of fruits, vegetables and legumes, smoking and alcohol abuse. The prevalence of smoking was lower among partnered elderly men [PR=0.68, CI95% (0.52-0.90)] than among widowers. There were no differences in the prevalence of other risk behaviors between widowers and other groups. When only widowers were taken into account, there was significant association of risk behaviors with age and educational level, but not with race/skin color.

The Influence of Marital Status on Contemporary Patterns of Postmastectomy Breast Reconstruction.

BACKGROUND: Marital status is known to influence quality of life, survival, and treatment decision-making after breast cancer diagnosis. We aimed to determine whether relationship status impacts contemporary patterns of immediate breast reconstruction. METHODS: Surveillance, Epidemiology, and End Results (SEER)-18 was used to identify females undergoing mastectomy for stage 0-III breast cancer from 1998 to 2014. Multivariate logistic regression was used to estimate the association of relationship status with the likelihood of postmastectomy reconstruction. Patients were grouped by diagnosis year to assess change in the reconstructed population with time. Among younger patients ≤45 years, a generalized logistic model was used to predict reconstruction subtype. RESULTS: Among 346,418 patients, reconstruction after mastectomy was more likely to occur in women with relationship support in the form of a marriage or partner [odds ratio (OR) 1.31; 95% confidence interval (CI), 1.28-1.34; p<0.001]. Women who were separated (OR 0.76), single (OR 0.73), or widowed (OR 0.56) were significantly less likely than married women to undergo reconstruction (all p<0.001). During the 17-year study period, change in reconstruction rates with time varied by relationship status (interaction p=0.02), with reconstruction rates among divorced patients increasing more slowly than those among married and partnered women. Among younger women, subtype patterns varied by relationship status (p=0.004), with divorced women less likely to receive autologous over implant reconstruction (OR 0.87; p = 0.03). CONCLUSION: Relationship status may influence decision-making regarding pursuit and type of postmastectomy reconstruction. Consideration of support networks of patients with breast cancer could facilitate tailored preoperative counseling by reconstructive surgeons.

Grief, depressive symptoms, and inflammation in the spousally bereaved.

Grief is conceptualized by strong negative emotions, which include longing, sadness, and preoccupations with thoughts, recollections, and images of the spouse. In the initial months after the loss of a spouse, those who are widowed are at risk for cardiovascular problems and premature mortality. In the general population, depression is characterized by chronic low-grade inflammation, a key predictor of cardiovascular problems, morbidity, and mortality. Although depression and grief share similarities, they are distinct constructs. We aimed to identify if grief was related to inflammation among those who had a spouse recently die. We also sought to determine if those who are widowed and already experience elevated levels of depressive symptoms compared with the general population had higher levels of inflammation compared with those who are widowed who report fewer depressive symptoms. Ninety-nine recently bereaved individuals (M = 84.74 days since passing, SD = 18.17) completed a blood draw and psychological assessments. Proinflammatory T cell-derived cytokines were assessed, which included interferon gamma (IFN-γ), interleukin (IL)-6, tumor necrosis factor alpha (TNF-α), IL17-A, and IL-2. Bereaved individuals with a higher grief severity (using an established cut-score) had higher levels of the proinflammatory cytokines IFN-γ, IL-6, and TNF-α than those with less grief severity. Those who experienced higher levels of depression exhibited elevated levels of proinflammatory cytokines compared with those who had lower levels of depression (using a continuous measure of depressive symptoms, as well as an established cut score). This is the first study to demonstrate that inflammatory markers can distinguish those who are widowed based on grief severity such that those who are higher on grief severity have higher levels of inflammation compared with those who are lower on grief severity. These findings also add to the broader literature on depression and inflammation by showing that even in a population with high levels of depressive symptoms, there is a positive relationship between depression and inflammation.

Health situation in the perception of elderly widows assisted by primary health care / Situación de salud en la percepción de viudas ancianas asistidas por la atención primaria de salud / Situação de saúde na percepção de idosas viúvas assistidas pela atenção primária à saúde

ABSTRACT Objective: Analyze the perception of elderly widow women about their health situation. Method: Descriptive and exploratory research, based on qualitative approach performed with 34 widowed women aged 60 years and over, enrolled in primary health care. It was used content analysis in its thematic analysis modality. Results: Three thematic nuclei were obtained: "positive self-perception of health in old age", "negative understanding of health related to the diseases" and "negative repercussions of the absence of the husband in the health situation of the widows". Presence of the family, chronic diseases under control, physical limitations and absence of the partner directly influenced the responses of the elderly widows. Final considerations: The elderly widows perceive their health situation as relatively good and some factors are challenges to a better health situation. For the participants, widowhood means more than just the physical loss of the husband, interfering negatively in the perception of their health situation.

RESUMEN Objetivo: Analizar la percepción de la mujer viuda anciana acerca de su propia situación de salud. Método: Investigación descriptiva y exploratoria, basada en el enfoque cualitativo realizado con 34 mujeres viudas de al menos 60 años, inscritas en la atención primaria de salud. Se utilizó análisis de contenido en su modalidad de análisis temático. Resultados: Se obtuvieron tres núcleos temáticos: "autopercepción positiva de la salud en la vejez", "comprensión negativa de la salud relacionada con las enfermedades" y "repercusiones negativas de la ausencia de la pareja en la situación de salud de las viudas". La presencia de la familia, las enfermedades crónicas bajo control, las limitaciones físicas y la ausencia de la pareja influyeron directamente en las respuestas de las viudas ancianas. Consideraciones finales: Las viudas ancianas perciben que su situación de salud es relativamente buena y algunos factores son desafíos para mejorar la situación de la salud. Para las participantes, la viudez significa más que solo la pérdida física del esposo, lo que interfiere negativamente en la percepción de su situación de salud.

RESUMO Objetivo: Analisar a percepção de mulheres idosas viúvas sobre sua situação de saúde. Método: Pesquisa descritiva e exploratória, baseada na abordagem qualitativa realizada com 34 mulheres viúvas com idade igual ou superior a 60 anos, cadastradas na atenção primária à saúde. Utilizou-se da análise de conteúdo em sua modalidade análise temática. Resultados: Foram obtidos três núcleos temáticos: "a autopercepção positiva da saúde na velhice", "compreensão negativa da saúde relacionada aos agravos" e "repercussões negativas da ausência do companheiro na situação de saúde das viúvas". Presença da família, doenças crônicas sob controle, limitações físicas e ausência do companheiro influenciaram diretamente as respostas das idosas viúvas. Considerações finais: As idosas viúvas percebem sua situação de saúde como relativamente boa e alguns fatores são desafios a uma melhor situação de saúde. Para as participantes, a viuvez significa mais que apenas a perda física do cônjuge, interferindo negativamente na percepção de sua situação de saúde.

Do single people want to date a cancer survivor? A vignette study.

OBJECTIVE: Qualitative studies indicated that cancer survivors may be worried about finding a partner in the future, but whether this concern is warranted is unknown. We examined single people´s interest in dating a cancer survivor, how they perceive survivors' traits, and their preferences about the timing of disclosing a cancer history. METHODS: In three experimental vignette studies, dating website members (n = 324) and college students (n = 138 and n = 131) were randomly assigned to a vignette of a person with or without a history of cancer (experiment 1 & 2), or a cancer survivor beyond or during active follow-up (experiment 3). Respondents rated their interest in dating this fictive person, this person's traits, and indicated their preferences about the timing of disclosure. ANOVAs with main and interaction effects of condition, gender, and relationship history were conducted, partial eta squared and Cohen's d were used to estimate the magnitude of effects. Correlations were used to investigate relationships between interest in a date and assessment of traits. RESULTS: Cancer survivors' traits were assessed more positively, but interest to date them did not differ from healthy vignettes for both men and women. However, widowed respondents were much less interested in a date with a cancer survivor, and women showed less interest in a cancer survivor during active follow-up relative to survivors beyond follow-up. Most respondents wanted to hear about the cancer diagnosis after a few dates, hardly anyone wanted to hear about this before the first date (2% - 5%). CONCLUSION AND IMPLICATIONS FOR CANCER SURVIVORS: Cancer survivors do not have to expect any more problems in finding a date than people without a cancer history, and can wait a few dates before disclosing. Survivors dating widowed people and survivors in active follow-up could expect more hesitant reactions and should disclose earlier.

Widowhood and Alcohol, Tobacco, and Other Drug Use Among Older Adults in India.

Objective: We sought to assess how widowhood among older adults in India was associated with alcohol consumption, smoking, and use of chewing tobacco or other drugs. Method: Data were collected in 2011 from 9,852 adults aged 60 and older from seven regionally diverse states in India. Regression analyses provided estimates of the relationship between widowhood and having smoked cigarettes, consumed alcohol, or used chewed tobacco or other drugs in the past month among men, adjusting for demographic and socioeconomic factors. We also estimated the relationship between widowhood and past-month substance use among women. Results: Recently widowed men (within 0-4 years) were 1.76 times (95% confidence interval [CI] 1.01-3.09, p < .05) more likely to have consumed alcohol and 1.62 times (95% CI 1.01-2.59, p < .05) more likely to have used chewing tobacco or other drugs as compared with married men. Women widowed for any length of time were 1.37 times (95% CI 1.11-1.69, p < .01) more likely to have used chewing tobacco or other drugs. Discussion: Interventions aimed at reducing use of chewing tobacco or other drugs among older adults in India should consider focusing on recently widowed men and women widowed for any amount of time.

Relationship Between Marital Transitions, Health Behaviors, and Health Indicators of Postmenopausal Women: Results from the Women's Health Initiative.

BACKGROUND: Historically, marital status has been associated with lower mortality and transitions into marriage were generally accompanied by improved health status. Conversely, divorce has been associated with increased mortality, possibly mediated by changes in health behaviors. METHODS: This study uses data from a prospective cohort of 79,094 postmenopausal women participating in the Women's Health Initiative Observational Study (WHI-OS) to examine the relationship between marital transition and health indicators (blood pressure, waist circumference, body mass index [BMI]) as well as health behaviors (diet pattern, alcohol use, physical activity, and smoking) in a sample of relatively healthy and employed women. Linear and logistic regression modeling were used to test associations, controlling for confounding factors. RESULTS: Women's transitions into marriage/marriage-like relationship after menopause were associated with greater increase in BMI (ß = 0.22; confidence interval (95% CI), 0.11-0.33) and alcohol intake (ß = 0.08; 95% CI, 0.04-0.11) relative to remaining unmarried. Divorce/separation was associated with a reduction in BMI and waist circumference, changes that were accompanied by improvements in diet quality (ß = 0.78, 95% CI, 0.10-1.47) and physical activity (ß = 0.98, 95% CI, 0.12-1.85), relative to women who remained married. CONCLUSION: Contrary to earlier literature, these findings among well-educated, predominantly non-Hispanic white women suggest that marital transitions after menopause are accompanied by modifiable health outcomes/behaviors that are more favorable for women experiencing divorce/separation than those entering a new marriage.

Grief and Healing in Young and Middle Age: A Widower's Journey.

The experience of grief is both uniquely personal and universal. Our personality, our relationship with the deceased, the manner in which the deceased died, our life stage, and many other contextual factors matter and impact grief, and yet there are many experiences, phases, stages of grief that are universal. Those who are grieving deeply or who are farther along in their healing are often trying to understand grief and its realities. It has been said that people die but relationships do not. As a widower twice, once at age 25 and then again nearly 30 years later, I agree with that sentiment, and it is the profound relationships with my wives Becky and Susan that propelled me to share my experiences and reflections on grief and healing. As a clinical psychologist and gerontologist I examined the grief and gerontology literature, learning new things that were useful and not as useful.

Widowhood and severity of coronary artery disease: a multicenter study.

OBJECTIVES: The aim of this study was to assess the association of widowhood with the severity and extent of coronary artery disease (CAD), and whether it is modified by sex or socioeconomic status. PATIENTS AND METHODS: A total of 1068 patients undergoing coronary angiography at five centers in Saudi Arabia and the United Arab Emirates were included in the study. CAD was defined as more than 70% lumen stenosis in a major epicardial vessel or more than 50% in the left main coronary artery. Multivessel disease was defined as more than one diseased vessel. RESULTS: Of 1068 patients, 65 (6%) were widowed. Widowed patients were older (65±15 vs. 59±12), more likely to be female (75 vs. 25%), less likely to be smokers (18 vs. 47%), of lower economic and education status, and more likely to have undergone coronary angiography for urgent/emergent indications (75 vs. 61%) (P<0.05 for all). There was a significant association between widowhood and the number of coronary arteries with more than 70% lumen stenosis. Consequently, such a high degree of lumen stenosis in those who were widowed was more likely to require coronary artery bypass graft surgery (38 vs. 16%; P<0.01). After adjusting for baseline differences, widowhood was associated with a significantly higher odds of CAD [adjusted odds ratio (OR) 3.6; 95% confidence interval (CI) 1.2-10.5] and multivessel disease (adjusted OR 4.6; 95% CI 2.2-9.6), but not left main disease (adjusted OR 1.3; 95% CI 0.5-3.1). All associations were consistent in men and women and not modified by age, community setting (urban vs. rural), employment, income, or educational levels (Pinteraction>0.1 for all). CONCLUSION: Widowhood is associated with the severity and extent of CAD. The association is not modified by sex or socioeconomic status.

End-of-life parental communication priorities among bereaved fathers due to cancer.

OBJECTIVES: To elicit widowed fathers' perspectives on which domains of parenting-related communication they consider most important for dying parents to discuss at the end of life (EOL). METHODS: Two hundred seventy nine fathers widowed by cancer completed a survey about their own depression and bereavement symptoms, their wife's illness, and EOL parental communication priorities. Chi square and Fisher's exact tests and logistic regression were used to evaluate relationships between maternal EOL characteristics and fathers' responses to parenting-related EOL communication priorities. RESULTS: Fathers identified raising children in a manner that reflected maternal wishes, whether/how to talk with children about their mother's death, and how the mother wanted to be remembered as the most important EOL communication domains. Fathers who reported that their dying wives were worried about the children were more likely to prioritize raising children in ways that reflect her wishes (p=0.01). Other EOL characteristics were not associated with communication domains. CONCLUSIONS: Communicating with children and maintaining emotional connection with the deceased parent are important priorities for bereaved fathers who lost a spouse to cancer. PRACTICE IMPLICATIONS: Health care providers working with seriously ill parents may improve family outcomes by supporting communication at the EOL between co-parents.

Increased risk of death immediately after losing a spouse: Cause-specific mortality following widowhood in Norway.

OBJECTIVE: This paper examines the short-term risk of cause-specific death following widowhood. METHOD: We followed all individuals registered as married in Norway in 1975 for marital status and mortality until 2006. Widowed individuals were followed for mortality for 7years following widowhood. Causes of death were categorized into five cause-groups. Life tables were used in survival analyses. RESULTS: Deaths among the widowed were most frequent in the week following widowhood. In this week and compared to married individuals, there were more deaths including those from malignant cancer in men (hazard ratio (HR) of 1.51; 95% CI: 1.12, 1.89), from external causes in men (HR=3.64; 95% CI: 2.01, 5.28), and from respiratory diseases (HR=2.18; 95% CI: 1.52, 2.84 in men and HR=3.18; 95% CI: 2.26, 4.09 in women). A majority of respiratory deaths were from pneumonia. Thereafter excess mortality among the widowed dropped gradually. Although these numbers stabilized, they were still elevated in year 7. Excess mortality was particularly high in the youngest age group considered (55-64years) and decreased with age, though more so in men than in women. Only a few more widowed individuals than expected died of a condition in the same cause-group as their spouses. CONCLUSION: A novel finding was that excess deaths in the week following widowhood also were from cancer and respiratory diseases. Men in the youngest age group seemed most vulnerable. Prevention should be considered directly after the death of a spouse, and measures should be aimed at virtually all causes of death.

Influence of marital status on the survival of patients with gastric cancer.

BACKGROUND AND AIMS: The influence of marital status on gastric cancer (GC) survival is controversial. The aim of our study was to investigate the relationship between marital status and the survival of GC patients. METHODS: The data of current study was from the Surveillance, Epidemiology, and End-Results database. We identified 18,815 GC patients between 2004 and 2009, who were categorized into married, never married, widowed, and divorced/separated groups. Kaplan-Meier analysis was performed to compare gastric cancer specific survival (GCSS), and Cox regression analysis was used to estimate the risk factors for different survival outcomes in four groups with diverse marital status. RESULTS: Married patients had better 5-year GCSS compared with patients who were never married, separated/widowed, or divorced. In stratified analyses by histological type and pathological differentiation, unmarried patients with gastric adenocarcinoma, signet ring cell carcinoma, moderately differentiated caicinoma, and poorly differentiated/undifferentiated carcinoma had an increased risk of cancer mortality. Widowed patients had the highest percentage of women and elderly, and were more susceptible to well and moderately differentiated gastric carcinomars and gastric adenocarcinoma with earlier TNM stage and lowest rate of surgery and radiation therapy. In addition, they also had the worst 5-year GCSS. CONCLUSIONS: Our study suggests that unmarried GC patients, especially widowed patients, are at a high risk of GCSS. Additionally, the survival benefit is more significant among married GC patients in higher malignancy status.

End-of-life experiences of mothers with advanced cancer: perspectives of widowed fathers.

OBJECTIVE: Despite the importance of parenting-related responsibilities for adult patients with terminal illnesses who have dependent children, little is known about the psychological concerns of dying parents and their families at the end of life (EOL). The aim of this study was to elicit widowed fathers' perspectives on how parental status may have influenced the EOL experiences of mothers with advanced cancer. SUBJECTS: 344 men identified themselves through an open-access educational website as widowed fathers who had lost a spouse to cancer and were raising dependent children. METHODS: Participants completed a web-based survey about their wife's EOL experience and cancer history, and their own depression (Center for Epidemiologic Studies Depression Scale, CES-D) and bereavement (Texas Revised Inventory of Grief, TRIG) symptoms. Descriptive statistics, Fisher's exact tests, and linear regression modelling were used to evaluate relationships between variables. RESULTS: According to fathers, 38% of mothers had not said goodbye to their children before death and 26% were not at all 'at peace with dying.' Ninety per cent of widowed fathers reported that their spouse was worried about the strain on their children at the EOL. Fathers who reported clearer prognostic communication between wife and physician had lower CES-D and TRIG scores. CONCLUSIONS: To improve EOL care for seriously ill patients and their families, we must understand the concerns of parents with dependent children. These data underscore the importance of parenting-related worries in this population and the need for additional clinical and research programmes devoted to addressing these issues.

Experiencing Loss: A Muslim Widow's Bereavement Narrative.

In this article, we explore how Islam, minority status and refugee experiences intersect in shaping meaning-making processes following bereavement. We do this through a phenomenological analysis of a biographical account of personal loss told by Aisha, a Muslim Palestinian refugee living in Denmark, who narrates her experience of losing her husband to lung cancer. By drawing on a religious framework, Aisha creates meaning from her loss, which enables her to incorporate this loss into her life history and sustain agency. Her narrative invites wider audiences to witness her tale of overcoming loss, thus highlighting the complex way in which religious beliefs, minority status and migration history come together in shaping meaning-making processes, and the importance of reciprocity in narrative studies.

An exploratory study of end-of-life prognostic communication needs as reported by widowed fathers due to cancer.

OBJECTIVE: Effective physician communication about prognosis is a critical aspect of quality care for families affected by terminal illness. This is particularly important for spousal caregivers of terminally ill parents of dependent children, who may have unique needs for communication about anticipated death. The objective of this study was to explore end-of-life prognostic communication experiences reported by bereaved fathers whose wives died from cancer. METHODS: From October 2012 to November 2013 we surveyed widowed fathers whose wives died from cancer through an open-access educational website. The survey included the following open-ended questions regarding prognostic communication: 'What is the most important thing you would like us to know about whether/how your wife's doctors communicated with you about her anticipated death? What do you wish had been different, if anything?' We performed traditional content analysis of responses. Two researchers coded and categorized the data. RESULTS: Two hundred forty-four men responded to the survey questions on prognostic communication. Major themes addressed by respondents were the importance of clear and honest communication and physician bedside manner. They also identified unmet information needs, including wanting to know prognosis sooner. Relevant sub-themes included death coming as a surprise, avoidance, and caregiver regret. CONCLUSIONS: Surviving spouses due to cancer can provide important insights for health care providers about optimum prognostic communication at the end of life. Increased physician attention to the communication preferences of both patients and their partners may improve bereavement outcomes for family members.

Overlooked and underserved: Widowed fathers with dependent-age children.

OBJECTIVE: Widowed fathers and their children are at heightened risk for poor coping and maladaptive psychosocial outcomes. This exploratory study is the first to explicitly examine the psychological characteristics of this population of fathers. METHOD: Some 259 fathers (mean age = 46.81; 90% Caucasian) with dependent-age children and whose wives had died from cancer within the previous five years completed a web-based survey that consisted of demographic questions, the Center for Epidemiologic Studies Depression Scale (CES-D), the Texas Inventory of Grief-Revised (TRIG-R), the Psychological Adaptation Scale (PAS), the Kansas Parental Satisfaction Scale (KPSS), and items assessing perceived parental efficacy. RESULTS: Fathers were found to have elevated depressive (CES-D mean = 22.6) and grief (TRIG-R mean = 70.3) symptomatology, low adaptation (PAS mean = 3.2), and high levels of stress related to their parenting role. They reported being satisfied with their parenting (KPSS mean = 15.8) and having met their own parental expectations. Multivariate analyses revealed an association between father's age and depression (p = <0.01), with younger fathers reporting greater depressive symptoms. Psychological adaptation was positively correlated with being in a romantic relationship (p = 0.02) and age of oldest child (p = 0.02). SIGNIFICANCE OF RESULTS: The results of our exploratory study suggest that, while widowed fathers perceive themselves as meeting their parental responsibilities, it comes at a substantial psychological cost, with particularly high stress related to being a sole parent. These findings may help guide interventions for this neglected population and underscore the importance of developing targeted therapies and research protocols to address their needs.

Involuntary freedom in elderly widows: narrative insights / Liberdade involuntária em idosas viúvas: olhares narrativos

Due to the existing age gap between the average life expectancy of males and females, the widowhood process in old age is mainly experienced by women. In light of this, this study aims to understand the state of widowhood from a female perspective, analysing its impact at the level of lifestyle choices, in addition to identifying the changes that took place in the lives of elderly women and to what extent widowhood influences the choice of daily life as well as leisure activities. This is an exploratory-descriptive study that resorts to a qualitative methodology, using a study group comprising 30 elderly widowed women, aged 65 or above. Data were collected during semi-structured individual interviews and its content was analysed with the WebQda Software (Web Qualitative Data Analysis). Results show that becoming a widow gave the elderly a greater sense of independence and freedom. Simultaneously, it also showed that in the early years of widowhood, widows experience more feelings of grief and nostalgia for their loved ones (feeling of missing someone immensely).

O processo de viuvez na terceira idade é predominantemente vivido pelas mulheres, devido ao diferencial etário entre a esperança média de vida do sexo feminino face ao masculino. Nesse contexto, através deste estudo, pretende-se compreender como o estado de viuvez feminino influenciou as opções de estilo de vida, identificando as alterações originadas em mulheres idosas e influencia as diferentes atividades do dia a dia e de lazer. Com uma metodologia qualitativa, assume-se como um estudo exploratório-descritivo, realizado junto de um grupo constituído por 30 idosas na situação de viúvas e com idade igual ou superior a 65 anos. Para a recolha de dados optou-se pela realização de entrevistas semiestruturadas, sendo posteriormente os dados analisados em termos de conteúdo e tratados com o suporte do Software WebQda (Web Qualitative Data Analysis). Os principais resultados evidenciam que o facto de as idosas terem ficado viúvas lhes deu maior independência e sensação de liberdade, apesar de o estudo inferir, igualmente, que a viuvez possui um impacto marcante, porquanto se observa uma tendência exponencial para a descrição de emoções associadas ao processo de luto.