Gender influence on loneliness and family and nonfamily support among older adults: The confounding role of widowhood.

Based on interviews with 465 community elders in Ekiti-State, Nigeria, this study addressed the questions: (a) Do older men and women differ in self-reported loneliness, family and nonfamily support?; and (b) If so, is this relationship maintained when controlling for widowhood, age, social-engagements, extroversion, and neuroticism? Three independent models were tested using one-way MANOVA and MANCOVA. Compared to males, females reported more loneliness and less family support. However, these outcomes became nonexistent after excluding widowhood. Gender maintained significance after excluding other covariates. The study buttresses the primary importance of widowhood in the gender differences found in later-life loneliness and family supports.

Urdu Translation of Friendship Scale: Evidence for the Validity and Measurement Invariance Across Gender.

Social isolation is a state of nearly-absolute lack of interaction between an individual and society. The Friendship Scale (Hawthorne, 2006) is a measure of social isolation that needed to be translated in the Urdu language for its validation for the Pakistani population owing to its brevity and sound psychometric properties. For the Urdu translation, the standard back-translation procedure was adopted, and the cross-language validation of the translated version was undertaken on a purposive sample of (N = 60) older adults with a minimum age of 60 years. The test-retest reliability of one week for the Urdu-English and English-Urdu version was .95 and .97, respectively. In an independent purposive sample of older adults (N = 500; men = 263 and women = 237) from Lahore and Sargodha districts, the CFA of the Friendship Scale revealed a single factor solution with six indicators, which demonstrated configural, metric, and scalar invariance across both genders and comparable latent mean scores of men and women. The Friendship Scale demonstrated a significant positive relationship with depression and non-significant association with the assimilation, which provided evidence for the convergent and discriminant validities, respectively. Furthermore, evidence of the concurrent validity was established as the older adults whose spouses had died scored significantly higher on the Friendship scale as compared to their counterparts who were living with their spouses. These pieces of evidence suggest that the Urdu version of the Friendship scale is a reliable and valid measure of flourishing for both genders.

Widowhood and mortality: gender, race/ethnicity, and the role of economic resources.

PURPOSE: We examine widowhood effects on mortality across gender and race-ethnicity, with attention to variation in the mediating role of economic resources. METHODS: Data were drawn from the Health and Retirement Study (1992-2016). The analytic sample included 34,777 respondents aged 51 years and older who contributed 208,470 person-period records. Discrete-time hazard models were estimated to predict the odds of death among white men, black men, Hispanic men, white women, black women, and Hispanic women separately. The Karlson-Holm-Breen analysis was conducted to examine the mediating role of economic resources across groups. RESULTS: Across all gender and racial-ethnic subgroups, widowhood effects on mortality were largest for Hispanic men. Black women and Hispanic women also suffered stronger effects of widowhood on mortality than white women. For both men and women, economic resources were an important pathway through which widowhood increased mortality risk for whites and blacks but not for Hispanics. CONCLUSIONS: Findings highlight that gender and race-ethnicity intersect with widowhood status to disadvantage some groups more than others. It is important to explore the complex pathways that contribute to the higher mortality risk of racial-ethnic minorities, especially Hispanic men, after widowhood so that effective interventions can be implemented to reduce those risks.

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.

A comparison of prevalence and risk factor profiles of prolonged grief disorder among French and Togolese bereaved adults.

BACKGROUND: With the introduction of the prolonged grief disorder (PGD) in the ICD-11 and most likely in the future DSM-5-TR, there is clinical need to examine cultural variations in grief phenomenon. We tested whether grief symptoms differ cross-culturally by examining the prevalence rates and predictors of PGD among French and Togolese bereaved individuals. METHODS: The sample comprised 235 widowed persons (73 French and 162 Togolese participants). They all completed the Prolonged Grief Scale-11 items. There were no statistically significant differences between both groups in terms of sociodemographic information (except for education). However, they differed on loss-related characteristics. We used two different symptom-diagnostic tests to estimate the prevalence rates. RESULTS: We found that French and Togolese bereavers reported almost similar PGD prevalence rates (21.9% [95% CI 0.13, 0.36] and 15.4% [95% CI 0.10, 0.23], respectively for the first test, 26% [95% CI 0.16, 0.41] and 17.3% [95% CI 0.12, 0.25], respectively for the second test). Through regression analyses, PGD severity was predicted by low education, being unemployed, long duration of a marital relationship, and traumatic death in the French sample, whereas it was predicted by being male and highly educated in the Togolese sample. Both groups only shared a recent bereavement period as a common risk factor. CONCLUSIONS: Even though French and Togolese widowed persons reported almost similar prevalence rates of PGD, etiology, risk, and protective factors are culturally distinctive. It is critical to consider cultural and individual differences when conducting research on diagnosis and intervention in cases of prolonged grief.

Predictive factors for differential changes in grief symptoms following group bereavement intervention for Chinese widowed older adults.

This study aimed to delineate changes in the patterns of prolonged grief severity in widowed adults following group bereavement interventions and to identify the predictive factors impacting these patterns. We performed a secondary analysis of data from a randomized trial of 125 Chinese widowed older adults who participated in either LOGBI or DPGBI. Self-ratings of prolonged grief symptoms via Inventory of Complicated Grief (ICG) were subjected to latent class growth analysis to identify subgroups according to symptomatic changes among baseline, post-treatment, and 8-week follow-up. Multinomial regression analysis examined whether participant classification could be predicted by demographics, loss-related characteristics, and the relationship with the deceased and baseline symptom severity. In the results, intervention sample comprised 96 completers with an attendance greater than 60%. A three-class categorization yielded the best model fit for changes in prolonged grief severity for both randomized and intervention samples: improved class (41.6% in the randomized sample, 42.8% in the intervention sample), partial responded class (48.1%/45.5%), and relapse class (10.3%/11.8%). Older widowed adults experiencing a high level of grief at baseline and bereavement following chronic illness had an elevated risk of symptomatic relapse after the completion of intervention. These findings indicated that Chinese widowed adults experienced different changing patterns of prolonged grief severity following group bereavement interventions. Practically, widowed adults with a higher risk of symptomatic relapse might need more intensive or longer term intervention or follow-up support.

Narratives of childless widows: exploring the lived experiences and well-being of childless widows in rural Nigeria.

Background: Widows are socioeconomically disadvantaged, especially in low resource regions. Childless widows are a group whose plight may be worse given sociocultural circumstances. In the current study, we examined the lived experiences of childless widows living in remote Nigeria, highlighting this group as being in critical need for social interventions.Method: Childless widows (n = 11) in rural settings in South East Nigeria were interviewed. Narrative analysis was used in navigating the lived experiences of the widows.Results: Extreme distress, ostracism, stigma, and traumatic experiences were common in the narratives of the widows. However, childlessness was at the core of their distress. Treated as outcasts, the widows resigned to God, though some were scarcely allowed to play supportive roles among relatives. As social welfare packages are almost non-existent in this region, religious groups often played supportive roles.Conclusion: Legislation protecting widows are good but may not be sufficient if it does not translate to improved wellbeing/welfare for widows. Childless widows, especially those in rural areas, are especially vulnerable as they face peculiar deprivation and psychological distress arising from cultural/social realities. Recognising the limited resources in low income countries, mobilisation of local structures and resources to educate and monitor local communities are important.

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.

Later-Life Trajectories of Cognitive Functioning among Married and Widowed Older Men and Women of Mexican Origin.

Research on marital status-gender differences in later-life trajectories of cognitive functioning is scarce. Drawing on seven waves of data from the Hispanic Established Population for the Epidemiologic Study of the Elderly, this research uses growth curve models to examine later-life dynamics of cognitive functioning among married and widowed older men and women of Mexican descent (aged 65+; N = 3329). The findings demonstrate that the widowed, regardless of gender, had lower initial levels of cognition but a less steep cognitive decline across waves, compared to married men. Age and socioeconomic resources accounted for these marital status differences in levels and rates of change in cognitive functioning completely among widowed men and partially among widowed women. Moreover, net of all the factors, married women had a slower cognitive decline than married men. This study also shows that health and social integration might shape cognitive functioning among older adults of Mexican descent.

Risk and Resiliency in the Relationship Between Widowhood and Depressive Symptoms Among Older Mexican Americans.

This study examined the association between widowhood and depressive symptoms and the extent to which the association is contingent upon risk and resiliency, including immigration status, functional limitations, financial strains, and intergenerational support, among older Mexican Americans. The sample included 344 parent-child pairs reported by 83 respondents. Clustered regression analysis showed that widowhood elevated risks for depressive symptoms. We found that having some functional limitations, having more children and living in the same city with children exacerbated the adverse effects of widowhood on depressive symptoms. We also found that living in the same city with children increased the detrimental effects of widowhood on the depressive symptoms in men, whereas we did not find this pattern in women. The findings highlight the heterogeneity within the widowed Mexican American older adults. Implications for future research and practice are discussed.

"The deceased has left; the alive has to move on": Experiences of Chinese Widows in the UK.

Relatively little is known about the experiences of Chinese widows, especially those living outside China. This qualitative study examines the experiences of eight Chinese or Hong Kong-born widows living in the UK. Using a semistructured approach to interviewing, participants were asked about their lives before, during, and after their spousal bereavement. Five major themes emerged: (1) complexity of marital lives; (2) experiences around the time of the death including fate; (3) loneliness and isolation; (4) the challenges of practical tasks; and finally, (5) current life. The implications of the findings for social policy and practice are briefly discussed.

Impact of marital status at diagnosis on survival and its change over time between 1973 and 2012 in patients with nasopharyngeal carcinoma: a propensity score-matched analysis.

The impact of marital status at diagnosis on survival outcomes and its change over time in patients with nasopharyngeal carcinoma (NPC) are unclear. The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients diagnosed with NPC in the United States from 1973 to 2012. A primary comparison (married vs. unmarried) was implemented with 1:1 propensity score matching. Secondary comparisons were performed individually between three unmarried subgroups (single, separated/divorced, widowed) and married group. The effect of marital status on cause-specific survival (CSS) and overall survival (OS) were evaluated using univariate/multivariate analysis. Moreover, we investigated the change over time (1973-2012) in the effect of marital status on NPC survival. Married patients had better 5-year CSS/OS than unmarried patients (61.1% vs. 52.6%, P < 0.001; 55.6% vs. 45.3%, P < 0.001, respectively). In multivariate analysis, unmarried patients had significantly poorer CSS/OS than married patients (adjusted hazard ratio [aHR] = 1.35, P < 0.001; aHR = 1.40, P < 0.001, respectively). The survival benefit of being married was only detected in non-Hispanic white and Chinese American patients. Single, separated/divorced, and widowed patients had significantly poorer CSS/OS than married patients (aHR = 1.37 and 1.37; 1.46 and 1.42; 1.43 and 1.48, respectively; all P < 0.001). The change over time in the effect of marital status on survival was more stable in male than female. The strength of the negative effect of separated/divorced and widowed status showed a downward and upward trend, respectively. Gender difference in the adverse effect of single status on NPC survival became smaller over time. Only non-Hispanic white and Chinese American patients with NPC obtain survival benefits from married status. Single and widowed patients are regarded as high-risk population.

Revisiting the Continuing Bonds Theory: The Cultural Uniqueness of the Bei Dao Phenomenon in Taiwanese Widows/Widowers.

In the present study, we used the phenomenological approach to rediscover the ontological meaning of relationships with the deceased in Taiwanese widows/widowers. We first revised the original Western definitions of grief, bereavement, and mourning to fit Taiwanese culture. We used the word bei dao to indicate the mixed nature of grief and mourning in the Taiwanese bereavement process. Then we reanalyzed data from a previous study, which was conducted in 2006. In the previous qualitative research, each subject was interviewed 3 to 4 times in the mourning state over an 18-month interval that began at the point of the spouse's death. Results showed that two main themes emerged in the present analysis: (a) a blurred boundary of life and death and (b) a transformation of ethical bonds. The present study reveals the culturally unique aspects of the Taiwanese bei dao process. Limitations of the present study and future directions are discussed and reflected.

Persistent Complex Bereavement Disorder and Culture: Early and Prolonged Grief in Nepali Widows.

OBJECTIVE: Persistent complex bereavement disorder (PCBD) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), has not been well studied in socioculturally diverse populations. Thus, this qualitative study examined (a) how widows in Nepal understand grief, (b) whether a local construct of PCBD exists, and (c) its comparability with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), terminology. METHODS: Using an adapted Explanatory Model Interview Catalogue (EMIC) framework, semistructured interviews with 25 widows and 12 key informants, as well as three focus-group discussions (n = 20), were conducted between October 2014 and April 2015. Through an inductive grounded theory-based approach, we used the constant comparative method, iteratively coding transcripts to identify themes and patterns in the data. Also, we created two lists of grief responses, one of early reactions and another all reactions to grief, based on the frequency of mention. RESULTS: No single term for grief was reported. Widows reported a local construct of PCBD, which was broadly compatible with DSM-5 terminology but with important variation reflecting societal influence. Surviving torture during conflict, economic and family stressors, and discrimination were mentioned as important determinants that prolong and complicate grief. Suicidal ideation was common, with about 31% and 62% of widows reporting past-year and lifetime suicidality, respectively. Findings may not be generalizable to all Nepali widows; participants were recruited from a non-governmental organization, from Kathmandu and its neighboring districts, and were primarily of reproductive age. CONCLUSIONS: While PCBD symptoms proposed in DSM-5 were mentioned as relevant by study participants, some components may need adaptation for use in non-Western settings, such as Nepal.

Worry about not having a caregiver and depressive symptoms among widowed older adults in China: the role of family support.

OBJECTIVES: Using the stress-coping framework, this study examined whether worry about not having a caregiver in old age was associated with depressive symptoms among widowed Chinese older adults, including the moderating effects of self-perceived family support. METHOD: Using a sample of 5331 widowed adults aged 60 years old or older from the 2006 National Sample Survey of the Aged Population in Urban/Rural China, we regressed measures of depressive symptoms on worry about not having a caregiver. We also tested moderation effects of family support. RESULTS: Individuals who were worried about not having a caregiver reported significantly higher levels of depressive symptoms. Feeling that their children are filial, having instrumental support from children, and having only daughters moderated the effects of worry about not having a caregiver on depressive symptoms. CONCLUSION: Our findings indicate the detrimental effects of worry about not having a caregiver on the psychological well-being of widowed older adults. This study also highlights some forms of family support that may help reduce such negative effects of widowhood.

The Effect of Widowhood on Parent-Child Relationships in Korea: Do Parents' Filial Expectations and Geographic Proximity to Children Matter?

Although previous research based on data from the U.S. suggests that parents' widowhood is associated with increased emotional support from children, little is known about the impact of late-life widowhood on intergenerational relationships in other cultures. Using data of Korean older adults, this paper examined: (1) the effect of widowhood on both positive and negative aspects of parent-child relationships and (2) whether these effects are moderated by older adults' expectations about children's filial responsibilities and the geographic proximity to their children. Analyses are based on data from the Hallym Aging Study, a stratified multi-stage probability sample of older adults living in the cities of Seoul and Chuncheon in Korea. Compared to married older adults, widowed persons in this sample reported higher levels of ambivalence, lower levels of positive interactions, and higher levels of negative interactions with their children. Parents' notion about filial responsibilities did not have a significant moderating effect, whereas geographic proximity to children was a significant moderator. Findings suggest that widowhood is associated with greater strain in intergenerational relationships in Korea. Helping widowed older adults forge constructive relationships with their children may enhance both bereaved older adults' and their children's well-being in this cultural milieu.

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.

Depressive Symptoms Among Older Mexicans: The Role of Widowhood, Gender, and Social Integration.

Widowhood is often associated with decreased mental health. In developing countries with low institutional support, such as Mexico, social integration can be particularly consequential for widowed older adults' psychological well-being. This study investigates the interplay among depressive symptoms, widowhood, gender, and social integration in a nationally representative sample of older Mexicans. Drawing on Waves 1 (2001) and 2 (2003) of the Mexican Health and Aging Study, we estimated the ordinary least squares regressions to examine the implications of widowhood, gender, social support, social network, and social engagement for changes in depressive symptoms between the waves among Mexicans aged 50 and older (N = 8,708). The findings indicate that social integration can mitigate as well as exacerbate depressive symptomatology among older Mexicans. Certain aspects of social integration can moderate marital status-gender differences in depressive symptoms among older Mexicans.

Widow discrimination and family caregiving in India: evidence from microdata collected from six major cities.

The purpose of this research is to address the lack of a region-wide view of widow discrimination in India, the home of 42 million widows. This study analyzed the household data collected in face-to-face interviews from January to March of 2011 in six major Indian cities. It was revealed that widow discrimination does not prevail across the nation. That is, this research did not deny the existence of traditional widow discrimination in some areas but demonstrated that this phenomenon does not represent the whole nation if we focus on the widows' old age and the treatment by their families.

The convergence of HIV/AIDS and customary tenure on women's access to land in rural Malawi.

This paper examines the convergence of HIV/AIDS and the social processes through which women access customary land in rural Malawi. Data were collected from focus group discussions with women in patrilineal and matrilineal communities. Women's land tenure is primarily determined through kinship group membership, customary inheritance practices and location of residence. In patrilineal communities, land is inherited through the male lineage and women access land through relationships with male members who are the rightful heirs. Conversely in matrilineal matrilocal communities, women as daughters directly inherit the land. This research found that in patrilineal communities, HIV/AIDS, gendered inequalities embedded in customary inheritance practices and resource shortages combine to affect women's access to land. HIV/AIDS may cause the termination of a woman's relationship with the access individual due to stigma or the individual's death. Termination of such relationships increases tenure insecurity for women accessing land in a community where they do not have inheritance rights. In contrast to the patrilineal patrilocal experience, research on matrilineal matrilocal communities demonstrates that where women are the inheritors of the land and have robust land tenure rights, they are not at risk of losing their access to land due to HIV/AIDS.