This chapter reviews the major findings of the Tubingen longitudinal study of bereavement, an in-depth study of younger widows and widowers that provides information about health deterioration following bereavement, the course of recovery and coping strategies over a 2-year period, and the risk factors that affect adjustment to the loss. The study employed methodological safeguards to avoid some of the pitfalls that typically threaten the validity of in-depth studies of bereavement.

Background

When we planned our longitudinal study, the decline in mental and physical health and general well-being following marital bereavement had already been well documented (for reviews, see Osterweis, Solomon, & Green, 1984, and W. Stroebe & Stroebe, 1987). A few earlier studies (e.g., Clayton, 1979) had tended to minimize the severity of these effects. However, epidemiological, clinical, and in-depth interview and questionnaire investigations strongly suggest otherwise. Although the majority of bereaved manage to adjust to their loss without professional help, a significant minority do succumb to a variety of ailments and ills, and the risk of this persists for a considerable time.

Therefore, instead of merely charting the health consequences of marital bereavement, it seemed important to identify the characteristics of people who were likely to suffer long-term health impairment, because they were the risk group that would need professional help. We investigated whether bereaved individuals' adjustment to loss was influenced by sociodemographic (e.g., socioeconomic status, age, gender) and individual (e.g., personality traits, religiosity) characteristics, by antecedent situational factors such as the quality of the marital relationship, by mode of death (sudden vs. expected loss), or by circumstances after the loss, like the extent to which the bereaved received social support (cf. W. Stroebe & Stroebe, 1987).

Increasingly in recent years researchers have focused on positive aspects of the experience of bereavement, emphasizing that it is a “growth experience,” that people are “resilient,” and that the illness metaphor should be abandoned in describing the consequences of grief. The chapters in this volume by Silverman and Worden, McCrae and Costa, and Shuchter and Zisook, to name only a few, underline this message. Yet the reason that so much research has focused on bereavement is because the loss of a loved one is associated with extreme mental and physical suffering, not for everyone, and not always lastingly, but for a significant minority. Even more disturbing are the statistics for mortality. Not only do some bereaved individuals fall ill following the loss of a loved one, but they also die.

Given that fatal consequences occur for some bereaved, it is important to identify those who are vulnerable and to understand why they and not others succumb. A decade ago we reviewed the research on mortality (M. Stroebe, Stroebe, Gergen, & Gergen, 1981) and concluded that there was some evidence that bereavement results in excess mortality. However, the surveyed research suffered from many methodological shortcomings. In the meantime, much research has been done and much has been written about the bereavement-mortality relationship. The goals of this chapter, therefore, are to review the scientific evidence that is now available, examine subgroup differences that suggest high-risk categories, and review and evaluate theoretical explanations that could account for the bereavement-mortality relationship.

Until fairly recently, researchers interested in the topic of bereavement tended to be scattered throughout the world, having little contact with one another and not much knowledge of each other's work. This was to some extent true of the editors of the current volume, until a conference meeting in the early 1980s led to the discussion of joint interests and the beginning of a collaboration that has continued without pause ever since. The main objective of our collaboration has been to work toward a synthesis of scientific evidence on the impact of bereavement. Out of this interest came a special issue of the Journal of Social Issues, “Bereavement and Widowhood,” in 1988, to which an international, interdisciplinary group of bereavement researchers contributed.

Due to the constraints of a journal, the scope of the issue had to be limited. Thus, it seemed a natural extension of this work to produce a more comprehensive volume that would provide readers with an up-to-date account of knowledge about bereavement's impact and effects and the possibilities for social or policy intervention and treatment: The Handbook of Bereavement is the result of this endeavor. Well over half of the chapters were newly commissioned. Leading researchers from many different disciplines and many countries, including Australia, Canada, Israel, the United Kingdom, and the United States, were invited to contribute. It was very gratifying that, as for the journal issue, the response was overwhelmingly positive, such that all of the chapters are by “first-choice” authors.

The loss of a loved one is a tragedy unequalled by any other for most bereaved people. It is an experience that occurs some time or other in nearly everyone's life, and many suffer losses long before they reach old age, when such events occur with increasing frequency. According to statistics for the year 1985, more than 2 million people can be expected to die in a single year in the United States alone. Of these, more than 16,000 are children between the ages of 1 and 14, and as many as 38,000 are young people between the ages of 15 and 24 (U.S. Department of Health & Human Services, 1985). Such statistics also show alarming infant mortality rates, more than 40,000 babies dying before they reach the age of 1 year. For each of these deaths, bereaved persons are left behind - parents, spouses, children, siblings, and friends - all of whom are at high risk of detrimental effects on their mental and physical health.

If one looks beyond such statistics to consider world events, concern for the bereaved becomes hugely magnified. Natural disasters and human conflicts have devastated families in many nations during recent years. Frequently under such circumstances, grief over the death of a loved one is compounded by related tragedies, as when one person alone survives the loss of an entire family, when personal injury adds to suffering, when the violent or brutal death of a loved one has been witnessed, or when homes and livelihoods are also lost through the circumstances of war or other disaster.