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- Hauksdóttir, Arna
(author)
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Towards improved care and long-term well-being of men who lose a wife to cancer : a population based study
- 2009
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Doctoral thesis (other academic/artistic)abstract
- Background: Grief can be seen as the mirror of love. However, some persons suffer beyond what can be viewed as normal grief, experiencing long-lasting decline of both mental and physical health - and even death. Investigating additional and avoidable risk factors connected to the loss may therefore be of vital importance for the development of preventive interventions. Aims: To identify avoidable risk factors for the long-term psychological morbidity of widowers. We hypothesized that widowers, compared to married men, have a higher risk for psychological morbidity 4-5 years after their loss. We also postulated that this excess morbidity is determined by the degree of preparedness for the wife's death at the time of death. Moreover, we suggest that such preparedness can be facilitated by providing several kinds of health-care interventions. Methods: Following a qualitative phase for study preparation, a study specific questionnaire (including questions on psychological morbidity and questions about the wife's disease period) was constructed and tested for face validity and for response rate and logistics in a pilot study on 76 widowers. The study base in the main study consisted of 907 men in Sweden who had lost a wife to cancer in the breast, ovary or colon in 2000 and 2001. Furthermore, we collected data from a control group of 330 married men who were frequency matched for age and residence. The questionnaires were sent out from November 2004 to November 2005. Results: Participation rate was 76 percent for the widowers and 79 percent for the married men. Single widowers reported more psychological morbidity 4-5 years after the loss of a wife than widowers who were in a new romantic relationship at the time of follow-up. Highest relative risks obtained were for depression (RR 2.3), emotional numbness (RR 2.2) and waking up at night with anxiety (RR 2.3). Widowers in a new romantic relationship did not report more morbidity compared to married men. Eighty-six percent of the widowers reported that the next-of-kin should be told immediately when the patient's cancer cannot be cured. Eighty percent of the widowers reported that they were told that the wife's cancer was incurable and a quarter of them were informed within one week before the patient's death. Our data indicated that a low degree of preparedness at the time of wife's death increases a younger widower's (38 to 61 years old) risk for (among other symptoms): anxiety (RR 2.3), emotional numbness (RR 2.2) and having difficulty falling asleep (RR 2.2) 4-5 years after loss. For older widowers (62 to 80 years old), this pattern was not as evident. Several possible avoidable predictors for preparedness were identified: longer duration of the widower's intellectual awareness time before his wife's death (RR 4.1), if the widower could take in the information that his wife's disease could not be cured (RR 3.5), the couple had arranged their economic affairs (RR 1.5) and if the wife had stayed at a palliative care unit during the last months of her life (RR 1.2). Findings: Widowers who remain single 4-5 years after their loss are at increased risk of psychological morbidity. Furthermore, the degree of preparedness before the wife's death may affect the long-term psychological well-being for widowers. Several care-related facilitators of preparedness were identified. Implication: Improved care of men whose wives are dying of cancer may diminish the widowers risk of long-term morbidity. An intervention study, aiming at influencing preparedness before the death of a loved one, can be designed based on our findings. Such an intervention may entail significant public health effects by decreasing psychological and even physical morbidity of widowers.
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- Onelöv, Erik, et al.
(author)
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Measuring anxiety and depression in the oncology setting using visual-digital scales.
- 2007
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In: Acta oncologica (Stockholm, Sweden). - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 46:6, s. 810-6
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Journal article (peer-reviewed)abstract
- We investigated the feasibility of using single-item visual-digital scales for measuring anxiety and depression for research purposes within the oncology and palliative care setting. Data were retrieved from five nationwide postal questionnaires comprising 3030 individuals (response rate 76%): cancer patients, widows/parents who had lost their husband/child to cancer and population controls. All questionnaires contained the Center for Epidemiological Studies Depression scale (CES-D) and Spielberger's State-Trait Anxiety Inventory (STAI-T) as well as seven-point Visual-Digital Scales (VDS) assessing anxiety and depression. Each stepwise increased score on the VDS-depression provided a statistically significant increase in the mean score on CES-D (Spearman's r=0.582). The VDS-anxiety correlated with mean scores on STAI-T (Spearman's r=0.493), however, not all stepwise increased scores on the VDS-anxiety gave a statistically significant increase on the STAI-T. Positive- and negative predictive values were 51% and 91% for VDS-depression and 64% and 80% for VDS-anxiety. Missing data for STAI-T were 7% and 9% for CES-D; the corresponding figures were 2% for the VDS-depression and 3% for VDS-anxiety. With low attrition and agreement with psychometric scales, the Visual-Digital Scales are a feasible alternative for research in the oncology setting. However, the high negative predictive value and the low positive predictive value suggest that the visual- digital scales mainly detect the absence of the symptoms.
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- Valdimarsdóttir, Unnur, et al.
(author)
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Parents' intellectual and emotional awareness of their child's impending death to cancer: a population-based long-term follow-up study.
- 2007
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In: The lancet oncology. - 1470-2045 .- 1474-5488. ; 8:8, s. 706-14
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Journal article (peer-reviewed)abstract
- BACKGROUND: We aimed to study care-related determinants of when parents gain awareness of their child's impending death to cancer, and whether the duration of this awareness affects the parents' long-term morbidity. METHODS: Between August 2001 and October 2001, 449 of 561 (80%) parents who had lost a child due to any malignancy in Sweden between Jan 1, 1992, and Dec 31, 1997 (identified on the Swedish Causes of Death Register), answered a 365-item postal questionnaire designed to ascertain when, before the child's actual death, they had become intellectually and emotionally aware of the child's impending death (awareness time). The primary endpoints were intellectual awareness time (defined as time between intellectual realisation that a disease is fatal and the actual time of death) and emotional awareness time (defined as time between emotional realisation that a disease is fatal and the actual time of death). Parents' awareness of less than 24 h was referred to as a short awareness time. FINDINGS: 436 parents answered the question about intellectual awareness and 433 parents answered the question about emotional awareness. 112 parents (26%) reported a short intellectual awareness time and 195 parents (45%) reported a short emotional awareness time. The risk of having short intellectual awareness time was increased if parents had absence of information on their child's fatal condition (mothers relative risk [RR] 3.6 [95% CI 2.3-5.5]; fathers 2.9 [1.8-4.5]) and if curative treatment was used towards the end of life (mothers 4.1 [2.6-6.5]; fathers 2.7 [1.7-4.2]). The risk of short emotional awareness time was increased if parents had absence of information indicating the child would die (mothers 1.5 [1.1-2.0]; fathers 1.8 [1.3-2.5]) and absence of talks about death with the other parent (mothers 1.5 [1.1-2.0]; fathers 1.7 [1.2-2.2]). Compared with fathers who had longer emotional awareness time, fathers with short emotional awareness time had an increased risk of depression (adjusted RR 1.8 [1.0-3.3]) and absence from employment due to sick leave or early retirement (RR 8.5 [1.1-67.8]) at follow-up. This difference was not noted for mothers. INTERPRETATION: Health-care professionals can influence parents' intellectual and emotional awareness of a child's impending death due to cancer. Short emotional awareness increases the risk of long-term depression in bereaved fathers.
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