Pakistan Journal of Medical Sciences

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EDITORIAL

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Volume 21

October December 2005

Number 4


 

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Depression following death of a spouse

Unaiza Niaz

Correspondence:
Unaiza Niaz MD, DPM, FRC Psych
E-Mail: drunaiza@cyber.net.pk

Major depressive illnesses are well known to be prevalent during the stress of bereavement. The nature of these depressive syndromes is that they are persistent and disabling and add to the burden of mood changes associated with bereavement.

This issue contains a study by Haroon Rashid Chaudhary and colleagues on frequency of depression after the death of spouse. Though it has certain limitations as it was a hospital based descriptive study and the number of patients enrolled were too small and even the number of female patients were much less 35% compared to 65% male, but it does highlight the problem which needs attention of healthcare professionals in general and the psychiatrists in particular.

Fortunately, a substantial number of bereaved individuals may suffer from these depressive symptoms that do not require quite the requisite number to meet the criteria for major depressive episode; and yet they may be quite disabling, if not be the actual forerunner of the major depression. This spectrum of depressive phenomena after spousal bereavement is commonly prevalent but unrecognized and persists during the first two years of bereavement. These individuals complain of poor physical health, dissatisfaction from work and disturbed social activities and ongoing relationships with friends.

Persistence of depressive symptoms, for an average of one year after the loss of a spouse may reflect a pathological condition rather than normal grieving. Experience of grief persists for at least 30 months in both older men and women who have lost their spouse1,2. Another study has indicated substantial morbidity (28%) in widows and widowers in the first full year of bereavement.3 In both widows and widowers past history of psychiatric illness especially major depressive disorders was a significant factor in developing a depressive episode after one year of bereavement4.

A widow who was in a shock state remained mute for days following the death of her husband in the battlefield but suddenly woke up when she saw her infant child crying and said " Sweet my child I live for thee!!! "

Young widows often "exist" rather than live life following the death of their husbands if they have children. In elderly couples it is well known to psychiatrists that after the death of an elderly spouse, the other spouse dies within six months.

Clinicians must be aware that depressive episodes are fairly common after death of a spouse. These bereaved peoples quality of life can be drastically improved, with proper psychiatric care. Clinically physicians must maintain a high index of suspicion for the possibility of a major depressive illness particularly in young widows and widowers; who have positive history of post depressive illness or onset of severe depressive symptoms soon after the death of spouse.

References

1. Thompson LW, Gallagher-Thompson D, Futterman A, Gilewski MJ, Peterson J. The effects of late-life spousal bereavement over a 30-month interval. Psychol Aging. 1991; 6(3):434-41.

2. Zisook S & Shuchter SR. Depression through the first year after the death of a spouse Am J Psychiatry 1991; 148:1346-52

3. Nuss WS, Zubenko GS. Correlates of persistent depressive symptoms in widows.Am J Psychiatry.1992; 149(3):346-51.

4. Zisook S, Shuchter SR, Sledge PA, Paulus M, Judd LL. The spectrum of depressive phenomena after spousal bereavement. J Clin Psychiatry. 1994;55 Suppl:29-36.


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