The loss of a husband to cancer : Additional and avoidable psychological traumata

Abstract: Background: The loss of a loved partner is a stressful event and the long-term outcome of such a trauma may partly be determined by characteristics of the death. When death is the result of a chronic illness such as cancer, the future widow may have an opportunity to prepare for the forthcoming death but may also be exposed to the additional burden of her husband's suffering. We investigated long-term physical and psychological morbidity of widows who had lost their husband to cancer and risk factors for such morbidity; risk factors being the length of time the widow was aware of the impending death (awareness time) and exposure to unrelieved suffering. Methods: We identified all men in Sweden 74 years or younger who had died owing to cancer of the prostate 1996 or of the urinary bladder 1995 or 1996, after a minimum disease duration of 3 months. All their surviving widows or partners (n=506) who were alive on the 1" of April 1999 and were 79 years or younger were contacted and compared to an age-matched control group of women married to or living with a man (n=287). The widows anonymously answered a questionnaire concerning their husband's disease and death, and both groups answered questions regarding their current health and functioning. Results: We received 379 (75 percent) questionnaires from the widows and 220 (77 percent) from the controls. The groups (mean age 67 years) were similar on an background characteristics and by an average of three years had elapsed from the time of death. Compared with controls, the widows had increased risk of anxiety (relative risk (RR) 1.9), depression (RR 2.2), sleep disturbance (RR 2.0), diabetes (RR 3.5) and economic dissatisfaction (RR 1.6). The widows' duration of time with awareness of the impending death varied greatly, with 48 percent having 3 months or shorter and 15 percent 24 hours or shorter. Awareness time predicted the widows' risk of psychological morbidity, with short awareness time carrying the highest risk, awareness time of three to six months typically carrying the lowest risk and awareness time of one year or longer having a tendency to give an increased risk. Compared with awareness time of three to six months, time of 24 hours or less gave a relative risk for anxiety of 1.9 and for depression 1.6. Information and psychological support from health care givers were the greatest predictors of awareness time; the absence of such predicted short awareness time. The patient's unrelieved psychological symptoms (but not physical) predicted the widows' psychological morbidity. If the patient was reported anxious during the last three months of life the relative risks for the widows' depression was 2.5, the corresponding figure for patient's unrelieved pain was 0.8. Thirty- three percent of the widows reported moderate or much access to psychological support for the patient but 93 percent reported access to physical pain relief. Approximately two-thirds of the widows indicated a need for contact with health care (information, psychological support or economic advice) during the first six months following their husband's death, but only about 20 percent of these reported access to such. Conclusion: A widow's long-term risk of psychological morbidity following the death of her husband from cancer is determined by her awareness time and exposure to the patient's unrelieved psychological symptoms. These risk factors are in turn closely related to the quality of health care; working for an optimal awareness time and relieving the patient's anxiety and depression may benefit the long-term situation of the surviving spouse.