Understanding adverse health effects of widowhood in old age – A cross-countries mixed methods study

IntroductionWidowhood in old age increases mortality and adverse health effects, particularly depression and need for psychiatric care. The causes of this are poorly understood. To study risk factors and mechanisms, theories about what to study are needed. A qualitatively approach to widowhood from the widow/widower's perspective may uncover important knowledge.ObjectivesTo investigate risk factors of the adverse health effects associated with widowhood in old age from the perspective of the widower/widowers and to test the generalisability of the theories quantitatively.MethodsThis is a cross-country mixed methods study combining narrative interviews with Danish widows/widowers and a 50-year follow-up study from Sweden – The Lundby Study. Widows/widowers above 65 years of age referred to in- or outpatient treatment at the Department of Psychiatry at Odense or Aarhus University Hospital are included. Narrative interviews are conducted and analysed according to grounded theory. The qualitatively developed theories will then be tested quantitatively through the Lundby Study by comparing widows/widowers above 65 years with age-matched controls, who are still married.ResultsIn the Lundby Study, 597 persons above 65 years were identified in the latest follow-up: 176 (29.5%) were widow/widowers, 421 (70.5%) were married/cohabitating. Depending on the theories developed a total of 384 possible variables regarding physical health, mental health and general living circumstances are tested. Further results will be presented.ConclusionsThe causes of adverse health effects in widowhood are poorly understood. This study will potentially contribute to unravelling these by identifying possible risk factors.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The Lundby Study - Background and Recent Findings in a 50-year Perspective

Aims:To describe the Lundby Study and present recent data for the period 1947-1997.Methods:The Lundby population consisting of 3563 probands was investigated by semi-structured interviews in 1947, 1957, 1972 and 1997. Sufficient information was available for 94-99%. Best estimate consensus diagnoses have been used since 1957 together with DSM-IV and ICD-10 in 1997.Results:From 1947-1972 to 1972-1997 a decrease in almost all age- and sex-specific incidences of neurotic and organic disorders was observed, whereas psychotic disorders increased consistently in males, but decreased in most age intervals in females. Women had higher first incidence depression rates than men and the average annual rate was lower for women and tended to be lower for men 1972-1997 as compared with 1947-1972. Median age at first onset of depression was around 35 years for individuals followed up for 30-49 years. The recurrence rate was about 40% and varied from 17% to 76% depending on length of follow-up. Transition to diagnoses other than depression was registered in 21% of the total sample, alcohol disorders in 7% and bipolar disorders in 2%.The overall long-term suicide risk varied from 5,6% to 6.8%. The long term suicide risk was 3.1% for medium and 13.7% for severe MDD. Severity and male sex were risk factors. After the introduction of TCAs a fall in suicide rates among depressed individuals was observed. Certain clusters of personality traits may predict functional psychosis.Conclusions:Low attrition rates over 50 years and reasonable diagnostic uniformity make comparisons over time justifiable.

The long-term course of depressive disorders in the Lundby Study

Background. The Lundby Study is a longitudinal cohort study on a geographically defined population consisting of 3563 subjects. Information about episodes of different disorders was collected during field investigations in 1947, 1957, 1972 and in 1997. Interviews were carried out about current health and past episodes since the last investigation; for all subjects information was also collected from registers, case-notes and key informants. This paper describes the course and outcome of 344 subjects who had their first onset of depression during the follow-up.Method. In this study individuals who had experienced their first episode of depression were followed up. Their course was studied with regard to recurrence of depression related to duration of follow-up, transition to other psychiatric disorders including alcohol disorders, as well as incidence and risk factors of suicide.Results. Median age at first onset of depression was around 35 years for individuals followed up for 30–49 years. The recurrence rate was about 40% and varied from 17% to 76% depending on length of follow-up. Transition to diagnoses other than depression was registered in 21% of the total sample, alcohol disorders in 7% and bipolar disorder in 2%. Five per cent committed suicide; male gender and severity of depression were significant risk factors.Conclusion. The low rates of recurrence and suicide suggest a better prognosis for community samples than for in- and out-patient samples.