OLDER ADULT BEREAVEMENT: A COMPARISON OF BEREAVED PARENTS AND SPOUSES by B. JANETTEE HENDERSON, B.A. A THESIS IN HUMAN DEVELOPMENT AND FAMILY STUDIES Submitted to the Graduate Faculty of Texas Tech University in Partial Fulfillment of the Requirements for the Degree of MASTER OF SCIENCE Approved December, 1993
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OLDER ADULT BEREAVEMENT: A COMPARISON
OF BEREAVED PARENTS AND SPOUSES
by
B. JANETTEE HENDERSON, B.A.
A THESIS
IN
HUMAN DEVELOPMENT AND FAMILY STUDIES
Submitted to the Graduate Faculty of Texas Tech University in
Partial Fulfillment of the Requirements for
the Degree of
MASTER OF SCIENCE
Approved
December, 1993
12 ACKNOWLEDGMENTS
0 Afi,)^ My deepest appreciation to Dr. Jean P. Scott, chair of
my thesis committee, for her continued encouragement and
support on this project. She has served as an excellent
role model, eloquently combining the polished skills of a
researcher with the warm and unconditional regard of a
trusted counselor. My heartfelt thanks also go to my
committee members. Dr. Joyce Munsch for her expertise in
the area of social support and her careful attention to
detail, and Dr. Ed Glenn for his kind support of this project
from the very beginning and his thought provoking advice.
I am deeply indebted to those persons who chose to
participate in this research. Their willingness to share
their pain and grief experience made this project possible.
Finally, I am most grateful to my husband, Dean, for his
constant love and encouragement throughout this program of
study. His "whatever it takes" attitude has allowed me to
pursue my dream. Many thanks also go to family and friends
who believed in me and supported me in reaching this goal.
11
TABLE OF CONTENTS
ACKNOWLEDGEMENTS ii
ABSTRACT v
LIST OF TABLES vi
CHAPTER
I. INTRODUCTION 1
II. LITERATURE REVIEW 12
Adaptation Model 12
Social Support and Bereavement
Outcomes 18
Loss of An Adult Child 23
Complicated Grief 25
Hypotheses 27
III. METHODS 31
Subjects 31
Measures 32
Procedures 41
Analyses 43
IV. RESULTS 45
Recruitment and Description of
the Sample 4 5
Hypotheses 1 and 2 50
Hypotheses 3 and 4 51
Social Support 53
Total Loss History 55 111
V. DISCUSSION
Double ABCX Model of Family Adaptation
Differences Between Bereaved Parents and Spouses
Differences Between Bereaved Parents
Limitations of the Study
Implications for Future Research
REFERENCES
APPENDICES
A. QUESTIONNAIRE
B. SCREENING QUESTIONNAIRE
C. INSTRUCTIONS FOR MAILED QUESTIONNAIRE
D. LOCAL SOCIAL SERVICES RESOURCE LIST
64
64
68
70
71
72
74
81
92
93
94
IV
ABSTRACT
The Double ABCX Model of Family Adaptation was used to
study the grief experience of older adults who had suffered
the loss of an adult child (Group 1) or spouse (Group 2).
As hypothesized, results indicated a poorer health status
outcome and a higher grief intensity level for Group 1 in
comparison to Group 2. Contrary to expectations. Group 1
revealed lower depression and social withdrawal scores
compared to Group 2. In addition, bereaved parents with a
low number of network sources of support were compared with
bereaved parents with a high number of network sources of
support. As predicted, parents with a high number of sources
of support reported less social withdrawal, significantly
less depression, and a significantly better health outcome.
Hypothesis 4, which predicted a lower grief intensity level
for parents with a high number of support sources, was not
supported. Implications for future research are also
discussed.
LIST OF TABLES
1. Cronbach' s Alpha Values 44
2. Recruitment Sources of Study Participants.... 56
3. Demographic Characteristics of a Sample of Older Bereaved Parents and Spouses 57
4. Means and Standard Deviations of Dependent and Independent Variables 59
5. Discriminators of Bereaved Parents Versus Bereaved Spouses 61
6. Discriminators of Low Versus High Sources of Social Support for Bereaved Parents 62
7. Cell Means and Standard Deviations of Discriminators of Low Versus High Sources of Social Support for Bereaved Parents 63
VI
CHAPTER I
INTRODUCTION
Of all the wonders that I yet have heard. It seems to me most strange that men should fear; Seeing that death, a necessary end. Will come when it will come.
Seemingly little has changed in the three centuries
since Shakespeare penned these lines. Death continues to
hold apprehension, if not fear, for many of us. Social
thanatologists Leming and Dickinson (1985) have noted that
based on the reactions of most people to death-related
topics "it appears that in contemporary society, death
discussions are considered in bad taste and something to be
avoided" (p. 3). DeSpelder and Strickland (1992) concur,
"Death has always been the central question of human
experience, although it is one that, for the greater part
of the twentieth century, most Americans have tried in
various ways to avoid" (p. 5).
Kubler-Ross (1969) in her landmark book On Death and
Dying went so far as to characterize our attitudes toward
death and dying as death denying. In support of this
argument. Brown (1988) has identified the "death
specialists" that our society has created in order to
remove all responsibility for dealing with death on a
personal level. Among those cited are hospitals to house
the very ill and dying, morticians to take care of the
necessary preparations of the body prior to burial, and
funeral directors to handle the actual details of the
burial.
Perhaps part of our distaste and distancing of death
is related to the acute physical and emotional suffering it
involves. Death is indeed considered a major stressor by
most individuals and their families and may result in a
crisis situation. Bowen (1976) has explored the potential
stress that a family may experience due to a death or other
loss in the family unit. Based on multigenerational family
research, Bowen identified the "Emotional Shock Wave" as:
...a network of underground "aftershocks" of serious life events that can occur anywhere in the extended family system in the months or years following serious emotional events in a family. It occurs most often after the death or the threatened death of a significant family member, but it can occur following losses of other types, (p. 339)
According to Hoxlingsworth and Pasnau (1977) death
possesses two unique characteristics that can contribute to
the development of a crisis situation. One, the absolute
finality of death and one's inability to retrieve the loss.
And, two, the likelihood that one remains comparatively
inexperienced in coping with death due to its relative
infrequency and the uniqueness associated with each death.
Death can be viewed as both a personal and a family crisis,
that is, each survivor must bear the pain associated with
the loss and the family unit as a whole must also cope with
and adapt to the death.
The bereavement literature is consistent in its
reports of the many difficulties that survivors endure due
to the death of a family member. It has been debated as to
which loss is the most devastating (e.g., loss of spouse,
child, parent, sibling, or other close relative); however,
it is generally agreed that an attachment loss (i.e., death
of child, spouse, or parent) is more problematic than a
nonattachment loss (i.e., death of sibling, grandchild, or
close friend) (Gass, 1989; Owen, Fulton, & Markusen, 1982;
Raphael, 1983; Sanders, 1980).
The most researched topics in the bereavement
literature have been widowhood and the parental loss of a
young child. There appears to be a paucity of literature
concerning parents who lose an adult child. As noted by
Rando (1986), "Interestingly, even in the literature on
bereaved parents, there is lictle about the loss of an
adult child" (p. 230).
There are several reasons why this area of bereavement
has not been adequately explored. Moss, Lesher and Moss
(1986) have noted the overall unwillingness of mental
health providers and social scientists to explore the
anguish connected to bereavement. Specifically, they have
speculated that the immense pain associated with the death
of anyone's child only adds to the desire to avoid the
issue. In addition, the authors have suggested that
perhaps due to the perceived infrequency of child death, it
has not been considered a topic meritorious of research.
The death of a child at any age may be seen as an
"off-time" event. The trauma associated with the loss is
greater than with an "on-time" death because it is
considered "unnatural" and upsetting to the flow of the
expected life cycle. Several authors have concluded that
the loss of a child is the most painful and longest lasting
grief experienced by most people (Gorer, 1965; Rando, 1984;
Rosen, 1988; Videka-Sherman & Lieberman, 1985). Based on
the observations of a self-help group. The Compassionate
Friends (TCF), Klass (1985) noted that one apparently never
gets over being a bereaved parent. Klass suggests that
"when your parent dies, you lose your past; when your child
dies, you lose the future" (p. 361). In a later article,
Klass and Marwit (1988) observed that "the resolution of
parental grief usually includes a sense that the world is
never what it once seemed to be" (p. 46).
Grief reactions to the loss of a family member may
vary in many different ways. Some factors affecting the
survivor's response to loss are: (a) the type of loss
(attachment, nonattachment or other); (b) the relationship
of the bereaved to the deceased; (c) the manner in which
the family member died; (d) the age of the deceased; (e)
the age of the survivor; and (f) whether or not the death
was sudden or anticipated. It should be noted that whether
the death is sudden or prolonged may affect the degree of
stress at the actual time of death; however, the grief work
for an anticipated death is just as stressful as that for a
sudden death; it simply occurs at a different time in the
grief process (Crosby & Jose, 1983).
Abnormal grief has been described in various ways and
given numerous labels, for example, morbid grief, chronic
Worden, 1991). These four components of social support
were examined in the present study. Also, social support
from both formal and informal network sources was examined.
22
Loss of an Adult Child
There is a dearth of empirical studies addressing the
issue of parental bereavement among older parents who lose
an adult child. In general, "The studies of parental
bereavement have been very few in number and have been
limited in their scope or have been included as a secondary
part of a larger study" (Levav, 1982, p. 24). This is
especially true for adult child loss.
Rando (1986), one of the few authors to write
specifically about the older parent who loses an adult
child, explored the unique issues that separate parents who
lose a grown child from those who lose a younger child.
Among the factors mentioned are: (a) difficulty accepting
the death because the child has successfully survived the
perils of early childhood and adolescence and "should"
easily be able to live out a long life as an adult; (b)
developmental issues of aging and loss of control; (c)
lifespan concerns of retirement, loss of same age siblings
or friends, and widowhood; (d) loss of meaning and sense of
generativity critical to successful aging (Erikson, 1950);
(e) loss of financial, psychological, social or physical
caregiver; (f) decreased abilities and choices for
reinvestment in new relationships; (g) a reduced social
support network due to loss of spouse, friends, or
coworkers; (h) lack of validation of their loss as they are
not considered the primary grievers (family of procreation
23
is considered primary griever); and (i) social
discrimination, that is, society's view that "old" people
are used to death and grief, and therefore they should be
less affected by the loss. Moss et al. (1986) mention the
increased risk of institutionalization that elderly
bereaved parents may face as a result of losing an adult
child caregiver. Raphael (1983) depicted the adult child
as:
a representative of the parent beyond the parent's death, symbolic of the parent's immortality - the only way the parent can go on into the future as he ages. So to lose this adult child would be to lose the continuity of the line, the denial of death that he [adult child] meant for the parent, (p. 234)
Rando (1986) also discusses secondary losses, that is,
those losses that accrue as a result of the death. For a
parent who loses an adult child these may include: (a) fear
of losing contact with a beloved in-law and/or
grandchildren; (b) concern that the grandchildren will
forget their natural parent in the event of re-marriage or
moving away; (c) seeing living reminders of their child in
the looks and actions of grandchildren; (d) having to
assume caretaking responsibilities for grandchildren; (e)
seeing the end of the family name if there is no one else
left to carry it on; and (f) loss of someone to entrust
with family heirlooms. All of these factors may be
considered pileup stressors for the older bereaved parent.
In short, there are a number of factors that can
impact the grief response of older parents mourning the
24
loss of an adult child. In addition to those mentioned
above are: (a) the age of the bereaved parent at the time
of the loss, (b) the cause of death, (c) whether or not the
death was anticipated or sudden, (d) the personal resources
available to the bereaved, and (e) the support of family
members and the social network.
Complicated Grief
According to Worden (1991), individuals who have
experienced a complicated grief reaction in the past will
have an elevated risk of having a complicated reaction in
the present. This is in agreement with the writings of
several other authors (Lindemann, 1944; Rando, 1984;
drug addicts, alcoholics, and schizophrenics) by Weissman,
Sholomskas, Pottenger, Prusoff, and Locke (1977) revealed
substantial evidence for the concurrent validity of the
36
CES-D. Support for the measure was based on the following
findings: (l) the CES-D was able to adequately
differentiate the psychiatric patients from the community
normals; (2) the acutely depressed patients indicated more
symptoms than the other psychiatric patients; (3) the
depressed subgroups within each psychiatric grouping
revealed higher scores than the nondepressed patients
within each of the respective groupings; (4) the acutely
depressed patients tested out higher than the recovered
depressives; and (5) correlations between the CES-D and
other depression measures (e.g., clinician ratings, the
Hamilton and the Raskin Depression Scale, and the Symptom
Checklist (SCL-90) were high. In addition, the
discriminant validity of the instrument was supported by
the low correlation of the CES-D with the variables of age,
sex, and social class.
A recent study by Williamson and Schulz (1992)
revealed "the mean CES-D score for at-risk subjects (24.09)
was close to the 27-point level shown by Schulberg et al.
(1985) to be a very good predictor of clinical depression"
(p. P371). Likewise, Thomas, Kelman, Kennedy, Ahn, and Yang
(1992) found the CES-D to accurately measure the absence of
depression in a sample of 1,855 elderly community residents
at two separate time points.
Due to its ability to consistently ascertain the
presence or absence of depressive symptomatology,
37
especially in an older adult population, the Center for
Epidemiologic Studies Depression Scale was the instrument
of choice for this project. Its brevity and ease of
administration were also considered advantages in the
present study.
Social withdrawal. As mentioned earlier, several
authors have included social withdrawal as one of the
symptoms commonly associated with complicated grief.
However, a suitable measure to tap this dimension of
bereavement was not found. As a result, the 5 items
contained in questions 36 and 39 of the questionnaire, used
to assess social withdrawal in this study, were taken from
Worden (1991) who has suggested that social withdrawal
following a death involves an overall loss of interest m
others and the outside world. Each item is scored based on
a five-point Likert-type scale ranging from strongly
disagree (0) to strongly agree (4). A higher score
indicates a greater level of social withdrawal. In the
present study a coefficient alpha of .85 was obtained for
the scale measuring social withdrawal at the present time.
A conceptual distinction between the social withdrawal
of the participant from family and friends (social
withdrawal measure) and the withdrawal of family and
friends from the participant, as indicated by their lack of
representation in the number of present supportive network
38
contacts (total sources of support index), was confirmed by
the low correlation between the two measures (r(108) =
-.09, n.s.).
Health status. Health status was evaluated using a
three-item index (items 9, 10 and 11). The overall
self-rating of health at the present time consists of four
options, ranging from (1) poor to (4) excellent. The
self-report of present health compared to five years ago
consists of three options, ranging from (1) worse to (3)
better. The extent to which health problems stand in the
way of performing desired activities consists of three
options, ranging from (1) a great deal to (3) not at all.
Responses are added together for a total health score.
Higher scores indicate better health. This three item
index was used recently in a study of older, rural adults
by Scott and Roberto (1985). Inter-item consistency was
.76 using Cronbach's alpha. Reliability using Cronbach's
alpha was .68 in the present study.
Independent Variables
Prior losses. Respondents were asked to identify all
the prior losses they had experienced (item 12 of the
questionnaire). The losses were then divided into
attachment and nonattachment categories. Each category was
summed for an attachment, nonattachment, and total combined
39
score. Higher scores reflect a greater number of pileup
factors contributing to a complicated bereavement outcome.
Social support. The items used to assess subject's
report of their support network and the amount of social
support provided (items 28 through 35 of the questionnaire)
are similar to those used by Ricketts (1989) to examine
parental grief in the case of the unexpected death of an
older child. The total number of present network sources
of support was summed to provide a Total Sources of Support
Index. In addition, the present amount of social support
provided by the most helpful member of the network (based
on the 19 options presented in item number 35 of the
questionnaire) was also summed, resulting in a Total Amount
of SoCj.al Support Index.
Th3 total amount of social support received was
further subdivided into four separate dimensions of social
support. This resulted in four subscales as follows: (a)
emotional support (e.g., shared personal experience), (b)
instrumental support (e.g., provided transportation), (c)
informational support (provided needed information), and
(d) social companionship (e.g., provided distractions).
The alpha coefficients for these indices may be found in
Table 1.
40
Procedures
Local ministers, a support group for bereaved parents
and hospice personnel were contacted regarding the
identification of potential study participants. Each of
these sources provided the researcher with the names and
telephone numbers of persons they felt met the eligibility
requirements of the study. Most of the church members had
been notified in advance and were expecting phone contact.
A phone call was made to each individual to answer any
remaining questions and to confirm participation.
In addition, a screening questionnaire (Appendix B)
suitable for mass distribution was designed for use by
agencies agreeing to participate but who did not wish to
release names and telephone numbers of potential subjects
directly to the researcher. The screening questionnaire
was used to ascertain whether persons had lost a spouse or
a child in the last five years and whether or not they
would be willing to participate in the study.
Approximately 800 screening forms were mailed out to
persons involved in a senior volunteer program. Fifty
forms were distributed to a local support group for
bereaved spouses, 130 forms were distributed to the local
Meals on Wheels office, and 30 forms were distributed at a
retirement community. Following return of the screening
questionnaire and determination of eligibility for the
41
study, a phone call was made to each person to answer any
remaining questions and to confirm participation.
Each participant was given the option of being
interviewed in person, having the information dropped off
personally, or having it mailed. A total of 53% (57) of
the interviews were completed orally and the remaining 47%
(51) were completed and returned by the participants.
Widowed persons responded to a questionnaire identical to
the one used by bereaved parents, except for rewording to
reflect the loss of a spouse rather than of an adult child
For those questionnaires delivered in person participants
were asked to call the researcher when they had been
completed so that a pickup time could be arranged. For
mailed questionnaires a cover letter containing
instructions for completion and return was included
(Appendix C). Phone calls were made to discuss missing
information and to follow-up non-returned materials.
A list of available community resources was provided
to each participant in the study (Appendix D). The
following services were identified:
(a) The Psychology Clinic at Texas Tech University,
(b) The Family Therapy Clinic at Texas Tech
University,
(c) Charter Plains Hospital,
(d) THEOS-Support group for widowed persons,
42
(e) Compassionate Friends-Support group for bereaved
parents.
Analyses
Cronbach's alpha was used to assess the reliability of
the Texas Revised Grief Inventory, the Center for
Epidemiologic Studies Depression Scale, the social
withdrawal scale, and the health index. The alpha
coefficients for these measures may be found in Table 1.
For Hypotheses 1 and 2 a discriminant analysis was
used to assess the differences between the groups on
depression, social withdrawal, grief intensity level, and
health status. For Hypotheses 3 and 4 a discriminant
analysis was used to assess the differences between the low
and high sources of support groups of bereaved parents on
depression, social withdrawal, grief intensity level, and
health status.
43
Table 1
Cronbach's Alpha Values
Health Index .68
Texas Revised Inventory of Grief Part II (TRIGII)
Social Withdrawal Scale - Present
Center for Epidemiologic Studies Depression Scale (CES-D)
Total Amount of Social Support Index
Emotional Support Subscale
Informational Support Subscale
Instrumental Support Subscale
Social Companionship Support Subscale
. 85
. 8 5
. 9 0
. 86
. 8 4
. 66
. 64
e . 48
44
CHAPTER IV
RESULTS
Recruitment and Description of the Sample
Participants for the study were recruited from
churches and community agencies in a southwestern city of
200,000 persons and several smaller surrounding
communities. Referrals from local churches accounted for
the majority of the participants (38.0%), while 5.6% lived
in retirement communities, 5.6% were Meals on Wheels
recipients, 16.7% were members of a bereavement support
group, 7.4% were active members of senior volunteer
programs, 11.1% were referrals from Hospice, and 15.7% were
referred by other study participants.
A total of 120 names were supplied and 115 screening
questionnaires were returned for a potential subject pool
of 235 persons. However, a number of potential
participants did not meet the study requirements.
Disqualifying reasons included: (a) subject being too young
when the child or spouse died; (b) child being too young at
time of death; (c) death was over five years ago; (d)
subject had overlapping losses (i.e., both spouse and adult
child had died in the last five years); or (e) subject did
not indicate loss of adult child or spouse on the screening
questionnaire. In addition, several persons were not able
to be contacted. The most common problem was a change of
45
address or unlisted telephone number. Also the list of
names provided by Hospice included several persons who had
died since the time of the target loss.
Following review for study eligibility, a final
potential subject pool of 154 subjects was identified. Of
this number, 30% refused to participate and the remaining
70% were included in the study (see Table 2). Reasons
given for refusal (when individual was personally
contacted) included: (a) present health (e.g., awaiting
surgery); (b) scheduling conflict (e.g., vacations or
visiting relatives); and (c) unwillingness to talk about
the death or fill out a questionnaire that would require
thinking about the death.
A total of 108 bereaved persons participated in the
project, 53 bereaved parents and 55 bereaved spouses.
Of the total, 20.4% were men and 79.6% were women. The age
range was from 55 to 93 with a mean of 71.2 years. The
sample was primarily Caucasian (95.4%), with
African-Americans making up 2.8%, and others making up
1.8%. The overall education level of the sample was 12.9
years. Slightly over half of the subjects were retired
(54.6%), 13.9% continued to work fulltime, 9.3% worked
parttime, and 22.2% indicated they were housewives.
Of those retired, most had been retired for 5 to 9 years
(32.2%). Only 5.1% had been retired 1 year or less, 13.6%
had been retired 2 to 4 years, 18.7% had been retired 10 to
46
15 years, 10.2% had been retired 16 to 20 years, and 20.2%
had been retired over 20 years.
The demographic characteristics of the bereaved parent
and spouse groups are presented in Table 3. As may be
seen, there were no significant differences between the
groups, except on income where parents reported higher
incomes than surviving spouses (t(98) = 2.28, p < .05).
Income was determined by asking participants to check the
appropriate range that represented their annual income.
The lowest range was from $1,000 to $4,999 and the upper
range was $50,000 or more. The mean range for annual
income for the total sample was between $20,000 and
$29,999.00. Eight participants did not disclose their
income.
There were no significant differences between the
bereaved parents or bereaved spouses on their total loss
histories (t(106) = -.17, n.s.) nor on their individual
attachment (t(96) = 1.02, n.s.) or nonattachment loss
(t(106) = -.81, n.s.) histories. T-tests revealed no
significant differences between the groups on their age at
the time the loss was experienced (t(106) = .48, n.s.), nor
on the time since the death (t(106) = -1.05, n.s.). Also
the groups did not reveal differences based on whether the
deaths were sudden versus slow (A^(l, N = 108) = .13, n.s.)
or expected versus unexpected {^{1, N = 108) = .13, n.s.).
47
There were no differences between the groups on
depression (t(lOO) = -1.52, n.s.), social withdrawal
(t(lOO) = -1.72, n.s.), or health (t(106) = -.44, n.s.).
However, the groups did differ significantly on grief
intensity level with bereaved parents scoring higher than
bereaved spouses (t(106) = 1.95, p < .05). The means and
standard deviations for these variables are presented in
Table 4.
A measure of diversity across the network based on
persons identified as helpful at the present time was also
developed. If participants indicated that they received
help from only one category (i.e., professionals, family
members, or nonfamily members) they received a value of
one, if they indicated that they received help from two of
the above mentioned categories they received a value of
two, and if they indicated they received help from all
three categories they received a value of three. Analysis
revealed no significant differences between the bereaved
parents and spouses groups across the networks to which
they were connected (A^(2, N = 104) = .10, n.s.).
Analyses were also conducted to determine any
differences between the low and high support groups of
bereaved parents based on the number of network sources of
support. T-tests revealed no significant differences
between the two groups on their total loss histories
(t(49) = -.32, n.s.) nor their individual attachment
48
(t(51) = .41, n.s.) or nonattachment loss histories
(t(51) = -.59, n.s.). There were no significant
differences between the groups on their age at the time the
loss was experienced (t(51) = .74, n.s.), nor on the time
since the death (t(51) = .33, n.s.). Also, the groups did
not reveal differences based on whether the deaths were
sudden versus slow (A^d, N = 53) = .23, n.s.) or expected
versus unexpected (A^(l, N = 53) = .10, n.s.).
In addition, there were no significant differences
between the groups on social withdrawal (t(22) = .93, n.s.)
or grief intensity level (t(29) = .19, n.s.). However, the
groups did differ significantly on depression with the high
support group scoring lower than the low support group
(t(51) = 2.61, p < .01). Also, the groups differed
significantly on health status with the high support group
reporting better health than the low support group (t(51) =
-2.27, p < .05).
The leading cause of death for adult children was
cancer (26.4%) followed closely by AIDS (20.8%). Heart
attack or stroke accounted for 13.2% of all adult child
deaths, 7.5% died as the result of a brain tumor, aneurysms
accounted for 5.7% and 11.3% died as a result of other
illnesses. Suicide was given as the cause of death for
3.8% and murder was also responsible for 3.8% of the
deaths. Accidents claimed the lives of 7.5% of the adult
children.
49
Heart attack or stroke was the primary cause of death
for spouses (52.7%) followed by cancer (32.7%). A brain
tumor was responsible for 1.8% of all deaths and 12.7% died
as a result of other illnesses.
Hypotheses 1 and 2
Hypothesis 1 predicted that older parents suffering
the loss of an adult child would have significantly higher
scores on measures of depression and social withdrawal, and
a significantly lower score for health status in comparison
to bereaved spouses. Hypothesis 2 predicted that older
bereaved parents would report significantly higher grief
intensity levels in comparison to bereaved spouses. Both
hypotheses were tested with a multivariate discriminant
analysis in order to see if a set of variables including
income, depression, grief intensity, social withdrawal, and
health could significantly discriminate between the two
bereaved groups. Income was entered on the first step
followed by depression, grief intensity, social withdrawal,
and health. The Wilks' lambda selection method was chosen.
The analysis revealed overall significance for the
combination of discriminating variables (Wilks' lambda =
.85, p < .01). The discriminant function was weighted
largely by grief intensity level (-.99) and depression
(.75). Taking all variables together, persons in the
parent group were distinguished from the spouses group by
50
having higher grief, a lower health status, less social
withdrawal, less depression, and higher income (see Table
5). The findings provided partial support for Hypothesis 1
and fully supported Hypothesis 2. Overall the ability of
the variables to separate the groups was modest, accounting
for only 15% of the total variance existing between the two
groups.
Hypotheses 3 and 4
Hypothesis 3 predicted that bereaved parents with a
greater number of network sources of support would have
significantly lower scores on measures of depression and
social withdrawal, and a higher score for health status in
comparison to bereaved parents with a lower number of
•\etwork sources of support. Hypothesis 4 predicted that
the bereaved parent group with a greater number of network
sources of support would report a significantly lower grief
intensity level in comparison to the bereaved parent group
with a lower number of network sources of support.
The total number of supportive sources reported by
bereaved parents at the present time ranged from 0 to 11
with a mean of 6.0. The groups were divided at the median,
with the low support group made up of those parents who
reported 0 to 5 (n=18) supportive sources and the high
support group made up of those parents who reported 6 to 11
(n=35) supportive sources.
51
Both hypotheses were tested with a multivariate
discriminant analysis in order to determine if a set of
variables including depression, grief intensity, social
withdrawal, and health could significantly discriminate
between the low and high support groups of bereaved
parents. Discriminant analysis revealed overall
significance for the combination of discriminating
variables (Wilks' lambda = .81, p < .05).
The discriminant function was largely represented by
depression (.83) followed by grief intensity (-.55). On
the whole, persons in the high support group were
distinguished from the low support group by having
significantly higher health status, significantly less
depression, and less social withdrawal (see Tables 6 and
7). These findings supported Hypothesis 3. However, the
analysis also revealed that bereaved parents with a greater
number of network support sources actually reported a
higher grief intensity level, thus Hypothesis 4 was not
supported. Overall the ability of the variables to
separate the bereaved parents groups was modest, accounting
for only 19% of the total variance existing between the two
support groups.
Interestingly, when the low versus high support groups
were divided so that the low group encompassed from 0 to 6
supportive sources (n=32) and the high group encompassed
52
from 7 to 11 supportive sources (n=21) discriminant
analysis did not meet established criteria for significance
(Wilks' lambda = .83, p = .06). The findings, while not
significant, were in the direction predicted by Hypothesis
3, that is, persons with a greater number of support
sources had better health, less depression, and less social
withdrawal. However, Hypothesis 4 was not supported as
those parents with a high number of support sources
continued to report a greater grief intensity.
Social Support
The total amount of social support received from the
most helpful person in the network at the present ranged
from 3 to 16 for the bereaved parents group with a mean of
9.55. The group? were divided at the median, the low level
support group being comprised of persons who received from
3 to 9 helpful behaviors (n=23) while the high level
support group encompassed those persons who received from
10 to 16 helpful behaviors (n=26).
A discriminant analysis using the outcome variables of
depression, grief intensity, social withdrawal, and health
did not discriminate between the low versus high social
support groups based on the amount of social support
received by bereaved parents (Wilks* lambda = .96,
^ _ 30). Of the dimensions of social support examined
(emotional, instrumental, informational, social
53
companionship) emotional support is considered to be
particularly beneficial following a loss. However, a
discriminant analysis using the four outcome variables
failed to discriminate between low and high emotional
support groups or any of the other dimensions of social
support (Wilks' lambda = .96, p = .73).
In addition, the sources of support were divided into
three subcategories: (a) professionals (e.g., doctor,
religious leader, funeral director); (b) family members
(e.g., spouse, mother, son); and (c) nonfamily members
(e.g., friend, neighbor, co-worker). With respect to these
subcategorizations of the network based on the most helpful
person, the bereaved parents group did not identify any
professional as the most helpful person at the present
time. Two parents indicated that they no longer needed any
help and therefore listed no one as most helpful at the
present time. Nonfamily members received 28% of the
mentions as the most helpful person and family members
received the highest number accounting for 68% of all
mentions. Friends were the most frequently mentioned
nonfamily members (17%) and spouses were the most mentioned
family members (36%).
When asked if anyone had disappointed them in
providing support following the loss of their child
bereaved parents most often indicated that no one had
54
disappointed them (73%). However, if someone was
mentioned, he/she was most often a family member (19%).
Only one parent indicated he/she was disappointed in a
professional (2%) and 6% mentioned disappointment in the
support provided by nonfamily members (6%).
Total Loss History
As may be expected at this point in the life cycle of
the participants most had experienced multiple losses,
ranging from a low of 2 to a high of 11 with a mean of
5.20. The groups were divided at the median with those
having 2 to 4 losses being considered the low loss history
group and those having 5 to 11 losses being considered the
high loss history group. A discr...minant analysis based on
these two loss history groups failad to reveal significant
differences in the groups according to the outcome measures
(Wilks' lambda = .84, p = .07).
55
Table 2
Recruitment Sources of Study Participants
Potential Source Subjects Refused Participated
Local Churches 43 2 41
Senior Volunteer Program 22 14 8
Support Group -Spouses 15 3 12
Support Group -Parents 7 1 6
Retirement
Community 12 6 6
Meals on Wheels 17 11 6
Hospice 17 5 12
Participant Referrals 21 4 17
Totals 154 46 108
(30%) (70%)
56
Table 3
Demographic Characteristics of a Sample of Older Bereaved Parents and Spouses
Characteristic Bereaved Bereaved Test of Parents Spouses Significance
Current age(X)
Education level(X*)
71.40 71.07 n. s
Gender
(1) Male
(2) Female
Race
(1) White
(2) Black
(3) Hispanic
(4) Other
Employment Status
(1) Fulltime
(2) Parttime
(3) Retired
(4) Housewife
(9.74)^ (8.0)
12.94
(3.89)
22.6
77.4
94.3
1.9
1.9
1.9
12.89
(3.07)
18.2
81.8
96.4
3.6
0.0
0.0
2 0 . 8
7 . 5
4 9 . 1
2 2 . 6
7 . 3
1 0 . 9
6 0 . 0
2 1 . 8
n. s
n. s
n. s
n. s
57
Table 3
Continued
Bereaved Bereaved Test of Characteristic Parents Spouses Significance
Years Retired n.s.
(1) 1 year or less 1.7 3.4
(2) 2 to 4 years 8.5 5.1
(3) 5 to 9 years 11.9 20.3
(4) 10 to 15 years 6.8 11.9
(5) 16 to 20 years 5.1 5.1
(6) over 20 years 10.1 10.1
Income
(1) $ 1,000-$ 4,999 2.1 1.9 p < .05
(2) $ 5,000-$ 9,999
(3) $10,000-$14,999
(4) $15,000-$19,999
(5) $20,000-$24,999
(6) $25,000-$29,999
(7) $30,000-$34,999
(8) $35,000-$39,999
(9) $40,000-$44,999
(10) $45,000-$49,999
(11) $50,000 or more
2 . 1
8 . 5
1 0 . 6
1 2 . 8
1 7 . 0
2 . 1
8 . 5
8 . 5
0 . 0
2 . 1
2 7 . 7
1.9
1 7 . 0
1 7 . 0
1 1 . 3
2 0 . 8
7 . 5
5 . 7
3 . 8
1 .9
1 .9
1 1 . 3
^Standard deviations are in parentheses.
*p < .05.
Note. Bereaved parents N=53 and Bereaved spouses N=55.
58
Table 4
Means and Standard Deviations of Dependent and Independent Variables
Variable
Depression
Parents
Spouses
Grief Intensity
Parents
Mean
10.42
13.33
45.19
Spouses
Social Withdrawal
Parents
Spouses
Health Status^
Parents
Spouses
Total Loss History
Parents
Spouses
Attachment Loss History
Parents
Spouses
Nonattachment History
Parents
Spouses
41.27
6.92
7.87
7.02
7.16
5.17
5.24
3.38
3.20
1.79
2.04
Standard Deviation
8.50
11.27
10.67
10.16
3.68
4.27
1.77
1.69
2.16
1.82
1.02
.76
1.58
1.54
Test of Significance
n.s.
p < . 05
n.s.
n. s
n. s
n. s
n. s
59
Table 4
Continued
Standard Test of Variable Mean Deviation Significance
Age at Time of Loss n.s.
Parents 69.49 9.86
Spouses 68.67 7.93
Time Since Loss n.s.
Parents 2.77 1.78
Spouses 3.13 1.71
Sudden Versus Slow Death n.s
Parents 1.40 .49
Spouses 1.53 .50
Expected Versus Unexpected n.s
Parents 1.38 .49
Spouses 1.51 .50
^Assessed by inquiring about participants present health status, change in health over the past 5 years, and extent of activity restriction due to health. High scores represent better health.
Note. N=108
60
Table 5
Discriminators of Bereaved Parents Versus Bereaved Spouses
Standardized Discriminant Coefficients Factor 1**
Step Variable Bereaved Parents vs. Bereaved Spouses
1. Income -.42
2. Depression .75
Grief Intensity -.99
Social Withdrawal .42
Health .38
**Wilks' lambda = .85, p < .01
Note. N=100
Group Centroids
Bereaved Parents -.44
Bereaved Spouses .39
61
Table 6
Discriminators of Low Versus High Sources of Social Support for Bereaved Parents
Standardized Discriminant Coefficients Factor 1*
Variables Low vs. High Sources of Social Support
Depression .83
Grief Intensity -.55
Social Withdrawal .24
Health -.49
Group Centroids
Low sources of social support .66
High sources of social support -.34
*Wilks' lambda = .81, p < .05
Note. N=53
62
Table 7
Cell Means and Standard Deviations of Discriminators of Low Versus High Sources of Social Support for Bereaved Parents
Variable Mean Standard Deviation
Depression
Low 12.16 9.19
High 7.76 6.70
Grief Intensity
Low 45.84 11.94
High 44.19 8.58
Social Withdrawal
Low 7.56 4.30
High 5.81 1.75
Health
Low 6.53 1.81
High
Note. N=53
7.76 1.45
63
CHAPTER V
DISCUSSION
This study examined the bereavement experiences and
outcomes resulting from the loss of an adult child and from
loss of a spouse. The Double ABCX Model of Family
Adaptation guided the selection of variables and
development of hypotheses. Partial support for Hypothesis
1 was found. Hypotheses 2 and 3 were supported and
Hypothesis 4 was not supported. This chapter will address
the following issues in regard to the theoretical model and
hypotheses: (a) the "fit" of the study results and the
factors of the Double ABCX Model of Family Adaptation; (b)
the differences between bereaved parents and bereaved
spouses; and (c) the differences between groups of bereaved
parents based on a low versus high number of network
sources of support. Also the limitations of the present
study and directions for future research will be discussed
in this chapter.
Double ABCX Model of Family Adaptation
Prior losses can act as pileup ("aiA" factor) in the
Double ABCX Model, contributing to the difficulty in
resolving the loss. In the present study a discriminant
analysis based on a low versus high number of total losses
failed to reveal significant differences in the outcome
64
measures. Findings did not support prior total losses as a
pileup factor. Perhaps the summation of one's total loss
history does not accurately tap unresolved loss
experiences. It may be that indices based on the salience
of the loss or the role the deceased played in the life of
the survivor would provide a better measure of the impact
of prior losses as a pileup factor.
Social support was examined as the resources factor
("bB") of the model. The findings do indicate that those
bereaved parents with a greater number of sources of
support from their network experienced less depression,
less social withdrawal, and a better current health status.
These findings support the bereavement literature regarding
the importance of social support as a resource capable of
influencing the grief response of bereaved individuals
Peterson, 1984). Bereaved spouses must not only suffer the
loss of a primary support relationship, they many times
must cope with a disruption in their established
interpersonal and support networks (Hansson & Remondet,
1988). Such disruption could be speculated to lead to an
increased level of social withdrawal.
This premise is borne out in the present study by the
experience of several widowed persons. Several bereaved
spouses shared stories in which they felt they had been
abandoned by their longtime couple friends. They were hurt
by being excluded from previously shared activities with
their former friends, but felt helpless to do anything to
change the situation. As one widow so poignantly pointed
out, "I can't bring back (the deceased) simply so I can
enjoy our travel club trips again ca.. I?"
Also bereaved spouses were more likely to mention that
they had been disappointed in the support they received
following their loss than were bereaved parents. In all,
38% of bereaved spouses indicated disappointment with
someone in their support network compared to 26% of
bereaved parents who made such mentions. Also 13% of
bereaved spouses mentioned another bereaved spouse as the
person most helpful to them at the present time, whereas
none of the bereaved parents listed another bereaved parent
69
(other than their spouse) as the person most helpful to
them.
Given the possible disruption in their network due not
only to the loss of a primary support member but also to
the lack of support from other network members, the
increased social withdrawal of bereaved spouses in
comparison to bereaved parents may be understandable. The
lack of support and increased social withdrawal may, in
turn, further increase their susceptibility to depression.
The bereaved parent group also revealed a
significantly higher income than the bereaved spouse group
(t = 2.28 (98), p < .05). This was due largely to the fact
that more parents were still employed than widowed persons
thus increasing their annual earnings. This income
differential between married and widowed persons is
consistent with income reported in other literature
(Heinemann & Evans, 1990).
Differences Between Bereaved Parents
According to the bereavement literature, social
support is an important resource in arriving at a healthy
resolution to the loss. This is supported in the present
study in that those bereaved parents with a higher number
of support sources reported significantly less depression
and less social withdrawal than those parents with a lower
number of support sources. In addition, those with a
70
higher number of support sources also reported
significantly better health. These findings provided
support for Hypothesis 3.
On the other hand, having a high number of support
sources did not appear to protect bereaved parents from
also having a high grief intensity level. It should be
noted that the presence of a high grief intensity level
does not by itself indicate the presence of complicated
grief. It may be that social support does indeed aid
bereaved parents in avoiding a complicated grief reaction.
However, social support (or anything else for that matter)
may not mitigate the intrapsychic pain and resulting grief
experience of losing a child.
Limitations of the Study
Several limitations of the present study should be
noted. First, the sample was not random nor was it
representative of all bereaved parents or spouses. The
sample was recruited from a number of different sources,
all of which may be said to involve a certain amount of
social interaction and hence social support. Care should
be taken in generalizing the results of the present study
inasmuch as all subjects were volunteers willing to be
queried about a sensitive and personal topic and all were
involved in some type of supportive network.
71
Second, the study used a cross-sectional design thus
limiting speculation about individual changes in the grief
experience over time. Issues of timing in the use of
resources, coping, and grief resolution could not be
adequately addressed in this study. Third, the sample size
was small and limited to those bereaved persons who had
experienced the loss of a child or spouse in the last five
years. These factors further limit the generalizability of
the results.
Implications for Future Research
Overall bereavement research is in its infancy. There
is a great need for additional research in all facets of
the bereavement experience. However, longitudinal research
is especially needed as we strive to understand more about
the grief process and its effects over time on bereaved
individuals. Such research will aid in assessing the
effects of grief on the long-term physical and mental
health of survivors.
As noted earlier, most of the bereavement literature
has focused on widowhood. With the graying of America
there is an increasing need for research directed at
helping parents cope with the death of an adult child. A
pressing concern is the number of adult children who die as
a result of AIDS. In this small study alone, 11 of the 53
parents interviewed attributed the cause of their child's
72
death to AIDS. Clearly, this is an area in need of
increased attention by researchers.
This study included only a few of the many possible
variables affecting the grief response of older adults. In
this regard, there is a need for investigation of other
factors identified by the Double ABCX Model of Family
Adaptation. For example, further exploration of pile-up
factors affecting the grief experience is called for, as is
future research directed at the survivor's perception of
the death.
A final concern involves the risk factors for a
complicated grief outcome. With an aging population it is
imperative that we determine those most at risk for a
maladaptive grief response and identify those factors which
will help alleviate the negative physical and psychological
outcomes associated with complicated grief.
73
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APPENDIX A
QUESTIONNAIRE
Please complete each question by checking the 'appropriate response item or by writing a response in the space provided, Your responses will remain confidential.
Name
Address
Telephone. Date of Birth ./.
3.
4.
5.
6.
Gender Female Male
Race White BlacJc Hispanic. Other
Marital Status Single Married Widowed Divorced Separated
Length of present marital status in years
Years of school completed
Employment Status Employed full-time. Employed part-time. Retired Housewife
7. xf ] 1 2 5 10 16 Ov«
retired, how year or less - 4 years - 9 years - 15 years - 20 years »r 20 years
Income - 4,999 - 9,999 - 14,999 - 19,999 - 24,999 - 29,999 - 34,999 - 39,999 - 44,999 - 49,999 or more
9. Rate overall health at present Excellent. Good Fair Poor
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10. Present health compared to health five years ago Better About the same Worse
11. How much your current health affects your activity level
Not at all A little (some) A great deal
12. Please check each type of loss you have experienced and indicate the age of the person at the time of death and the year the death occurred.
IF DECEASED, AGE AT IN WHAT YEAR DID IifiSS QLL TIME QZ DEATH? DEATH OCCUR?
.Mother
.Father
.Brother(s)
.Sister(s)
.Spouse(s)
.Child(ren)
.Grandchild(ren)
.Other Family
.Close Friend(s)
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13. I have strong rel igious beliefs Agree. Strongly agree Disagree Strongly disagree.
14. I attend church Frequently - at least once a week Occasionally - at least once a month Seldom Never
15. I was years old when the death occurred
16. I viewed the death as Mildly Stressful. Very Stressful Overwhelming, I couldn't do anything
17. I feel as if I should have been able to prevent the death Yes No
18. Cause of death
19. The death was Sudden. Slow
20. The death was Expected. Unexpected.
21. I attended the funeral of the person who died True False
22. I feel that I have really grieved for the person who died True False
23. I feel that I am now functioning about as well as I was before the death True
False
24. I seem to get upset each year at about the same time the person died True
False
25. Sometimes I feel that I have the same illness as the person who died True
False
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26. Think back to the time your child died and answer all of these Items about your feelings and actions at that time by indicating whether each item i« Completely True, Mostly True, Both True and False, Mostly False, or completely False as it applied to you after this person died. Check the best answer.
g. I hide my tears when I think about the person who died. _
h. No one will ever take the place in my life of the person who died. _
i. I can't avoid thinking about the person who died. _
j. I feel it's unfair that this person died. _
k. Things and people around me still remind me of the person who died..
1. I am unable to accept the death of the person who died. _
m. At times I feel the need to cry for the person who has died. _
28. Please indicate by checking the appropriate category the frequency of help you received from the following persons in the month immediately following your child's death.
About Several No Once Times
Contact A Month A Month Weekly Daily
Spouse
Religious Leader
Mother
Father
Sister
Brother
other Relatives
Friends
Co-Workers
Neighbors
Doctors
Self-help Group
Nurses
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About Several No Once Times
Contact A Month A Month Weekly Daily
Funeral Director
Other Bereaved Parents
Mental Health Professional
Other
29. Who was the most helpful to you in helping you deal with the death of your child in the month immediately following the death?
_(from list above)
30. If a relative was listed as the most helpful, please give his/her specific relationship to you.
31. What types of help did the most helpful person listed above offer?
Please check all that apply
Opportunity to talk Expressed concern Was a good listener Was there when I needed them Provided me with a- new way of seeing things Offered to lend me money Helped me get involved in social activities again Provided needed information Talked to me about religion Provided transportation Shared personal experience Spoke highly of my lost loved one Avoided criticism Helped with household tasks Provided distractions Helped me with things that needed to be done Gave me advice Encouraged me to recover Other
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32. Please indicate by checking the appropriate category the frequency of help you presently receive from the following persons.
Spouse
Religious Leader
Mother
Father
Sister
Brother
Other Relatives
Friends
Co-Workers
Neighbors
Doctors
Self-help Group
Nurses
Funeral Director
Other Bereaved Parents
Mental Health Professional
Other
About No Once
Contact A Month
Several Times
A Month Weekly Daily
33. Who is presently the most helpful to you m helping you deal with the death of your child?
_(from list above)
34. If a relative was listed as the most helpful, please give his/her specific relationship to you.
87
"• ^ISov/SHr?' "•'" ""̂ "• "'°" "•̂ •""̂ "•"<"> l " " " Please check a l l that apply
Opportunity to talk . Expressed concern
Waa a good l i s tener Was there when I needed them of?«i**!**.'"',*'^i^ * "*'' '̂̂ y °^ seeing things Offered to lend me money 2! iS?2 ?• '^5 involved in soc ia l a c t i v i t i e s again Provided needed information Talked to me about rel ig ion Provided transportation Shared personal experience Spoke highly of my lost loved one Avoided cr i t i c i sm Helped with household tasks Provided dis tract ions Helped me with things that needed to be done Gave me advice Encouraged me to recover Other
36. Please indicate how much you agree with each of the fo l lowing statements concerning your a c t i v i t i e s m the month following your ch i ld ' s death.
Strongly Not Strongly Disagree Disagree Sure Agree Agree
a. I stopped watching t e l e v i s i o n .
b. I withdrew from family and f r i e n d s .
c. I stopped reading newspapers and magazines.
d. I found it difficult to go out.
e. I lost interest in the outside world.
37. Was there anyone who disappointed you in providing support? If so, please indicate their relationship to you from the list above m question #27.
38. In what way were you disappointed?
88
39. Please indicate how much you agree with each of the following statements concerning your present activity level.
Strongly Not Disagree Disagree Sure Agree
Strongly Agree
a. I still do not watch television.
b. I am withdrawn from family and friends.
c. I have stopped reading newspapers and magazines.
d. I still find it difficult to go out.
e. I have lost interest in the outside world.
40. Below is a list of the way you might have felt or behaved. Please indicate how often you have felt this way during the last w«ek.
During the last week:
a. I was bothered by things that usually don't bother oe.
b. I did not feel like eating; my appetite was poor.
c. I felt that I could not shake off the blues even with help from my family or friends.
d. I felt that I was just as good as other people.
e. I had trouble keeping my mmd on what I was doing.
f. I felt depressed. g. I felt that everything I
did was an effort. h. I felt hopeful about the
future. 1. I thought my life had been a
failure, j. I felt fearful.
Rarely or none of the time (less than 1 day)
Some or little of the time (1-2 days)
Occasionally or a moderate amount of time (3-4 days)
Most or all of the time (5-7 days)
89
Rarely or none of thm time (less than 1 day)
Some or little of the tiioe (1-2 days)
Occasionally or a moderate aaount of tia« (3-4 days)
Host or all of the time (5-7 days)
k. My sleep was restless. 1. I was happy. m. I talked less than usual. n. I felt lonely. o. People were unfriendly. p. I enjoyed life. q. I had crying spells. r. I felt sad. s. I felt that people disliked
me. t. I could not get 'going
, I
41. What has changed in your life since the death of your child?
42. What meaning have you been able to make out of the death of your child?
90
43. How has the death of your child been different from other deaths you have experienced?
44. Are there any other comments you would like to make?
Thank you for your participation in this project. Your time, effort, and willingness to share this information is gratefully acknowledged and appreciated.
91
APPENDIX B
SCREENING QUESTIONNAIRE
The purpose of this survey is to better understand the grief experience of older adults. Please complete the questions below concerning the deaths of family members that you have experienced. Your responses will be treated confidentially. I hope you will choose to become a part of this important project. After completing the following questions, please return this form to: Janettee Henderson, 6907-B Hartford Avenue, Lubbock, TX 79413 by April 15 m order for it to be processed in a timely manner.
Name
Address:
Telephone:.
Female Male / / Date of Birth
Please check each type of loss you have experienced and indicate the age of the person at the time of death and the year the death occurred.
IF DECEASED, AGE AT IN WHAT YEAR DID LOSS OF: TIME QZ DEATH? D£AIH OCCVR?
.Mother
.Father
_Brother(s)
_Sister(s)
.Spouse(s)
Child(ren)
Other family member :— (specify relationship . '
yes I would be willing to be interviewed in more depth about the losses I have experienced,
no Your time and willingness to participate m this survey is greatly appreciated. ^ janettee Henderson
Texas Tech University
92
APPENDIX C
INSTRUCTIONS FOR MAILED QUESTIONNAIRES
Enclosed please find a consent form, a questionnaire and a stamped return envelope for your use m participating in the bereavement research project at Texas Tech University. It will take approximately 45 minutes of your time to fill out the questionnaire. Please answer all questions using either a pencil or ball point pen. Please complete this form using only your own thoughts.
It is very important that you sign and return the consent form. Once data collection is complete the actual questionnaires will be destroyed. Only group data will be compiled. No names or identifying information will be used in the completed report.
If in the process of completing this information you experience any distress, a list of local mental health services and bereavement self-help groups is enclosed for your use.
Please return the enclosed information in the next week so that the project can proceed in a timely manner. Again, I appreciate your cooperation in learning more about the grieving process of seniors. If you have any questions, please feel free to call mf* at 806/793-9458.
B. Janettee Henderson Texas Tech University
6907-B Hartford Avenue Lubbock, TX 79413
93
APPENDIX D
LOCAL SOCIAL SERVICES RESOURCE LIST
The Psychology Clinic at Texas Tech University 742-3737
The Family Therapy Clinic at
Texas Tech University 742-3074
Charter Plains Hospital 744-5505
THEOS - Support group for bereaved spouses Contact: Kathy Taylor 792-3615
Compassionate Friends - Support group for bereaved parents Contact: Jan Thompson 747-3924
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Texas Tech University Health Sciences Center, I agree that the Library
and my major department shall make it freely available for research
purposes. Permission to copy this thesis for scholarly purposes may
be granted by the Director of the Library or my major professor. It
is understood that any copying or publication of this thesis for
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Agree (Permission is granted.)
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