The elderly population is especially vulnerable to depression because of numerous factors linked to the aging process, including loss of independence and freedom as well as a decrease in memory, speed, health, and skin elasticity. In fact, one of the most imperative factors is the fact that at some time in his or her life, an older person will most likely end up losing his or her spouse, leaving him or her spousally bereaved (Cleiren, 2019). Spousal bereavement is a very devastating and life-altering event that becomes more likely or evident with advancing age. According to Hawton and Harris (2008), widowhood affects a great number of elderly men and women around the world, annually. As a result of this latter, a great report of complaints associated with symptoms of depression, including poor sleep, suicidal ideation, despair, and the like are likely observed or evidenced in the spousally bereaved elderly population (Hawton & Harris, 2008). This paper is going to focus on the high rate of persistent depression experienced by older adults over the age of 65 due to trauma from the loss of a spouse.
Losing a spouse can be both frightening as older widows/widowers must try to adjust and adapt to their new life’s condition of being old and single. The loss of a loved one usually compels people to experience an immediate period of acute and chronic grief that involves intrusive thoughts, intense emotional distress, and withdrawal from daily functioning activities (Cleiren, 2019). Furthermore, Monk, Pfoff, and Zarotney (2013) state that while about only 80% of elderly widows/widowers have been fully diagnosed with depression in the United States of America, only 20% are properly receiving treatment because health care providers assume that it has to do with a normal consequence of medical illnesses, medication side effects, lack of healthcare insurance, or other problems faced by them. Unfortunately, this misunderstanding represents one of several causative factors contributing to underdiagnosing depression in older bereaved widows/widowers during bereavement (Cleiren, 2019). Moreover, Cleiren (2019) states that older bereaved widowers/widows over the age of 65 are predominantly more vulnerable to depression during bereavement than those under the age of 65 (Monk, Pfoff, & Zarotney, 2013). Therefore, not only a proper assessment of depression is critically warranted during a suspicion of subclinical depression in older adults, but also a correct diagnosis is highly beneficial during bereavement as elderly widows/widowers with depression usually respond well to treatment.
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Depression in older adults should not be considered lightly by anyone, bereaved or not. Hawton and Harriss (2008) postulate that depression, the most prevalent mental health issue in the middle stage of old adults, is characterized by feelings of frustration, sadness, hopelessness, guilt, changes in eating and sleeping habits, lack of concentration and motivation, loss of energy and interest in usual activities, social isolation, and suicidal ideation. According to the Substance Abuse and Mental Health Services Administration [SAMHSA] (2013), about 92% of middle to late-old-adults experience a depressive episode during adolescence, while 86% to 90% experience chronic depression lasting from a few days or months to years due to the traumatic loss of a spouse. SAMHSA (2013) has also reported that both elderly males and females (those assigned either male or female at birth) have demonstrated similar rates of depression during the bereavement period, globally. Thus, depression in older adults during the bereavement period is also a global mental health issue that should also be immediately addressed.
While factors such as being single, females, and lacking social connectedness increase the likelihood of depression in older bereaved spouses, gender represents a significant factor in the heightened rate of depression in older bereaved spouses, worldwide. According to Conejero (2018), older windows are more prone to experience depression during bereavement. In fact, Conejero, (2018) states that 70-85% of older widowers, over the age of 65, have somehow experienced chronic depression (or attempted to commit suicide) ten times more often than older widows during the bereavement period. Consequently, this former continuously constitutes the demographic group with the highest depression rate worldwide when mourning, especially in most countries reporting suicide statistics to the World Health Organization, including European Union countries, Canada, the U.S., and several Asian countries (SAMHSA, 2013). In addition, elderly white men are predominantly at a higher risk of experiencing depression after the loss of their respective spouses (Conejero, 2018). In fact, suicide rates in older Caucasian widowers aging from 80 to 90 are more than twice that of the general population during the bereavement period (SAMHSA, 2013). Despite the high prevalence of mental health-related issues evidenced in the elderly population during bereavement, depression is commonly overlooked due to old age, medication, and physical illness.
Consequently, if left untreated, depression can seriously reduce the quality of life for older bereaved spouses. According to Abuse (2013), while medical illnesses, as well as certain medications or combinations of medications, may increase the risk of depression in older adults over the age of 65, bereavement worsens the condition further. In fact, Fassberg et al. (2016) postulate that about 7 million older bereaved spouses daily display either suicidal ideation or have attempted to commit suicide while grieving. Furthermore, Abuse (2013) states that the onset of depression, during the mourning period, may either delay recovery from or deteriorate the course of any physical illness already suffered by elderly bereaved spouses. Henceforth, applying an effective intervention with elderly bereaved spouses over 65 who are experiencing depression during bereavement will likely help to reduce its symptoms, increasing the likelihood of their longevity during and after bereavement.
PsychInfo database through the USC library was the search engine this writer used to obtain information related to her topic areas. This writer also utilized google scholar to double-check for search accuracy. She also selected peer-reviewed journals and articles on the google scholar search engine. When searching, the terms or combinations used by this writer included most effective intervention, reduction of depression symptoms, and in bereaved elderly widows/widowers over 65. Unfortunately, the first results mainly displayed literature with dozen hits involving subjective studies such as quasi-experimental and qualitative designs with no randomization. Moreover, the articles used were found on the bottom of the search pyramid, which was not therapeutically viable.
So, this writer had to narrow the search term down to fewer words such as the most effective treatment to reduce depression symptoms, in older bereaved spouses over 65, during the bereavement period. This latter was done in order to ensure the correct results came up for the specific problem, population, and treatment. The terms searched and the criteria used were highly specific and strictly limited to the topic of interest. The evidence hierarchy highly accentuated that systematic reviews, randomized controlled trials, and meta-analyses were all found near the top of the pyramid, indicating the strength of the new research’s sources. These types of literature were preferred in preparation for this brief because they were accessible to reveal materials essential to the chosen topic areas. Moreover, their data findings and results were written in a clear language for all readers to comprehend. About half a dozen reviewed articles thoroughly discussed the topic of interest via Google Scholar and PsychInfo database through the USC library. As several options were given to refine search criteria and deselecting irrelevant materials, the second search results came up with other literature displaying different applications of methodology as one was quantitative with no random control and the other one was systematic. The results also displayed literature reviews involving CBT and Strength-Base approaches as having been the most effective interventions that could reduce depression symptoms in older bereaved spouses over 65 who are experiencing depression during the bereavement period. These papers were published in journals including Clinical Psychology Review and Mental Health Services Administration (SAMHSA).
Cognitive-behavioral therapy (CBT). Cognitive-behavioral therapy, the most commonly used treatment for anxiety and depression, is defined as a psycho-social intervention that primarily focuses on improving clients’ mental health, mood, and behavioral regulation (Monk, Pfoff, and Zarotney, 2013).
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