Grief, depressive symptoms, and inflammation in the spousally bereaved

Abstract

Grief is conceptualized by strong negative emotions, which include longing, sadness, and preoccupations with thoughts, recollections, and images of the spouse. In the initial months after the loss of a spouse, those who are widowed are at risk for cardiovascular problems and premature mortality. In the general population, depression is characterized by chronic low-grade inflammation, a key predictor of cardiovascular problems, morbidity, and mortality. Although depression and grief share similarities, they are distinct constructs. We aimed to identify if grief was related to inflammation among those who had a spouse recently die. We also sought to determine if those who are widowed and already experience elevated levels of depressive symptoms compared with the general population had higher levels of inflammation compared with those who are widowed who report fewer depressive symptoms. Ninety-nine recently bereaved individuals (M=84.74 days since passing, SD=18.17) completed a blood draw and psychological assessments. Proinflammatory T cell-derived cytokines were assessed, which included interferon gamma (IFN-γ), interleukin (IL)-6, tumor necrosis factor alpha (TNF-α), IL17-A, and IL-2. Bereaved individuals with a higher grief severity (using an established cut-score) had higher levels of the proinflammatory cytokines IFN-γ, IL-6, and TNF-α than those with less grief severity. Those who experienced higher levels of depression exhibited elevated levels of proinflammatory cytokines compared with those who had lower levels of depression (using a continuous measure of depressive symptoms, as well as an established cut score). This is the first study to demonstrate that inflammatory markers can distinguish those who are widowed based on grief severity such that those who are higher on grief severity have higher levels of inflammation compared with

The Psychobiology of Bereavement and Health: A Conceptual Review From the Perspective of Social Signal Transduction Theory of Depression

“…Some researchers have thus suggested that it is not interpersonal loss or bereavement but rather depression that is responsible for causing the increases in morbidity and mortality seen in bereaved individuals ( 9 , 12 , 49 , 89 , 98 ). On the other hand, though, research has shown that grief and depression are independently associated with health-damaging inflammation ( 99 ). Therefore, it may be the case that bereavement and depression are associated with similar but distinct patterns of inflammatory activity, and that interpersonal loss is a common precipitating stressful life event that may lead to both grief and depression.…”

Matters of the Heart: Grief, Morbidity, and Mortality

“…Specifically, widows and widowers showed enhanced proinflammatory cytokine production by in vitro lipopolysaccharide-stimulated peripheral blood leukocytes than did matched comparison subjects (Fagundes et al, 2018). When examining between-persons differences among widows and widowers, we found that individuals with higher grief severity had higher levels of proinflammatory T-cell-derived cytokines than those with less grief severity (Fagundes et al, 2019). We also examined the association between depressive symptoms and inflammation because we wanted to know whether the well-established relationship between elevated inflammation and greater depressive symptoms existed among widows and widowers (Kiecolt-Glaser, Derry, & Fagundes, 2015).…”

“…We found that those who experienced higher levels of depression exhibited elevated levels of T-cell-derived proinflammatory cytokines compared with those who had lower levels of depressive symptoms. However, depression did not explain the relationships with grief and proinflammatory cytokines (Fagundes et al, 2019).…”

“…In addition to the mental-health toll, broken-hearted widows and widowers are at risk for premature morbidity and mortality, especially as it relates to cardiovascular events (Moon, Glymour, Vable, Liu, & Subramanian, 2014). The focus of our recent work has been to understand why individuals who are spousally bereaved are at heightened risk of morbidity and mortality (Chirinos, Ong, Garcini, Alvarado, & Fagundes, 2019; Fagundes et al, 2019; Fagundes et al, 2018; Knowles, Ruiz, & O’Connor, 2019).…”

Emotional Traumatic Brain Injury

“…Proinflammatory cytokines including interferon gamma, interleukin IL-6, and tumor necrosis factor alpha have also been shown to be associated with the level of an individual’s grief severity ( Fagundes et al, 2019 ). Takotsubo cardiomyopathy (ie, broken heart syndrome) is a vivid example of these interactions, where stress hormones cause abnormal movement of the heart muscle, resulting in typical angina symptoms and, in some cases, infarction.…”