Mortality and medical care after bereavement: a general practice cohort study

Abstract

Bereaved spouses or partners are thought to be at increased risk of morbidity and mortality. However, there are few large prospective studies and results are inconsistent. We estimated the relative mortality, prescription of psychotropic medication and use of primary medical care services in adults whose cohabitee died of cancer. To do this, we undertook a cohort study using The Health Improvement Network (THIN) UK primary care database. Participants were 1) people aged over 40, who were registered with general practices and had been exposed to the death of a cohabitee from cancer; and 2) a comparison cohort frequency matched on five year age bands and sex who were cohabiting with a living partner. The baseline was chosen as six months before the date of the cancer death for the exposed group and a random date for the unexposed group. Incidence rate ratios (IRR) with 95% confidence intervals (CI) were estimated using random effects Poisson regression to account for clustering within general practices and adjusting for other key variables. 92,129 patients were studied for a median follow up of 4 years. Cohabitees of patients who died of cancer were less likely to die of any cause (IRR 0.71, CI 0.68-0.74) after adjustment for age, gender, number of non-psychotropic prescriptions 6 months before the cancer death/index date, use of psychotropic medication 6 months before the cancer death/index date, smoking, alcohol and area deprivation score. Exposed patients were more likely to receive a prescription for antidepressant or hypnotic medication and to attend their GP both before and after the death of the cohabitee. In conclusion, we did not confirm increased mortality in cohabitees of people dying from cancer.

Anxiety, depression and quality of life in family caregivers of palliative cancer patients during home care and after the patient's death

“…Furthermore, family members who care for a dying relative suffering from cancer are bur- interviewed bereaved caregivers of cancer patients and found that the experience of waiting and watching while a loved one dies without being able to do anything about it was characterised by shock and distress (Sanderson et al, 2013). The release from the stress of caring may lead to reduced psychological distress for caring relatives as the acute phase of grief subsides (King et al, 2013). The death of a close one can be traumatising, no matter how well families are prepared and symptoms are managed (Sanderson et al, 2013).…”

Death following partner bereavement: A self-controlled case series analysis

“…Given that neither material circumstances, nor access to health care, appear to be protective[6, 7], psychological and lifestyle factors may well play a key role. Our earlier analyses using the THIN database demonstrated that bereaved widows and widowers were about twice as likely to be prescribed hypnotics or antidepressants, even after adjustment for levels of such prescribing before the partner’s death[11]. It has long been thought that the emotional stress of bereavement might be part of the mechanism of increased mortality in bereavement[21] through changes in pulse rate, arterial blood pressure and endocrine function.…”

“…In the UK, however, there is evidence that reduced health care for cardiovascular disease before and after bereavement may play a role[8]. However, not all prospective studies agree on the findings[4, 9–11], possibly because of the difficulties of finding appropriate comparison cohorts and because of confounding. Research into whether death of a spouse or partner increases morbidity and mortality in older people has yielded conflicting results[4, 10, 11].…”

“…However, not all prospective studies agree on the findings[4, 9–11], possibly because of the difficulties of finding appropriate comparison cohorts and because of confounding. Research into whether death of a spouse or partner increases morbidity and mortality in older people has yielded conflicting results[4, 10, 11]. In an analysis of bereavement in primary care electronic records in the UK, we found little evidence for increased mortality[11] and a recent cohort study of older people in the US reported a similar lack of effect at least in bereaved women[12].…”

“…Research into whether death of a spouse or partner increases morbidity and mortality in older people has yielded conflicting results[4, 10, 11]. In an analysis of bereavement in primary care electronic records in the UK, we found little evidence for increased mortality[11] and a recent cohort study of older people in the US reported a similar lack of effect at least in bereaved women[12]. Thus, there appears to be an increased risk[4], but it is not a consistent finding.…”