McHorney C A, Mor V
Center for Gerontology and Health Care Research, Brown University, Providence, Rhode Island 02912.
Med Care. 1988 Sep;26(9):882-93. doi: 10.1097/00005650-198809000-00007.
As a crisis event and major life transition, bereavement is believed to precipitate or exacerbate physical and psychologic dysfunction. Yet, despite an ever-growing body of research, the causal relationship between bereavement and subsequent morbidity remains unsettled. Using a large sample, prospective measurements, and multivariate analyses, a literature-based model of the determinants of clinical depression after bereavement was tested. Results show that consanguinity, patient age, poor prior physical and mental health, family tension, and survivor dissatisfaction with their caretaking abilities during the terminal phase were the most important determinants of risk of depression after bereavement. Among spouses, bereavement depression was significantly associated with poor prior physical and mental health and dissatisfaction with caretaking abilities. Analyses of the consequences of bereavement in terms of health-care utilization found strong effects of depression on physician utilization. In light of the aging of the United States population, and thus the growth of the bereaved population, the results suggest the importance of preventive medicine to avert the costs to the health-care system of depression-related somatization following bereavement.
作为一种危机事件和重大生活转变，丧亲之痛被认为会引发或加剧身体和心理功能障碍。然而，尽管研究数量不断增加，但丧亲之痛与随后发病之间的因果关系仍未确定。利用大量样本、前瞻性测量和多变量分析，对基于文献的丧亲后临床抑郁症决定因素模型进行了检验。结果显示，血缘关系、患者年龄、既往身心健康状况不佳、家庭关系紧张以及幸存者在终末期对其照顾能力的不满是丧亲后抑郁风险的最重要决定因素。在配偶中，丧亲后抑郁与既往身心健康状况不佳以及对照顾能力的不满显著相关。对丧亲后医疗保健利用后果的分析发现，抑郁症对医生利用有强烈影响。鉴于美国人口老龄化，因此丧亲人口不断增加，研究结果表明预防医学对于避免丧亲后与抑郁症相关的躯体化给医疗保健系统带来成本的重要性。
