Predictors of bereavement depression and its health services consequences.

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.