Lichtenstein P, Gatz M, Berg S
Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
Psychol Med. 1998 May;28(3):635-43. doi: 10.1017/s0033291798006692.
Previous research has shown an increased risk of mortality after spousal bereavement, with the highest risk in the first weeks or months closest to the loss. One difficult issue in these designs is appropriate covariates and control groups.
This study is based on 1993 pairs of twins discordant for marital status and on 35860 married individuals from the Swedish Twin Registry born between 1886 and 1958 and followed for marital and vital status between 1981 and 1993.
Spousal bereavement was a risk factor for mortality for both men and women using the still married co-twin as a control to the widowed proband, and controlling for earlier health status and health-related risk factors. The mortality risk was higher for young-old (under 70 years) individuals, and for recently widowed than for longer-term widowed. Young-old women had a pattern with increased mortality risk during the first years after bereavement, but also a markedly decreased risk if they survived 4 years after bereavement, as compared to married women.
The results support a causal effect of bereavement on mortality. The decrease in risk for long-term young-old women is congruent with reports by widows of psychological growth after bereavement, involving increased sense of mastery and competence after learning to live in new sets of circumstances following the loss of their husband.
先前的研究表明，配偶丧亡后死亡风险会增加，在丧亡后的最初几周或几个月内风险最高。这些研究设计中的一个难题是合适的协变量和对照组。
本研究基于1993对婚姻状况不一致的双胞胎，以及来自瑞典双胞胎登记处的35860名已婚个体，这些个体出生于1886年至1958年之间，并在1981年至1993年期间跟踪其婚姻和生命状况。
以仍处于婚姻关系的双胞胎作为丧偶先证者的对照，并控制早期健康状况和与健康相关的风险因素，配偶丧亡对男性和女性而言都是死亡的一个风险因素。年轻老人（70岁以下）以及近期丧偶者的死亡风险高于长期丧偶者。年轻老年女性在丧亡后的头几年有死亡风险增加的模式，但与已婚女性相比，如果她们在丧亡后存活4年，风险也会显著降低。
结果支持丧亡对死亡率有因果效应。长期年轻老年女性风险的降低与寡妇关于丧亡后心理成长的报告一致，这种成长包括在学会在丈夫去世后的新环境中生活后，掌控感和能力感增强。
