Every widow wakes one morning, perhaps after years of pure and unwavering grieving, to realize she slept a good night's sleep, and will be able to eat breakfast, and doesn't hear her husband's ghost all the time, but only some of the time. Her grief is replaced with a useful sadness. Every parent who loses a child finds a way to laugh again. The timbre begins to fade. The edge dulls. The hurt lessens. Every love is carved from loss. Mine was. Yours is. Your great-great-great-grandchildren's will be. But we learn to live in that love.”  Jonathan Safran Foer

There are few things in life more likely to lead to depression than losing a spouse, especially for seniors in their twilight years. 

As numerous research studies have demonstrated, spousal bereavement is a major source of life stress that often leaves people vulnerable to later problems, including depression, chronic stress, and reduced life expectancy.   While the grief process usually takes weeks or months to subside, a small minority of bereaved persons experience symptoms for much longer. In many cases, these symptoms can resemble other psychiatric conditions such as Major Depressive Disorder (MDD) to the point that it is almost impossible for mental health professionals to tell them apart.

While MDD is usually diagnosed according to the criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5),  psychologists and psychiatrists are cautioned in a footnote to "differentiate between normal grieving associated with a significant loss and a diagnosis of a mental disorder."  In fact, the question of how to tell normal grief apart from pathological depression is still being debated and often raises concerns about misdiagnosing patients who might be wrongly medicated as a result.

So far, researchers are still unclear about the different causes of depression.  There are a wide range of biological, psychological, and environmental factors which can lead to the kind of depressive symptoms that can result in a formal diagnosis of MDD.   And these symptoms can appear in far too many different ways to be easily classified.  In fact, one recent paper suggests that there can be as many as 1500 different symptom profiles that can meet the MDD diagnostic criteria, some of which don't have a single symptom in common.  Unfortunately, the current criteria are just too broad to be able to pin down exactly what major depression actually means and how it can be linked to any particular cause.

To examine the link between losing a spouse and depressive symptoms, a new study published in the Journal of Abnormal Psychology used data from the Changing Lives of Older Couples study (CLOC). The CLOC is a multi-wave prospective study looking at the effects of spousal bereavement over time. Using 1,532 older men and women recruited from the Detroit, Michigan area, all participants were first interviewed between 1987 and 1988. For those people in the studies who lost a spouse, additional interviews were held to measure how well they coped with their loss over time. 

In the new study, lead researcher Eiko Fried of the University of Leuven and a team of researchers followed over 250 widowed older participants over three time periods (six months, eighteen months, and forty-eight months after the spouse's death) to see how their loss affected depressive symptoms.  What they found was that loneliness was especially strong in bereaved seniors and it was feeling lonely that, in turn, activated other depressive symptoms. Loneliness and depression can often send people dealing with bereavement into a downward spiral that is  extremely hard to break.  Still, despite many widowed seniors experiencing problems with depression after the death of a spouse, only a minority of the participants in the study developed severe depression.

Loneliness also represents perhaps the greatest challenge for seniors dealing with the loss of a spouse making it particularly hard to move on with their lives afterward.  This can also become a major health risk for seniors.  Along with increased depression and risk of suicide, seniors dealing with the death of a spouse are also more likely to engage in risky health behaviour, including smoking, drug or alcohol abuse, failing to care for themselves, or generally becoming more inactive. It's probably not surprising that loneliness after losing a spouse can also lead to a reduced life expectancy and an increased risk of dementia and other serious health problems.

So, what solutions are there for someone dealing with bereavement?  Mental health professionals working with older adults who have lost a spouse need to be aware of how depression and loneliness can lead to health problems.  Social support alone is often not enough and cognitive behavioural therapy may be needed to curb the kind of negative thinking that can bring on serious depression and the problems that can result.

To make things even more complicated, not everyone is going to develop the same symptoms after losing a spouse.  There can also be enormous differences in terms of the circumstances involved, such as whether the spouse's death was unexpected.   Does it make a difference whether the spouse died from an accident or as the result of a long illness during which the spouse had time to say goodbye?  

The kind of relationship the surviving and deceased spouses had can make a difference as well.    Research suggests that widowed spouses who were highly dependent on their spouses are more likely to develop problems with anxiety afterward.  On the other hand, strong marital closeness can also lead to greater loneliness for surviving spouses. 

So, what can these research  results tell us?   Sooner or later, every married couple will face the prospect of their relationship coming to an end, whether due to death or divorce.  For those people dealing with the loss of a spouse,  overcoming loneliness represents the greatest challenge in moving on with life afterward.  That the depressive symptoms linked to loneliness and grief can often be misdiagnosed as severe depression is something that health professionals need to take into consideration when trying to help. For example, anti-depressant medication may be useful as a short-term solution for emotional distress but it's hardly an effective way of dealing with the loneliness that is the real cause of that distress.  Supportive counseling and short-term cognitive-behavioural therapy are probably better treatment options for people coping with grief.

Overcoming grief and loneliness are special challenges that many senior face, particularly those seniors who have lost a spouse.  Whether they are able to move on  afterward depends on their own inner resources as well the kind of support they receive from friends and family.  For those widowed seniors having a particularly hard time coping, treatment counseling represents a useful way of getting  their lives back on track.

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