Love Hurts

"That will be us someday!" It's the sweet wish of a young couples when they spy older couples on the street, in restaurants, on the dance floor who still seem to be in love. 

But the other side of that wish is this: love may have no expiration date, but all people do. Death of a partner is most likely to happen in old age, more likely to happen to older women, and is often considered to be one of the most traumatic events a person can experience.

This sort of loss, or bereavement, is often related to Major Depressive Disorder (clinical depression). The most recent version of the Diagnostic and Statistical Manual (DSM-V) removed the "bereavement exclusion": thus a grieving person who exhibits the symptoms of depression may receive that diagnosis even though these symptoms are a normative response to loss of a loved one.

Fried, Bockting, Arjadi, Borsboom, Amshoff, Cramer, Epskamp, Tuerlinckx, Carr, and Streoebe (2015) note that we often assume bereavement causes a person to have depression, and depression produces symptoms. This is called the "Common Cause Hypothesis" because all symptoms are thought to come from one situation: depression. However, the authors caution us that this hypothesis may not be appropriate because there are thousands of symptoms that depressed people may have, these may contradict each other (e.g.; some depressed people eat too much while other depressed people don't feel like eating at all), and risk factors, such as suicide, may vary depending on the constellation of symptoms that an individual exhibits.

Instead, Fried et al. (2015) encourage us to consider a Network model. From this view, bereavement would cause symptoms, and these symptoms would create situations, such as depression. These symptoms could also interact with (influence) each other to produce such situations.

To test these two viewpoints, the authors used data on depression symptoms from the Changing Lives of Older Couples (CLOC) study. First, they compared the scores on a depression test from 241 widowed seniors (from Follow-Up 1) to 274, age- and gender-matched, married seniors (from Follow-Ups 1-3). The majority of the participants were female and senior citizens. When these individuals joined the CLOC study there was no difference in their reported depression symptoms, but in the follow-up interviews, six months after the death of a spouse the bereaved seniors demonstrated slightly more of these symptoms compared to the seniors who were still married. In fact, 84 of the widowed seniors exceeded the criteria for Major Depressive Disorder by endorsing at least six symptoms. The most commons symptoms were: feeling lonely; feeling sad; feeling depressed; having trouble motivating themselves; problems sleeping; problems eating.

Then Fried et al. (2015) applied complicated statistical models to see if the Common Cause or the Network frameworks would best explain the relationship between bereavement, depression, and depression symptoms. For the Common Cause model to be supported these six symptoms should be better predicted by Depression; instead four of these symptoms were better predicted by loss itself (bereavement) lending support to the Network model. Further investigation revealed that bereavement was especially linked to one symptom, feeling lonely.

These results caution us to think more broadly about depression and spousal loss in older age, especially for older women. Instead of assuming that bereavement causes depression, it may be that bereavement causes a set of symptoms including loneliness. In turn, it could be that this loneliness is what eventually leads a person to experience Major Depressive Disorder. 

As this week's meme suggests, true love may last forever: into old age and even when the person we love is gone. With love still in our hearts but now suddenly on our own, it is easy to see how loneliness could set in. And that is a depressing thought.

FURTHER READING:

The Fried et al. (2015) Journal of Abnormal Psychology article can be accessed through your local college library.

Advice from the American Association of Retired Persons (AARP) on ways to survive bereavement.

WebMD's suggestions to "Help Yourself Out of Depression." If loneliness or depression are causing you to have suicidal thoughts, it is very important that you get help. In the U.S. you can call the National Suicide Prevention Lifeline is 1-800-273-8255.

BONUS!

A TEDx talk by Dr. John Cacioppo on "The Lethality of Loneliness."