In Anticipation of Grief

Death of a partner ranks first among the major life stressors.1 Centuries of literature and extensive quantitative research document the link between grief and adverse changes in physical and mental health.2–4 All-cause mortality risk and cause-specific mortality from accidents, cancer, heart disease, and suicide increase after spousal bereavement.3–6 Although it was long thought that perhaps the widowhood effect was a reflection of shared lifestyle and risk factors for spouses, increasingly rigorous controls for shared risk factors make this explanation unlikely. There is also growing recognition that in the period leading up to spousal death, there are often profound emotional and physical stressors that may affect the health of the surviving spouse. These stressors include caregiving and grief related to the illness and impending loss of a loved one, as well as financial worries for many spouses. Indeed, a major challenge in research on caregiving is distinguishing the mental and physical health effects of providing care from the effects of having a loved one who needs care, for example, a spouse with severe illness.Article see p 2745Although the association between bereavement and mortality, sometimes dubbed “the widowhood effect,” has long been recognized, it has not been clear how to translate this empirical association into better health for the surviving spouse. As with many findings on social or psychosocial determinants of health, it is easy to dismiss the widowhood effect as unfortunate but inevitable. The article by Shah et al7 in this issue of Circulation upends this perspective by providing compelling evidence on modifiable mechanisms that elevate the cardiovascular risk of surviving spouses. This work fits within the social epidemiology translation framework, which notes that evidence on social risk factors for disease can be used to guide interventions to reduce the incidence …