It can take at least two years to start recovering from a bereavement - and women living in urban areas who experience the sudden death of a spouse are at greatest risk of associated depression. These are some of the findings of a study conducted by a Galway-based psychologist on bereavement in the west of Ireland.
The value of the traditional wake, and the need for education about the impact of death at school age, are other issues identified in the Galway Bereavement Project. The study took eight years and was conducted by Dr Helen Greally, under the direction of Dr Ruth Curtis and Prof Martin McHugh of the psychology department at NUI, Galway.
It concentrated on scientifically valid information and aimed to banish myths and anecdotes about bereavement. The results show that while the majority of bereaved spouses adapt over time, a small number continue to have psychological difficulties, such as higher levels of depression, weaker coping strategies and lower levels of self-esteem.
The research concentrated on bereaved spouses in the west, as identified from the Register of Deaths for Galway city and county. A group of married spouses was used for comparison purposes. The study tracked the same group over 21/2 years, dating from the death of a partner.
Each participant was interviewed four times, with the first interview taking place six months after the death and the last two years later. Complementing the interviews was a range of psychological scales, measuring the bereavement experience, which participants were asked to complete.
The findings show sadness and isolation decrease only towards the end of the second year after the death of a partner has occurred. Dr Greally believes this is very significant, given that many people expect the bereaved person to be "better" by the end of the first year.
Frequently, the bereaved person expressed frustration with other people's expectations. They noted that people called less often to see them, presuming that they had "recovered".
More than 60 per cent of participants experienced at least mild depression some six months after the death of a spouse. Again, Dr Greally notes that this is significant. "Bereaved spouses could benefit from reassurance that feelings of depression are common in the early phases," she says.
One of the keenest debates in this type of research relates is whether grief and depression are similar, or fundamentally different. She says current data support the view that while symptoms of depression overlap with grief, they are not the same.
"The relationship between the two appears to be unique for each individual," she says. "The alleged link between grief and bereavement has often served to `medicalise' the bereavement process, whereas intense grief does not indicate the presence of intense depression." Her use of separate scales in her study was of particular value, she says, in differentiating between these "two easily confused states".
The research suggests those with strong religious beliefs are able to reappraise their experience of bereavement in a positive way; the tendency to lapse into denial and other "confrontational" ways of coping also appears to be on the wane. More than 22 per cent of participants noted that the traditional wake helped them to recover, while more than 97 per cent identified "keeping busy" as the most useful way of coping, particularly in the early stages.
During final interviews, many noted that the best strategy was the "decision" to recover - suggesting adaptation to bereavement is very much an active experience for individuals.
Dr Greally says the results have implications for practice and policy. She believes there is a need for public education about the nature of grief, highlighting the fact that it is an "individual journey". Education about bereavement should begin at school, where much preventative groundwork should be laid, she says. The highest "at risk" group - which she identifies to be adapting poorly at least 2 1/2 years after a death - should be given whatever professional support is required, she adds.
Dr Greally notes that counselling for those who most need it is not easily availed of in the early stages and intervention often occurs when the "process of grief has become in some way distorted". The lack of properly funded and organised bereavement services frequently increases the burden on individuals, families and the wider community, she says.
She warns against the trend to forgo the wake - as our society speeds up - and emphasises that it does have a particular value. She also challenges the Irish perception that we are "good about funerals". The Government and society in general should acknowledge that bereavement is often a "neglected part of the lifecycle", she concludes.
