The study findings have the potential to make an important contribution to preventive mental health services to an underserved population--older bereaved adults. This study's further significance lies largely in its potential to demonstrate the efficacy of a replicable short-term preventive intervention for facilitating older spouse's adjustment to widowhood and reducing morbid bereavement outcomes and their associated health care costs in a sample at high risk for poor bereavement outcomes. Spousal death is a profoundly stressful event that places the individual at increased risk for mortality and morbidity. We propose to assess the efficacy of a preventive intervention for older married adults facing the impending death of their spouse who is terminally-ill with cancer. The goal of the intervention is to facilitate bereaved spouses' psychosocial adjustment and transition to widowhood, thereby reducing their risk of psychopathology and other morbid outcomes in the post-bereavement period. The preventive intervention will begin during the last 6 months of the dying spouse's illness and continue five/six months into the postdeath period. Using a true experimental design, spouses of terminally-ill patients are randomly assigned to either the preventive intervention (n=110) or to a control group (n=110). Pre-death baseline interviews will be conducted with the well spouses shortly after accrual. Group differences in the bereaved spouses' morbidity levels will be assessed at 7 months post- death, following the period of acute grief, and 14 months post-death, following the period of short-term resolution. In order to assess the efficacy of the preventive intervention we will be selecting a population at high risk for psychopathology and other morbid bereavement outcomes due to their possessing all of these predisposing factors: duration of terminally-ill spouse's illness, prolonged, 6+ months by accrual; soon- to-be-bereaved spouse's caregiving responsibilities, average of more than 8 hours of illness-related practical or instrumental assistance per week; surviving spouse's own age, older adult--aged 55-75; and surviving spouse's health status, has a chronic illness or activity-limiting health condition for 6+ months at accrual. The study's specific aims are: (1) To determine the efficacy of a preventive intervention in facilitating bereaved spouses (aged 55+) psychosocial adjustment to their loss and transition to widowhood, as evidenced by decreased psychopathology and lower morbidity on indicators of psychological well- being, physical health and social functioning. (2) To evaluate the predictive value of additional risk factors for the poorest bereavement outcomes within this pre-selected high risk sample. (3) To evaluate the relative efficacy of the preventive intervention for those bereaved spouses who, on the basis of these additional risk factors are at highest risk for morbid bereavement outcomes. The study will also demonstrate the feasibility of using high risk criteria to target the delivery of the program to those individuals with the greatest need, keeping the service delivery costs down. The proposed intervention is brief (8 pre- and 8 post-death sessions) and the intervention can be readily implemented in a variety of health care settings.
