A cross-sectional study to identify the depression among widowed in a rural community

V Kavya; B Suganya; M Alagarsamy; A Kalaivanan; Ponnambily Chandy

doi:10.4103/ijcn.ijcn_106_21

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Year : 2022 | Volume : 23 | Issue : 2 | Page : 201-204

A cross-sectional study to identify the depression among widowed in a rural community

V Kavya¹, B Suganya¹, M Alagarsamy¹, A Kalaivanan¹, Ponnambily Chandy²
¹ Students of B.Sc. Nursing III Year, Chettinad Academy of Research and Education, Kanchipuram, Tamil Nadu, India
² Assistant Professor, Department of Community Health Nursing, Chettinad College of Nursing, Chettinad Academy of Research and Education, Kanchipuram, Tamil Nadu, India

Date of Submission	04-Nov-2021
Date of Decision	07-Dec-2022
Date of Acceptance	04-Jan-2023
Date of Web Publication	24-Jan-2023

Correspondence Address:
Mrs. Ponnambily Chandy
Department of Community Health Nursing, Chettinad College of Nursing, Chettinad Academy of Research and Education, Kanchipuram, Tamil Nadu
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijcn.ijcn_106_21

Abstract

There is a limited understanding of depression among widowed in the literature. Thus, the investigators conducted a study to explore the level of depression among widowed in a rural community. Using the Zung Self-Rating Depression Scale, the investigators identified the level of depression among 80 widowed who had lost their spouse more than 1 year ago and had not married again. It is shown that the majority of the widows 28 (70%) and widowers 22 (55%) are moderately depressed. However, 3 (8%) widows and 4 (10%) widowers are severely depressed. In the present study, 25 (63%) of the widowers and 18 (45%) widows reported feeling downhearted and discouraged by their family members. Similarly, half a portion of the study participants stated that the family would feel better if they were dead 40 (50%) and the majority of the widows had suicidal thoughts 32 (80%). The findings showed that widows are more moderately depressed than widowers. The study concluded with a recommendation that the widowed population needs special attention in mental health programmes.

Keywords: Depression, spousal death, widow, widowed, widower, widowhood

How to cite this article:
Kavya V, Suganya B, Alagarsamy M, Kalaivanan A, Chandy P. A cross-sectional study to identify the depression among widowed in a rural community. Indian J Cont Nsg Edn 2022;23:201-4

How to cite this URL:
Kavya V, Suganya B, Alagarsamy M, Kalaivanan A, Chandy P. A cross-sectional study to identify the depression among widowed in a rural community. Indian J Cont Nsg Edn [serial online] 2022 [cited 2023 May 31];23:201-4. Available from: https://www.ijcne.org/text.asp?2022/23/2/201/368420

Introduction

The sudden demise of a life partner is an upsetting situation that denotes a twisting moment in the journey, which needs adaptation to survive in society for the left-alone partner.^[1],[2] Widowhood is also related to serious budgetary issues, the presumption of new roles and responsibilities in the family and changes in social connections, all of which may compound or exacerbate mental health issues for the surviving partner. Since both social roles and responsibilities vary in accordance with the shift to widowhood by gender, it has been proposed that all genders experience bereavement periods in various manners that are reflected as anxiety and depression. Nonetheless, the paucity of literature reviews revealing gender differences in depression among widowed has been consistent. Most of the widowed studies marked that men had a stronger adverse effect than women.^[3],[4]

The aftereffects of spousal demise on the partner's health are very well recorded.^[1] In contrast to their wedded counterparts, widowed people show more physical problems, mental health issues and low life achievement and happiness.^[5],[6] Sometimes, widowhood needs social and behavioural adaptation, regularly requiring an adjustment of one's social outlook, especially for widows, and is expected to reduce public appearances and social contacts and networks.^[7] Widowed people have to alter their daily routines to manage the family's responsibilities on their own that were once carried out by both of them.^[8] The unexpected burden of responsibilities due to little information on the task completed by their bereaved partner leads to depression.^[9]

It may be said that no vulnerable group is more badly affected by neglect than widows. They are horrendously missing from the national records of many developing nations like India, and they are not frequently referenced in the national reports on hunger, poverty, unemployment, health, violence or their rights published in the most recent 25 years. Developing proof of their vulnerability, both financial and mental presently challenges numerous regular perspectives and presumptions about this 'undetectable' gathering of groups.^[10] Women are more affected than men due to spousal death for two reasons. To start with, women live longer than men as per the years of life expectancy projected in the national demographic data. Furthermore, women marry elder men, although this age gap has been narrowing. Since women live longer and marry older men, their chances of being bereaved by spousal loss are greater than men.^[2]

On the contrary, the results from a 1986 public review showed that having ever been widowed is related to the current level of depression and anxiety and this association is more significant for men than women. Widowhood additionally is connected to various kinds and amounts of life strain for people. It is proposed that widows struggled due to budgetary constraints, and on the other hand, widowers were burdened with the management of household difficulties. A study has reported that the widowhood period is related to more elevated levels of symptoms of depression and this is seen more among men than in women. Apparently, over long periods of bereavement, women adjust to widowhood more effectively than men.^[3]

The contradicting reports from literature quoted on depression among widowhood have motivated the investigators to explore the present scenario on the level of depression among widowed. Thus, a cross-sectional study was conducted to assess the level of depression among widows and widowers in a rural community in a selected district of Tamil Nadu, India. This was done as part of the nursing research requirement under the undergraduate (UG) programme.

Methodology

A cross-sectional design was used. The population was widows and widowers in rural areas. The total sample size was 80. Forty widows and 40 widowers were selected using the purposive sampling technique for maintaining uniformity for the analysis of sociodemographic variables and level of depression. The main inclusion criteria for the study were men and women who had been widowed for more than 1 year and were not married again. The exclusion criteria were the widows and widowers who were sick during the data collection period and were migrants from other states of India. The data collection instrument has two parts; sociodemographic data and Zung Self-Rating Depression Scale (SDS) cited by the World Health Organization.^[11],[12] The psychometric properties of the Zung SDS had been validated among the elderly population.^[13] Each item is scored on a Likert scale ranging from 1 to 4. The total score ranges from 25 to 80. Higher scores indicate a higher level of depression and are divided into four categories: 'normal range' (score 25–49), 'mildly depressed' (score 50–59), 'moderately depressed' (score 60–69) and 'severely depressed' (score above 70). The scores are useful for assessing depression severity in the clinical and research process.

During data analysis, more than 20% of cells (normal and severely depressed) had shown expected frequencies which were <5. Therefore, the investigators reduced the four categories to two (low and high) to develop contingency tables (with expected frequencies of more than 5) for the Chi-square test. The Chi-square test was manually computed and the fourth and fifth investigators counter-checked the calculation for any mathematical errors. A score of <60 indicates low, whereas a score of 61 and above indicates high levels of depression. This was carried out to find out the association between the levels of depression and demographic variables of widows and widowers.

The duration of the study was 4 weeks. The UG committee and the Human Ethics Committee approvals were obtained. The investigators obtained informed consent and the purpose of the study was explained to ensure better cooperation during the data collection period. Descriptive statistics such as frequency distribution and inferential statistics were used to analyse the data.

Results and Discussion

It is shown that the majority of the total study participants belonged to 40–60 years of age 43 (54%), uneducated 48 (60%), with no occupation 32 (40%) and most of them had chronic illnesses such as diabetes mellitus 13 (16%), hypertension 6 (08%) and other illnesses such as arthritis and hypothyroidism 47 (58%) [Table 1]. There is a paucity of studies available exclusively among widowed on the variable of depression. However, it is seen that bereavement is associated with morbidity, deterioration of health with symptomatic illness and mortality over time.^[6]

Table 1: Demographic details of the participants

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The figure shows that the majority of the widows 28 (70%) and widowers 22 (55%) were moderately depressed [Figure 1]. However, 3 (8%) of widows and 4 (10%) of the widowers were severely depressed. This was similar to the study on conjugal loss and depression among the elderly which showed that the prevalence of depression among widows was 7.2% and widowers 5.5%.^[14] Of the 80 study participants, 57 (71%) of them were reported moderate depression. Another study on widowed people for more than 1 year had shown 48% of depression among them.^[15]

Figure 1: The categories of depression among widowed participants

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In the present study, 25 (63%) of the widowers and 18 (45%) widows reported that they felt downhearted and discouraged by members who were close to them. The death of the spouse has been narrated as having a negative impact on the physical, mental and social health of surviving partners.^[16],[17] Frequent crying spells, especially at the night were reported by 33 (83%) widows and 37 (92%) widowers. Widowhood is described as one of the most stressful life and is a dreaded phase of life due to lack of support, deteriorating health and self-isolation.^[18],[19] It is highlighted in the present study that the majority of the widows (62%) and widowers (55%) had trouble sleeping at night.

The widows (95%) reported that they eat as before their loss. In contrast, the majority of the widowers (62%) reported that they were losing weight some of the time. Many studies support the large overlap of anxiety disorders with depression throughout the bereavement period.^{[16],[17],[18],[19]} Depression is a painful experience that involves intense suffering that can drain a life of meaning, excitement and pleasure. These disorders are nearly twice more common among women than men. Thus, as mentioned by Aniruddha, widowhood seems to have mental, social, behavioural and biological consequences, consistent with a stress-inducing process.^[19]

Very few widowers 7 (17%) reported in the present study that they are hopeful about the future 6 (15%); they find it easy to make decisions 3 (8%) in their life; they feel useful for society 4 (10%); they are needed by the society 8 (20%); their life is complete and happy 6 (15%). Similarly, a few widows said that they still enjoy being alone 11 (28%); they find it easy to do activities of daily living 8 (20%); they are hopeful about the future 8 (20%); they are needed in the family 7 (17%); they enjoy the present life 5 (14%). It is shown that 45% of the widows and 63% of the widowers felt loneliness in their life. Loneliness is associated with family support, especially from children, whereas emotional support from friends helps to reduce the degree of depression and anxiety level during widowhood. The value of being part of a family and social support group was described in two studies on outcomes of bereavement care among widowed older adults.^[18],[20] In contrast, half a portion of the study participants in the current study stated that the family would feel better if they were dead (50%) and the majority of the widows had thoughts about dying 32 (80%). Being widowed as opposed to married was associated with worse health outcomes for women. Moreover, recently widowed men and women are more likely to experience psychological distress, worse self-rated health and physical illness, than those who were widowed long-term ago.^[20] These are related to the age of the widowed, duration of widowhood, lack of support from family and difficulty to do daily activities of living.^[18],[20] In the current study, no association was found between the categories of depression and demographic variables of the study participants.

Recommendations

We recommended improving the primary mental health-care system for older persons in Tamil Nadu by achieving the below suggestions.^[20]

Family-led approach – Families need to be strengthened to provide effective mental healthcare for older people that help them to live as long as possible in their environment
Community empowerment – The community needs to be empowered in participating in mental health-care services for older persons
Workforce and infrastructure development – We suggested developing geriatric mental health training centres for nurses to provide mental healthcare to widowed (older) people in the community
Integrating geriatric mental health training – Community health nurses will have to be trained in geriatric mental health services.

Conclusion

The current study findings showed that widows are moderately depressed than widowers. We concluded that the widowed population needs special attention in mental health programmes and will share the findings with health policy planners in Tamil Nadu. We look forward to conducting further studies to determine the associated factors of depression among widowed and evaluate the effectiveness of various interventions to promote their well-being and happiness.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Sasson I, Umberson DJ. Widowhood and depression: New light on gender differences, selection, and psychological adjustment. J Gerontol B Psychol Sci Soc Sci 2014;69:135-45.
2.	Umberson D, Wortman CB, Kessler RC. Widowhood and depression: Explaining long-term gender differences in vulnerability. J Health Soc Behav 1992;33:10-24.
3.	van Grootheest DS, Beekman AT, Broese van Groenou MI, Deeg DJ. Sex differences in depression after widowhood. Do men suffer more? Soc Psychiatry Psychiatr Epidemiol 1999;34:391-8.
4.	Chou KL, Chi I. Stressful events and depressive symptoms among old women and men: A longitudinal study. Int J Aging Hum Dev 2000;51:275-93.
5.	Stroebe M, Schut H, Stroebe W. Health outcomes of bereavement. Lancet 2007;370:1960-73.
6.	Utz RL, Swenson KL, Caserta M, Lund D, deVries B. Feeling lonely versus being alone: Loneliness and social support among recently bereaved persons. J Gerontol B Psychol Sci Soc Sci 2014;69:85-94.
7.	Utz RL, Reidy EB, Carr D, Nesse R, Wortman C. The daily consequences of widowhood: The role of gender and intergenerational transfers on subsequent housework performance. J Fam Issues 2004;25:683-712.
8.	Bennett KM, Gibbons K, Mackenzie-Smith S. Loss and restoration in later life: An examination of dual process model of coping with bereavement. Omega (Westport) 2010;61:315-32.
9.	Carr D. Gender, pre-loss marital dependence and older adults' adjustment to widowhood. J Marriage Fam 2004;66:220-35.
10.	Trivedi JK, Sareen H, Dhyani M. Psychological aspects of widowhood and divorce. Mens Sana Monogr 2009;7:37-49. [PUBMED] [Full text]
11.	World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Geneva (Switzerland): World Health Organization; 1993.
12.	Zung WW. A self-rating depression scale. Arch Gen Psychiatry 1965;12:63-70.
13.	Jokelainen J, Timonen M, Keinänen-Kiukaanniemi S, Härkönen P, Jurvelin H, Suija K. Validation of the Zung self-rating depression scale (SDS) in older adults. Scand J Prim Health Care 2019;37:353-7.
14.	Turvey CL, Carney C, Arndt S, Wallace RB, Herzog R. Conjugal loss and syndromal depression in a sample of elders aged 70 years or older. Am J Psychiatry 1999;156:1596-601.
15.	Vezina J, Bourque P, Belanger Y. Spousal loss: Depression, anxiety and well-being after grief periods of varying lengths. Can J Aging 1988;7:391-6.
16.	Golden J, Conroy RM, Bruce I, Denihan A, Greene E, Kirby M, et al. Loneliness, social support networks, mood and wellbeing in community-dwelling elderly. Int J Geriatr Psychiatry 2009;24:694-700.
17.	Holm AL, Berland AK, Severinsson E. Factors that influence the health of older widows and widowers-A systematic review of quantitative research. Nurs Open 2019;6:591-611.
18.	Bansal P, Chaudhary A, Soni RK, Sharma S, Gupta VK, Kaushal P. Depression and anxiety among middle-aged women: A community-based study. J Family Med Prim Care 2015;4:576-81. [PUBMED] [Full text]
19.	Mendes de Leon CF, Kasl SV, Jacobs S. A prospective study of widowhood and changes in symptoms of depression in a community sample of the elderly. Psychol Med 1994;24:613-24.
20.	Avasthi A. Preserve and strengthen family to promote mental health. Indian J Psychiatry 2010;52:113-26. [PUBMED] [Full text]