Risk factors are those aspects of a situation that tend to increase vulnerability to complications and that may slow recovery. Existing studies suggest that risk factors relate to the characteristics of an individual, the nature of the relationship to the deceased, the circumstances of the death, and the social context within which recovery takes place. Some risk factors relate to the larger situation in which the bereaved finds him- or herself, and some risk factors relate to the bereaved individual's specific history and makeup. While both kinds of risk factors raise the distress level of the bereaved person, it is useful for clinicians to be particularly aware of the bereaved' s individual situation.
The following risk factors have been identified:
- Socioeconomic Status
Lower socioeconomic status is related to a poorer health status in general. Bereavement appears to affect people similarly, regardless of socioeconomic status.
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Bereavement appears to be somewhat more stressful for younger individuals than it is for older individuals, with the exception of elderly people. The disparity between how older individuals are affected and how elderly people are affected may be because the stress experienced by elderly people is related to pre-existing health problems.
There is some evidence that men, especially widowers, have more bereavement-related health problems than women, especially when dealing specifically with the loss of a spouse. Although both men and women are deeply affected by the loss of close family members and friends, the death of a child may be more difficult for mothers than for fathers. Women may also recognise the effects of bereavement more readily than men, and men and women may cope differently.
- Individual Characteristics
Overall, individuals who are defined as "neurotic" have been shown to have more health problems. Low internal locus of control is generally associated with more depression. This is not specific for bereavement. On the other hand, high internal locus of control does not act as a buffer for bereavement-related distress. Anecdotal evidence suggests that a belief in life after death may be protective. However, when this was examined in a study, a protective effect was not found (Stroebe & Stroebe, 1987). Guilt or self-blame about the death may contribute to traumatic grief.
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Relationship quality may affect men and women differently when it comes to difficulty with bereavement. A good marriage may be associated with more bereavement-related problems in women, while the opposite may be true for men. In general, data does not support clinical lore that implies that bereavement problems occur because of ambivalence or problems in a relationship. It is very clear that in some instances an especially positive relationship may be associated with very difficult bereavement reactions.
- Circumstances of the Death
Not surprisingly, sudden death is associated with more symptoms of bereavement difficulty in the first 6 months after the loss. In some studies, this difference was not present in later interviews, while in other studies it was. A low score on a measure of internal locus of control signified a greater likelihood for difficulty for younger bereaved spouses. In some studies, there is evidence of continuing distress from the loss for many years following a sudden, violent loss. Experiencing multiple losses or witnessing the death (especially a factor for children who witness a death) has been found to correlate with levels of grief intensity. Feelings of helplessness and powerlessness, survivor guilt, threat to one's own life, confrontation with the massive and shocking deaths and mutilations of others, and a violation of one's assumptive world of safety and meaning are traumatic factors that may impact a person's ability to resolve grief. It is clear that many of those bereaved by the WTC disaster may experience treatable psychiatric difficulties for a long period of time. It is important for professionals to be vigilant about this possibility.
Both perceived and received social support are related to lower symptoms of depression in the general population, but there does not appear to be a specific relationship between social support and bereavement outcome. However, it is important to note that bereaved individuals often perceive that others lack empathy and that others are hostile about the bereaved' s continued symptoms. This perception is likely related to a poorer outcome but has not been specifically studied. In general, however, social support and positive family functioning, along with the opportunity to express grief, may help to mitigate the negative effects of bereavement.
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