Journal of Religion and Health, Vol. 27, No. 1, Spring 1988
Factors Affecting Grief Adjustment BILL FLATT A B S T R A C T : Earlier research has suggested that therapy and time are factors of change in grief level for those who are grieving. This follow-up study of widows and widowers suggests that there are also other relevant factors such as church activities, death of other relatives, other activities, time of grief counseling group, health, age, consideration of remarriage, religion, number of months widowed, and financial situation. A regression analysis of 138 widows and widowers found each of these factors significantly related to the .05 critical level of significance to various measures of grief level.
It has long been recognized that time heals, not always perhaps, but usually. This is true in many broken relationships but especially so in grief. The idea that grief proceeds in stages assumes that time is a factor in the grief process. Many writers have contributed to our understanding of such stages, including Jackson, Freud, Bowlby, Westberg, Lindemann, Moriarty, Ktibler-Ross, Peretz, Hodge, Parkes, Wiehe, Spiegel, Switzer, Rees, Miller, Oates, Gerson, Redden, Kisner, and Alexy.1 People who grieve often proceed through such stages as the following: shock, lamentations, withdrawal, frustrations, panic, depression, detachment, adaptation, reinvestment, and growth. ~ Although these and others have contributed to our understanding of grief in general, Redden found that no studies had been published on the effects of grief therapy using the group method in helping widows and widowers work through grief? The fact that this is still true prompted this project. Research of 500 widows and widowers demonstrated that group therapy is a significant factor in grief recovery.' Those who participated in Grief Recovery of Widowed groups made significantly more progress during the six weeks of group therapy than they did either the six weeks before or the six weeks after the group meetings. Yet there were still several questions to be resolved, such as the following: What has been learned from all of this? Did the effects of treatment last? What factors other than the treatment group affect grief recovery? Such questions led to this follow-up study. Everything learned from previous research and experience went into the Bill Flatt, Ed. D., is Professor of Counseling at Harding Graduate School of Religion in Memphis, Tennessee. 8
9 1988 Institutes of Religion and Health
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making of a follow-up questionnaire. Some eighteen possible factors became independent variables: year of G.R.O.W. group, age, sex, months widowed, dating experience, remarriage, months mate was sick before death, relationship with mate, financial situation, health, loss of other relatives since the death of spouse, required to get a job, went back to work, church activity, religion, and the beginning of new activities. Several measures of grief adjustment became dependent variables: perceived grief level, number of social relationships, nature of actions, perceived depression level as measured by such factors as weight loss, apetite loss, and sleep disturbance; expression of feelings, ability to live with memories, feelings about the future, happiness level, and sexual adjustment. The research design analyzed the relationship between all independent and dependent variables. Such questions as these were pondered: Does one sex adjust better than the other? Do healthy people adjust better than unhealthy people? Does age make a difference? What about remarriage? What about money? What about other factors? The statistical procedure chosen was a regression analysis on all independent and dependent variables. The statistical package used was the SPSS Release 9 on the Sperr~v/62 computer. An attempt was made to send a follow-up questionnaire to all of the 500 widows and widowers who had participated in the forty-three treatment groups from 1976 through 1985. Correct addresses were found on 350, and questionnaires were returned by 138 (39 percent). Certain information on this group was interesting. Their profile is shown in Table 1. TABLE 1 Profile of Follow-up Group N = 138
Category Average age Range of age Sex Months widowed Dated others Remarried Considered remarriage Months mate sick Relationship with departed mate Financial situation Health
Frequency 66 43 to 89 136 female, 2 male 58 38 9 (7 percent) 52 (38 percent) 23 4.44 (good-extremely good) 5 (bad), 66 (okay), 67 (good) 11 (bad), 56 (okay), 71 (good)
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T A B L E 1 (Continued) Profile o f F o l l o w - u p Group N = 138
Category
Frequency
Lost other relatives Other "setbacks" Had to find job Went back to work More active in church More religious Less religious Began other activities
70 (yes), 67 (no), 1 (blank) 66 (yes), 69 (no), 3 (blank) 4 (yes), 134 (no) 16 (yes), 122 (no) 45 (yes), 93 (no) 52 (yes), 86 (no) 7 (yes), 131 (no) 82 (yes), 56 (no)
This follow-up group also gave data on their grief adjustment. This revealed how they were doing five (average) years after treatment. Their profile is shown in Table 2. TABLE 2 Grief A d j u s t m e n t M e a s u r e m e n t s o f the F o l l o w - u p Group N = 138
Category Years after treatment Grief level Number of social relationships Nature of actions Ability to live with memories Feelings about the future Level of happiness Number depressed Ashamed to express feelings Sexual adjustment problems
Frequency 5 3.66 3.24 4.05 4.56 3.82 3.50 32 (23 percent) 9 (7 percent) 18 (13 percent)
The regression analysis produced some rather significant information. Remember that the questions of this follow-up study had to do with relationships between independent and dependent variables. For example, what relationship exists between health and grief adjustment? F statistics give the odds of
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happenings by chance. The .05 level of significance insures a .95 level of confidence of being right. With this in mind, let us look at the various regression coefficients for different measures of grief. The first measure (dependent variable) was grief level. What relationship exists between the grief level of this group and various other factors (independent variables such as age and sex)? A total of 29 percent of the variation is explained by all of the independent variables: other activities, year of G.R.O.W. group, age, months widowed, dating, remarriage considered, months mate sick, relationship with departed mate, financial situation, health, other relatives lost by death, other setbacks, returned to work, more church activities, more religious, or less religious. This means that there is a relationship between these variables but that the relationship is not strong enough to be significant. By going by independent variables alone, one's prediction of grief adjustment would have a 71 percent chance of being wrong; that much variance is unaccounted for. The F statistic for all independent variables was 1.79, far below the 3.96 needed for statistical significance at the .05 level of significance. Breaking it down to each independent variable, there were six independent variables with an F statistic of two or more, an interesting relationship but not statistically significant at the .95 level of confidence. They were as follows: began other activities (2.62), dating (2.73), months mate sick (2.94), relationship with departed mate (3.02), more religious (3.44), and more church activity (3.98). The regression coefficients on these were: began other activities .42, dating - . 5 4 , months mate sick - . 4 6 , relationship with departed mate - . 2 2 , more religious .51, and more activities in church - . 5 9 . These were the only strong relationships between independent variables and estimate of grief level. Notice the plus (no sign) or minus signs to the left of the coefficients. Plus indicates a positive relationship, minus an inverse or negative relationship. The only significant relationship for perceived grief level was "more church activities." Those who had begun more church activities reported a lower level of grief. The specific relationships of the other variables mentioned previously are as follows: 1. 2. 3. 4. 5,
Those who had begun "other activities" tended to feel less grief. Those who had dated felt less grief. The longer one's mate was sick before death, the more grief was still felt. The better the relationship between the respondents and their departed mates, the greater the level of continued perceived grief. Those who had become more religious reported a greater grief level. This relationship approached significance at the .95 level of confidence with a regression coefficient of .51 and an F statistic of 3.44 (slightly less t h a n the required score of 3.96). This presents a strange set of results: "more
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church activity" helped grief adjustment; those who became "more religious" reported more grief. Perhaps persons who grieve more tend to become more religious, thinking t h a t it will help, but find out t h a t they still hurt. Church activity is perhaps a sign t h a t actions are more normal and withdrawal has ceased. The second regression equation dealt with number of social relationships and various independent variables. In this equation, 47 percent of the variation of the dependent variable is explained by the independent variables, almost significant at the .95 level of confidence with an F statistic of 3.94, barely below the 3.96 required for significance. The F statistic was significant at the .05 critical level of significance for three independent variables: more activities in church, with a regression coefficient of - . 8 3 and an F statistic of 9.18; losing other relatives by death, with a correlation of .55 and an F statistic of 6.58; and beginning "other activities," with a regression coefficient score of - . 4 9 and an F statistic of 4.21. The only other independent variable with an F statistic of more t h a n two was financial situation, with a regression coefficient of .36 and an F statistic of 2.68. Specifically this means that: 1.
2.
3.
There is a significant relation between church activities and number of social relationships: as church activities increase, social relationships increase. There was a significant relation between losing other relatives by death and number of social relationships: as the loss of relatives increased, the number of social relationships decreased. Withdrawal began all over again. There was a significant relation between "beginning other activities" and the number of social relationships: as "other activities" increased, the number of social relationships increased.
The other variable with an F statistic of two or more was finances, at 2.68 and a regression coefficient of .36. As finances increased, so did social relationships. The third measurement of grief measured the nature of actions: mechanical (one), forced (three), or natural (five). The only significant independent variable on this measurement was year of G.R.O.W. group. There was a significant inverse relationship between actions and year of G.R.O.W. group: the earlier the group, the higher their action scores. This perhaps says that time over a long period of time is a significant factor with regard to one's actions in grief. Or it might be that the earlier groups changed more during their group existence. The F statistic was 5.81, and the regression coefficient was -.20. The only other F statistic t h a t was two or more was "dating" with a score of 2.68 (below the .95 confidence level score of 3.96) and a regression coefficient
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of -.41. This indicates t h a t as dating increases, one's actions become more normal. Even though there were a number of other relationships between actions and the various independent variables, no others approached statistical significance at the .95 level of confidence. Only a total of 29 percent of the variation was explained by the independent variables with reference to actions. The next measurement had to do with expression of feelings. On this variable, only 15 percent of the variance was explained by independent variables. The F statistic of .76 was far below significance. Looking at individual independent variables on this measure, none were significant with regard to the expression of feelings. Only one produced an F statistic of two or more: age, with a score of 2.03 and a regression coefficient of .64. Though not statistically significant at the .95 level of confidence, there is a tendency t h a t says that the older the respondent, the more ashamed he or she is to express feelings. Perhaps society is changing toward allowing people to express their grief feelings without shame. Most respondents (92 percent) marked t h a t they were not ashamed to express their feelings, and the younger ones were less ashamed. Only 13 percent of the variance was accounted for by the independent variables with regard to ability to live with memories, with an F statistic of . 6 6 , insignificant. No single independent variable was significant, and only o n e - relationship with departed spouse reached the level of two, with an F statistic of 2.07 and a regression coefficient of .15. The slight relationship here says t h a t the better the relationship with the departed mate, the easier it is to live with memories, which makes sense. In such cases, there are not m a n y regrets. The estimate of level of happiness produced a mean of 3.54 and an overall F statistic of 2.91, not significant. On this measure, however, 40 percent of the variance is explained by independent variables. Two specific independent variables are significant: year of G.R.O.W. group, with an inverse relationship and health with a positive relationship. For year of G.R.O.W. group, the regression coefficient was - .25 and the F statistic was 5.49. For health, the regression coefficient was .55 and the F statistic was 6.96, far above the 3.96 required for significance at the .95 levels of confidence. Specifically this says that: 1. 2.
As health increases so does happiness; The longer it had been since respondents went through their G.R.O.W. group, the greater was their level of perceived happiness.
Other independent variables with F statistics of two or more are age, w i t h a regression coefficient of .25 and an F statistic of 2.05; months widowed, - . 1 4 and 2.97; months mate was sick before death, - . 5 0 and 3.26; going back to work, .70 and 2.64; more religious, - . 4 6 and 2.60; and less religious, .79 and 2.49. These relationships, though not significant, indicate the following:
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1. 2. 3. 4. 5. 6.
As age increases, so does the perceived level of happiness; As months widowed increase, level of perceived happiness decreases; The longer a spouse was sick before death, the less the perceived happiness level; Those who go back to work report a greater level of happiness; Those who report "becoming more religious" report less happiness; On the other hand, those who report becoming less religious report a greater happiness level.
Most (84 percent) respondents said that they did not have a sexual adjustment problem. One older widow added that she had a lover. Another said that she had learned the value of masturbation. Only 25 percent of the variance was accounted for by the independent variables. The F statistic of 1.39 was not significant. Yet, when looking at specific independent variables, three were significant: age, with a regression coefficient of .12 and an F statistic of 4.12; consideration of remarriage, .20 and 4.23; becoming less religious, .39 and 5.32. Specifically, this says that: 1. 2. 3.
As age increases, sexual adjustment problems decrease; Those who would consider remarriage to the "right person" were more likely to report a sexual adjustment problem; Those who had become "less religious" were less likely to have a sexual adjustment problem.
In addition to these significant variables, there was one other independent variable with an F statistic of two or above. Health had a regression coefficient of .14 and an F statistic of 3.90, just under the .05 critical area of 3.96. This says that as health increases, one is more likely to have a sexual adjustment problem; or as health decreases, so do sexual adjustment problems. The last measurement of grief level had to do with feelings about the future. Respondents reported a mean of 3.85 with an overall F statistic of 2.37 (not significant) and 37 percent of the variability accounted for by all of the independent variables. Looking at specific independent variables, three were statistically significant at the .05 level: year of G.R.O.W. Group, with a regression coefficient of - . 2 2 and an F statistic of 5.16; months widowed, - . 16 and 4.71; and financial situation, .51 and 5.61. Specifically, this says that: 1. 2. 3.
The earlier the G.R.O.W. group, the better were feelings about the future. The longer the respondent had been widowed, the worse were feelings about the future; The better the financial situation, the better the feeling about the future.
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In addition to these variables, there was one other variable with an F statistic of two or above: health, with a regression coefficient of .30 and an F statistic of 2.76. This indicates t h a t as health increases, so do positive feelings about the future. Table 3 gives a comparison of means. There is throughout the study a big increase during the period of treatment, and the gains tended to hold up for five years and six months after the treatment. By way of summary, there were written significant relationships at the .95 level of confidence between certain independent and dependent variables in this study. They are as follows: 1. 2. 3. 4. 5.
More church activities and less grief; More church activities and more social relationships; Losing additional relatives by death and fewer social relationships; Beginning "other activities" and more social relationships; Earlier G.R.O.W. groups and actions t h a t are more normal; TABLE 3 A C o m p a r i s o n o f M e a n s at D i f f e r e n t T e s t i n g T i m e s Total P o p u l a t i o n = 500 Six Weeks Before
After
Six Weeks After
Five Years After
Before
Grief Level
2.57
2.57
3.66
3.56
3.75
Social Relationships
2.49
2.51
3.60
3.09
3.23
Actions
2.96
2.98
4.36
4.00
4.18
Expressions of Feelings
4.19
4.23
4.60
4.56
Yes, 92 percent
Living with Memories
3.87
3.96
4.66
4.56
4.59
Depression
3.38
3.40
4.36
3.97
75 percent not depressed
Happiness Level
2.25
2.25
3.68
3.66
3.54
Feelings about future
3.34
3.36
4.34
4.15
3.85
Grief Measurement
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Journal of Religion and Health
6. 7. 8. 9. 10. 11. 12. 13.
Earlier G.R.O.W. groups and increased level of happiness; Better health and increased happiness; Increased age and decreased sexual problems; Consideration of remarriage and increased sexual adjustment problems; Becoming less religious and less sexual adjustment problems; Earlier G.R.O.W. groups with better feelings about the future; Months widowed with negative feelings about the future; Better finances with positive feelings about the future.
In addition to these statistical data, several respondents wrote additional comments on their follow-up instrument, providing some rich information along different lines of thought. Highlights follow. Some spoke of the continuing pain that they experience. One wrote that she accepted the death of her husband but that she missed him terribly. "You certainly don't get over this in two years." Another wrote that she would like to have a woman to share her home with her, "as I lost my only child in 1969, and I do not drive a car." Another said, "I believe the bottom line is making all decisions alone. It's like you've lost half of your mind." Still another said that she just wanted to find companionship. One stated that "to lose your husband is the saddest thing that can happen to you." One simply wrote, "Death leaves scars that are easily opened again and memories of never-realized dreams, plans, and hopes. The worst thing is that death is FINAL, the end of a relationship." Another said, "Even at church, you sit alone." One spoke of emptiness and "a need to feel good about myself." Loneliness was no doubt the most often used word in these additional remarks. Many, however, mentioned the value of friendships that were formed in the groups. One widow said that she and her new friends get together nearly weekly. "They have meant more to me than nearly anyone. I can be myself with them; whereas I have to stay cheerful and upbeat around my children and fool them into not worrying about me." Another wrote that she and her group still get together every month and are good friends who "enjoy life much better." One widow mentioned the activities her group has enjoyed: meals together in different homes each month, and various trips. Others wrote about spiritual help. One widow said, "Everything breaks down or tears up, but God is still with me. He is our refuge and strength." Another said that she thanked God each day for "my many, many blessings." One wrote that she continued to say the 23d Psalm every day and, "Dear Lord, help me to remember that nothing is going to happen to me today that you and I can't handle." Another stated that she shoveled her problems and circumstances into God's hands and left them there: "God has supplied my needs in all areas of my life, and he molds and shapes my life daily." One widow just said that God knew that her husband was ready to go and that he should be released from his pain. Another stated that she "lived on" Philippians 4:4-13.
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One wrote t h a t she trusts in the Lord each day, t h a n k i n g him for his m a n y blessing "to me." Still another said t h a t Psalms 23 had been her "salvation." One widow wrote t h a t her favorite Bible verse was Isaiah 40:31: "They who wait for the Lord shall renew their strength, they shall mount up with wings like eagles, they shall run and not be weary, they shall walk and not faint." She added t h a t her faith in God had sustained and strengthened her. Another said, "I gripe and then count my m a n y blessings and feel ashamed." Still another said what m a n y expressed in substance, "I have found t h a t acceptance of life with reliance on Christ is the way for me." Some wrote about their new mates. One said, "Dr. Flatt, I am so completely happy with my new husband of three years t h a t I am afraid t h a t I have been of no help to you in your research." Another wrote, "The group was of great help to me during my time of grief. I am again happily married to a fine Christian, and we are happy and active." Still another stated, "I was lucky to meet and m a r r y a wonderful man. I'm very happy now." A widower wrote t h a t he had married again and t h a t he was very happy although sexual adjustment at first was difficult. After his second marriage, he reports t h a t he lost all contact with his first wife's family and t h a t this was sad. Several wrote of new activities. The list is endless: church, painting, tutoring children, Bible Study Fellowship, singles' groups, physical exercise, senior citizens' groups, craft classes, going back to work, serving as a volunteer for the Hospice Support Group, visiting nursing homes, talking to friends who have lost loved ones, joining a spa, and spending money on self-improvement in various ways. There were numerous other comments of interest. One wrote "Your book, From Worry to Happiness, helped me so much. I have passed it on to several others." Another said t h a t she had learned to accept t h a t she is alone, t h a t life must go on, and t h a t there are a lot of good things to do and places to go and to see. Still another stated t h a t it helps just to know t h a t someone cares! "The last thing you could do for your life partner is to be the one who is left [alone]!" She continued, "When I remember this, I can make it." "I could testify to the most radical change t h a t anyone could have dreamed of," still another said. One widow summarized her thoughts this way: "I have a very good life now. I still miss my husband and the happy life we had together, but I don't dwell on it. I do occasionally have some sad times, but am determined to have a happy Act Three in my life." Another said, "We need to accept our loss, face reality, a n d work out our own problems." One widow wrote t h a t she enjoyed her independence, t h a t she could come and go as she pleased. "I just don't want to be a burden to my children," another said. One stated, "Your counseling sessions are very worthwhile." Another added these thoughts, "If you have inner peace you can rise above your circumstances. It is not what happens to you but how you react to it. Make advantages out of disadvantages." One said t h a t she became adjusted when she decided to count "what I still have, instead of t h i n k i n g of what I no longer have." Another wrote t h a t she had become a counselor to
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Journal of Religion and Health
friends and family and had "found no one to be without problems." One simply said, "I have no children and live alone. I miss my husband very much. However, I feel that I have made a good adjustment." Another stated, "I have no family in this area. I sold my house and moved into the same apartment complex where two of my fellow G.R.O.W. members live. So many blessings come from G.R.O.W. I'm thankful every day for that."
References 1. Jackson, E., Understanding Grief New York, Abingdon Press, 1957; Freud S., "Mourning and Melancholia." In Riviere, J., ed. and trans., Collected Papers, 5 vols. New York, Basic Books, 1959; Bowlby J., "Processes of Mourning," International J. Psycho-Analysis, 1961, 42,333-338; Westberg, G.E., Good Grief Philadelphia, Fortress Press, 1962; Lindemann, E., "Symptomatology and Management of Acute Grief." In Parad, H.J., Crisis Intervention. New York, Family Service Association of America, 1965; Moriarty, D.M., ed., The Loss of Loved Ones. Springfield, Ill., Charles C. Thomas, 1967; Ktlbler-Ross, E., On Death and Dying. New York, Macmillan Publishing Company, 1969; Peretz, D., "Reaction to Loss." In Schoenberg, B., et. al., eds., Loss and Grief" Psychological Management in Medical Practice. New York, Columbia University Press, 1970; Hodge, J., "They That Mourn." J. Religion and Health, 11, July 1972, 232-236; Parkes, C.M., Bereavement: Studies of Grief in Adult Life. New York, International University Press, 1972; Wiehe, V.H., "The Role of the Clergyman in the Grief Process," Concordia Theological Monthly, 1972, 43, 131-137; Spiegel, Y., The Grief Process, Elsbeth Duke, trans. Nashville, Abingdon Press, 1973; Switzer, D.K., The Minister as Crisis Counselor. Nashville, Abingdon Press, 1974; Rees, W.D., "The Bereaved and Their Hallucinations." In Schoenberg, B., ed., Beareavement: Its Psychological Aspects. New York, Columbia University Press, 1975; Miller, W.A., When Going to Pieces Holds You Together. Minneapolis, Augsburg Publishing House, 1976; Oates, W., Pastoral Care and Counseling in Grief and Separation. Philadelphia, Fortress Press, 1976; Gerson, G.S., "The Psychology of Grief and Mourning in Judaism," J. Religion and Health, 1977, 16, 262-272; Redden, J., An Evaluation of the Responses of Treated and Untreated Widows to Questions Presented Before and Following Group Treatment." Unpublished master's guided research paper, Harding Graduate School of Religion, Memphis, Tennessee, 1978; Kisner, J.A., A Family Systems Approach to Grief," Pastoral Psychology, 1980, 28, 265-276; Alexy, W.D., "Dimensions of Psychological Counseling That Facilitates the Grieving Process," J. Counseling Psychology, 1982, 29, 298-507. 2. Flatt, B., "Grief Recovery of Widowed Persons," J. Pastoral Counseling (in process of publication). See also Flatt, B., Growing Through Grief Nashville, Gospel Advocate, 1987. 3. Redden, op. cir. 4. Flatt, op. cit.
