psychological resilience and the well-being of widowed women

PSYCHOLOGICAL RESILIENCE AND THE WELL-BEING OF

WIDOWED WOMEN

NORM O'ROURKE

The majority of older women in enduring relationships contend with conjugal bereavement. Although most experience considerable distress in the immediate aftermath of this loss, the majority adjusts over the course of time. The current study applies the theory of psychological resilience (or hardiness) to this topic. Results of this study suggest that psychological resilience is significantly associated with both satisfaction with life and (inversely) with psychiatric distress (N = 232). These findings emerged despite statistical control for a myriad of sociodemographic factors (e.g., years married, preparation for death, duration of widowhood). Of the resilience factors, commitment to living appears most salient with respect to the well-being of widowed women. Limitations of the use of the Internet as a vehicle for data collection are considered as well as directions for future study.

Key words: bereavement, psychological resillience, well-being, widowed women.

The death of a spouse has consistently been identified as among the most stressful of normative life events (Miller & Rahe, 1997). This finding is particularly germane given that roughly half of all women over the age of 64 years will experience the death of their husbands (Carr et al., 2001). Over their life course, it has been estimated that three-quarters of married women will be widowed and remain unmarried for 18 years on average (Barrett, 1977).

Although the majority of widows adapt to this loss with the passage of time (Canadian Study of Health and Aging Working Group, 2002; McCrae & Costa, 1988), it is estimated that 20% to 40% never fully recover (Kessler, Price, & Wortman, 1985). Despite this significant proportion of those for whom significant distress persists, a paucity of empirical research effectively distin- guishes between those who adapt to conjugal bereavement versus those who remain symptomatic (Stroebe & Schut, 2001; Wortman & Cohen Silver, 1989).

At this time, few conclusions can be drawn as to who is most likely to exhibit prolonged distress. Aside from factors such as low socioeconomic

Ageing International, Summer 2004, Vol. 29, No. 3, pp. 267-280.

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268 Ageing International/Summer 2004

status (Vachon, Lyall, & Rogers, 1980), few demographic factors appear to be associated with adaptation to widowhood. And though initial research had suggested that social support and quality of the marital relationship were significantly associated with adjustment (Raphael, 1977), more recent studies have questioned these global assertions. For instance, findings reported by Carr and colleagues (2000) suggest that characteristics of the marriage such as warmth, conflict, and instrumental dependence have distinct and complex associations with adjustment to the loss of one's spouse. Similarly, findings reported by Morgan (1989) suggest that much of the social support received by widows (particularly from their families) is perceived negatively. This finding is in accord with the general consensus in the literature suggesting that perceptions of quality, availability, and continuity are more germane to well- being than levels of instrumental assistance received (Seeman, 2000).

In contrast, phenomenological factors such as the absence of pessimism (Barrett & Becker, 1978) and perceived control (Stroebe, Stroebe, & Domittner, 1988) appear to predict adjustment to conjugal bereavement. These findings attest to the salience of idiosyncratic cognitive factors that may have little direct association with more objective factors vis-ft-vis adjustment to widowhood. Given this observation, the theory of psychological resilience (or hardiness) may be germane to our understanding of adjustment to conjugal bereavement.

As defined by Kobasa, Maddi, and Kahn (1982), psychological resilience reflects a pervasive belief that one can respond under stress effectively. This tendency is thought to be comprised of three interrelated constructs. First, resilient persons espouse a commitment to living, that is, the tendency to en- gage fully in daily activities. In addition, resilient persons enjoy challenge and believe that change rather than stability is normal. From this perspective, life's hurdles provide opportunities to increase one's skills and self-knowl- edge. Lastly, psychological resilience entails the perceived ability to exercise control over the life's circumstances. This manifests as a sense of personal autonomy and the belief that one is able to directly affect life's destiny (Kobasa et al., 1982). 1

Research to date suggests that those who typify psychological resilience do not discount the existence of stress in their lives; instead, stressful conditions are appraised as opportunities for growth and development as opposed to threats to well-being. In other words, life's travails are embraced as opposed to heralding one's demise. Given this mindset, psychologi- cally resilient persons make use of more proactive coping strategies and thus respond to stressful life circumstances more effectively (Maddi & Kobasa, 1984).

Research to date has suggested that psychological resilience is related to reduced illness among bus drivers under high stress (Bartone, 1989), the psychological well-being of military disaster relief workers (Bartone et al., 1989), reduced physical illness among corporate executives (Kobasa, Maddi, Puccetti, & Zola, 1985), enhanced quality of life among working adults (Manning,

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Williams, & Wolfe, 1988), and lower levels of clinical depression and fatigue among caregivers of persons with dementia (Clark, 2002).

To date, it appears that one other study has examined resilience and adaptation to widowhood; yet for this previous study, resilience was operationalized as the absence of depressive symptomatology (Bonanno, Wortman, & Nesse, 2004). For the current study, in contrast, it is hypothesized that the core constructs of psychological resilience (i.e., commitment to living, challenge, perceived control) will each be associated with the absence of psychopathology and life satisfaction among widowed women. Furthermore, it is assumed that this association will be observed subsequent to statistical control for a myriad of sociodemographic factors (i.e., age, education, socioeconomic status, years married, years widowed, anticipatory bereavement, physical health). Both life satisfaction and the absence of psychiatric distress are examined as outcome variables of interest . This decis ion was based on the con temporary acknowledgement that well-being in later life entails more than the absence of distress (Keyes, 2002).

Methods

Participants

A total of 232 women were recruited for this study over an 18-month interval (January, 2003 to July, 2004). 2 In addition to being widowed, a further inclusion criterion required that participants remained unmarried as it was assumed that the experience of living with a new spouse would affect perceptions of the prior marriage. The average age of these women was 60.62 years (SD = 9.29). On average, they had been married for 25.70 years (SD = 12.17) and had been widowed for 8.59 years (SD = 8.27).

Recruitment

Data were obtained via an Internet website constructed specifically for this study. Responses to study questionnaires were forwarded automatically by e- mail as participants proceeded from one page to the next. Data were routed through the Internet service provider thus masking the e-mail address and time zone in which responses originated. Prior research suggests that there are few demographic differences between older adults recruited via the Internet and more traditional self-selection research methodologies (O'Rourke, 2002; O'Rourke & Cappeliez, 2003).

Similar conclusions were reached by Gosling and colleagues (2004) in their recent analysis of Internet-derived participants relative to more traditional recru i tment methods . They compared responses and par t ic ipant sociodemographic characteristics from studies published in the prestigious Journal of Personality and Social Psychology (2002; n = 102,959) vis-gt-vis


two large research websites (n = 361,703 and n = 132,515). In contrast to common misconceptions regarding use of the World Wide Web, participants recruited via the Internet appear more demographically diverse and equally motivated to provide viable data. Of particular relevance to the current study, web-based study participants do not appear to differ from self-selected participants recruited by more traditional means with respect to well-being constructs (Gosling et al., 2004).

Postings announcing this study were placed at dedicated websites for older adults (e.g., American Association of Retired Persons, SeniorNet, 50+ Net, Age of Reason). Direct appeals were also made to seniors seeking e-mail pen- pals, a request for participants was placed in an Australian electronic newslet- ter (About Seniors), and reciprocal links were placed between this website and others directed toward older adults. Roughly 82% of respondents (191/ 232) indicated their country of origin with the majority living in the United States (49% or 113/232). Notable percentages of respondents also lived in Australia (24% or 55/232) and Canada (10% or 23/232). For the most part, demographic features did not differ by country of residence. Although Aus- tralian participants had been widowed significantly longer than their Ameri- can and Canadian counterparts (F[2,186] = 4.51, p < .01), neither age (F[2,186] = 1.64, ns) nor years married differed by country (F[2,186] =.40, ns). Neither did participants' socioeconomic status based on work currently performed or prior to retirement differ by country of origin (Z2120, N=220] = 27.82, ns).

Study Instruments

Dispositional Resilience. The abridged Dispositional Resilience Scale (DRS; Bartone et al., 1989) is comprised of 30 items with responses recorded along 4-point Likert-type scales ranging from 0, not at all true to 3, completely true. The DRS was developed as a measure of hardiness or psychological resilience comprised of three interrelated factors or subscales: perceived control, commitment, and challenge (e.g., "When I make plans, I 'm certain I can make them work," "By working hard, you can always achieve your goals," "I like a lot of variety in the tasks I perform" respectively). Internal consistency of responses as measured by Cronbach's alpha has been reported as ot = .85 by Bartone and colleagues (1989) for the full scale. Responses to subscales appear to have acceptable test-retest reliability (r = .66, r = .82, r = .62 respectively over a one-month interval as reported by Pergadia, 2002).

Satisfaction With Life Scale. According to Pavot and Diener (1993), the Satisfaction With Life Scale (SLS; Diener, Emmons, Larsen, & Griffin, 1985) serves to measure perceived quality of life on the basis of person-specific criteria. It is assumed that participants compare their current circumstances against subjective standards to arrive at a global appraisal of life satisfaction (Diener, 2000). Respondents are presented with five separate questions with seven response alternatives ranging from strongly disagree (1) to strongly agree

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(7). Higher totals are suggestive of greater life satisfaction (e.g., "In most ways my life is close to ideal"; "The conditions of my life are excellent").

Internal consistency of responses to the SLS has been reported as ct = .85 (range 53 to 92 years of age). Among these same participants, test-retest reliability over a one-month interval was reported as r(39) = .84 (Pavot et al., 1991).

Construct validity of responses to the SLS has been demonstrated relative to the Fordyce Global Scale among older adults (r[39] = .82; Pavot et al., 1991). Negative correlations have also been reported between the SLS and measures of clinical distress such as the Beck Depression Inventory (Blais et al., 1989).

General Health Questionnaire. Burvill and Knuiman (1983) have described the General Health Questionnaire (GHQ; Goldberg, 1978) as the primary self- report measure of non-psychotic mental illness in community settings. The 20-item GHQ is composed of ten negatively- and ten positively-keyed items with responses recorded along 4-point Likert-type scales (possible range of scores 0 to 60). The GHQ has widely been used in clinical and research studies as a global measure of psychiatric distress. As noted by McDowell and Newell (1996), the GHQ is intended to identify departure from normal func- tioning as opposed to enduring psychopathology (e.g., "have you recently lost much sleep over worry," "have you recently been thinking of yourself as a worthless person").

A split-half reliability coefficient of .90 has been reported for the 20-item GHQ as well as indices of internal consistency ranging from .82 to .90 (Cronbach's alpha and KR-20; Vieweg & Hedlund, 1983). A test-retest reliability coefficient of r = .85 has been reported with neurology patients (no time interval specified; McDowell & Newell, 1996). Also of note, responses to the GHQ do not appear to be confounded by socially desirable responding (r = -.08, Vieweg & Hedlund, 1983).

A consistent 4-factor structure of responses to the GHQ has been identified across populations, language versions, and item formats (e.g., somatic symptoms, social dysfunction, depression, anxiety, and insomnia; McDowell & Newell, 1996). Construct validity of responses to the GHQ has been demonstrated vis-gl-vis standardized psychiatric interviews. As reported by Vieweg and Hedlund (1983), responses to the GHQ do not appear to be affected by the age of respondents.

Demographics and Health Questionnaire. A questionnaire was constructed for this study to gather personal data and participant health information. As well as information pertaining to socioeconomic variables and particulars of one's marital relationship, several questions derive subjective and objective health information. The latter were adapted from the demographics questionnaire used in the Canadian Study of Health and Aging (CSHA Working Group, 2002) in which participants were asked to indicate whether or not they had experienced a series of health problems over the past year (i.e., allergies, chest


problems, heart condition, kidney disease, cancer, diabetes, high blood pres- sure, arthritis/rheumatism, digestive troubles, nervousness, stroke, insomnia). A cumulative variable was computed on the basis of endorsement of these health conditions. See Table 1 for psychometric features of study variables.

Results

The PRELIS program (Jtreskog & Strbom, 1996) was used to estimate values for missing data (estimated at less than 3% of usable data). As opposed to substituting mean item scores, PRELIS imputes values on the basis of like- responses. This method is preferable to substitution with item mean values which can obscure between group differences (Little & Rubin, 1987). Visual inspection and summary statistics did not reveal a discernible pattern among missing data (i.e., not specific to a particular scale or set of questions).

Well-Being of Widowed Women

The hypotheses of this study were examined by means of hierarchical multiple regression. Life satisfaction of participants was first examined (i.e., dependent variable). With 10 independent variables, the derived sample size (N = 232) was sufficient to guard against ~ or Type II errors where ct = .01 assuming a moderate effect size (Cohen, 1992).

Descriptive variables were entered to control for the contribution of demographic variables relative to life satisfaction (i.e., socioeconomic status, age, years of education, years married, warning of death, duration of widowhood, physical health conditions). This step did not result in significant prediction of life satisfaction scores (R 2 = .06, ns).

Table 1

Psychometric Features of Study Variables (N = 232)

Instrument M SD A l p h a R a ng e Kurtosis Skewness

Life Satisfaction Index 19.53 6.93 .85 5 - 33 -.90 -. 14 General Health Questionnaire 22.95 13.54 .95 1 - 59 -.48 .72 DRS---Commitment to Living 20.40 4.71 .74 6 - 30 .25 -.52 DRS---Perceived Control 19.40 3.66 .67 3 - 27 1.51 -.60 DRS---Challenge 16.78 4.28 .62 4 - 27 -.17 -.12

Note: These indices suggest that the distribution of responses to these instruments is within normal parameters (Tabachnick & Fidell, 2001). Although the overall alpha for the Dispositional Resilience Scale (DRS) is a = .81, estimates of internal consistency are less than ideal for two of the three DRS subscales. This may be attributable to item total sensitivity in the calculation of Cronbach's alpha (Cortina, 1993).

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The three resi l ience subscales were next entered resulting in a significant

increase in prediction of life satisfaction (AR 2 = .24, p < .01, d = .42). O f note, both perceived control (F[10,202] = 6.86, p < .01) and commitment to living (F[10,202] = 21.22, p < .01) each contr ibuted significantly to observed vari-

ance whereas the chal lenge factor did not (F[10,202] = .05, ns ) .

As noted by Courvi l le and T h o m p s o n (2001), beta values a lone are not sufficient when interpreting the results of regression analyses; structure coef-

ficients should also be calculated and reported. (Whereas beta values repre- sent the p red ic t ive s trength o f independen t variables, s t ructure coef f ic ien ts con vey the degree o f associa t ion be tween independen t and dependen t vari-

ables. The latter are interpreted similar to correlat ion coefficients .) As shown in Table 2, those independent variables that s ignif icantly con-

Table 2

Regression Analysis of Life Satisfaction among Widowed Women

Variables B SE B ~ F r s

Socioeconomic Status

Age of Participant

Years of Education

Years Married

Warning of Death (months)

Duration of Widowhood (months)

Physical Health Conditions

-.55 .34 -.11 2.55 .02

-.08 .06 -.11 2.01 -.05

.08 .12 .04 .40 .04

.09 .04 .16 4.14 .07

-.03 .02 -.08 1.71 -.09

.01 .01 .05 .49 -.04

-.35 .21 -.10 2.83 -.21

Resilience Factors:

Commitment to Living

Perceived Control

Challenge

.54 .12 .37 21.22 ** .49

.38 .14 .20 6.86 ** .39

-.03 .11 -.02 .05 .24

* p < .05 ** p < .01

2 Note: r s = structure coefficients. R = .06, ns for sociodemographic variables; D R z = .24, p < .01, d = .42 subsequent to inclusion of psychological resilience.


tribute to prediction of life satisfaction also had the highest structure coefficients (i.e., commitment to living and perceived control). This suggests that the degree of association between these resilience subscales and life satisfaction is similar to their predictive strength (i.e., beta values).

A second regression equation was computed to examine the relationship between psychological resilience and psychopathology. In this instance, demographic variables significantly contributed to prediction of psychiatric distress (R ~ = .12, p < .01). In contrast to prior analyses where demographic variables accounted for only 6% of observed variance in life satisfaction, these variables accounted for twice the observed variance in psychiatric distress. In large degree, this is due to the significant association between physical health

Table 3

Regression Analysis of Psychiatric Distress among Widowed Women

Variables B SE B ~ F r s

Socioeconomic Status

Age of Participant

Years of Education

Years Married

Waming of Death (months)

Duration of Widowhood (months)

Physical Health Conditions

.71 .63 .07 1.27 -.07

-.17 .11 -.12 2.54 -.19

.09 .22 .03 .15 .03

-.09 .08 -.09 1.34 -.13

-.02 .04 -.03 .22 -.03

-.01 .01 -.11 2.60 -.12

1.02 .38 .16 7.14 ** .26

Resilience Factors:

Commitment to Living

Perceived Control

Challenge

-1.32 .21 -.47 37.61 ** -.53

-.17 .26 -.05 .42 -.32

-.10 .20 -.03 .16 -.27

* p < .05 ** p < .01

Note: r s = structure coefficients. R 2 =. 12, p < .01 for sociodemographic variables; AR E = .23, p < .01, d = .55 subsequent to inclusion of psychological resilience.

O'Rourke 275

conditions and psychopathology (F[7,210] = 7.14, p < .01). None of the other demographic variables provided unique contribution to prediction of psychiatric distress. See Table 3.

Again, entry of psychological resilience subscales led to a significant increase in prediction (DR 2 = .23, p < .01, d = .55). This percentage is almost identical to that provided in the prediction of life satisfaction. Here, however, only commitment to living contributed significantly to observed variance (F[7,207] = 37.61, p < .01); this result was observed for neither perceived control (F[7,207] =.42, ns) nor challenge factors (F[7,207] =.16, ns). Overall, a greater portion of observed variance in psychopathology was explained by these independent variables (R 2 = .35, p < .01) than for life satisfaction (R 2 = .30, p < .01). This finding emerged as a result of the significant association between sociodemographic variables and psychiatric distress.

In contrast to the previous regression analyses, moderately large structure coefficients were observed for both perceived control and challenge resilience subscales relative to psychiatric distress. Both were larger than that observed for physical health conditions which significantly contributed to prediction of psychiatric distress (i.e., .39 and .24 vs. -.21).

These apparent contradictions are likely attributable to the significant correlations between commitment to living and the two remaining resilience factors (i.e., r = .59 and r = .45 for commitment and control, and commitment and challenge respectively). Although both these resilience factors appear to be significantly associated with psychiatric distress, commitment to living which exhibited the largest structure coefficient (and beta value), subsumed variance shared with these remaining resilience factors in the prediction of psychiatric distress. Despite their association with psychopathology, the unique contribution of both control and challenge factors was comparatively minor once shared variance with commitment to living was proportionately partialed out in the computation of the regression equation.

Discussion

The results of this study provide support for the hypothesis that psychological resilience is related to the well-being of widowed women. Subsequent to control for sociodemographic variables, psychological resilience or hardiness accounted for more than 20% of observed variance of both life satisfaction and psychiatric distress. These findings suggest that psychological resilience as defined by Kobasa and colleagues (1982) is significantly associated with the well-being of widowed women over and above context-specific features (e.g., years married, preparation for death, duration of widowhood). For both life satisfaction and psychiatric distress, the contribution of resilience was greater than that observed for sociodemographic variables (i.e., 24% vs. 6%, 23% vs. 12% respectively) despite initial entry of these independent variables. In other words, the significant association between psychological resil-


ience and the well-being of widows is observed in excess of variance provided by context-specific variables. We may interpret these findings as indi- cation that psychological resilience is unique to the individual as opposed to the specific circumstances pertaining to her loss.

Also of note, sociodemographic variables do not significantly predict the life satisfaction of those recruited for this study. This result suggests that characteristics of the individual as opposed to the specifics of her loss predict post bereavement satisfaction with life. This finding is in accord with previous research attesting to the association between phenomenological factors and adjustment to widowhood (Barrett & Becker, 1978; Stroebe et al., I988) and the comparatively minimal contribution of sociological factors.

The same observation does not hold, however, with respect to psychopathology. Here, sociodemographic factors appear significantly associated with psychiatric distress among widowed women recruited for this study, largely due to the contribution of physical health. This finding attests to the significant association between the physical and mental health of older adults (O'Rourke, Cappeliez, & Guindon, 2003).

For both life satisfaction and psychiatric distress, commitment to living emerges as the most salient of the resilience factors. Perceived control also predicts life satisfaction but not psychopathology among these widowed women. For both, the challenge factor provides negligible contribution. These findings suggest that a positive orientation to the future is a significant facet of widows' adaptation to loss and well-being. In other words, a positive future orientation appears to preclude a negative preoccupation with the past (i.e., the death of one's husband). These women would seem to have reconciled themselves to their loss; widowhood does not appear to define their existence, but stands as significant life event from which they have moved on (O'Rourke, 2004).

Limitations and Directions for Further Study

Although the results of this study support initial hypotheses, several methodological factors must be acknowledged which limit conclusions that can be drawn. For instance, all data were derived at one point in time thus causal conclusions cannot be made. Although it appears that psychological resilience fosters well-being, in fact, the opposite may be the case (i.e., life satisfaction and the absence of distress lead to resilience). Longitudinal study is required in order to discern causal relationships between these phenomena.

Also of note, all data were provided directly by participants without oppor- tunity to corroborate responses. This limitation is particularly relevant with respect to physical health data as it would have been ideal had objective labo- ratory or physician data also been available. It is feasible that psychological well-being may enable some to forget about physical health concerns whereas distressed widows are more likely to be acutely aware of their health problems. This possible limitation is consistent with research regarding mood con-

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gruent memory processes (i.e., the tendency for dysphoric persons to recall negative details; Mineka & Sutton, 1992).

A final caveat pertains to the use of the Internet as a vehicle for data collection and selection biases this methodology may introduce. Although prior research with older adults identified few differences between Internet respondents and self-selected participants recruited by more traditional means (O'Rourke & Cappeliez, 2002), this conclusion cannot be extrapolated automatically to the current study. Use of the Internet allowed for recruitment of participants from several English-speaking countries yet the challenge remains to ascertain what confounds, if any, use of the Internet provides (see Gosling et al., 2004).

Despite these limitations, results of this study provide support for the hypothesis that psychological resilience is associated with the well-being of widowed women. Consistent with findings reported among other populations, endorsement of these belief systems appears to buffer widows from distress and to promote life satisfaction despite the death of one's husband. Further research is required to determine if psychological resilience exists prior to conjugal bereavement or emerges as a function of dealing effectively with this loss.

Biographical Notes

Corresponding author: Norm O'Rourke, Ph.D., Gerontology Research Centre, Simon Fraser Univer- sity at Harbour Centre, 515 West Hastings Street, Suite #2800, Vancouver (BC) V6B 5K3 Canada. Tel: (604) 291-5175, Fax (604) 291-5066, E-mail: [email protected].

Norm O'Rourke, Ph.D., R.Psych, is a clinical psychologist and assistant professor with the Depart- ment of Gerontology at Simon Fraser University (associate member of the Department of Psychol- ogy). Previously published research has examined affective disorders among older adults, the relative efficacy of pharmacotherapy in the treatment of geriatric depression, couples coping with illness, and family caregiving.

Acknowledgments

This study was conducted with the financial support of a President's Research Grant, Simon Fraser University.

Notes

1. Although resilience has been operationalized differently by others (see Masten & Powell, 2003), this three-construct model espoused by Kobasa and colleagues is the most widely recognized and quantitatively tested.

2. Seventeen widowers also completed study questionnaires. Given this comparatively small percentage (less than 10% of total), analyses were performed only on responses from female participants.

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Revised manuscript accepted for publication in September, 2004. Action Editor: P.S. Fry

psychological resilience and the well-being of widowed women

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