Physical Health Outcomes of Conjugal Bereavement: A Psychoneuroendocrine Model of Resilience

Spousal bereavement is considered as one of the most intense stressors requiring substantial life readjustment [1]. The consequences for physical health of the loss of a spouse have been studied extensively over the last three decades. Summarizing findings from 13 longitudinal studies published since 1999, Stroebe et al. [2] pointed out that an increase in morbidity is consistently observed in the early months of bereavement, and that young-old widowers is the most vulnerable subgroup. The risk of a new or worsened illness increases in the early months after loss, but decreases after six months. Excessive mortality is also observed during the early months after bereavement but decreases over time. The causes of mortality among the bereaved are various, and include suicide. Despite the significance of the aforementioned data, several dimensions of the relationship between conjugal bereavement and physical ill health have received relatively little attention. The first concerns the psychophysiological mechanisms that mediate lossinduced morbidity. Despite three decades’ worth of research in this area, the process by which bereavement is translated into physical ill health is still not completely understood. Second, as the existing research has focused exclusively on vulnerability factors, few insights have been gained into the factors that confer resilience on the bereaved. Although it is now widely appreciated that both risk and resilience factors determine the trajectory of adaptation to bereavement, relatively few studies have addressed resilience in this context. I will address these gaps in the literature in the following and propose a psychoneuroendocrine model of resilience to inform future research directions.