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From Loss to Loneliness: The Relationship Between Bereavement and Depressive Symptoms

This study explores the relationship between bereavement and depressive symptoms, examining whether all symptoms are affected and if the effect can be explained by a common cause or through a network of direct effects. The research is based on the Lives of Older Couples (CLOC) study and includes baseline and follow-up data.

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From Loss to Loneliness: The Relationship Between Bereavement and Depressive Symptoms

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  1. From Loss to Loneliness: The Relationship Between Bereavement and Depressive Symptoms Eiko Fried KU Leuven ICPS Amsterdam March 2015

  2. Currentresearchpractices • Depression understoodas a latent variable • Wecanmeasurethis latent variable byassessingits observable indicators • Weassesssymptoms such assadmood, fatigue, andinsomniatoindicatethepresenceoftheunderlyingdisorder • Wecan so becausedepressionisthecommoncauseforitssymptoms • Symptom sum-scoresusedtoprovideinformationaboutpeople'sposition on the latent variable • Cutoffs on sum-scoresusedtodistinguishbetweenhealthyanddepressed Introduction

  3. Currentresearchpractices • Consequences: • Depression isstudiedashomogeneous, discretediagnosticcategory ("genes fordepression", "riskfactorsfordepression") • Symptoms modeledas passive andinterchangeableindicators • Reciprocalinteractionsamongsymptoms (emotiondynamics) areconsidered irrelevant Introduction

  4. Currentresearchpractices • Consequences: • Depression isstudiedashomogeneous, discretediagnosticcategory ("genes fordepression", "riskfactorsfordepression") • Symptoms modeledas passive andinterchangeableindicators • Reciprocalinteractionsamongsymptoms (emotiondynamics) areconsidered irrelevant • This contrastswithevidence: • 1,030 unique depression symptom profiles identified in 3,703 depressed patients Introduction

  5. Currentresearchpractices • Consequences: • Depression isstudiedashomogeneous, discretediagnosticcategory ("genes fordepression", "riskfactorsfordepression") • Symptoms modeledas passive andinterchangeableindicators • Reciprocalinteractionsamongsymptoms (emotiondynamics) areconsidered irrelevant • This contrastswithevidence: • 1,030 unique depression symptom profiles identified in 3,703 depressed patients • MD symptomsdiffer in theirriskfactors, impacton impairmentoffunctioning, andbiologicalmarkers Introduction

  6. Currentresearchpractices • Consequences: • Depression isstudiedashomogeneous, discretediagnosticcategory ("genes fordepression", "riskfactorsfordepression") • Symptoms modeledas passive andinterchangeableindicators • Reciprocalinteractionsamongsymptoms (emotiondynamics) areconsidered irrelevant • This contrastswithevidence: • 1,030 unique depression symptom profiles identified in 3,703 depressed patients • MD symptomsdiffer in theirriskfactors, impacton impairmentoffunctioning, andbiologicalmarkers • MD symptomsorganized in dynamicnetworksofcausalinfluences Introduction

  7. From Loss to Loneliness: The Relationship Between Bereavement and Depressive Symptoms  Fried, E. I., Bockting, C., Arjadi, R., Borsboom, D., Tuerlinckx, F., Cramer, A., Epskamp, S., Amshoff, M., Carr, D., & Stroebe, M. (2015). From Loss to Loneliness: The Relationship Between Bereavement and Depressive Symptoms. Journal of Abnormal Psychology, 1–10. doi:10.1037/abn0000028

  8. Research question • Doesthestressfullifeeventspousallossaffect all oronlysomedepressionsymptoms? (Keller & Nesse 2005, 2006; Keller et al. 2007) From Loss to Loneliness

  9. Research question • Doesthestressfullifeeventspousallossaffect all oronlysomedepressionsymptoms? (Keller & Nesse 2005, 2006; Keller et al. 2007) • Can the effect be better explained by … • H1: the common cause framework, indirect effect of partner loss on depressive symptoms that goes through a latent variable s1 s2 D s3 B s4 s5 From Loss to Loneliness

  10. Research question • Doesthestressfullifeeventspousallossaffect all oronlysomedepressionsymptoms? (Keller & Nesse 2005, 2006; Keller et al. 2007) • Can the effect be better explained by … • H2: a network, directeffect of loss on symptoms s2 B s1 s3 s4 From Loss to Loneliness

  11. Methods • Lives of Older Couples (CLOC) study • Baseline: married couples enrolled (60+ years) • Bereaved: N=241 • Controls: N=274 (still-married) • CES-D11, dichotomized Death Follow-up Baseline … 6 months … t From Loss to Loneliness

  12. Demographics • N=515 • 85.4% female • Meanageduringenrollment: 73.3 • Bereavedparticipantsexperiencedspousalloss on average 31 months after enrollment • Most frequent causes of death: • heart attacks (29.5%) • cancer (25.3%) • arteriosclerosis and related conditions (12.4%) • strokes (8.7%) From Loss to Loneliness

  13. Results • Lives of Older Couples (CLOC) study • Baseline: married couples, 65 years or older • Bereaved: N=241 • Controls: N=274 (still-married) • Baseline: nodifferencesbetweenbereavedandcontrolparticipants (age, sex, depressive symptoms) Death Follow-up Baseline … 6 months … … 31 months … t From Loss to Loneliness

  14. Results • Lives of Older Couples (CLOC) study • Baseline: married couples, 65 years or older • Bereaved: N=241 • Controls: N=274 (still-married) • Baseline: nodifferencesbetweenbereavedandcontrolparticipants (age, sex, depressive symptoms) Death Follow-up … 6 months … … 31 months … t From Loss to Loneliness

  15. Results I From Loss to Loneliness

  16. Results II: commoncausemodel Model fit: ²= 288.7, df = 54, p < .001RMSEA = .09, CFI = .90 From Loss to Loneliness

  17. Results II: alternative model From Loss to Loneliness

  18. Results II: alternative model Model fit: ²= 171.4, df = 58, p < .001RMSEA = .07, CFI = .95 Model comparison: ²diff = 124.69, dfdiff = 6, p < .001 From Loss to Loneliness

  19. Results III: Network model • Ising Model (binarydata) • "Partial correlations" • Conservativeestimationofedges due topenalization(lassobased on EBIC) • Fruchterman-Reingoldalgorithmforvisualization From Loss to Loneliness

  20. ResultsIII: Network model • Ising Model (binarydata) • "Partial correlations" • Conservativeestimationofedges due topenalization(lassobased on EBIC) • Fruchterman-Reingoldalgorithmforvisualization From Loss to Loneliness

  21. Conclusion • Bereavement differentially impacts on depression symptoms; common cause explanation problematic • In line with other research documenting "situation-symptom-congruence" • Sum-scores obfuscate important (dynamic) insights • Loneliness as a gateway symptom; implications for intervention and prevention • DSM-3 and DSM-4 bereavement exclusion criterion From Loss to Loneliness

  22. Thank you

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