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. Author manuscript; available in PMC: 2011 Apr 27.
Published in final edited form as: Illn Crises Loss. 2010;18(4):301–321. doi: 10.2190/il.18.4.b

A Tale of Two Counties:Bereavement in Socio-Demographically Diverse Places

Dale Lund (1), Michael Caserta (2), Rebecca Utz (2),(3), Brian deVries (4)
PMCID: PMC3083022  NIHMSID: NIHMS194454  PMID: 21533005

Abstract

The “Living After Loss” study was designed to test the effectiveness of the dual process model (DPM) of coping with bereavement. In order to obtain a larger and more diverse sample we studied 328 recently widowed men and women (61%) age 50+ in two counties, Salt Lake (n=197) and San Francisco (n=131) in two states, Utah and California. This paper does not report on the effects of the intervention but focuses on a comparison of the bereaved spouses/partners in these two cites. First, the only socio-demographic differences we found between those in SF and SL were that those in San Francisco were more racially, ethnically and religiously diverse, higher in education, had slightly fewer years in their relationship to the deceased and were two weeks longer in their grief process. Second, there were far more similarities than differences between SF and SL regarding nearly all of the study variables. Third, we found that those in SF had more positive qualitative features in their friendship support networks and that for bereaved in both counties, we found strong associations with having highly supportive friend-based networks and more positive bereavement adjustments (especially experiencing lower levels of loneliness and depression). Limitations and suggestions for future research are described.

The primary purpose of this article is to compare recently 328 bereaved widows and widowers who live in two very socio-demographically counties, San Francisco, California and Salt Lake, Utah to identify both similarities and differences in their early grief adjustments. While doing this we examine their socio-demographic features, aspects of their support networks and then their early grief-related adjustments. Also, regardless of the location of their residence we investigate the way selected aspects of their grief adjustments might be associated with socio-demographic and social support network features. We conclude by discussing how the identified similarities and differences and relationships can impact future research and interventions.

Data for this article come from a larger study “Living After Loss”, designed to test the effectiveness of the Dual Process Model (DPM) of coping with bereavement (Stroebe & Schut, 1999) among recently widowed men and women age 50 and over. In order to increase the religious, racial and ethnic diversity among the research participants and the overall size of the sample we decided to do the study in both Salt Lake and San Francisco Counties where the investigators were located. Because the residents in these two sites or counties differ on a number of dimensions that could potentially impact their course of bereavement, it is critically important to make statistical comparisons between them in our early data analysis plan to know the extent to which they can be considered as one larger and more diverse sample. These differences also provide us the opportunity to examine these unique features and assess their impact on early bereavement adjustments. Therefore, the primary purpose of this paper is to identify the similarities and differences between participants from two culturally and demographically unique counties, Salt Lake and San Francisco. We compare the participants' socio-demographic characteristics, bereavement outcomes, and other moderating influences such as social support to determine whether the experience or process of grief is unique or widely shared.

Research on Spousal/Partner Bereavement

The death of a spouse or partner in mid and later life, after many years of intimate relationship is one of the most common of all major stressful life transitions. Research on spouse/partner loss has revealed that although the long-term bereavement process is experienced with considerable variability, common outcomes include profound sadness, pining, depression, altered identity, negative health effects, and loneliness (Bennett et al., 2005; Bisconti et al., 2004; Carr et al., 2006; Hansson & Stroebe, 2007; Lee & Carr, 2007; Lund, 1989; Lund & Caserta, 2002; Stroebe et al., 1993), as well as stress associated with role changes, disruptions in life patterns and daily routine, taking on new unfamiliar tasks, and changes in social activities and relationships (Anderson & Dimond, 1995; Carr, 2004; Moss et al., 2001; Utz et al., 2002; Utz et al., 2004).

The loss of a spouse or partner also can be disruptive to existing self- care and daily living behaviors, as well as interfere with the adoption of new ones (Chen et al., 2005; Pienta & Franks, 2006; Powers & Wampold, 1994; Rosenbloom & Whittington, 1993; Williams, 2004). For example, meal planning and preparation, household maintenance, managing finances, as well as other tasks often go unattended by the surviving spouse if these tasks were primarily the responsibility of his or her deceased partner. Those who fail to acquire new skills to accomplish these tasks are at increased risk for long-term mental and physical health problems following widowhood (Carr et al., 2000; Lund, Caserta, Dimond et al., 1989; Stroebe & Schut, 1999; Utz, 2006; Wells & Kendig, 1997).

Although spouse or partner loss is often associated with a variety of disruptive and negative outcomes, theory, research and practice also has focused on successful adaptation, resiliency and personal growth among the bereaved (Boerner et al., 2005; Bonanno, 2004; Calhoun & Tedeschi, 2006; Caserta et al., 2009; Dutton & Zisook, 2005; Lund et al., 2008; Montpetit et al., 2006; O'Rourke, 2004; Ong & Bergeman, 2004; Ong et al., 2004; Wilcox et al., 2003; Znoj, 2006). There is evidence that positive daily emotions among bereaved persons can regulate, moderate or protect against some of the negative psychosocial reactions associated with grief (Fredrickson, 2001; Ong et al., 2004). Keltner & Bonanno (1990) reported that bereaved persons who engaged in full-laughter were more successful in emotionally distancing themselves from grief. Similarly, bereaved adults who valued humor, laughter and happiness in their daily lives and experienced these positive features were found to have more favorable early bereavement adjustments in terms of lower levels of grief and depression (Lund, Utz, Caserta & de Vries, 2008–09).

Research on Culture and Bereavement Adjustments

There is a considerable amount of literature on the topic of cultural variations in expressions of grief and mourning practices worldwide (Irish, Lundquist & Nelsen, 1993; Morgan, Laungani & Palmer, 2009). Culture obviously shapes the way in which people are expected to mourn, for how long and what specific rites of passage should be followed. Much less is known, however, about the cultural influence on how people adjust psychosocially to loss, especially using comparable measures of adjustment in the same study. Carr (2006), and others (Lund, et al., 1993) have reported that there is little systematic comparative research that has been conducted on how ethnic and religious groups grieve. She goes on to document the growing diversity among older adults (age 65+) in the U.S population by stating that the following cultural groups will increase in percentage from current figures to estimates in 2050 as follows; African Americans projected to increase from 8% to 12%, Hispanics (of any race) from 6% to 18%, Asians from 3% to 8%, while non-Hispanic Whites will decline from 83% to 61% (based on Federal Interagency Forum on Aging-Related Statistics, 2004). These increases in diversity forewarn bereavement educators, researchers, clinicians and policy planners to be better prepared for meeting the needs of this growing diverse population.

Carr (2006) also summarizes some of what is known about ethnic and racial differences in bereavement coping. She reports that African Americans are more likely to use religious participation as a coping strategy (e.g. Levin, Chatters & Taylor, 1995). African American couples have shorter marriages, more marital conflict but a more egalitarian division of labor for household tasks with the female also being more likely to work outside the home (Orbuch & Eyster, 1997). African Americans also have more disperse support networks than Whites which include friends, distant relatives, neighbors and church members (Ajrouch, Antonucci & Janevic, 2001). Further, Carr found in an earlier study (2004), that older African Americans bereaved spouses had lower levels of anger and despair and that it was due primarily to higher levels of social and religious support. Blacks and whites, however, were found to report similar levels of grief, yearning, intrusive thoughts, shock, depression, and anxiety.

Latinos have been described as being more inclined to express their feelings of sadness and anger in the presence of others and in visible bodily reactions such as shouting, swearing and falling to the ground (Guarnaccia, DeLaCancela & Carillo, 1989). Chinese bereaved spouses sometimes feel ashamed to go outside the family to use public agencies for support. Filial piety from Confucian principles places strong responsibility on adult children to meet the needs of their aging parents, including times of grief (Wei-Ming, 1994). In a cross-national study by Antonucci et al., (2001) widowed Japanese aged 70 – 90 had smaller social networks than similar older persons in France, Germany and the United States.

Socio-demographic data comparisons between Salt Lake and San Francisco reveal some striking differences regarding racial, ethnic, religious, age, income and educational characteristics of the residents. The 2000 Census reports (U.S. Bureau of the Census, 2010) indicate that San Francisco has a larger population of adults age 55 and over (22.0% compared with 16.9% in Salt Lake County). Those in San Francisco County also have higher educational attainment with 45.0 % having earned B.S/B.A degrees and 16.4% earning graduate or professional degrees compared with 27.4% and 9.1%, respectively in Salt Lake County. San Francisco residents have median household incomes of $67,000 compared with $56,000 in Salt Lake. San Francisco also has slightly higher rates of widowed persons (6.1% compared with 4.1% in Salt Lake). With respect to race and ethnicity, San Francisco County is much more heterogeneous than Salt Lake. In San Francisco, there are four sizeable populations of white non-Hispanic, Asian, Latino, and African American (46%, 31%, 14%, and 5%, respectively). In Salt Lake County, 76% of the population is white non-Hispanic followed by 16% who are Latino. The next largest racial/ethnic groups are Asian (3%), African American (2%), Pacific Islanders (1%) and American Indians (1%). and they account for relatively small percentages of the population. Religious affiliation data from 2000 shows Salt Lake to consist of a large population of Mormons (56%) with only less than 1% living in San Francisco. Both counties have sizeable populations of Protestants, Catholics and persons who claim no religious affiliations (Association of Religion Data Archives, 2010).

In short, we know very little about the ways in which culturally diverse groups adjust to late life bereavement and widowhood. Also, in our opinion, most of the known research on this topic appears to be more focused on finding and reporting the differences, rather than the similarities between groups. We should be equally interested in finding and reporting the similarities among these groups as they are quite likely to be substantial. Our comparison of bereaved spouses/partners in Salt Lake and San Francisco provides an opportunity to investigate both the differences and similarities across diverse groups within the population. By searching for similarities along with differences, we might be better able to distinguish between the unique and universal features of bereavement experiences. Future interventions can also benefit by focusing on both the unique and shared ways to provide assistance in the adjustment processes.

METHODS

Data come from Living After Loss (LAL) project, a study designed primarily to test the effectiveness of an intervention based on the Dual Process Model of Coping (Stroebe & Schut, 1999). Participants were randomly assigned to the DPM treatment intervention that combined restoration-oriented (RO) and loss-oriented (LO) coping activities into one group condition and compares their outcomes with those in a comparison group condition that comprised of bereavement support, which is largely loss-oriented in focus (Lund, Caserta, de Vries, & Wright, 2004). The control condition represented what typically comprises community-based bereavement support groups. Both groups met for 14 weekly meetings and all participants, regardless of study condition, completed a series of four questionnaires prior to and after the intervention to assess their adjustment to widowhood. In this report, we use data from the baseline questionnaire only; thus capturing the widowed persons' experiences prior to the intervention and at the earliest stages of bereavement (two to six months post-loss). Other reports are underway that examine directly the short- and long-term effects of the DPM guided intervention.

Sample

Eligibility for the LAL project was restricted to persons who had recently lost their spouse or partner (within the last 2–6 months), were over the age of 50, English speaking, and could attend a 14-week group meeting in either the Salt Lake City or San Francisco area. Potential participants were recruited for the study after primarily being identified through a random selection of death records maintained by the Salt Lake and San Francisco county health departments. Potential participants meeting the eligibility requirements above, were mailed letters explaining the purposes of the study, how they were identified and what would be expected of them. The letters indicated that we would be contacting them by phone or they were invited to call the project office. After telephone confirmation with each participant, appointments were made for a trained member of the project staff to make a home visit to obtain signed consent, answer questions, and explain sections and items in the baseline questionnaires. Additional details on the sampling and recruitment procedures used in the LAL study can be found elsewhere (Caserta et al, 2009; Lund et al, 2008–09).

The analytic sample for this paper is the full LAL baseline sample, consisting of 328 persons (197 [60%] from Salt Lake County, Utah and 131 [40%] from San Francisco County, California) who participated in the project and completed a baseline questionnaire between February 2005 and April 2008. The average participant completed the baseline questionnaire approximately 4 months (15.6 weeks) after the spouse's death, with some completing it as early as 5 weeks post-loss and some as late as 24 weeks post-loss. The sample includes 61% women (n = 200) and 39% men (n = 128). The average age of our sample was 69.6 years (SD = 10.6), with a range of 50 to 93 years. Participants had been married or partnered for an average of 39.8 years (SD = 16.9). The majority were Caucasian (85%), with 5% African American and 10% other races including Asian, Latino, Native American, and Multi-Racial. The LAL sample is quite educated: only 15% of the sample had a high school education or less; 41% had some college; and 44% had graduated from a college.

Measures

In addition to selected demographic and background factors, the self-administered questionnaires included five primary measures of bereavement outcomes and eight measures of informal social support. The demographic characteristics assessed included gender, age, education, race, employment status, financial well-being, marital length, religion, self-reported health. All of these variables were measured approximately four months post-loss, as perceived or reported by the widowed person. In addition, we considered whether the bereaved expected the death and how many weeks after the death the survey was completed. The five primary bereavement adjustment outcome measures are described first and then followed by descriptions of the measures of social support. All five of the measures are available for other's use through the reference citations noted below.

Grief was measured by the Texas Revised Inventory of Grief—Present Feelings (TRIG - Faschingbauer, 1981). This scale consists of 13 Likert-type items that are summed to produce a score ranging from 13 (low grief) to 65 (high grief). Faschingbauer, Zisook, and DeVaul (1987) established construct validity using a variety of discriminations according to age, sex, and relationship to deceased. They also reported a split-half reliability coefficient equal to .88 and an alpha coefficient equal to .86. The alpha coefficient for the present sample was .90. Although other scales have been recently developed, the TRIG continues to be among the most widely used grief measures in bereavement studies (Neimeyer & Hogan, 2001).

Depression was assessed using the Geriatric Depression Scale (GDS) (Short Form) (Sheikh & Yesavage, 1986), a 15-item version of the longer GDS (30 items). The short form was developed with items that produced the greatest item-total correlations and was reported to be equally effective as the long form in discriminating depressed from non-depressed older adults (r = .84) (Sheikh & Yesavage). The alpha coefficient generated by the sample in this study was .84

We measured Loneliness using the UCLA Loneliness Scale – Short Form (Russell, 1996), which has been validated on a community-based older sample with an alpha equal to .89 and significant correlations with life satisfaction (−.36) and depression (.45). Although originally designed as a 20-item scale, Russell reported that the 13-item short form produced item-total correlations >.50 for a sample aged 65+. This scale was found to be internally consistent, generated an alpha coefficient equal to .89 for this sample.

The Coping Self-Efficacy Scale (CSES - Hayslip, Allen, & McCoy-Roberts, 2001) consists of 27 dichotomous (Y/N) items that measure beliefs about one's ability to cope with the loss of a loved one, whether physically, emotionally or socially. Hayslip and colleagues reported the scale to be internally consistent (alpha = .89) and that it correlated with a variety of well-being indicators among a bereaved sample. The sample for this study generated an alpha coefficient equal to .91.

Stress-related growth was measured through the 15-item Stress-Related Growth Scale - Short Form (SRGS-SF) (Cohen, Hettler, & Pane, 1998; Park, Cohen, & Murch, 1996). The short form was developed through the highest item-total correlations among two samples (Cohen, Hettler, & Pane, 1998) and it generated an alpha coefficient equal to .91 for the sample

Informal social support was assessed using items that examined facets of social support from both family and friends. These consisted of a single measure of network size for each relationship type (number of family members or friends in network) and three measures of support quality including ease of contact, support frequency, and satisfaction with the support received, again for each relationship type. Each of the three quality measures were rated on a 5-point Likert scale where higher values indicated greater ease of contact or higher levels of support frequency and satisfaction. (Dimond, Lund, & Caserta, 1987).

Analytic Plan

The analysis is largely descriptive, comparing participants from San Francisco and Salt Lake Counties on three sets of variables: demographic characteristics, bereavement adjustment outcomes, and moderating influences associated with informal social support from friends and family. Because we compared participants from the two counties across 24 different variables. we adjusted all significance tests with the Bonferroni Correction procedure. Thus, only those variables where the between-group difference was p ≤ .002 (calculated as 0.05 / 26) are considered to be statistically different between sites. We did further exploratory analyses on those the specific variables where we found significant differences between the two sub-samples to assess their correlation with bereavement adjustment indicators.

RESULTS

Table 1 compares the characteristics of the Salt Lake and San Francisco sub-samples. As expected, the Salt Lake sample was less racially, ethnically, and religiously diverse than the San Francisco sample. Salt Lake was primarily Caucasian (96%), while nonwhites comprised 32% of the San Francisco sample including 14% Asians and 11% African Americans. More than half (59%) of the Salt Lake sample was Mormon, whereas the San Francisco sample had 31% Catholic, 27% Protestant, 7% Jewish, 22% reporting no religious affiliation, and 13% reporting some other religious affiliation.

Table 1.

Baseline Characteristics of Recently-Bereaved Participants in Salt Lake (N = 197) and San Francisco (N = 131)

Salt Lake
 San Francisco
N % N % for categorical variables
Characteristics M (SD) M (SD) for continuous variables
Gender
 Male 75 38% 53 41%
 Female 122 62% 78 59%
Age 69.2 (10.5) 70.0 (10.7)
Education
 High school grad or less 34 17% 16 12% †, ***, a
 Some college/vocational 95 48% 38 29%
 4-year college graduate 28 14% 23 18%
 Some post-college 15 8% 19 14%
 Grad/Professional degree 25 13% 35 27%
Race
 White 189 96% 89 68%
 Asian 4 2% 19 14% †, ***, a
 African-American 0 0% 15 11%
 Latino 3 2% 5 4%
 Native American 1 1% 0 0%
 Multi-racial 0 0% 3 2%
Employment Status
 Not working 127 65% 85 65%
 Part-time 26 13% 15 12%
 Full-time 44 23% 30 23%
Financial Adequacy (1= Not very good; 3= More than adequate)
2.0 (0.5) 2.1 (0.6)
Years Married 41.5 (16.3) 37.4 (17.5) †, ***, b
Religion
 Catholic 16 8% 40 31% †, ***, a
 Jewish 2 1% 10 7%
 Mormon 116 59% 1 1%
 Protestant 30 17% 20 27%
 Other 10 5% 7 12%
 None 22 11% 29 22%
Death was expected 110 56% 74 57%
Self-Rated Health (1 = poor; 7 = excellent)
5.1 (1.1) 5.2 (1.3)
Weeks Bereaved 16.2 (3.6) 14.8 (3.7) †, ***, b
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Notes: Percentages might not add up to 100% due to rounding.

a

Statistically significant between-group differences were assessed with Chi-Square

b

Statistically significant between-group differences were assessed with independent samples t-test

*

p<.05

**

p<.01

***

p<.001.

†

indicates that the between-group comparison remained significant after applying a Bonferroni Correction procedure (p<.002). Percentage totals for race are greater and less than 100% due to rounding.

Beyond those expected differences, the bereaved persons in these two counties differed in only three other socio-demographic variables: First, those in Salt Lake had been married or cohabiting four years longer than those in San Francisco (41 and 37 years, respectively). Second, the Salt Lake participants were bereaved approximately two weeks longer at the beginning of the study than the San Francisco participants (16 and 14 weeks, respectively). And, third, although both samples had a high proportion of participants who had at least some college (83% in Salt Lake, 88% in San Francisco), fewer individuals (35%) in the Salt Lake sample had a degree from a four-year college, whereas 59% of those in the San Francisco sample did. The two samples did not differ in terms of gender, employment status, financial adequacy, expectedness of the death, and self-rated health. The difference in marital length is likely due to the trend of early age at marriage among Utah whereas the difference in weeks bereaved is likely a result of slightly different recruitment methods used across the two sites (Caserta, et al, 2009).

Table 2 shows remarkable similarity between the two samples in terms of bereavement-related outcomes. The two samples differed on only one of the five adjustment outcome measures. Those in the Salt Lake sample had a slightly higher degree of stress-related growth (M=17.8 and 16.0) than those in the San Francisco sample, but the significance of this between-group comparison was lost when adjusted for the Bonferroni Correction. Thus, the bereavement adjustment appears to be remarkably similar across these two demographically diverse groups of bereaved persons.

Table 2.

Comparison of Salt Lake (N=197) and San Francisco (N=131) Participants on Selected Bereavement-Related Outcomes

Salt Lake City
 San Francisco
Bereavement Outcomes M (SD) M (SD)
Grief 42.7 (10.8) 44.1 (10.4)
Depression 4.1 (3.7) 4.3 (3.5)
Loneliness 26.6 (6.2) 26.1 (6.1)
Stress-Related Growth 17.8 (6.6) 16.0 (7.2)*
Coping Self Efficacy 48.9 (5.6) 49.0 (5.2)
Self Esteem 32.5 (4.6) 33.5 (4.5)
Mastery 21.2 (3.6) 21.2 (3.4)
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Notes: Statistically significant between-group differences were estimated with independent samples t-tests

*

p<.05

**

p<.01

***

p<.001.

†

indicates that the between-group comparison remained significant after applying a Bonferroni Correction procedure (p<.002)

Table 3 compares the two samples on several measures of social support, since social support is an important buffer in early bereavement. Overall, those in Salt Lake reported larger family and friendship networks, but those in San Francisco reported slightly more favorable ratings of the quality of support received from their friendship networks. The average Salt Lake participant's family network was almost 15 people, compared to less than 7 for the San Francisco sample. Similar differences were found in the friendship networks of the two sub-samples: Salt Lake participants reported an average of 14.5 friends, whereas the San Francisco participants reported less than 10. The reported size of friend and relative networks of Salt Lake participants were positively skewed, given the very large numbers of family and friends reported by some of the Salt Lake participants (up to 250 for friends and 250 for family/relatives); thus, the median values of these variables may provide a more accurate picture of the differences in network size between groups: 5 relatives & 6 friends in San Francisco versus 10 relatives and 8 friends in Salt Lake). Despite the differences in network size, participants from both samples reported similar levels of support quality in terms of ease of contact, frequency of help, and satisfaction with support received from family members. However, those in the San Francisco sample reported greater ease of contact with friendship networks than those in the Salt Lake sample (M=4.3 versus 3.9). They also reported higher frequency of support (M=3.8 versus 3.4) and greater satisfaction with their friendship support networks (M=4.2 versus 3.8) than the Salt Lake sample did. After applying the Bonferroni correction, the large familial networks among Salt Lake participants remained statistically different than the familial networks of San Francisco; however, the different size of the friendship networks across the two cities was no long statistically significant. Furthermore, the higher quality of friendship support among San Francisco participants largely remained statistically significant after adjusting for multiple comparisons.

Table 3.

Comparison of Salt Lake (N=197) and San Francisco (N=131) Participants on Social Network and Support Measures

Salt Lake
 San Francisco
Social Support Measures M Median (SD) M Median (SD)
Family Support Network
 Network Size (#) 14.7 10 (21.8) 6.8 5 (6.8)***†
 Ease of Contacta 4.3 (1.0) 4.3 (1.0)
 Frequency of Helpb 4.0 (0.9) 3.9 (1.0)
 Support Satisfactionc 4.2 (0.9) 4.1 (1.0)
Friendship Support Network
 Network Size (#) 14.5 8 (25.8) 8.8 6 (7.9)*
 Ease of Contacta 3.9 (1.0) 4.3 (0.9)**†
 Frequency of Helpb 3.4 (1.0) 3.8 (1.0)**†
 Support Satisfactionc 3.8 (1.1) 4.2 (0.9)*
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Notes: Between-group differences for “Network Size” were determined using the Mann-Whitney U test, given the skewed distribution on these variables. Between-group differences for all other variables were estimated with independent samples t-tests.

*

p<.05

**

p<.01

***

p<.001.

†

indicates that the between-group comparison remained significant after applying a Bonferroni Correction procedure (p<.002). Variables were measured with the following response options:

a

Ease of Contact: 5-point scale: 1= very difficult; 5= very easy

b

Frequency of Help: 5-point scale: 1 = never; 5= very often

c

Support Satisfaction: 5-point scale 1 = not at all satisfied; 5= very satisfied

With a series of OLS multiple regression equations (not shown, but available by request), we attempted to look at the relative contribution of site (San Francisco or Salt Lake) on the five bereavement outcome measures both before and after controlling for the demographic and social support variables investigated in this analysis. This type of stepwise regression approach, where the effect of site on an outcome measure could first be explored as a bivariate regression and then again after adding in the blocks of variables representing demographic and social support measures, proved to be unsuccessful. For each of the five outcome measures, site was consistently excluded from the full model. Given the high Variance Inflation Factor (VIF) estimates, it was evident that there was multicollinearity across variables leading to instability of the b and beta coefficients. Thus, we were unable to statistically illustrate if 1) the effect of site was mediated by the addition of demographic or social support variables, or 2) whether site played a relatively more or less prominent role than the other variables considered. Given the statistical inability to run these mediation analyses and the high correlation of site to several of the other variables assessed (refer back to Tables 1, 2, and 3), this exercise furthermore suggest that site is indeed a proxy for the demographic and social support differences associated with the participants from these two counties.

As a final step in the analysis and as a follow-up or compromise to the unsuccessful estimation of stepwise regression equations, we present the correlation values among seven bereavement-related outcome measures and the ten identified characteristics on which the two sub-samples differed (refer back to Tables 1, 2, 3). We did this to further explore whether the socio-cultural differences between the two sub-samples may also be associated with different bereavement experiences across the two counties. Table 4 summarizes the results of this exploration. While the two samples characteristically differed in terms of racial composition, religious affiliation, and educational attainment (refer back to Table 1), when we examined the associations of these variables on the indicators of bereavement adjustment, we found only one significant association out of the 15 possible. We discovered that non-whites had slightly higher levels of personal growth than white participants (M=19.5 compared with 16.6, p<.01). Earlier in the discussion of Table 1, we also reported that the Salt Lake sample had longer pre-bereavement relationships and shorter post-widowhood experiences than the San Francisco sample; Table 4 shows that longer relationships were associated with higher levels coping self-efficacy (r =.11) and growth (r=.12), but lower levels of grief (r=−.18), depression (r = −.26) and loneliness (r = −.19), but the number of weeks bereaved was not significantly associated with any of the bereavement outcomes. Perhaps, the most striking finding is that out of the 25 possible correlations among demographic characteristics and outcome measures, only 6 were found to be significant and nearly all of them had to do with the length of the relationship between the deceased and surviving spouse/partner.

Table 4.

Statistically Significant Associations Between Selected Socio-Demographic and Social Support Factors and Bereavement-Related Outcome Measures

Bereavement Related Outcomes
Grief Depression Loneliness Stress-Related Growth Coping Self Efficacy
Demographic Differences Between Sites
Educational Attainment
Race Mwhite: 16.6**
Mnonwhite: 19.5
Religion
# of Weeks Bereaved
Relationship Length (in years) −.18*** −.26 *** −.19*** .12* .11*
Social Support Differences Between Sites
# of Relatives −.14* −.18** .17**
# of Friends −.12* −.21 *** .12*
Ease of Contact with Friends −.16** −.30** −.40** .14* .33**
Frequency of Contact with Friends −.15** −.40** .17**
Support Satisfaction from Friends −.21*** −.35*** −.53*** .14* .32***
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Notes: Bivariate correlation value presented in cell, unless otherwise designated by means.

*

p<.05

**

p<.01

***

p<.001

When comparing the association of social support and bereavement related outcomes, a different story emerged. Earlier in Table 3, we found that participants in Salt Lake had larger networks, but less perceived quality in friendship networks than those in San Francisco. Out of the 25 possible associations between social support and outcome measures, only 6 were non-significant. All of these associations were in the expected direction with greater support being associated with more favorable outcomes defined as lower depression, grief, loneliness and increased growth and coping self efficacy. The strongest of these correlations was exemplified by the strong negative relationship between the size and quality of networks on loneliness. For example, the strongest relationship was found between high support satisfaction from friends and experiencing lower degrees of loneliness (r= −.53). Also, regarding lower levels of loneliness, we found strong associations with ease in contacting friends and frequency of contact with friends (r=−.40 for both). Also, there were strong positive associations between ease in contacting friends and support satisfaction from friends on having higher levels of coping self-efficacy (r= .33 and r= .32, respectively). It is clear that having strong support from friends was associated with lower levels of grief, depression, loneliness and greater coping self-efficacy..

CONCLUSIONS & DISCUSSION

Before we summarize and discuss our major findings it is important to note some of the limitations of the present study. Although we were successful in obtaining a larger sample of participants for the larger we would have preferred having an even more diverse total population. We still had a total sample that was 85% White. However, this means that we included 50 persons who were not Caucasian and that is somewhat more diverse than many other studies of bereavement, particularly those that are testing theoretically-based interventions. The other primary limitation is that we were able to only examine the baseline, pre-intervention data in the study as we continue to engage in data coding and cleaning for the post-intervention assessments. As these data become available we will be able to address the longitudinal questions raised in this paper along with answering questions about the effectiveness of the intervention.

The first and perhaps most important conclusion from our comparisons of bereaved spouses/partners in Salt Lake and San Francisco is that while there were some differences between the two samples in their socio-demographic characteristics and support network features, there was only one difference between the counties in terms of bereavement adjustment outcomes. There were far more similarities than differences between the study sites. Particularly noteworthy were the similarities in four of the five adjustment comparison measures (i.e. grief, depression, loneliness, and coping self-efficacy). The only difference was that those in Salt Lake had slightly higher levels of stress-related growth. We have no obvious reason to explain this unless it may have some relationship to Mormon religious beliefs.

It was not surprising that the San Francisco sample was more racially, ethnically and religiously diverse than the Salt Lake sample. As noted earlier, approximately 56% of the residents of Salt Lake County are Mormon and they are predominantly non-Hispanic white. In all of our past studies on bereavement using a Utah population, we have compared the Mormons with non-Mormons and have only found them to differ in having larger families and support networks, more likely to visit the grave of the deceased, and less likely to smoke and drink alcohol as coping strategies (Lund, Caserta & Dimond, 1993). We have not found Mormons to differ from non-Mormons in Utah in any of the major bereavement adjustments. And, we have not found Mormons to differ from non-Mormons in other bereavement studies in Los Angeles and Miami (Lund, 1989).

As expected, we did find Salt Lake participants to have larger support networks of both family and friends compared with those in San Francisco. However, while the participants in both counties had similar levels of support from family members, those in San Francisco reported receiving more qualitative support from those in their friendship networks. This is the second major conclusion of this investigation because it also appears that having more positive assessments of support from friends (rather than family) is significantly associated with having lower levels of depression and loneliness. Those in San Francisco gave similar qualitative ratings to both relatives and friends as support persons but those in Salt Lake gave slightly higher qualitative ratings to those in the family support network. But, when the county of residence is ignored, the role of friendships has a stronger association with positive outcomes. Especially noteworthy are the strong associations between the qualitative features of the friendship support network on loneliness with bivariate associations ranging from −.40 to −.53. The clear benefits from having support from friends, compared with having support from family members, may have something to do with the potential of being able to be more open in communications with close friends. Our data do not allow us to address this question more directly. Further investigation of these relationships is warranted and especially, consideration for incorporating friendships into future interventions.

Fourth, race was found to be associated with only one of the five bereavement adjustment indicators. Non-Whites in the two counties did have slightly higher scores on the stress-related growth scale. Very little is known about the associations between this adjustment scale and racial and ethnic groups, but, there are some items in the scale that reflect a potential role for religion and spirituality. Finding meaning in the death is often enhanced by using religious beliefs as part of the effort. The central role of religion in the lives of many African Americans, Latinos and Asians may contribute to this finding.(Wortmann & Park, 2008).

In short, we want to emphasize that while we did identify some important findings related to the role of social support networks, and in particular, the importance of friendship networks and bereavement adjustments we found far more similarities than differences between the participants in the two counties. Also, there were more similarities than differences between the residents of the two counties with regard to all of the socio-demographic factors including race, ethnicity and religion. We are not surprised by this finding as we indicated earlier that this is often what we find in our investigations of bereavement. Perhaps we can assume that people of all variations and groups also share much in common because we all eat and sleep, seek love, friendships, work, play, and experience stress and life transitions and find ways to manage our daily lives. Having numerous common daily life experiences may result in developing common coping strategies when confronted with loss. While we acknowledge and celebrate diversity we should not fail to acknowledge the many similarities that we also share as humans. Differences among bereaved persons due to their unique cultural, socio-demographic, and situational and circumstantial factors should continue to be identified and noted as they can impact the strategies professionals use to intervene to assist them. Cultural sensitivity on the part of professional clinicians should be encouraged along with a reminder that persons from diverse backgrounds can also share many commonalities. When we intervene to help bereaved persons we are likely to be more effective if we match our strategies to the actual clients rather than making assumptions based on simply group characteristics.

Acknowledgements

The study was funded by the National Institute on Aging (R01 AG023090).

Footnotes

An earlier version of this paper was presented at the meetings of the Pacific Sociological Association (April, 2009), San Diego, California.

We also express our appreciation to the project consultants: Drs. Bert Hayslip (University of North Texas), Judith Hays (Duke University) & Marilyn Skaff (retired, formerly University of San Francisco).

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