kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2014.14.2.43 kjhp-14-43 Original Article Effects of Satisfaction with Social Support on Complicated Grief in Bereaved Dementia Caregivers NamIlSung 1 HyunDhawoon 2 Hallym University Institute of Aging, Chuncheon, Korea Department of Social Welfare, Graduate School of Hallym University, Chuncheon, Korea ￭ Corresponding author：Dhawoon Hyun, MSW Department of Social Welfare, Graduate School of Hallym University, 1 Hallymdaehak-gil, Chuncheon 200-702, Korea Tel: +82-10-5797-1957, Fax: +82-33-248-3095 E-mail: tree333h@hanmail.net 01 2014 20 01 2014 14 2 43 49 02122013 10062014 Copyright © 2014 The Korean Society of Health Promotion and Disease Prevention 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background

While complicated grief can lead to adverse health outcomes, social support has been shown to be an important protective factor of its negative effects. The present study investigated the relationship between social support including satisfaction with support, received support, and negative interactions and complicated grief in the transitional context from caregiving to bereavement.

 Methods

Bereaved caregivers (n=221) who participated in a multi-site study of dementia caregiving were assessed for complicated grief. Social support measured before and after death were used to examine the longitudinal associations among social support and complicated grief.

 Results

We found that caregivers reporting greater increase in satisfaction with social support were likely to experience lower levels of complicated grief, while the amount of received social support did not significantly impact complicated grief. Negative social interaction was significantly associated with the level of complicated grief after the death of the care recipient.

 Conclusions

The relationship between social support and complicated grief suggests that satisfaction with social support may be associated with lower levels of complicated grief. Study findings point to the importance of the type of social support for reducing the level of complicated grief.

 Complicated grief Social support Bereavement References Schulz R Boerner K Shear K Zhang S Gitlin LN Predictors of complicated grief among dementia caregivers: a prospective study of bereavement Am J Geriatr Psychiatry 200614 8 6508 Prigerson HG Horowitz MJ Jacobs SC Parkes CM Aslan M Goodkin K Prolonged grief disorder: psychometric validation of criteria proposed for DSM-V and ICD-11 PLoS Med 20096 8): e1000121. Simon NM Pollack MH Fischmann D Perlman CA Muriel AC Moore CW Complicated grief and its correlates in patients with bipolar disorder J Clin Psychiatry 200566 9 110510 Prigerson HG Bierhals AJ Kasl SV Reynolds CF 3rd Shear MK Day N Traumatic grief as a risk factor for mental and physical morbidity Am J Psychiatry 1997154 5 61623 Germain A Caroff K Buysse DJ Shear MK Sleep quality in complicated grief J Trauma Stress 200518 4 3436 Maytal G Zalta AK Thompson E Chow CW Perlman C Ostacher MJ Complicated grief and impaired sleep in patients with bipolar disorder Bipolar Disord 20079 8 9137 Burke LA Neimeyer RA McDevitt-Murphy ME African American homicide bereavement: aspects of social support that predict complicated grief, PTSD, and depression Omega (Westport) 201061 1 124 Macias C Jones D Harvey J Barreira P Harding C Rodican C Bereavement in the context of serious mental illness Psychiatr Serv 200455 4 4216 Ogrodniczuk JS Joyce AS Piper WE Changes in perceived social support after group therapy for complicated grief J Nerv Ment Dis 2003191 8 52430 Vanderwerker LC Prigerson HG Social support and technological connectedness as protective factors in bereavement J Loss Trauma 20049 1 4557 Hogan DP Eggebeen DJ Sources of emergency help and routine assistance in old age Soc Forces 199573 3 91736 Gallagher SK Gerstel N Kinkeeping and friend keeping among older women: the effect of marriage Gerontologist 199333 5 67581 Wilsey SA Shear K Descriptions of social support in treatment narratives of complicated grievers Death Stud 200731 9 80119 White DL Walker AJ Richards LN Intergenerational family support following infant death Int J Aging Hum Dev 200867 3 187208 Bedard M Raney D Molloy DW Lever J Pedlar D Dubois S The experience of primary and secondary caregivers caring for the same adult with Alzheimer's disease J Ment Health Aging 20017 2 28796 Litwin H Landau R Social network type and social support among the old-old J Aging Stud 200014 2 21328 Mitrani VB Czaja SJ Family-based therapy for dementia caregivers: clinical observations Aging Ment Health 20004 3 2009 Krause N Markides K Measuring social support among older adults In J Aging Hum Dev 199030 1 3753 Somhlaba NZ Wait JW Psychological adjustment to conjugal bereavement: do social networks aid coping following spousal death? Omega (Westport) 200857 4 34166 Hebert RS Dang Q Schulz R Preparedness for the death of a loved one and mental health in bereaved caregivers of patents with dementia: findings from the REACH study J Palliat Med 20069 3 68393 Tables

Demographic characteristics, social support, and caregiving characteristics

  Mean SD
Outcome and main predictors    
Complicated grief 18.51 12.81
Satisfaction with social support    
 Before death 5.40 2.30
 After death 6.58 2.22
 Change 1.18 2.19
Received social support    
 Before death 13.00 6.55
 After death 9.95 8.04
 Change –3.05 8.29
Negative social interaction    
 Before death 2.69 2.64
 After death 2.27 2.15
 Change –0.42 2.17
Continuous covariates    
Care recipient age, y 80.91 7.64
Caregiver age, y 64.76 13.47
Time since loss, d 107.87 70.25
Years of caregiving for care recipient 4.38 4.43
Hours per day spent caregiving 13.12 6.69
  N %
Categorical covariates    
Caregiver gender    
 Female 186 84.16
 Male 35 15.84
Care-recipient gender    
Female 103 46.61
 Male 118 53.39
Caregiver race/ethnicity    
 Caucasian 146 66.06
 African American 45 20.36
 Hispanic/Latino 30 13.58
Caregiver education    
 Did not complete high school 52 23.53
 High school graduate 80 36.20
 College graduate 89 40.27
Relationship with care-recipient    
 Non spouse 112 50.68
 Spouse 109 49.32
Intervention assignment    
 Control group 80 36.20
 Intervention group 141 63.80
Antidepressant use    
 No 176 79.64
 Yes 45 20.36

Correlations for complicated grief and social support constructsa

  Correlation coefficient Pa
Satisfaction with social support
 Before death ‐0.10 0.071
 After death ‐0.26 <0.001
 Change ‐0.16 0.031
Received social support    
 Before death 0.02 0.142
 After death 0.12 0.065
 Change 0.10 0.072
Negative social interaction    
 Before death 0.12 0.065
 After death 0.21 0.003
 Change 0.06 0.105

Assessed by zero-order correlation analysis.

Regression results on relationships between satisfaction with social support and complicated griefa

  B SE Pa
Change in satisfaction with social support –0.783 0.391 0.041
Caregiver's age –0.052 0.071 0.471
Care-recipient's age –0.264 0.112 0.033
Female –3.591 2.361 0.132
Race (ref group: White)
 Black 1.791 2.193 0.412
 Hispanic 0.262 2.794 0.934
Caregiver education (ref group: <high school)
 High school graduate –2.564 2.264 0.261
 College graduate –4.734 2.271 0.042
Time since loss 0.023 0.013 0.123
REACH intervention assignment –1.872 1.774 0.292
Antidepressant use 5.611 2.092 0.011
Years of caregiving for care-recipient –0.017 0.201 0.934
Hours per day spent caregiving –0.041 0.131 0.774

Assessed by multiple regression analysis.