Social Science & Medicine 63 (2006) 2440–2451
The prediction of bereavement outcome: Development of an
integrative risk factor framework
Margaret Susan Stroebe
a,
Ã
, Susan Folkman
b
, Robert O. Hansson
c
, Henk Schut
a
a
Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3508 TC Utrecht, The Netherlands
b
Osher Center for Integrative Medicine, University of California, San Francisco, USA
c
Department of Psychology, University of Tulsa, 600 S. College Avenue, Tulsa, OK 74104, USA
Available online 27 July 2006
Abstract
We propose an integrative risk factor framework to enhance understanding of individual differences in adjustment to
bereavement and to encourage more systematic analysis of factors contributing to bereavement outcome (e.g., examination
of interactions between variables and establishing pathways in the adaptation process). The examination of individual
differences in adaptation to bereavement is essential for practical (e.g. targeting high risk individuals for intervention) and
theoretical (e.g. testing the validity of theoretical claims about sources of differences) purposes. And yet, existing
theoretical approaches have not led to systematic empirical examination and empirical studies in the current literature are
fraught with shortcomings. Derived from Cognitive Stress Theory [Lazarus, R. S. & Folkman, S. (1984). Stress, appraisal,
and coping. New York: Springer] and the stressor-specific Dual Process Model of Coping with Bereavement [Stroebe, M.
S., & Schut, H. A. W. (1999). The dual process model of coping with bereavement: Rationale and description. Death
Studies, 23, 197–224], the framework incorporates an analysis of stressors, intra/interpersonal risk/protective factors, and
appraisal and coping processes that are postulated to impact on outcome. Advantages of using the approach are outlined.
Challenges in undertaking such research are addressed.
r 2006 Elsevier Ltd. All rights reserved.
Keywords: Grief; Coping; Health; Bereavement; Factor framework
Introduction
The impact of the death of a loved one on the
mental and physical health of the surviving family
member or friend has been widely investigated, and
there is ample evidence of its deleterious effects
(Archer, 1999; Parkes, 1996). Bereaved persons are
at elevated risk of developing a variety of mental
and physical health problems that may persist long
after the loss has occurred. A minority of indivi-
duals are vulnerable to complications in the grieving
process itself, for example, chronic grief, which is
characterized by protracted grief and prolonged
difficulty in normal functioning (Bowlby, 1980;
Parkes & Weiss, 1983). Although small in terms of
absolute numbers, even the risk of mortality for
bereaved persons is higher than for non-bereaved
persons of equivalent age and gender (Stroebe &
Stroebe, 1993).
Nevertheless, there is considerable variability
among surviving family members’ and friends’
responses to loss. While some bereaved persons
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doi:10.1016/j.socscimed.2006.06.012
Ã
Corresponding author.
E-mail address: M.S.Stroebe-Harrold@FSS.UU.NL
(M.S. Stroebe).