Evaluating Bereavement Services for Primary Caregivers

Purpose: Increased longevity means that a growing group of couples find their relationships changing dramatically as one person nears the end of a long life and the other provides primary care. While primary caregivers often express the desire to care for their partners, they also often experience stress, social isolation, and physical fatigue. After the death of their partners, caregivers can experience the loss is a way that few others truly understand. Developing and testing bereavement services to improve quality of life for people who have recently lost loved ones is of growing importance in our aging society. Bereavement services are thought to help these caregivers, but are rarely evaluated systematically.  In this paper, we report findings from a study on support group services for grieving caregivers. We analyze data from support group participants who completed the Impact of Event Scale-Revised (IES-R) before and after the intervention, and report on support group components that participants rated most and least favorably as the intervention came to an end. 

Methods: Using a pre-post design with the IES-R, we measured subjective responses to the death of a loved one. The IES-R is comprised of three subscales (intrusion, avoidance, and hyper-arousal).  Our sample of 119 participants in a six-week bereavement support group was comprised of older adults living in two adjacent communities in the Midwest. In addition to the pre-post IES-R data, we also analyze data on the helpfulness of various components of the bereavement support group as rated by participants as the program ended.

Results: Our findings suggest significant decreases in negative subjective responses to the loss of a loved one based on IES-R scores from the beginning to the end of a 6-week bereavement support group intervention.  On the full scale, IES-R scores are significantly higher at pre-test (mean=59.50; sd=18.01) than at post-test (mean=49.70; sd=16.59) suggesting emotional healing over the course of participation in the 6-week bereavement support group.  Turning to the sub-scales, our findings show consistency in reduction of negative subjective responses on the intrusion, avoidance, and hyper-arousal sub-scales from pre-test to post-test. 

We then conducted paired sample t-tests to test whether the differences between baseline and exit IES-R and subscale scores were statistically significant. Our findings indicate that the reduction in mean IES-R scores was significant [t(118)=7.05; p<.001].  Further, participant scores on each of the sub-scales had improved over the course of the intervention [intrusion t(118)= 6.00, p <.001; avoidance t(118)=5.29, p<.001; hyper-arousal t(118)= 6.69, p<.001].  We also find that support group participants reported that the facilitators, who were professional social workers, were knowledgeable and provided appropriate guidance.  They also gave high ratings to the experience of being with other caregivers who were also grieving.  The aspects of the bereavement support group that received the least favorable ratings had to do with the “homework” assignments.   

Implications: This study discusses one relatively easy and affordable model for practice-based research on bereavement services. We conclude with implications for social work practice in settings that offer bereavement services to primary caregivers.