Skip to main content
SpringerLink
Log in

Development and Validation of an Instrument for the Assessment of Dependency Among Bereaved Persons

  • Published:
Journal of Psychopathology and Behavioral Assessment Aims and scope Submit manuscript

Dependency among bereaved individuals has been hypothesized to be an important predictor of severe and enduring grief reactions. However, although there are a number of instruments that assess interpersonal dependency as a personality trait or style, no scales are available to assess bereavement-related dependency. Data from 170 widowed participants in a community-based longitudinal investigation, who had been bereaved for an average of 10.8 months, were used to investigate the reliability and validity of the Bereavement Dependency Scale (BDS), an instrument that was developed to assess dependency on the deceased among bereaved persons. Results indicated that the BDS demonstrated acceptable internal reliability and satisfactory convergent, discriminant, and construct validity. The BDS may be a clinically useful predictor of enduring and complicated grief reactions, major depressive disorder, and suicidality among recently bereaved individuals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1.

Similar content being viewed by others

REFERENCES

  • Barry, L. C., Kasl, S. V., & Prigerson, H. G. (2002). Psychiatric disorders among bereaved persons: The role of perceived circumstances of death and preparedness for death. American Journal of Geriatric Psychiatry, 10, 447–457.

    Article  PubMed  Google Scholar 

  • Beck, A. T., Kovacs, M., & Weissman, A. (1979). Assessment of suicidal intention: The scale for Suicidal Ideation. Journal of Consulting and Clinical Psychology, 47, 343–352.

    Article  PubMed  Google Scholar 

  • Beck, A. T., Weissman, A., Lester, D., & Trexler, L. (1974). The measurement of pessimism: The Hopelessness Scale. Journal of Consulting and Clinical Psychology, 42, 861–865.

    Article  PubMed  Google Scholar 

  • Bierhals, A. J., Prigerson, H. G., Frank, E., Reynolds, C. F., Fasiczka, A., & Miller, M. (1995–1996). Gender differences in complicated grief among the elderly. Omega, 32, 303–317.

  • Birnbaum, G. E., Orr, I., Mikulincer, M., & Florian, V. (1997). When marriage breaks up—Does attachment style contribute to coping and mental health? Journal of Social and Personal Relationships, 14, 643–654.

    Google Scholar 

  • Bornstein, R. F. (1995). Interpersonal dependency and physical illness: The mediating roles of stress and social support. Journal of Social and Clinical Psychology, 14, 225–243.

    Google Scholar 

  • Bornstein, R. F. (1997). Interpersonal dependency and physical illness: A meta-analytic review of retrospective and prospective studies. Journal of Research in Personality, 32, 480–497.

    Article  Google Scholar 

  • Bornstein, R. F. (1999). Criterion validity of objective and projective dependency tests: A meta-analytic assessment of behavioral prediction. Psychological Assessment, 11, 48–57.

    Article  Google Scholar 

  • Bornstein, R. F. (2001). A meta-analysis of the dependency-eating disorders relationship: Strength, specificity, and temporal stability. Journal of Psychopathology and Behavioral Assessment, 23, 151–162.

    Article  Google Scholar 

  • Bornstein, R. F. (2005). The dependent patient: A practitioner's guide. Washington, DC: American Psychological Association.

    Google Scholar 

  • Bornstein, R. F., Languirand, M. A., Geiselman, K. J., Creighton, J. A., West, M. A., Gallagher, H. A., et al. (2003). Construct validity of the Relationship Profile Test: A self-report measure of dependency-detachment. Journal of Personality Assessment, 80, 60–74.

    Article  Google Scholar 

  • Bornstein, R. F., & O'Neill, R. M. (2000). Dependency and suicidality in psychiatric inpatients. Journal of Clinical Psychology, 56, 463–473.

    Article  PubMed  Google Scholar 

  • Bowlby, J. (1980). Attachment and loss: Vol. 3. Loss: sadness and depression. New York: Basic Books.

  • Bruce, M. L., Kim, K., Leaf, J. P., & Jacobs, S. (1990). Depressive episodes and dysphoria resulting from conjugal bereavement in a prospective community sample. American Journal of Psychiatry, 147, 608–611.

    PubMed  Google Scholar 

  • Byrne, G. J. A., & Raphael, B. (1997). The psychological symptoms of conjugal bereavement in elderly men over the first 13 months. International Journal of Geriatric Psychiatry, 12, 241–251.

    Article  PubMed  Google Scholar 

  • Chen, J. H., Bierhals, A. J., Prigerson, H. G., Kasl, S. V., Mazure, C. M., & Jacobs, S. (1999). Gender differences in the effects of bereavement-related psychological distress in health outcomes. Psychological Medicine, 29, 367–380.

    Article  PubMed  Google Scholar 

  • Clayton, P. J. (1990). Bereavement and depression. Journal of Clinical Psychiatry, 51, 34–38.

    PubMed  Google Scholar 

  • Cohen, S., Mermelstein, R., Kamark, T., & Hoberman, H. M. (1985). Measuring the functional components of social support. In I. G. Sarason & B. Sarason (Eds.), Social support: Theory, research, and applications (pp. 73–94). Hague, The Netherlands: Martinus Nijhoff.

    Google Scholar 

  • First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1995). Structured clinical interview for DSM-IV Axis I disorders—Patient edition (SCID-I/P, Version 2.0). New York: New York State Psychiatric Institute.

  • Glass, T. A., Prigerson, H. G., Kasl, S. V., & Mendes de Leon, C. F. (1995). The effects of negative life events on alcohol consumption among older men and women. Journal of Gerontology, 50B, S205–S216.

    Google Scholar 

  • Helsing, K. J., & Szklo, M. (1981). Mortality after bereavement. American Journal of Epidemiology, 114, 41–52.

    PubMed  Google Scholar 

  • Irwin, M., Daniels, M., & Weiner, H. (1987). Immune and neuroendocrine changes during bereavement. Psychiatric Clinics of North America, 10, 449–465.

    PubMed  Google Scholar 

  • Johnson, J. G., Cohen, P., Skodol, A., Oldham, J. M., Kasen, S., & Brook, J. S. (1999). Personality disorders in adolescence and risk of major mental disorders and suicidality during adulthood. Archives of General Psychiatry, 56, 805–811.

    Article  PubMed  Google Scholar 

  • Kaprio, J., Koskenvuo, M., & Rita, H. (1987). Mortality after bereavement: A prospective study of 95,647 widowed persons. American Journal of Public Health, 77, 283–287.

    PubMed  Google Scholar 

  • L'Abate, L., & Goodrich, M. E. (1980). Marital adjustment. In R. H. Woody (Ed.), Encyclopedia of Clinical Assessment. San Francisco: Jossey-Bass.

    Google Scholar 

  • Latham, A. E., & Prigerson, H. G. (2004). Suicidality and bereavement: Complicated grief as psychiatric disorder presenting greatest risk for suicidality. Suicide and Life Threatening Behavior, 34, 350–362.

    Article  PubMed  Google Scholar 

  • Linehan, M. M. (1983). Reasons for staying alive when you are thinking about killing yourself: The Reasons for Living Inventory. Journal of Consulting and Clinical Psychology, 51, 276–286.

    Article  PubMed  Google Scholar 

  • Luoma, J. B., & Pearson, J. L. (2002). Suicide and marital status in the United States, 1991–1996: Is widowhood a risk factor? American Journal of Public Health, 92, 1518–1522.

    PubMed  Google Scholar 

  • McGrath, R. E. (2001). Toward more clinically relevant research. Journal of Personality Assessment, 77, 307–332.

    Article  PubMed  Google Scholar 

  • Mor, V., McHorney, C., & Sherwood, S. (1986). Secondary morbidity among the recently bereaved. American Journal of Psychiatry, 143, 158–163.

    PubMed  Google Scholar 

  • Nietzel, M. T., & Harris, M. J. (1990). Relationship of dependency and achievement/autonomy to depression. Clinical Psychology Review, 10, 279–297.

    Article  Google Scholar 

  • Pilkonis, P. A. (1988). Personality prototypes among depressives: Themes of dependency and autonomy. Journal of Personality Disorders, 2, 144–152.

    Google Scholar 

  • Piper, W. E., Ogrodniczuk, J. S., Joyce, A. S., McCallum, M., Weidman, R., & Azim, H. F. (2001). Ambivalence and other relationship predictors of grief in psychiatric outpatients. Journal of Nervous and Mental Disease, 189, 781–787.

    Article  PubMed  Google Scholar 

  • Prigerson, H. G., Bierhals, A. J., Kasl, S. V., Reynolds, C. F., Shear, M. K., Day, N., et al. (1997a). Traumatic grief as a risk factor for mental and physical morbidity. American Journal of Psychiatry, 154, 616–623.

    PubMed  Google Scholar 

  • Prigerson, H. G., Bierhals, A. J., Kasl, S. V., Reynolds, C. F., Shear, M. K., Newsom, J. T., et al. (1996b). Complicated grief as a distinct disorder from bereavement-related depression and anxiety: A replication study. American Journal of Psychiatry, 153, 1484–1486.

    PubMed  Google Scholar 

  • Prigerson, H. G., Bridge, J., Maciejewski, P. K., Beery, L. C., Rosenheck, R. A., Jacobs, S. C., et al. (1999a). Influence of traumatic grief on suicidal ideation among young adults. American Journal of Psychiatry, 156, 1994–1995.

    PubMed  Google Scholar 

  • Prigerson, H. G., Frank, E., Kasl, S. V., Reynolds, C. F., Anderson, B., Zubenko, G. S., et al. (1995a). Complicated grief and bereavement-related depression as distinct disorders: Preliminary empirical validation in elderly bereaved spouses. American Journal of Psychiatry, 152, 22–30.

    PubMed  Google Scholar 

  • Prigerson, H. G., Frank, E., Reynolds, C. F., George, C. J., & Kupfer, D. J. (1993). Protective psychosocial factors in depression among spousally bereaved elders. American Journal of Geriatric Psychiatry, 1, 296–309.

    Google Scholar 

  • Prigerson, H. G., & Jacobs, S. (2001). Traumatic grief as a distinct disorder. In M. S. Stroebe & R. O. Hansson (Eds.), Handbook of bereavement research: Consequences, coping, and care (pp. 613–645). New York: APA Press.

    Chapter  Google Scholar 

  • Prigerson, H. G., Maciejewski, P. K., Reynolds, C. F., Bierhals, A. J., Newsom, J. T., Fasiczka, A., et al. (1995b). Inventory of Complicated Grief: A scale to measure maladaptive symptoms of loss. Psychiatry Research, 59, 65–79.

    Article  PubMed  Google Scholar 

  • Prigerson, H. G., Maciejewski, P. K., & Rosenheck, R. A. (1999b). The effects of marital dissolution and marital quality on health and health service use among women. Medical Care, 37, 858–873.

    Article  PubMed  Google Scholar 

  • Prigerson, H. G., Maciejewski, P. K., & Rosenheck, R. A. (2000). Preliminary explorations of the harmful interactive effects of widowhood and marital harmony on health, health service use, and health care costs. Gerontologist, 40, 349–357.

    PubMed  Google Scholar 

  • Prigerson, H. G., Shear, M. K., Bierhals, A. J., Pilkonis, P. A., Wolfson, L., Hall, M., et al. (1997c). Case histories of traumatic grief. Omega, 35, 9–24.

    Google Scholar 

  • Prigerson, H. G., Shear, M. K., Frank, E., Beery, L. C., Silberman, R., Prigerson, J., et al. (1997b). Traumatic grief: A case of loss induced trauma. American Journal of Psychiatry, 154, 1003–1009.

    PubMed  Google Scholar 

  • Prigerson, H. G., Shear, M. K., Jacobs, S. C., Reynolds, C. F., Maciejewski, P. K., Davidson, J. R. T., et al. (1999c). Consensus criteria for traumatic grief: A preliminary empirical test. British Journal of Psychiatry, 174, 67–73.

    Article  PubMed  Google Scholar 

  • Prigerson, H. G., Shear, M. K., Newsom, J. T., Frank, E., Reynolds, C. F., Maciejewski, P. K., et al. (1996a). Anxiety among widowed elders: Is it distinct from depression and grief? Anxiety, 2, 1–12.

    Article  PubMed  Google Scholar 

  • Silverman, G. K., Jacobs, S. C., Kasl, S. V., Shear, M. K., Maciejewski, P. K., Noaghiul, F. S., et al. (2000). Quality of life impairments associated with diagnostic criteria for traumatic grief. Psychological Medicine, 30, 857–862.

    Article  PubMed  Google Scholar 

  • Silverman, G. K., Johnson, J. G., & Prigerson, H. G. (2001). Preliminary explorations of the effects of prior trauma and loss on risk for psychiatric disorders in recently widowed people. Israeli Journal of Psychiatry, 38, 202–215.

    Google Scholar 

  • Spanier, G. B. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and the Family, 38, 15–28.

    Article  Google Scholar 

  • Stewart, S. H., Knize, K., & Pihl, R. O. (1992). Anxiety sensitivity and dependency in clinical and non-clinical panickers and controls. Journal of Anxiety Disorders, 6, 119–131.

    Article  Google Scholar 

  • van Doorn, C., Prigerson, H. G., Kasl, S. V., Beery, L., & Jacobs, S. (1998). The influence of marital quality and attachment styles on traumatic grief. Journal of Nervous and Mental Disease, 186, 566–573.

    Article  PubMed  Google Scholar 

  • Walker, J. G., Manion, I. G., & Cloutier, P. F. (1991). Measuring marital distress in couples with chronically ill children: The Dyadic Adjustment Scale. Journal of Pediatric Psychology, 17, 345–357.

    Google Scholar 

  • Widiger, T. A., & Bornstein, R. F. (2001). Histrionic, narcissistic, and dependent personality disorders. In P. B. Sutker & H. E. Adams (Eds.), Comprehensive handbook of psychopathology (3rd edn., pp. 509–531). New York: Kluwer Academic/Plenum Publishers.

    Google Scholar 

  • Williams, J. B. W., Gibbon, M., First, M. B., Spitzer, R. L., Davies, M., Borus, J., et al. (1992). The Structured Clinical Interview for DSM-III-R (SCID): II. Multsite test–retest reliability. Archives of General Psychiatry, 49, 630–636.

    PubMed  Google Scholar 

Download references

ACKNOWLEDGMENTS

This research was supported in part by the following grants: MH56529 (HGP) and MH63892 (HGP) from the National Institute of Mental Health and CA106370 (HGP) from the National Cancer Institute; a Soros Open Society Institute Project on Death in America Faculty Scholarship (HGP); a RAND/Hartford Interdisciplinary Geriatric Health Research Center Grant (HGP); a Fetzer Religion at the End-of-Life Grant (HGP); the American Foundation for Suicide Prevention (LCV); the Center for Psycho-Oncology and Palliative Care Research, Dana-Farber Cancer Institute (HGP, LCV, BZ)

Author information

Authors and Affiliations

  1. Department of Psychiatry, Columbia University College of Physicians and Surgeons, and the New York State Psychiatric Institute, New York, New York, USA

    Jeffrey G. Johnson

  2. Center for Psycho-Oncology and Palliative Care Research, Dana Farber Cancer Institute, Boston, Massachusetts, USA

    Lauren C. Vanderwerker, Baohui Zhang & Holly G. Prigerson

  3. Department of Psychology, Gettysburg College, Gettysburg, Pennsylvania, USA

    Robert F. Bornstein

  4. Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Holly G. Prigerson

  5. Harvard Medical School Center for Palliative Care, Boston, Massachusetts, USA

    Holly G. Prigerson

  6. Center for Psycho-Oncology and Palliative Care Research, Dana Farber Cancer Institute, 44 Binney St-SW G440A, Boston, Massachusetts, 02115, USA

    Holly G. Prigerson

Authors
  1. Jeffrey G. Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lauren C. Vanderwerker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert F. Bornstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Baohui Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Holly G. Prigerson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Holly G. Prigerson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Johnson, J.G., Vanderwerker, L.C., Bornstein, R.F. et al. Development and Validation of an Instrument for the Assessment of Dependency Among Bereaved Persons. J Psychopathol Behav Assess 28, 261–270 (2006). https://doi.org/10.1007/s10862-005-9016-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10862-005-9016-3

KEY WORDS:

Search

Navigation