How Grief, Funerals, and Poverty Affect Bereaved Health, Productivity, and Medical Dependence in Japan

死別による生産性の低下・疾病・医療福祉依存の実態を調査 --死別悲嘆のコストに、いかに対応できるか--. 京都大学プレスリリース. 2020-09-28.Reducing the high social cost of death. 京都大学プレスリリース. 2020-10-06.Grief has been shown to weaken bereaved persons' health, but measurements of their lost time and medical expense remain rare. Funerals traditionally managed and assuaged grief through ritual expression, approval, and social support. Research suggests that satisfying funeral participation reduces grief, while poverty exacerbates it. We hypothesized that: (1) psycho-physical symptoms of grief, (2) abbreviation/dissatisfaction in the funeral, and (3) poverty, correlate with decreased productivity and increased medical and social services use. We collected data from 165 mourning families about their grief, funerals, and subsequent medical conditions. (1) Deeper grief after bereavement in Japan correlated with more physical problems, more down time, and more medical dependency. (2) Low satisfaction with funerals correlated with higher hospital, pharmacy, and counseling costs. (3) Low income families lost more time, while declining incomes showed increased pharmaceutical costs. This suggests that satisfying funerals and income safeguards may reduce costs of low productivity and increased public services dependency

Identifying bereaved grievers with greatest medical or social service needs in Japan

[Objective] Severe grief adversely affects the health of bereaved families, potentially burdening medical and community health services. Interventions for effective community health maintenance must identify the people likely to face severe effects of bereavement. The present study identified characteristics of mourners who experience severe grief within a year of bereavement to confirm whether this grief increased their reliance on Japanese medical and social services. [Design] We conducted a nationwide postal survey of Japanese bereaved within the previous year, to compare those reporting daily or overwhelming ‘heavy’ grief to those with less heavy grief, in terms of demographic and socioeconomic details, daily work and non-work activity, frequency of medical and social service use. [Setting/participants] In 2019, with the support of the Ministry of Education and the All Japan Funeral Co-Operation, we distributed approximately 5500 questionnaires to Japanese who had presided at funerals within the past year for anonymous return. By January of 2020, we received 1078 complete voluntary responses from bereaved Japanese. [Results] Half of the ‘heavy grief’ group (n=143) reported adverse effects on health and daily life, including needs for pharmacological, medical or welfare support. Losses of husbands or children were particularly connected to severe grief; ‘unexpected’ death from cancer caused the greatest shock. Employment (even part-time) buffered against severe grief; grief was greater for the unemployed and substantially worse for those who lost significant income at the same time as they lost loved ones. [Conclusion] These findings suggest that prior counselling should reduce the shock of bereavement and economic loss, which increases subsequent medical dependence. Medical professionals and community health workers can use the above factors to target in advance the family members in greatest danger of heavy grief, to intervene lest grief adversely affect their physical and psychological health after bereavement

Unexplored Costs of Bereavement Grief in Japan: Patterns of Increased Use of Medical, Pharmaceutical, and Financial Services

Our Japan-wide survey (n=1, 078) revealed that bereaved who showed increased reliance on medical, pharmaceutical, and financial/legal services was in the ‘50’s age bracket, and for unemployed widows; it corresponded less with low annual income than with high income. Increased users reported their decline in physical health seriously influencing their work and lives, suggesting “presenteeism”. Moreover, they spent 2.7 times more for medical and pharmaceutical services than those reporting continual use, portending 4 to 10 times more Japanese government expense for this group, half of whom considered their own out-of-pocket expenses a financial burden

<依頼論文>中年期と死--中年期後期を生きる日本人女性の事例から

What is the focus of Death-and-Life Studies? (In Japan, we use the English term “Death-and-Life Studies” rather than “Thanatology, ” for the field covers not only “death, ” but concerns both “life” and “death”). This broad scientific study still holds many possibilities concerning study and research from “birth to life” and “death.” People can speak of their births through acquired memory. People can experience death as their own but cannot speak of it in the first person; we have not yet resolved a method for people to speak of their own experience of death, nor hear of it. That is, we gaze at life and death standing in between these two momentary but momentous experiences. Cancer patients face some issues embedded uniquely in their disease, however, they also face issues inseparable from their previous life experiences (including physical, social, psychological, and spiritual pain). This research focuses further on the question of “self-existence” which has much to do with “life” and “death.” In this research, I interviewed a terminal cancer patient using a phenomenological method. The interview consisted of watching the patient as she went through the process of living her life with her family, and focusing on the things she underwent as she experienced and departed from life. Through interviews with a middle aged female patient, this research attempts to shed some light on “death” and “life” not merely as personal issues, but as coming from relationships centering around family members. 人のその一生の流れを包含する生涯発達心理学では、死はどのような意味を持つものとして語られてきたのだろうか。例えば、人の生きる過程を年齢段階という軸に沿って捉える視点からは、死は「老いることの意味」として中年期以降に着目され、人は自分の死を自覚することによって喪失感や焦りを感じ、その一方で死を自覚するからこそ、残された生への思いが強くなるという生への渇望として死の意味が説かれる（やまだ2002）。このような死を生の終わりとしてどう理解し受容するのかという視点からは、自分が死ぬ存在であることをその内に抱えながら生きることや、死を見送る者の生と逝く者の生が重なりながら並走し、互いの生の中に死という出来事があるという死生の意味の動的な部分をみつめる視点を欠いている、年齢に沿った発達という人前の死生の普遍性だけではなく、個々人が持つ死生の意味をも包含する変様性にも着目する必要があるといえる。そこで本稿では、自らの死を考えながら生きることを余議なくされている末期癌患者との対話を取り上げ、死から照らし出された生の意味、死に逝く当事者にとっての死生の意味 について、死生の固有性を含めた新たな生涯発達論について論じた

A Terminal Patient’s Hopes for Connections Transcending Time

Terminal cancer patients face not only issues unique to their diseases, but also issues rooted in their previous life experiences, including physical, social, psychological, and spiritual pain. This study focuses on the hopes of a terminal patient for “Continuing Bonds.” Much current research emphasizes the importance of “continuing bonds” for the health of bereaved families, but little has looked at the meaning of “continuing bonds” for dying patients themselves. I attended an elderly terminal cancer patient in a Japanese hospital, observing and conversing with her as she went through the process of examining her life and faith. The patient granted permission to record and share these observations to shed light on Japanese views of “death” and “life.” This research shows that Japanese face death not merely as personal issues, but in the broader perspective of continuing family bonds