Reducing the high social cost of death

Japan – How will you cope with the death of your mother or spouse? Their death may disturb your concentration, causing accidents or lowering your productivity. Some bereaved cannot sleep, and others cannot get out of bed. Some lose all appetite, while others binge eat constantly. Some grow alcoholic, and some suicidal. Our responses may depend on our family, culture, community, or belief-systems, but we all struggle to accept our loved ones’ deaths.

The cost of grief is not confined to personal mental anguish. It reduces productivity, causes dependency on medicine and social services, and increases mortality risks for survivors. While this is well documented in Europe, we have little data for Japan, the world’s most elderly country. To fill this gap, a research team led by Kyoto University is conducting a nationwide survey of bereavement.

“Japan’s society is rapidly aging. By 2030, nearly everyone in Japan will suffer the death of a parent, elder relative, spouse, or close friend,” explains lead author Carl Becker of the Center for the Promotion of Interdisciplinary Education and Research, who garnered the 2020 Educator Award from the international Association for Death Education and Counseling.

“Recent UK studies suggest that about 10% of bereaved individuals show significant decline in health, resulting in prolonged use of resources. If Japan faces the same percent, the impact will be catastrophic.” The team decided to conduct similar surveys throughout Japan with additional questions focusing on economic and lifestyle changes.

Their pilot report — published in the journal OMEGA — shows that deeper grief correlates with an overarching decline in quality of life, seen in physical ailments, more down time, and higher rates of medical reliance. Interestingly, lower income families lost more productivity and pharmaceutical expenses, while lower satisfaction with funerals was linked to higher medical costs.

Results show that bereaved Japanese are similar to Europeans in their losses of everything from time, productivity, health, and medical expenses. Factors like the circumstances of death, the loss of income, lack of family or social support, and satisfaction with funeral proceedings can help predict who may need the most help in the future.

“By identifying key problems, we can begin to see what solutions are required to mitigate severe bereavement,” states Tohoku University’s Yozo Taniyama, second author of the study. “For example, better testing, medical care, and psychological treatment can help people handle unexpected death. More robust financial and social aid can help with the loss of income.”

Tradition and rituals appear to facilitate better responses as well. Funeral services offer friends and relations a chance to reconnect and support the bereaved, reducing their loneliness and isolation. Moreover, rituals help the bereaved to come to terms with death.

The research team predicted that people with low or declining incomes would find funeral costs more burdensome. Although that group did lose more time and spend more on pharmaceuticals, they displayed little dissatisfaction with funeral costs. In fact, the people who expressed greater dissatisfaction were those who abbreviated funerals, who later tended to show higher rates of physical as well as psychological problems.

Becker concludes, “Japan has a tradition of ceremonies that bring people together to help the bereaved process their trauma. Much of the world is learning from Japan’s traditions that value spiritual bonds with departed loved ones. It is healthier to revere our dead than to try to forget them.”

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The paper “How Grief, Funerals, and Poverty Affect Bereaved Health, Productivity, and Medical Dependence in Japan” appeared on 25 August 2020 in OMEGA, with doi: 10.1177/0030222820947573

Kyoto University is one of Japan and Asia’s premier research institutions, founded in 1897 and responsible for producing numerous Nobel laureates and winners of other prestigious international prizes. A broad curriculum across the arts and sciences at both undergraduate and graduate levels is complemented by numerous research centers, as well as facilities and offices around Japan and the world. For more information please see: http://www.kyoto-u.ac.jp/en