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Health Effects

Health Effects:

The Influence of Bereavement on Health

Conjugal bereavement is associated with increased numbers of physician visits and consequent increases in the cost of health care (Prigerson et al. 2000). Detrimental influences on health are most marked during the first six months after bereavement. Only in a few cases do they become long-standing.

Physical Health

During the first few weeks after bereavement neuro-endocrine changes and impairment of immune response have been found (Hall & Irwin, 2001). These are thought to reflect emotional factors although the causal links are still under investigation. Major bereavements are associated with increases in incidence of specific disorders and mortality.

Specific Disorders

 Cancers, cardiovascular disease, hyperthyroidism and other psychosomatic disorders (SeeOsterweiss 1984 for a review).

Mortality

 After conjugal bereavement, mortality is greater than that of married people of the same age. The increase is highest during the first year of bereavement, it is mainly attributable to cardiovascular disease and is much higher in men than in women. There is also an increased risk of suicide. (Helsing 1981, Schaefer 1995).

Post-Traumatic Stress Disorder

 Post-Traumatic Stress Disorder is not confined to bereavement and can arise in any situation in which a person is exposed to an event evoking intense fear, helplessness, or horror. It is characterized by intrusive memories of the event which are so distressing that people go to great lengths to avoid any confrontation or reminder of what has happened. This makes it difficult for them to grieve.

Psychological Health

These disorders follow the same pattern and often coexist with the physical health problems.

Non-Specific Disorders

 In order of frequency:

  • Anxiety and Panic Disorders
  • Major Depression (with or without suicidal ideation)
  • Alcohol or Drug Abuse
  • Exacerbation of other pre-existing disorders.

Specific Disorders

 These are less common than Anxiety/Panic and Depression and they often coexist with these conditions.

  • Complicated Grief
  • Post-Traumatic Stress Disorder

Anxiety and Panic Disorders

 Although anxiety is a common feature of grief it may be so severe as to interfere with important responsibilities and roles. This is most likely if people misinterpret the physiological accompaniments of anxiety/fear as indicating illness or madness. This sets up a vicious cycle, which may escalate into a panic syndrome (Jacobs, 1993).

Criteria for Complicated Grief

Criterion A
Daily intrusive and disruptive chronic and persistent yearning, pining, or longing for the deceased.

Criterion B
The person should have 4 of the following 7 remaining symptoms at least several times a day or to a marked degree:

  1. Trouble accepting the death
  2. Inability to trust others
  3. Excessive bitterness or anger related to the death
  4. Uneasy about moving on
  5. Survivor Guilt
  6. Feeling life is empty or meaningless without deceased
  7. Preoccupation with thoughts of deceased

These features may

  • come on immediately after bereavement and continue = Chronic Grief
  • or they may be delayed or inhibited = Delayed Grief.

The chronic form is the most frequent.

Distinguishing Complicated Grief from Clinical Depression (Prigerson et al.1995).

The following have been found to co-vary independently of Complicated Grief, they constitute a cluster of symptoms that characterize clinical depression:

  • depressed mood,
  • suicidal thoughts,
  • psychomotor retardation (slowing of thought and movement),
  • apathy,
  • early morning waking, and
  • irrational guilt.

The symptoms listed above have been found to co-vary independently of Complicated Grief.
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