Bereavement is associated with excess risk of mortality, particularly in early weeks and months after loss. This and the other adverse effects of the death of a significant loved one on physical and mental health are discussed in a Review in this week's edition of The Lancet.
Dr Margaret Stroebe, Research Institute for Psychology and Health, Utrecht University, Netherlands, and colleagues studied a range of literature published to date to prepare their Review. They say that while grief is not a disease and most people adjust without professional psychological help, it increases mortality from many causes, is related to illness and increases use of medical services.
Many studies from Europe and North America have looked at excess mortality connected with bereavement. Li (USA, 1995) found a 3.3 fold increase in risk of suicide in men over 60-years-old that had lost their wife, but no increased suicide risk in women in the same age group who had lost their husband. Christakis and Allison and colleagues (2006) found that widowers had a 21% increased risk of all-cause mortality, and widows a 17% increased risk. These risks increased further sill in the first 30 days after bereavement. Christakis and Elwert (in two 2006 studies) showed that excess mortality occurred in white widowers and widows yet this difference was not seen in black widowers or widows. Of course, bereavement is not just related to spouses. A Danish study from 2003 showed fathers and mothers have a raised suicide risk after the death of a child, a risk which is higher the younger the child and is particularly high in the first 30 days post-bereavement.
Referring to published studies, the authors say: "The patterns are quite consistent, enabling the conclusion that the mortality of bereavement is attributable in large part to a so-called broken heart." However, they add "Although mortality is a drastic outcome of losing a loved one, it must be assessed in terms of the absolute number of bereaved people who die. Baseline rates are low, with, for instance, about 5% of widowers versus 3% of married men in the 55 years and older age category dying in the first 6 months of bereavement."
The Review also examines mental ill-health associated with bereavement, including depression, despair, loss of appetite, and fatigue, and also risk factors that can make people more or less prone to adverse health outcomes connected to bereavement, such as support from other people and characteristics of the person suffering the loss. The effect of psychological interventions is also explored. The authors say: "As Parkes, the leading expert on bereavement, stated, there is 'no evidence that all bereaved people will benefit from counselling and research has shown no benefits to arise from the routine referral to counselling for no other reason than they have suffered a bereavement.'"
The authors conclude by calling for more research into non-spousal bereavement, eg, losses of parents or children rather than one's spouse, since large gaps remain in this knowledge. Further, they add: "Likewise, we need to learn more about codeterminants of the poorer outcomes of bereavement experience, to understand how the circumstances of bereavement interact with pre-bereavement experience, personal factors, and ways of coping with grief to cause difficulties. Finally, there is scope for improvement in the design of intervention studies and for strict assessment of their effectiveness following evidence-based treatment criteria."
Dr Margaret Stroebe, Research Institute for Psychology and Health, Utrecht University, Netherlands T) +31 30 2531470 E) M.S.Stroebe@UU.NL
View the paper associated with this press release by clicking on the link below:
http://multimedia.thelancet.com/pdf/press/Bereavement.pdf
Journal
The Lancet