Lecture 1 – Henk Schut: Health Outcomes of
Bereavement
(Stroebe et al., 2007)
Abstract
Bereavement is associated with excess risk of mortality, particularly in the early weeks and months
after loss.
- Diverse factors (circumstances of death, intrapersonal and interpersonal variables, ways of
coping) are likely to co-determine excesses in ill-health
- Interventions should be tar
geted:
o high risk people
o those with complicated grief or bereavement-related depressions and stress
disorders
Introduction
Bereavement: the situation of having recently lost a significant person through death
it’s associated with a period of intense suffering
increased risk of developing mental and physical health problems
Grief: the mainly emotional reaction to bereavement, incorporating diverse psychological and
physical reactions
Mortality of bereavement
Dying of a broken heart – Does the death of a loved one increase the mortality risk of the bereaved
person?
Yes: early excess risk or mortality, in some research risk persists longer than 6 months
Subgroup Differences
Greater risk:
White people than in black people
Widowers
o Associated with alcohol consumption and the loss of the wife who would have overseen the husband’s
health status
Women when kinship is a child
Younger people when losing a spouse
o Note: caution in interpreting age differences: institutionalized individuals are sometimes excluded
from large samples and rates for residential relocation increase on the death of a partner. People who are frail
and who’s mortality risk is high could be excluded from samples, boosting the survival rate of elderly
populations compared with young people.
Causes of Death
Mortality high after:
Early after bereavement
, Accidental and violent causes of death
o Moderate after chronic ischeamic and lung cancer
Being a mother losing their child (extends to 18 years), after natural causes
Greater risk for fathers early in bereavement from unnatural causes
Death by suicide
Note from author: see the interaction effect between subgroup difference and cause of death
Absolute numbers:
5% widowers vs 3% married men in 55 years and older die within
first 6 months post loss.
Physical ill health
Greater occurrence of physical health complains
Worse health for mothers after violent death of child than fathers
o But fathers health deteriorate instead of improve
Bereaved spouses 40 times risk than of non-bereaved people
Self-reported medication 73 times higher
Note: visits to doctors did not increase:
Women with high intensity of grief reduced use of health services for physical health
Bereaved people who are most in need of help might not be obtaining such help
High intensities of grief at earlier point predicts severe physical health disorders
Substantially increased activity-limiting pain and moderate-to-severe current pain in people
shortly after bereavement
Weight loss, more likely in spouses who had not undertaken caregiving of their spouse
o Attributable to unpredictable nature of the death
Psychological symptoms and ill health
Psychological reactions most intense in early bereavement
Affective, cognitive, behavioral, and physiological-somatic, immunological and endocrine
changes
Depression and grief distinct but related clusters of reaction
,
, Physiological reactions differ in culture:
Egyptian Muslims: express intense overt grief
Bali Muslims: avoid any display of grief
Cognitive and somatic symptoms alike across diverse cultures
There are specific reaction patterns to various different types of bereavement:
Grandparents feel enormous sadness and pain for their grieving adult child and a sense of
survivors guilt.
Stages / phases and the task model
Shock, yearning & protest, despair and recovery
Task model: accepting the loss, experiencing the pain of grief, adjusting to the environment without
deceased, relocating the deceased emotionally and moving on.
Be careful: people are not uniform.
Depression is a normal response to early bereavement.
Psychiatric Disorders
25-45% mild depression; 10 – 20% clinical levels of depression
PTSS when loss of life has been massive, or death horrific
o 7% mother / 5% fathers vs 5% women / 3% men in normative samples
Mothers especially high rates of first psychiatric admission, particularly during first year of
bereavement
Complication in the Grieving Process
In some cases the grieving process can be disturbed or complicated
Complicated grief: a deviation from the normal (in cultural and societal terms) grief experience in
either time course, intensity, or both, entailing a chronic and more intense emotional experience or
an inhibited process, which either lacks the usual symptoms or in which onset of symptoms is
delayed.
- Separation Distress (preoccupation with thoughts of the deceased)
- Traumatic Distress (feelings of disbelief about the death)
Numbers of occurrence of CG differ
- 9% - 20% adults
- 78 % in parents after suicide or accidents
- 58% in parents sudden infant death syndrome
Additional medical implications:
Impaired memory, nutritional problems, work and relationship difficulties and difficulties
concentrating; decreases in social participation.
Bereavement
(Stroebe et al., 2007)
Abstract
Bereavement is associated with excess risk of mortality, particularly in the early weeks and months
after loss.
- Diverse factors (circumstances of death, intrapersonal and interpersonal variables, ways of
coping) are likely to co-determine excesses in ill-health
- Interventions should be tar
geted:
o high risk people
o those with complicated grief or bereavement-related depressions and stress
disorders
Introduction
Bereavement: the situation of having recently lost a significant person through death
it’s associated with a period of intense suffering
increased risk of developing mental and physical health problems
Grief: the mainly emotional reaction to bereavement, incorporating diverse psychological and
physical reactions
Mortality of bereavement
Dying of a broken heart – Does the death of a loved one increase the mortality risk of the bereaved
person?
Yes: early excess risk or mortality, in some research risk persists longer than 6 months
Subgroup Differences
Greater risk:
White people than in black people
Widowers
o Associated with alcohol consumption and the loss of the wife who would have overseen the husband’s
health status
Women when kinship is a child
Younger people when losing a spouse
o Note: caution in interpreting age differences: institutionalized individuals are sometimes excluded
from large samples and rates for residential relocation increase on the death of a partner. People who are frail
and who’s mortality risk is high could be excluded from samples, boosting the survival rate of elderly
populations compared with young people.
Causes of Death
Mortality high after:
Early after bereavement
, Accidental and violent causes of death
o Moderate after chronic ischeamic and lung cancer
Being a mother losing their child (extends to 18 years), after natural causes
Greater risk for fathers early in bereavement from unnatural causes
Death by suicide
Note from author: see the interaction effect between subgroup difference and cause of death
Absolute numbers:
5% widowers vs 3% married men in 55 years and older die within
first 6 months post loss.
Physical ill health
Greater occurrence of physical health complains
Worse health for mothers after violent death of child than fathers
o But fathers health deteriorate instead of improve
Bereaved spouses 40 times risk than of non-bereaved people
Self-reported medication 73 times higher
Note: visits to doctors did not increase:
Women with high intensity of grief reduced use of health services for physical health
Bereaved people who are most in need of help might not be obtaining such help
High intensities of grief at earlier point predicts severe physical health disorders
Substantially increased activity-limiting pain and moderate-to-severe current pain in people
shortly after bereavement
Weight loss, more likely in spouses who had not undertaken caregiving of their spouse
o Attributable to unpredictable nature of the death
Psychological symptoms and ill health
Psychological reactions most intense in early bereavement
Affective, cognitive, behavioral, and physiological-somatic, immunological and endocrine
changes
Depression and grief distinct but related clusters of reaction
,
, Physiological reactions differ in culture:
Egyptian Muslims: express intense overt grief
Bali Muslims: avoid any display of grief
Cognitive and somatic symptoms alike across diverse cultures
There are specific reaction patterns to various different types of bereavement:
Grandparents feel enormous sadness and pain for their grieving adult child and a sense of
survivors guilt.
Stages / phases and the task model
Shock, yearning & protest, despair and recovery
Task model: accepting the loss, experiencing the pain of grief, adjusting to the environment without
deceased, relocating the deceased emotionally and moving on.
Be careful: people are not uniform.
Depression is a normal response to early bereavement.
Psychiatric Disorders
25-45% mild depression; 10 – 20% clinical levels of depression
PTSS when loss of life has been massive, or death horrific
o 7% mother / 5% fathers vs 5% women / 3% men in normative samples
Mothers especially high rates of first psychiatric admission, particularly during first year of
bereavement
Complication in the Grieving Process
In some cases the grieving process can be disturbed or complicated
Complicated grief: a deviation from the normal (in cultural and societal terms) grief experience in
either time course, intensity, or both, entailing a chronic and more intense emotional experience or
an inhibited process, which either lacks the usual symptoms or in which onset of symptoms is
delayed.
- Separation Distress (preoccupation with thoughts of the deceased)
- Traumatic Distress (feelings of disbelief about the death)
Numbers of occurrence of CG differ
- 9% - 20% adults
- 78 % in parents after suicide or accidents
- 58% in parents sudden infant death syndrome
Additional medical implications:
Impaired memory, nutritional problems, work and relationship difficulties and difficulties
concentrating; decreases in social participation.
