Grief: Overview for Clinicians

Studies have linked bereavement or grief to depression, anxiety-related symptoms and disorders, impaired immune function, poorer physical health, increased physician visits, increased use of alcohol and cigarettes, suicide, and increased mortality from conditions such as cardiovascular disease.

Grief is a reaction to loss and is a different entity from depression.

• Can occur following any type of major loss, not only death.
• Encompasses behavioral, cognitive, emotional, physical, and spiritual elements.
• Patients may be labeled depressed when instead are grieving a major loss.
• Appropriate action often is different for grief versus depression.

Assessment

Query patients about known or possible losses, their reactions to those losses, and the time period involved. Differential diagnosis: typical grief vs complicated grief vs major depressive disorder vs posttraumatic stress disorder.

Wide variation in grieving

Commonalities exist in grief reactions, but the grief experience varies widely. It is influenced by cultural, gender, and individual differences.

Times for heightened clinician sensitivity

• Anticipatory grief: when a loss is perceived as imminent and an individual begins grieving before the actual loss occurs.
• Disenfranchised grief (hidden sorrow): when a loss is not or cannot be openly acknowledged, publicly mourned, or socially supported.

Grief theory: a shifting paradigm

Thinking has shifted from Elizabeth Kubler Ross' stage theory of dying to task-oriented models, such as William Worden's Tasks of Mourning. The goal for the bereaved is not to "recover" from the loss but rather to learn how to integrate the loss into one's life.

How to help

The PLISSIT model includes four levels of intervention, ranging from basic to complex, guiding clinicians to support patients according to their own comfort level and expertise and the needs of patients.

• Permission - Give patients an opportunity to talk about the loss.
• Limited Information - Answer basic questions. Dispel misconceptions.
• Specific Suggestions - Collaboratively problem-solve with patient.
• Intensive Therapy - Refer to professional who specializes in grief.

Helping strategies

People cope and respond differently to helping approaches. Some approaches:

• Salutogenesis-oriented sessions
• Addressing spirituality issues
• Facilitating support from family/friends
• Grief support groups
• Non-pharmaceutical approaches to prevent or treat depression
• Rituals
• Exercise
• Spending time in nature
• Writing or journaling
• Forgiving
• Massage
• Healing touch

Importance of self-care

Loss is inherent in health care. These losses can be disenfranchised for clinicians. Acknowledging and incorporating this professional grief into one's life can prevent losses from negatively affecting one's work and personal life.

Please see the downloads section at the right for more detailed clinician and patient information.

Disclaimer: This information is for general education. Please work with your health care practitioner to use it in the best way possible to promote your health.