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.

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.
  • At least seven percent of those bereaved experience complicated grieving, which interferes with life and requires specialized treatment.
  • A 5-question screening tool for complicated grief, the Brief Grief Questionnaire, can be found in the Coping with Grief document for clinicians.

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 other 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.

Helping strategies

Please see the Coping with Grief documents for both clinicians and patients for information.

Simon's clinical review (JAMA. 2013;310:416-423) suggests the first approach to consider for complicated grief is referral to therapy targeted especially for this condition (that helps resolve complicating issues and facilitates the natural healing process), with anti-depressants as an adjunct if needed. Significant depression and/or suicidal ideation suggest earlier anti-depressant treatment.

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.