Overview
Bereavement refers to the experience surrounding the death of a person with whom there has been an enduring relationship. Bereavement is the “entire experience of family members and friends in the anticipation, death and subsequent adjustment to living following the death of a loved one.” [1] It therefore includes psychological expressions and adaptations of families and communities in terms of relationships and future expectations.
Grief is how bereavement affects us personally and is a universal human experience. Grief, especially in the early stages, often causes disruption and disturbance of everyday life. However, grief can be expressed by people very differently. Some people do not experience an intense reaction. Most people experience fluctuating reactions for a period of time while others can develop a complex grief reaction. [2] Grief is a “set of cognitive, emotional and social difficulties that follow the death of a loved one. Individuals vary enormously in the type of grief they experience, its intensity, its duration and their way of expressing it.” [1] Culture can play a major role in the expression of grief. [3]
Common expressions of grief are varied and can include [4] :
- Emotional
- Depression
- Anxiety
- Guilt
- Anger
- Loneliness
- Loss of pleasure
- Shock and numbness
- Cognitive
- Thinking all the time about the person who has died
- A sense that the dead person is still about
- Denial
- Hopelessness
- Behavioural
- Over or under activity
- Social withdrawal
- Agitation
- Physical feelings
- Loss of appetite
- Sleep disturbances
- Tiredness
- Physiological
- Susceptibility to illness
What is Known
- Grief for most people is accommodated over time with support of family and friends. [5]
- There is no evidence that grief counselling improves outcomes for people who experience normal grief. [6-8]
- There is no evidence that sharing and disclosure of feelings will lead to ‘healthy’ or less intense grieving for those people who experience normal grief reactions. [4]
- Protective factors [4] in the health outcomes of bereavement may include:
- Responsive health care for the dying patient and reduction of patient distress before death
- Optimistic and resilient personality characteristics of bereaved individuals
- Secure relationships with family and community (surprisingly not much evidence).
Active research areas / controversies
Research into grief and bereavement is becoming more refined however there are methodological problems which need development. Researchers have not yet identified and used positive adaptive outcome measures which may provide useful knowledge about improved outcomes and resilience in grief. [5] Such developments may alter current understandings of what is known.
Also there is a trend in research which is critical of the ‘moving on’ model of grief work where one confronts the reality of the death/loss and gives up the bond or connection to the dead person. Positive and negative adaptations to the loss appear to be important in a process where a grieving person fluctuates between confronting and denying the death – it is the ability to shift between the positive and negative emotions and cognitions which may provide a pathway to coping with loss. [4]
Research is yet to identify specific grief considerations for different groups such as parents [9], children [10], those from different cultural backgrounds [3] and indigenous populations.
Key messages
- Expressions of grief can vary widely from person to person. No-one can tell others how they 'should' be grieving.
- Most people who experience normal grief reactions do not require specialist counselling.
- For those people who experience normal grief reactions reassurance, acknowledgement of their losses and access to information may be all that is required.
- A proportion of people who grieve may develop complex grief
- A number of options for referral for complicated bereavement exist:
- Specialist bereavement counsellors
- Palliative care services usually offer bereavement follow up to their clients, often based on a risk assessment, and may accept referrals from other sources
- Other mental health professionals with appropriate skills and expertise.
Finding out more
Related CareSearch pages
Complex grief
Review Collection: Bereavement
PubMed Topic Search (Bereavement)
References
- Christ, Bonanno G, Malkinson R and Rubin S. (2003) Bereavement experiences after the death of a child. Institute of Medicine. When Children Die: improving palliative care and end-of-life care for children and their families. Washington, DC: National Academy Press; Appendix E, pp 553-579
- Wortman C. and Cohen Silver R. The Myths of Coping Revisited in Stroebe M. Hansson R. Stroebe W. Schut H. Hanbook of Bereavement Research: consequences, coping and care. Washington DC, American Psychological Association, 2001
- Brown A, Buchan M, Copeland S, Dempster P, Grundy M, Ramadge F, Unwin R, Wilcock S, Wimpenny P, Work F. Literature Review on Bereavement and bereavement care. Joanna Briggs Collaborating Centre for Evidence-based Multi-professional Practice. 2006 Jan:246pp
- Stroebe M. Schut H, Stroebe W. Health Outcomes of Bereavement. Lancet , 2007; 370: 1960-73
- Agnew A. Manktelow R. Taylor B. Jones L. Bereavement Needs Assessment In Specialist Palliative Care: a review of the literature. Palliative Medicine, 2010 24(1):46-59.
- Jorden J. Neimeyer R. Does Grief Counselling Work? Death Studies, 2003; 27(9): 765-786
- Currier J. Neimeyer R Berman J. Effectiveness of Psychotherapeutic Interventions for Bereaved Persons: A Comprehensive Qualitative Review. Psychological Bulletin, 2008; 134(5): 648-661
- Schut H. Stroebe M. Interventions to Enhance Adaptation to Bereavement. Journal of Palliative Medicine, 2005, 8 supplement 1, S140-S147
- Hendrickson K Morbidity, mortality and parental grief: A review of the literature on the relationship between the death of a child and the subsequent health of parents. Palliative and Supportive Care (2009), 7, 109–119.
- Currier J. Holland J. Neimeyer R. The Effectiveness of Bereavement Interventions with children : a meta-analytic review of controlled outcome research. Journal of Clinical and Child and Adolescent Psychology, 2007; 36(2):253-259.
This page was created on 22 January 2010
Last updated 05 February 2010