Conjugal bereavement is associated with increased numbers of physician visits
and consequent increases in the cost of health care (Prigerson
et al. 2000). Detrimental influences on health are most marked during
the first six months after bereavement. Only in a few cases do they become long-standing.
Physical Health
During the first few weeks after bereavement neuro-endocrine changes
and impairment of immune response have been found (Hall
& Irwin, 2001). These are thought to reflect emotional factors
although the causal links are still under investigation. Major bereavements
are associated with increases in incidence of specific disorders and mortality.
Specific Disorders
Cancers, cardiovascular disease, hyperthyroidism and other
psychosomatic disorders (See Osterweiss
1984 for a review).
Mortality
After conjugal bereavement, mortality is
greater than that of married people of the same age. The increase is highest
during the first year of bereavement, it is mainly attributable to cardiovascular
disease and is much higher in men than in women. There is also an increased
risk of suicide. (Helsing 1981, Schaefer
1995).
Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder is not confined to bereavement
and can arise in any situation in which a person is exposed to an event
evoking intense fear, helplessness, or horror. It is characterized by
intrusive memories of the event which are so distressing that people go
to great lengths to avoid any confrontation or reminder of what has happened.
This makes it difficult for them to grieve.
Psychological Health
These disorders follow the same pattern and often coexist with the physical
health problems.
Non-Specific Disorders
In order of frequency:
Anxiety and Panic Disorders
Major Depression (with or without suicidal ideation)
Alcohol or Drug Abuse
Exacerbation of other pre-existing disorders.
Specific Disorders
These are less common than Anxiety/Panic and Depression
and they often coexist with these conditions.
Complicated Grief
Post-Traumatic Stress Disorder
Anxiety and Panic Disorders
Although anxiety is a common feature of grief it may be so
severe as to interfere with important responsibilities and roles. This is
most likely if people misinterpret the physiological accompaniments of anxiety/fear
as indicating illness or madness. This sets up a vicious cycle, which may
escalate into a panic syndrome (Jacobs,
1993).
Criteria for Complicated Grief
Criterion A
Daily intrusive and disruptive
chronic and persistent yearning, pining, or longing for the deceased.
Criterion B
The person should have 4 of the following 7
remaining symptoms at least several times a day or to a marked
degree:
Trouble accepting the death
Inability to trust others
Excessive bitterness or anger related to the death
Uneasy about moving on
Survivor Guilt
Feeling life is empty or meaningless without deceased
come on immediately after bereavement and continue = Chronic Grief
or they may be delayed or inhibited = Delayed Grief.
The chronic form is the most frequent.
Distinguishing Complicated Grief from Clinical Depression (Prigerson
et al.1995).
The following have been found to co-vary independently of Complicated
Grief, they constitute a cluster of symptoms that characterize clinical
depression:
depressed mood,
suicidal thoughts,
psychomotor retardation (slowing of thought and movement),
apathy,
early morning waking, and
irrational guilt.
The symptoms listed above have been found to co-vary independently of
Complicated Grief.
