- Risk of suicide is 2.5x greater in the first year of bereavement
- Particularly high risk at the anniversary of the death
- Death from physical illness is also increased in the first year after bereavement – particularly death from cardiovascular disease
Normal Grief reaction
- The patient may be pre-occupied with thoughts of their deceased relative. The thoughts may at first be distressing, but later, may be comforting. They may dream of their relative. They may concentrate of physical objects that remind them of the deceased.
- Illusions – the patient may think they hear or see the deceased (pseudohallucinations), and may interpret unusual noises at home as their relative moving around the house. They may feel as though the deceased is still nearby or present, and may talk to them, and even prepare meals for them.
Many patients exhibit anger after the response of denial – they may feel it is unfair that they are in this position and others are not. The anger can cause problems for the care of the patient. Doctors and relatives of the patient may feel that the anger is directed at them, even though the original cause of the anger is totally unrelated to them. Anger can be directed at other family members, medical practitioners, and God.
(E.g. trying to justify it, or seeking to change behaviours in an attempt to reverse / alleviate the event) - in this stage the patient makes a ‘promise’ either with themselves, or others (or perhaps God), that if they are allowed to carry out a favourite task, ritual or experience ‘one more time’, then after this event, they may be more willing to accept the truth. However, often after the event itself, the patient is not satisfied, and may make further attempts at bargaining.
There is usually a triad of low mood, poor sleeping pattern and weeping. This is seen in >50% of grieving relatives. There are usually also other features of depression, that in many cases are enough to satisfy the diagnostic criteria, and thus be treated. There can also be:
- Suicidal thoughts – the individual may feel they could have done more to prevent the death of the loved one, and may feel guilt, and may want to join them
- Somatic symptoms –often similar to those felt by the deceased before they passed away
- Generalised anxiety –the individual may be very restless, they may pace about the house, they may visit public places, or the cemetery looking for the deceased.
This is frequently the final stage that the patient will experience. They will often have been on an emotional journey through several other stages before they reach this state.
Atypical grief reaction
- More common in women
- Different types of atypical grief reaction, most commonly:
- Often very prolonged
- Denial may last >2 weeks
- Total grief reaction may last >1 year
- Social withdrawal
- Inability to work
- Suicidal thoughts and acts
- Sever guilt
- Sever feeling of hostility to others
- Extreme somatisation and hypochondrial symptoms, similar to those of the deceased
- Other types:
- Delayed grief reaction – the individual functions normally for up to several months after the event, before entering a state of grief.
- Denial – the patient spends a very long time in the denial stage of the grief reaction.
- The death is sudden and unexpected
- Circumstances have prevented normal grief at an early stage (e.g. Unable to see the body)
- The relationship before the deceased died was hostile / there were unresolved problems
- The loss involves a child of the affected (even if ‘child’ is now adult)
- The patient has a small social circle, and/or few relatives