Summary: While grief is a natural part of loss, some people experience persistently high levels that can have long-term health consequences. A decade-long study in Denmark found that individuals with intense, prolonged grief symptoms had significantly higher rates of healthcare use and were nearly twice as likely to die within 10 years.
These individuals were more likely to receive mental health treatment and medications, including antidepressants and sedatives. Early signs, such as pre-existing mental health conditions and medication use, could help clinicians identify those at greatest risk for tailored support.
Key Facts:
- Elevated Risk: People with persistent high grief symptoms had an 88% higher risk of dying within 10 years.
- Healthcare Burden: This group had significantly higher odds of using mental health services and being prescribed psychotropic medications.
- Early Indicators: Pre-loss use of medications and mental health history may predict vulnerability to long-term grief complications.
Source: Frontiers
Grief after the loss of a loved one is a natural response – an inevitable part of living and loving.
But in a minority of the bereaved, grief is so overwhelming that it can lead to physical and mental illnes, even if they don’t necessarily qualify for a diagnosis with the mental health condition ‘prolonged grief disorder’.
For example, studies have shown that people who recently lost a loved one use healthcare services more often, and have an increased mortality rate, over the short term.
Now, researchers from Denmark have shown that bereaved people with persistent high levels of intense grief used more healthcare services and were more likely to die within 10 years.
The results are published in Frontiers in Public Health.
“This is the first study to investigate the long-term use of healthcare and patterns of mortality over a decade after bereavement in a large-scale cohort,” said Dr Mette Kjærgaard Nielsen, a postdoctoral researcher at the Research Unit for General Practice in Aarhus, Denmark, and the study’s corresponding author.
Starting in 2012, Nielsen and colleagues followed a cohort of 1,735 bereaved women and men living in Denmark with a mean age of 62 years on enrollment. Among them, 66% had recently lost their partner, 27% a parent, and 7% another kind of loved relation. Through the national register of drug prescriptions, the researchers knew which patients had recently been prescribed treatment for a terminal condition.
They were thus able to contact those dying patients to invite them and their loved ones to participate in the study. The protocol had been approved by the Health Research Ethics of the Central Denmark Region and the Danish Data Protection Agency.
‘Grief trajectories’
Previously, Nielsen et al. had identified five common ‘trajectories’ among this cohort, based on changes in the intensity of grief symptoms over the first three years after losing a loved one. They measured this with the tried-and-tested ‘Prolonged Grief-13’ (PG-13) questionnaire, which assesses symptoms through 13 questions.
People on the ‘low’ trajectory (38%) displayed persistently low levels of grief symptoms, while 6% followed a ‘high’ trajectory with persistently elevated levels. Three other categories lay between these extremes: 18% and 29% followed a ‘high but decreasing’ and a ‘moderate but decreasing’ trajectory, respectively, and 9% a ‘late onset’ trajectory with a peak of symptoms around six month after bereavement.
In the present study, the researchers extended their follow-up of the participants for a total of 10 years until 2022, except for those who died or emigrated earlier. To do so, Nielsen et al. used data from the Danish National Health Service Register to assess how often each participant received ‘talk therapy’ from a GP or specialist, or were prescribed any psychotropic medication. Records from the Danish Registry of Causes of Deaths gave information on deaths from any cause.
The results showed that for participants on the ‘high’ trajectory, the hazard rate (ie, instantaneous event rate) of dying within 10 years was 88% higher than for participants on a ‘low’ trajectory. They also showed that participants on the ‘high’ trajectory were most likely to receive additional health care services beyond three years after bereavement.
For example, these had 186% higher odds of receiving talk therapy or other mental health services, 463% higher odds of being prescribed antidepressants, and 160% higher odds of being prescribed sedatives or anxiety drugs.
Catching the warning signs
Differences in the frequency of use of these healthcare services between the five trajectories were no longer significant after the first eight years, but the excess mortality of participants on the ‘high’ trajectory remained pronounced over the full 10 years of follow-up.
What might be the physiological cause of the excess mortality? The researchers aren’t sure yet.
“We have previously found a connection between high grief symptom levels and higher rates of cardiovascular disease, mental health problems, and even suicide. But the association with mortality should be further investigated,” said Nielsen.
The authors point out that people at risk for a ‘high’ grief trajectory may be recognizable for intervention early, since the data showed that these patients were prescribed psychotropic medication more often even before their loss.
“The ‘high grief’ group had lower education on average, and their more frequent use of medication before bereavement suggested that they had signs of mental vulnerability, which may cause greater distress on bereavement,” said Nielsen.
“A GP could look for previous signs of depression and other severe mental health conditions. They can then offer these patients tailored follow-up in general practice, or refer them to a private-practice psychologist or secondary care. The GP may also suggest a bereavement follow-up appointment focusing on mental health,” suggested Nielsen.
About this grief and mortality research news
Author: Mischa Dijkstra
Source: Frontiers
Contact: Mischa Dijkstra – Frontiers
Image: The image is credited to Neuroscience News
Original Research: Open access.
“Grief trajectories and long-term health effects in bereaved relatives: a prospective, population-based cohort study with 10-year follow-up” by Mette Kjærgaard Nielsen et al. Frontiers in Public Health
Abstract
Grief trajectories and long-term health effects in bereaved relatives: a prospective, population-based cohort study with 10-year follow-up
Bereavement may affect the health of relatives, causing increased use of health care services and increased mortality shortly after the patient’s death. However, the long-term consequences for those with a high level of grief symptoms remain largely unexplored.
We aimed to investigate associations between grief symptom trajectories and four long-term health outcomes among relatives bereaved by natural death: contacts to general practice and mental health services, use of psychotropic prescription medication, and mortality, over a period of three to ten years post-bereavement.
We assessed grief symptoms using the Prolonged Grief-13 scale in a cohort of 1,735 bereaved relatives at three different time points (prior to bereavement, six months after bereavement, and three years after bereavement) and identified five main grief trajectories.
The trajectory with persistent low levels of grief symptoms in relatives (n=670 (45%)) was called the low grief trajectory (LGT) and was used as reference.
The high grief trajectory (HGT) consisted of 107 (6%) relatives with persistent high grief symptom levels. We investigated associations between grief trajectories and 1) contacts to general practitioner (GP) including out-of-hours using negative binomial regression analysis, 2) contacts to mental health services (GP talk therapy, private-practice psychologist or psychiatrist), 3) use of psychotropic medications (antidepressants, anxiolytics and sedatives) using logistic regression analysis, and 4) mortality using Cox regression analysis.
The follow-up period started at three years after bereavement and long-term outcome were further followed until ten years after the patient’s death.
Relatives in the HGT had a significantly higher yearly incidence of GP contacts until seven years after bereavement compared to the LGT. The HGT was associated with higher use of mental health services (OR=2.86 (95%CI 1.58;5.19)), antidepressants (OR=5.63 (95% CI 3.52; 9.01)), sedatives and anxiolytics (OR=2.60 (95%CI 1.63;4.14)), and excess mortality (OR=1.88 (95% CI 1.1;3.2)) compared to the LGT.
This study shows that patients with high and sustained grief symptoms have an increased healthcare use up to ten years after loss.
Future research should assess whether current health care services sufficiently meet the prolonged needs of these relatives.
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