Course and prognosis

The grief process usually resolves by 4 months. ICD-10 stipulates a maximum duration of up to 6 months for uncomplicated cases. This is a simplification as individual symptoms have their own time course. For example, emotional and behavioural attachment features often persist for years after the loss, and many changes of philosophy or attitude are permanent.

At least 50 per cent of depressive episodes will resolve within the first 6 months. This leaves about 10 to 20 per cent of those widowed with significant symptoms at more than a year. The re-emergence of symptoms at anniversaries is well recognized

At the turn of the century, March published data showing that the widowed and divorced had over twice the age-specific mortality rate of the married. Higher rates of hospital admission and increased medical consultation among the bereaved were also demonstrated. The evidence in favour of an effect of bereavement directly upon mortality is subject to several confounding factors. Large-scale prospective studies, which have adjusted for age, socio-economic status, and health, show that the maximum mortality risk is during the first 6 months following a bereavement, although the effect is almost certainly present up to 2 years post-loss.

Bereaved parents and children may also be at increased risk, although the evidence here is less conclusive. The elevated mortality rate in the bereaved is more pronounced in the young (below 70 years) and in men. Further, there is a suggestion that if the surviving spouse successfully negotiates the first few years following the loss, his or her risk of subsequent death is actually lower than expected.

Higher rates of suicide are seen with proximity to the loss, and particularly during the first week. Bunch (29) showed that the risk applied to parents and children, as well as spouses, and noted that 60 per cent of people who committed suicide following bereavement had a prior psychiatric history.

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Dealing With Sorrow

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