Bereavement

Although loss by death of someone close is a significant life event, the degree of adversity that death brings is variable. There are multiple prospective, longitudinal studies, with controls, of entry into widowhood. Their results are remarkably similar. Most survivors, unrelated to gender, experience significant depressive symptoms - crying, depressed mood, loss of appetite and weight loss, fatigue, difficulty sleeping, difficulty concentrating, feeling guilty about some aspect of the death, agitation, loss of interest and poor memory. They seldom experience the self-depreciatory symptoms of major depression or have motor retardation. They frequently misidentify some stranger as the deceased but rarely have hallucinations referring to the deceased. Almost half of them would qualify for a diagnosis of major depression in the first month. These symptoms slowly dissipate over the year but sadness remains on holidays and dates of specific events. By 1 year, about 15% meet criteria for major depression and about 10% have been depressed for the entire year. A more severe response, called complicated grief, which resembles Post Traumatic Stress Disorder, is now being identified and studied, but because all bereaved experience symptoms immediately, it cannot be separated out until at least 6 months. The morbidity of bereavement includes depressive symptoms and complicated grief and an increase in drinking, smoking, and drug use in these early months. There is an increase in mortality in men less than 75 years old for the first 12 months, which may not hold true for women. Treatment of the more severe reactions is either an antidepressant alone or in combination with a specific complicated grief counseling. © 2007