Summary: Grief is a normal response to loss, but for some people it becomes prolonged and severe, with lasting consequences for both mental and physical health. A decade-long Danish cohort study found that bereaved individuals who experienced persistently intense grief symptoms used substantially more healthcare services and faced markedly higher mortality: people in the most severe grief trajectory had an 88% higher risk of death within ten years.
Those with persistent high grief were more likely to receive mental health care and to be prescribed psychotropic medications, including antidepressants and sedatives. Pre-existing mental health conditions and prior medication use appeared to identify many at higher risk, suggesting opportunities for early detection and targeted support in primary care.
Key Facts:
- Elevated mortality risk: Individuals with persistent high grief symptoms showed an 88% greater risk of dying within 10 years compared with those with low grief symptoms.
- Greater healthcare burden: The high-grief group had substantially higher odds of accessing mental health services and being prescribed psychotropic drugs.
- Early indicators available: Prior prescriptions and a history of mental health problems were more common in those who later followed a high grief trajectory, offering potential markers for early intervention.
Source: Frontiers
Grief after losing a loved one is an expected and natural response, but for a minority of bereaved people the intensity and duration of grief can lead to lasting health problems even if they do not meet the formal diagnostic criteria for prolonged grief disorder.
Previous research has linked recent bereavement to short-term increases in healthcare use and mortality. The new study from Denmark extends these findings by tracking long-term outcomes over a full decade for a large, population-based sample of bereaved relatives. The results are published in Frontiers in Public Health.
“This is the first large-scale study to examine long-term healthcare use and mortality patterns up to ten years after bereavement,” said Dr Mette Kjærgaard Nielsen, a postdoctoral researcher at the Research Unit for General Practice in Aarhus and the corresponding author.
Beginning in 2012, the research team followed 1,735 bereaved adults in Denmark (mean age 62 at enrollment). Among participants, 66% had recently lost a partner, 27% a parent, and 7% another close relation. The study recruited participants, including relatives of patients known to be terminally ill through national prescription registers, under ethical approvals from the Central Denmark Region and data protection oversight.
Grief trajectories
Earlier work from the same cohort identified five common grief trajectories over the first three years after loss, measured by the standardized Prolonged Grief-13 (PG-13) questionnaire. Trajectories were labeled as follows: a persistent low-grief trajectory (about 38% of participants), a persistent high-grief trajectory (6%), two decreasing trajectories—“high but decreasing” (18%) and “moderate but decreasing” (29%)—and a “late onset” trajectory (9%) with symptoms peaking around six months after bereavement.
For the current report, investigators extended follow-up to ten years (until 2022), using national registers to capture contacts with general practice and mental health services, prescriptions for psychotropic medications, and deaths from any cause. Follow-up began three years after bereavement and continued through year ten, excluding participants who died or emigrated earlier.
Findings indicated that participants in the persistent high-grief trajectory faced the greatest long-term burden. Their instantaneous risk of death within ten years was 88% higher than that of the low-grief group. They also had much higher odds of seeking mental health services more than three years after bereavement and of being prescribed psychotropic medications: 186% higher odds for talk therapy or other mental health services, 463% higher odds for antidepressant prescriptions, and 160% higher odds for sedatives or anxiolytics.
Identifying early warning signs
Although differences in healthcare use between the trajectories diminished after about eight years, excess mortality in the high-grief group persisted across the full ten-year period. The physiological mechanisms behind the increased mortality remain uncertain. The authors note previous associations between high grief symptoms and cardiovascular disease, mental health problems, and suicide, but say further research is needed to clarify causal pathways.
Importantly, the study suggests that patients who later develop prolonged, severe grief may be identifiable before bereavement: the high-grief group had higher rates of psychotropic medication use prior to the loss and, on average, lower educational attainment. These markers point to a profile of mental vulnerability that could guide early, targeted follow-up.
“General practitioners can look for prior depression or other serious mental health conditions and offer tailored follow-up, including referral to private-practice psychologists or secondary care when appropriate,” Nielsen recommended. “A focused bereavement follow-up appointment that prioritizes mental health may help address prolonged needs.”
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 can affect relatives’ health, producing increases in healthcare contacts and short-term mortality after a patient’s death. However, the long-term consequences for those who experience sustained, high grief symptom levels are less well understood.
This study examined associations between grief symptom trajectories and four long-term outcomes—contacts to general practice, contacts to mental health services, use of psychotropic prescription medication, and mortality—over three to ten years after bereavement in relatives of people who died of natural causes.
Grief symptoms were measured with the Prolonged Grief-13 scale in 1,735 bereaved relatives at three time points: before bereavement, six months after, and three years after bereavement. Five principal grief trajectories were identified. The persistent low-grief trajectory (n=670, ~45%) served as the reference group. The persistent high-grief trajectory (n=107, ~6%) comprised relatives with sustained, elevated grief symptom levels.
Statistical analyses included negative binomial regression for GP contacts, logistic regression for mental health service contacts and psychotropic medication use (antidepressants, anxiolytics/sedatives), and Cox regression for mortality. Follow-up began three years post-bereavement and continued through year ten.
Relatives in the high-grief trajectory had a higher annual incidence of GP contacts up to seven years after bereavement and showed increased odds of using mental health services (OR=2.86, 95% CI 1.58–5.19), receiving antidepressants (OR=5.63, 95% CI 3.52–9.01), and receiving sedatives/anxiolytics (OR=2.60, 95% CI 1.63–4.14). Excess mortality for the high-grief group was also observed (OR=1.88, 95% CI 1.1–3.2) compared to the low-grief trajectory.
These results indicate that persistently high grief symptoms are associated with increased healthcare use and elevated mortality risk up to ten years after loss. Future work should evaluate whether current healthcare systems adequately meet the prolonged needs of bereaved relatives with sustained high grief.