Prolonged grief nearly doubles risk of death, 10-year study finds

Grief after the loss of a loved one is a natural response, an inevitable part of life and love. But for a minority of bereaved people, grief can be so overwhelming that it leads to physical and mental illness, even if they don’t formally qualify for a mental health diagnosis known as prolonged grief disorder. For example, studies have shown that people who have recently lost a loved one use more health care and have higher rates of short-term mortality.

Now, researchers from Denmark have shown that people who experience persistently high levels of intense grief use health care more often and have a higher risk of dying over 10 years. The findings are published in the journal Frontiers in Public Health.

“This is the first study to examine long-term health care use and mortality patterns over a decade after a loss in a large cohort study,” said Dr. Mette Kjaergaard Nielsen, a postdoctoral fellow at the General Practice Research Unit in Aarhus, Denmark, and lead author of the study.

Trajectories of Grief

Previously, Nielsen and colleagues identified five common grief trajectories in this cohort based on changes in grief symptom intensity over the first three years after loss. They assessed this using the validated Prolonged Grief-13 (PG-13) questionnaire, which includes 13 questions.

People in the low trajectory (38%) showed consistently low levels of grief symptoms, while 6% were on a high trajectory with consistently elevated levels. The other three categories fell between these extremes: 18% and 29% were on “high but declining” and “moderate but declining” trajectories, respectively, and 9% were “late onset,” with symptoms peaking around six months after the loss.

In the current study, the researchers followed the participants for 10 years, until 2022, excluding those who had died or emigrated earlier. To do this, the team used data from the Danish National Health Register to estimate how often each participant received talking therapy from a GP or specialist, or received prescriptions for psychotropic medication. Records from the Danish Cause of Death Register provided information on deaths from any cause.

Identifying warning signs

Differences in the frequency of use of these health services between the five trajectories were no longer statistically significant after the first eight years, but excess mortality among high trajectory participants remained marked throughout the 10 years of follow-up.

What could be the physiological reason for the increased mortality? Researchers are not yet sure.

"We have previously found a link between high levels of grief symptoms and higher rates of cardiovascular disease, mental health problems and even suicide. But the link to overall mortality requires further study," Nielsen said.

The authors note that people at risk for a high grief trajectory may be identified for early intervention, as the data showed that they were more likely to be prescribed psychotropic medications before the loss.

"The 'high grief' group had lower levels of education on average, and their greater use of medications before the loss suggests signs of psychological vulnerability that may lead to greater suffering after the loss," Nielsen said.

"A GP may look for previous signs of depression and other severe mental health problems. They may then offer these patients individual care in their GP practice or refer them to a private psychologist or secondary care. They may also offer grief counselling with a focus on mental health," Nielsen suggested.