Data Back Some Grief Theories, Refute Others

The death of a loved one is most frequently followed by feelings of both yearning and acceptance. Most of the negative feelings associated with the death of a loved one begin to diminish by about six months after the death.

These are the findings from an analysis of more than 200 people enrolled in the Yale Bereavement Study, the vast majority of whom were widowed and whose loved ones died of a terminal illness. The results were published in the February 21 Journal of the American Medical Association.

“What does typical grief look like? That is what we were trying to determine here,” study co-author Holly Prigerson, Ph.D., told Psychiatric News. Prigerson is an associate professor of psychiatry at Harvard Medical School and director of the Center for Psychooncology and Palliative Care Research at the Dana Farber Cancer Institute.

A variety of experts have theorized that there are different stages inherent in the grieving process. For instance, based on the theories of other grief experts, such as Elisabeth Kubler-Ross, M.D., John Bowlby, M.D., and Collin Murray Parkes, M.D., Selby Jacobs, M.D., in his 1993 book Pathological Grief: Maladaptation to Loss postulated that response to loss progresses through the stages of numbness and disbelief, separation distress and yearning, depression and mourning, and recovery or acceptance within a six-month period after a loved one's death, according to the report

In this study, Prigerson and her colleagues empirically measured whether and how often bereaved individuals experienced the emotions described by Bowlby and Parkes and others for up to two years after the death of a loved one.

Prigerson emphasized that people who met criteria for complicated grief disorder and those who lost a family member or loved one due to an unnatural cause such as suicide or murder were excluded from the study.

The sample came from t he Yale Bereavement Study, a longitudinal examination of a sample of bereaved subjects living in Bridgeport, Fairfield, and New Haven, Conn., and data were collected between January 2000 and January 2003.

In Bridgeport and Fairfield, the researchers obtained a list of names from the American Association of Retired Persons Widowed Persons Service, a community-based outreach program. In New Haven, they identified subjects via names listed in the obituary section of the New Haven Register as well as through newspaper ads and flyers discussing participation in their study. In addition, the chaplain's office of a local hospital referred some of the subjects.

They sent a letter to the bereaved people describing the study and inviting them to participate. Of the 575 people contacted, the final sample included 233 people who completed the Inventory of Complicated Grief–Revised. The 35-question instrument measures how often people experienced disbelief, yearning, anger, and acceptance in relation to their loved one's death. About 84 percent of the respondents were spouses of the deceased.

Researchers evaluated participants at least once at three points after the deaths of their loved ones: between one and six months, six and 12 months, and one and two years.