Intense grief linked to higher risk of death for a decade

Grief after the loss of a loved one is a natural response — but in a minority of the bereaved, grief is so overwhelming that it can lead to physical and mental illness. Now, Danish researchers have found that bereaved people with persistent high levels of intense grief use more healthcare services and are more likely to die within 10 years, as published in the journal Frontiers in Public Health.

Previous studies have shown that people who recently lost a loved one use healthcare services more often, and have an increased mortality rate, over the short term. But according to Dr Mette Kjærgaard Nielsen, a postdoctoral researcher at the Research Unit for General Practice in Aarhus and corresponding author on the new study, this is the first investigation of the long-term use of health care and patterns of mortality over a decade after bereavement in a large-scale cohort.

Starting in 2012, Nielsen and colleagues followed a cohort of 1735 bereaved women and men living in Denmark with a mean age of 62 years on enrolment. Among them, 66% had recently lost their partner, 27% a parent and 7% another kind of loved relation. Through the national register of drug prescriptions, the researchers knew which patients had recently been prescribed treatment for a terminal condition. They were thus able to contact those dying patients to invite them and their loved ones to participate in the study.

Previously, the researchers had identified five common ‘trajectories’ among this cohort, based on changes in the intensity of grief symptoms over the first three years after losing a loved one. People on the ‘low’ trajectory (38%) displayed persistently low levels of grief symptoms, while 6% followed a ‘high’ trajectory with persistently elevated levels. 18% and 29% followed a ‘high but decreasing’ and a ‘moderate but decreasing’ trajectory, respectively, and 9% a ‘late-onset’ trajectory with a peak of symptoms around six months after bereavement.

In the new study, the researchers extended their follow-up of the participants for a total of 10 years until 2022, except for those who died or emigrated earlier. To do so, they used data from the Danish National Health Service Register to assess how often each participant received ‘talk therapy’ from a GP or specialist, or were prescribed any psychotropic medication. Records from the Danish Registry of Causes of Deaths gave information on deaths from any cause.

For participants on the ‘high’ trajectory, the hazard rate (ie, instantaneous event rate) of dying within 10 years was 88% higher than for participants on a ‘low’ trajectory. Participants on the ‘high’ trajectory were also more likely to receive additional healthcare services beyond three years after bereavement, including 186% higher odds of receiving talk therapy or other mental health services, 463% higher odds of being prescribed antidepressants, and 160% higher odds of being prescribed sedatives or anxiety drugs.

Differences in the frequency of use of healthcare services between the five trajectories were no longer significant after the first eight years, but the excess mortality of participants on the ‘high’ trajectory remained pronounced over the full 10 years of follow-up. Nielsen said this association with mortality should be further investigated, with the researchers having found “a connection between high grief symptom levels and higher rates of cardiovascular disease, mental health problems, and even suicide”.

The authors noted that people at risk for a ‘high’ grief trajectory may be recognisable for intervention early, since the data showed that these patients were prescribed psychotropic medication more often even before their loss, suggesting mental vulnerability. Nielsen suggested that GPs could thus look for previous signs of depression or other severe mental health conditions, and offer these patients a bereavement follow-up appointment focused on mental health.

Image credit: iStock.com/Kayoko Hayashi