David Baxter PhD
Late Founder
Yearning, not depression, the most common grief response
In clinical depression
Contrary to accepted theory, yearning and acceptance are the two most salient emotions individuals experience after a significant loss, according to a new study in the February 21 issue of Journal of the American Medical Association.
"The notion that a natural psychological response to loss involves an orderly progression through distinct stages of bereavement has been widely accepted by clinicians and the general public," the authors provide as background information in the article. The stage theory of grief (disbelief, yearning, anger, depression and acceptance) is commonly attributed to Elizabeth Kubler-Ross, a Swiss physician, and relied upon heavily in medical education.
"The identification of the patterns of typical grief symptom trajectories is of clinical interest because it enhances the understanding of how individuals cognitively and emotionally process the death of someone close. Such knowledge aids in the determination of whether a specific pattern of bereavement adjustment is normal or not," the authors explain.
Paul K. Maciejewski, Ph.D., from the Yale University School of Medicine, New Haven, Conn., and colleagues analyzed data collected between January 2000 and January 2003 from 233 individuals participating in the Yale Bereavement Study. The study participants had a family member or loved one who died from natural, not traumatic causes; and had at least one complete assessment of the five grief indicators included in the stage theory of grief within 24 months following the death. The vast majority (83.8 percent) of participants were spouses of the deceased. The remaining participants (16.2 percent) were adult children, parents, or siblings of the deceased.
The researchers found "Acceptance was the most frequently endorsed item and yearning was the dominant negative grief indicator from one to 24 months postloss. In models that take into account the rise and fall of psychological responses, once rescaled, disbelief decreased from an initial high at one month postloss, yearning peaked at four months postloss, anger peaked at five months postloss, and depression peaked at six months postloss." The authors add, "acceptance increased steadily through the study observation period ending at 24 months postloss."
Surprisingly, depression was not the most common reaction. "Up until now I think people thought that sadness was, sad mood, depressed mood was the characteristic feature of a bereavement response, and these data say that's really more about yearning and pining and missing the person," noted one of the authors. So "clinical guidelines should focus more on symptoms of yearning and pining and heartache and missing rather than on symptoms of sadness and feeling blue."
"The focus on depression is misguided," said senior author Holly Prigerson said in an interview. The new study showed that yearning peaks after four months but depression peaks considerably later.
"Identification of the normal stages of grief following a death from natural causes enhances understanding of how the average person cognitively and emotionally processes the loss of a family member," the authors write. "Regardless of how the data are analyzed, all of the negative grief indicators are in decline by approximately six months postloss. The persistence of these negative emotions beyond six months is therefore likely to reflect a more difficult than average adjustment and suggests the need for further evaluation of the bereaved survivor and potential referral for treatment," the authors conclude.
Source: Maciejewski PK, Zhang B, Block SD, Prigerson HG. An Empirical Examination of the Stage Theory of Grief JAMA. 2007;297:716-723. [Abstract]
In clinical depression
Contrary to accepted theory, yearning and acceptance are the two most salient emotions individuals experience after a significant loss, according to a new study in the February 21 issue of Journal of the American Medical Association.
"The notion that a natural psychological response to loss involves an orderly progression through distinct stages of bereavement has been widely accepted by clinicians and the general public," the authors provide as background information in the article. The stage theory of grief (disbelief, yearning, anger, depression and acceptance) is commonly attributed to Elizabeth Kubler-Ross, a Swiss physician, and relied upon heavily in medical education.
"The identification of the patterns of typical grief symptom trajectories is of clinical interest because it enhances the understanding of how individuals cognitively and emotionally process the death of someone close. Such knowledge aids in the determination of whether a specific pattern of bereavement adjustment is normal or not," the authors explain.
Paul K. Maciejewski, Ph.D., from the Yale University School of Medicine, New Haven, Conn., and colleagues analyzed data collected between January 2000 and January 2003 from 233 individuals participating in the Yale Bereavement Study. The study participants had a family member or loved one who died from natural, not traumatic causes; and had at least one complete assessment of the five grief indicators included in the stage theory of grief within 24 months following the death. The vast majority (83.8 percent) of participants were spouses of the deceased. The remaining participants (16.2 percent) were adult children, parents, or siblings of the deceased.
The researchers found "Acceptance was the most frequently endorsed item and yearning was the dominant negative grief indicator from one to 24 months postloss. In models that take into account the rise and fall of psychological responses, once rescaled, disbelief decreased from an initial high at one month postloss, yearning peaked at four months postloss, anger peaked at five months postloss, and depression peaked at six months postloss." The authors add, "acceptance increased steadily through the study observation period ending at 24 months postloss."
Surprisingly, depression was not the most common reaction. "Up until now I think people thought that sadness was, sad mood, depressed mood was the characteristic feature of a bereavement response, and these data say that's really more about yearning and pining and missing the person," noted one of the authors. So "clinical guidelines should focus more on symptoms of yearning and pining and heartache and missing rather than on symptoms of sadness and feeling blue."
"The focus on depression is misguided," said senior author Holly Prigerson said in an interview. The new study showed that yearning peaks after four months but depression peaks considerably later.
"Identification of the normal stages of grief following a death from natural causes enhances understanding of how the average person cognitively and emotionally processes the loss of a family member," the authors write. "Regardless of how the data are analyzed, all of the negative grief indicators are in decline by approximately six months postloss. The persistence of these negative emotions beyond six months is therefore likely to reflect a more difficult than average adjustment and suggests the need for further evaluation of the bereaved survivor and potential referral for treatment," the authors conclude.
Source: Maciejewski PK, Zhang B, Block SD, Prigerson HG. An Empirical Examination of the Stage Theory of Grief JAMA. 2007;297:716-723. [Abstract]
