Bereavement in later life

Meet the patient

A 79-year-old man comes to clinic fourteen months after his wife died. His daughter made the appointment. He apologises for taking up the slot.[6][7]

He still sets two places at the table. He has not opened her wardrobe. He has stopped going to the bowls club because people ask how he is going, and he cannot make his face do the right thing. He says, without any apparent distress, that he would not mind if he did not wake up.[4][7][13]

Three questions are now live. Is this grief, prolonged grief disorder, depression — or more than one of them? Is he safe tonight? And which treatment does the answer commit me to? They are not the same question and examiners will not let you merge them.[4][11][13]

Word origin worth one line: bereave comes from Old English bereafian — to rob, to deprive by force. The same root gives us reaver*, a raider. The word has always described a theft rather than a sadness, which is exactly what the yearning of prolonged grief is about: not low mood, but something taken.*[4][10]

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1. [1]Shear MK, Wang Y, Skritskaya N, Duan N, Mauro C, Ghesquiere A Treatment of complicated grief in elderly persons: a randomized clinical trial JAMA Psychiatry, 2014.PMID 25250737
2. [2]Shear K, Frank E, Houck PR, Reynolds CF 3rd Treatment of complicated grief: a randomized controlled trial JAMA, 2005.PMID 15928281
3. [3]Shear MK, Reynolds CF 3rd, Simon NM, Zisook S, et al. Optimizing Treatment of Complicated Grief: A Randomized Clinical Trial JAMA Psychiatry, 2016.PMID 27276373
4. [4]Prigerson HG, Horowitz MJ, Jacobs SC, Parkes CM, et al. Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11 PLoS Med, 2009.PMID 19652695
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8. [8]Stroebe M, Schut H, Stroebe W Health outcomes of bereavement Lancet, 2007.PMID 18068517
9. [9]Elwert F, Christakis NA The effect of widowhood on mortality by the causes of death of both spouses Am J Public Health, 2008.PMID 18511733
10. [10]Stroebe M, Schut H The dual process model of coping with bereavement: a decade on Omega (Westport), 2010.PMID 21058610
11. [11]Kendler KS, Myers J, Zisook S Does bereavement-related major depression differ from major depression associated with other stressful life events? Am J Psychiatry, 2008.PMID 18708488
12. [12]Zisook S, Corruble E, Duan N, Iglewicz A, et al. The bereavement exclusion and DSM-5 Depress Anxiety, 2012.PMID 22495967
13. [13]Simon NM, Shear MK, Reynolds CF, Cozza SJ, et al. Commentary on evidence in support of a grief-related condition as a DSM diagnosis Depress Anxiety, 2020.PMID 31916663
14. [14]Hao F, Qiu F, Liang Z, Li P Psychotherapies for prolonged grief disorder in adults: A systematic review and network meta-analysis Asian J Psychiatr, 2024.PMID 38970900