Risk Factors For Pathological Grief
To some extent, the severity of the grief experienced by an individual can be predicted, given the presence or absence of identified risk factors for maladjustment to the loss. Current knowledge about such risk factors is reviewed below.
Demographic characteristics. Younger people have often been found to experience higher levels of grief. This may be understandable, in part, because they are more likely to be mourning a death that is considered untimely. However, Catherine Sanders found that though this was true initially for younger widows, two years following the death they had made significant improvements in their mental health, while older widows, who initially had lower levels of grief, now had more anxiety, loneliness, and feelings of helplessness, and also had declined in physical health. This difference over the long term may be explained, at least partially, by younger widowed people's greater resilience and tendency to feel less vulnerable following the loss of their spouse.
Though women tend to report more symptoms than men, Colin Murray Parkes and R. J. Brown found that between two and four years after the loss, widows were no more depressed than married women the same age, whereas widowers were still more depressed than married men. It is hypothesized that the reason for this is that during marriage, men may be more likely to depend on a spouse for emotional support and social contacts. When this resource is no longer available, these men, not in the habit of meeting new people, often isolate themselves or throw themselves into their work. Women, on the contrary, are more likely to cope with the loss by seeking out social support that might facilitate the bereavement process.
Low socioeconomic status has also been found to contribute to poor bereavement adjustment, worse health, reduced social participation, and greater loneliness. Unemployment is also a risk factor for depression following bereavement.
Nature of the death. If the death is particularly sudden, unexpected, or violent, the bereaved person may be predisposed to a pathological reaction, particularly to elements of traumatic distress and PTSD. Similarly, experiencing multiple losses near each other in time, known as "bereavement overload," has been found to increase risk of psychopathology.
Nature of the relationship. If the bereaved person was highly dependent (emotionally, physically, or otherwise) on the deceased person, or if their lives were largely intertwined with shared activities (an "enmeshed" relationship), the loss will result in major disruption in the survivor's daily life. Feelings of purposelessness, loss of meaning, and a shattered worldview are likely to be prominent and contribute to a diagnosis of traumatic grief. One study (The Gerontologist, 2000) by Holly Prigerson and colleagues found that, following the loss of their spouse, people who had harmonious marriages used a significantly greater number of health services than those whose marriages were discordant.
The nature of the relationship is partly dependent upon the personality and "attachment style" of the bereaved person. Attachment disturbances, such as excessive dependency or insecure or anxious attachment, are likely to result in severe separation distress following the loss. Such disturbances are often established during childhood, when the ability to form secure attachments is learned. A study by Gabriel Silverman and others (2000) found that adversities experienced during childhood (physical or sexual abuse, death of a parent) were significantly associated with traumatic grief, while adversities occurring in adulthood (nonbereavement traumatic events and death of a child) were associated with PTSD. This suggests that there is a vulnerability to traumatic grief explicitly rooted in childhood experiences.
Social support. Lack of social support (i.e., friends or family who are available to provide emotional and practical help) has been widely cited as a risk factor for poor bereavement adjustment. However, Lund notes that simply having available family members is not enough, because such "support" can be negative (e.g., judgmental, inconsiderate, pushy, demanding, unreliable). Rather, only empathetic support, stable over time, appears to result in lower rates of depression and more positive ratings of coping, health, and life satisfaction.