People who suffer intense and persistent grief are twice as likely to die within the next 10 years.

Researchers at Aarhus University in Denmark have shown that bereaved individuals with high and persistent levels of intense pain had greater access to health services and were more likely to die within 10 years . The results are published in Frontiers in Public Health .

Grief following the loss of a loved one is a natural response , an inevitable part of life and love. However, for a minority of bereaved individuals, grief is so overwhelming that it can lead to physical and mental illness , even if they do not qualify for a diagnosis of prolonged grief disorder. For example, studies have shown that people who have recently lost a loved one use health services more frequently and have a higher short-term mortality rate .

"This is the first study to investigate long-term healthcare use and mortality patterns over a decade after bereavement in a large-scale cohort," said Dr. Mette Kjargaard Nielsen, a postdoctoral researcher at the General Medicine Research Unit in Aarhus, Denmark, and corresponding author of the study.

Beginning in 2012, Nielsen and colleagues followed a cohort of 1,735 bereaved women and men living in Denmark, with a mean age of 62 at enrollment. Among them, 66% had recently lost a partner, 27% a parent, and 7% another relative. Using the national drug prescription register, the researchers knew which patients had recently received treatment for a terminal illness. They were then able to contact these terminally ill patients to invite them and their loved ones to participate in the study. The protocol had been approved by the Health Research Ethics Committee of the Central Denmark Region and the Danish Data Protection Agency.

Previously, researchers had identified five common "trajectories" in this cohort, based on changes in grief symptom intensity during the first three years after the loss of a loved one. We measured this with the proven Prolonged Grief-13 (PG-13) questionnaire , which assesses symptoms using 13 questions.

People on the "low" trajectory (38%) showed persistently low levels of grief symptoms, while 6% followed a "high" trajectory with persistently elevated levels. Three other categories fell between these extremes: 18% and 29% followed a "high but decreasing" and "moderate but decreasing" trajectory, respectively, and 9% a "late-onset" trajectory with peak symptoms around six months after the bereavement.

In the current study, the researchers extended the follow-up of participants for 10 years , until 2022, except for those who died or emigrated earlier. To do this, the researchers used data from the Danish National Health Service Register to assess how frequently each participant received talking therapy from a GP or specialist, or was prescribed any psychotropic medication. Records from the Danish Cause of Death Registry provided information on deaths from any cause.

The results showed that for participants in the "high" trajectory, the hazard rate (i.e., the instantaneous event rate) of dying within 10 years was 88% higher than for participants in the "low" trajectory. They also showed that participants in the "high" trajectory were more likely to receive additional healthcare services three years after the bereavement. For example, these participants were 186% more likely to receive talk therapy or other mental health services, 463% more likely to be prescribed antidepressants, and 160% more likely to be prescribed sedatives or anti-anxiety medications.

The differences in the frequency of use of these healthcare services among the five trajectories were no longer significant after the first eight years , but the excess mortality of participants in the "high" trajectory remained pronounced throughout the full 10 years of follow-up. As for what the physiological cause of the excess mortality might be, the researchers are still unsure. "We have previously found a connection between high levels of grief symptoms and higher rates of cardiovascular disease, mental health problems, and even suicide . However, the association with mortality needs to be further investigated," Nielsen notes.

The authors note that people at risk for a "high" grief trajectory may be eligible for early intervention , as the data showed these patients were more frequently prescribed psychotropic medications even before their loss. "The 'intense grief' group had a lower average educational level, and their more frequent use of medications before bereavement suggested they had signs of mental vulnerability, which can cause greater distress during bereavement," Nielsen adds.

A primary care physician could look for early signs of depression and other serious mental disorders. They can then offer these patients personalized follow-up care in their general practice, or refer them to a private psychologist or a secondary care center. The professional may also suggest a grief follow-up appointment focused on mental health, suggests Nielsen.