Not an Onion Study: Loss of a Loved One Increases Risk of Psychological Distress

When a loved one dies, some people are more likely to become very sad, drink more, and be diagnosed by mental health professionals as having psychiatric disorders, according to research published in the American Journal of Psychiatry. Columbia, Harvard and Boston University researchers examined 27,534 people from the National Epidemiologic Survey on Alcohol and Related Conditions who’d lost a loved one at some point in their lives, and correlated them to subsequent occurrences of psychiatric diagnoses. The researchers found that people who have lost a loved one are more likely to be diagnosed as having depression, posttraumatic stress, and other mood, phobia, anxiety and alcohol disorders, especially immediately following a death.

“Unexpected death is associated with heightened vulnerability for onset of virtually all commonly occurring psychiatric disorders that we assessed,” concluded the researchers. Although some of the associated psychiatric disorders actually only emerged many years after people had lost their loved ones, the researchers found that in most cases these diagnoses were meted out by doctors shortly after the loved one died. “For most disorders, a marked increase was observed in onset frequency in the time period during which the unexpected death occurred,” they wrote.

The researchers noted that the majority of people in the study who’d lost a loved one were never diagnosed with any mental disorders. However, a change in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders will make it more likely in future that people who’ve experienced the loss of a loved could be diagnosed with depression. DSM-IV had a “bereavement exclusion” that clarified to physicians that grieving the loss of a loved one was normal for up to two months and should not be identified and treated as clinical depression during that time, but that exclusion was removed from DSM-V. In addition, for longer-lasting bereavement, a new mental disorder called “Persistent Complex Bereavement Disorder” was added to DSM-V. Kenneth J. Doka commented on the rationale in a Huffington Post blog, noting that this “pathologizing of grief may be embraced by pharmaceutical companies, which may now see an emerging market of grievers open to the suggestion to consult a physician if they are struggling with a loss.”

In an editorial in the American Journal of Psychiatry accompanying the new study, Julie Kaplow and Christopher Layne described the study as “an essential first step” in helping physicians understand and mitigate the risks of “bereavement-related pathology” that evidently begin “as early as age 5.” Layne and Kaplow are co-developers of the Bereavement Risk and Resilience Index, the Persistent Complex Bereavement Disorder Checklist, and the Trauma and Grief Component Therapy for Adolescents.

The Burden of Loss: Unexpected Death of a Loved One and Psychiatric Disorders Across the Life Course in a National Study (Keyes, Katherine M. Keyes et al. Am J Psychiatry 2014;171:864-871. doi:10.1176/appi.ajp.2014.13081132)

Sudden Loss and Psychiatric Disorders Across the Life Course: Toward a Developmental Lifespan Theory of Bereavement-Related Risk and Resilience (Kaplow, Julie B. and Layne, Christopher M. Am J Psychiatry 2014;171:807-810. doi:10.1176/appi.ajp.2014.14050676)

Grief and the DSM: A Brief Q&A (Kenneth J. Doka, Huffington Post, May 29, 2013)