1. In patients who have experienced a loss prepare them for the types of reactions (e.g., emotional, physical, varying length) they may have.
  2. In all grieving patients, especially those with a prolonged or complex grief reaction:
    1. Inquire about depression, suicidal ideation, self-medication, and alcohol and substance use
    2. Consider the requirement for additional treatments or referral
  3. Recognize that grief reactions may vary based on the individual’s context and experiences; life cycle and developmental stages; and cultural and family contexts.
  4. In patients with presentations suggestive of grief reactions without obvious triggers look for triggers that may be unique to each patient (e.g., death of a pet, loss of a job, reactions to anniversary).
  5. In patients with unexplained or unresponsive physical or mental health concerns; alcohol or substance use; or functional or behavioural change ask about loss and/or grief as possible contributing factors.

General Overview

  • Adaptive response to loss (includes physical, emotional, cognitive, behavioral, and spiritual responses)
    • Acute grief can be intense and disruptive, but usually is integrated over time (usually 6-12 months)
    • Complicated grief is a form of acute grief that is abnormally prolonged, intense, and disabling
  • In grief, symptoms come in waves (mixed with positive memories) and decreases over time, daily function is difficult initially but manageable
    • Denial, anger, disbelief, yearning, anxiety, sadness, helplessness, guilt, sleep and appetite changes, fatigue, and social withdrawal
  • Differentiate from depression
    • Severe persistent symptoms, persistent decreased function, suicidal ideation
  • Management
    • Acknowledge the loss and the associated grief
    • Actively listen to and explore patients' concerns, reinforce patients' strengths in coping with their illness
    • Encourage external sources of support including family, friends, and faith communities, or support groups
    • Consider psychotherapy if requests or in complicated grief