In this Review, we look at the relation between bereavement and physical and mental health. Although grief is not a disease and most people adjust without professional psychological intervention, bereavement is associated with excess risk of mortality, particularly in the early weeks and months after loss. It is related to decrements in physical health, indicated by presence of symptoms and illnesses, and use of medical services. Furthermore, bereaved individuals report diverse psychological reactions. For a few people, mental disorders or complications in the grieving process ensue. We summarise research on risk factors that increase vulnerability of some bereaved individuals. Diverse factors (circumstances of death, intrapersonal and interpersonal variables, ways of coping) are likely to co-determine excesses in ill-health. We also assess the effectiveness of psychological intervention programmes. Intervention should be targeted at high-risk people and those with complicated grief or bereavement-related depression and stress disorders.

The Dual Process Model of Coping with Bereavement (DPM; Stroebe & Schut, 1999) is described in this article. The rationale is given as to why this model was deemed necessary and how it was designed to overcome limitations of earlier models of adaptive coping with loss. Although building on earlier theoretical formulations, it contrasts with other models along a number of dimensions which are outlined. In addition to describing the basic parameters of the DPM, theoretical and empirical developments that have taken place since the original publication of the model are summarized. Guidelines for future research are given focusing on principles that should be followed to put the model to stringent empirical test.

There are shortcomings in traditional theorizing about effective ways of coping with bereavement, most notably, with respect to the so-called "grief work hypothesis." Criticisms include imprecise definition, failure to represent dynamic processing that is characteristic of grieving, lack of empirical evidence and validation across cultures and historical periods, and a limited focus on intrapersonal processes and on health outcomes. Therefore, a revised model of coping with bereavement, the dual process model, is proposed. This model identifies two types of stressors, loss- and restoration-oriented, and a dynamic, regulatory coping process of oscillation, whereby the grieving individual at times confronts, at other times avoids, the different tasks of grieving. This model proposes that adaptive coping is composed of confrontation--avoidance of loss and restoration stressors. It also argues the need for dosage of grieving, that is, the need to take respite from dealing with either of these stressors, as an integral part of adaptive coping. Empirical research to support this conceptualization is discussed, and the model's relevance to the examination of complicated grief, analysis of subgroup phenomena, as well as interpersonal coping processes, is described.

We propose an integrative risk factor framework to enhance understanding of individual differences in adjustment to bereavement and to encourage more systematic analysis of factors contributing to bereavement outcome (e.g., examination of interactions between variables and establishing pathways in the adaptation process). The examination of individual differences in adaptation to bereavement is essential for practical (e.g. targeting high risk individuals for intervention) and theoretical (e.g. testing the validity of theoretical claims about sources of differences) purposes. And yet, existing theoretical approaches have not led to systematic empirical examination and empirical studies in the current literature are fraught with shortcomings. Derived from Cognitive Stress Theory [Lazarus, R. S. & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer] and the stressor-specific Dual Process Model of Coping with Bereavement [Stroebe, M. S., & Schut, H. A. W. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23, 197-224], the framework incorporates an analysis of stressors, intra/interpersonal risk/protective factors, and appraisal and coping processes that are postulated to impact on outcome. Advantages of using the approach are outlined. Challenges in undertaking such research are addressed.

In the last quarter of the twentieth century numerous intervention programs for bereaved persons were developed, ranging from mutual-help groups open for anyone suffering a loss to full-blown therapeutic programs for complicated or pathological forms of grief. Likewise, strategies have ranged from individual to group interventions. The basic idea behind offering help is to benefit the bereaved individual, to help him or her to deal with the emotional and practical problems following the loss of a loved one. If societal developments are taken as the criterion, it must be concluded that there has been uncritical acceptance of the assumption that help is beneficial. In the United States, Australia, and Europe social workers, psychologists, funeral organizations, hospitals, organizations of bereaved individuals, and various religious and humanistic organizations offer grief counseling and therapy. Undoubtedly they have done so with good intentions, but there is reason to doubt whether what they are trying to achieve is actually being achieved. A substantial number of grief intervention efficacy studies have resulted in disappointing, sometimes even negative, re-705

The loss of a marital partner results in substantial increases in morbidity and mortality among both men and women, but the effects are relatively greater for widowers than for widows in the acute grieving period. Evidence is reviewed, and explanations of the pattern are examined. An interpretation in terms of gender differences in social support (cf. M. Stroebe & W. Stroebe, 1983), although plausible, has not yet been empirically confirmed. Likewise, with respect to gender differences in coping styles, women are more confrontive and expressive of their emotions than men, but there has been little validation of the generally accepted grief work hypothesis (working through grief by women brings about their better recovery). Cognitive processes underlying effective coping with bereavement are analyzed, and a stressor-specific framework, the dualprocess model of coping with loss, is suggested to help explain gender differences in health outcomes.

This longitudinal study examined the relative impact of major variables for predicting adjustment (in terms of both grief and depression) among bereaved parents following the death of their child. Couples (N ϭ 219) participated 6, 13, and 20 months postloss. Use of multilevel regression analyses enabled assessment of the impact of several predictors and facilitated analysis of factors that were either shared by parents or individual. Grief was predicted mainly by shared parent factors: child's age, cause and unexpectedness of death, and number of remaining children. By contrast, depression was predicted by individual parent factors: gender, religious affiliation, and professional help seeking. Theoretical implications of these findings are discussed.

A longitudinal study of a matched sample of 60 recently widowed and 60 married men and women tested predictions from stress and attachment theory regarding the role of social support in adjustment to bereavement. Stress theory predicts a buffering effect, attributing the impact of bereavement on well-being to stressful deficits caused by the loss and assuming that these deficits can be compensated through social support. In contrast, attachment theory denies that supportive friends can compensate the loss of an attachment figure and predicts main effects of marital status and social support. Attachment theory further suggests that marital status and social support influence well-being by different pathways, with the impact of marital status mediated by emotional loneliness and the impact of social support mediated by social loneliness. Results clearly supported attachment theory.