Physiological correlates of bereavement and the impact of bereavement interventions

Abstract

The death of a loved one is recognized as one of life's greatest stresses, with reports of increased mortality and morbidity for the surviving spouse or parent, especially in the early months of bereavement. The aim of this paper is to review the evidence to date to identify physiological changes in the early bereaved period, and evaluate the impact of bereavement interventions on such physiological responses, where they exist. Research to date suggests that bereavement is associated with neuroendocrine activation (cortisol response), altered sleep (electroencephalography changes), immune imbalance (reduced T-lymphocyte proliferation), inflammatory cell mobilization (neutrophils), and prothrombotic response (platelet activation and increased vWF-ag) as well as hemodynamic changes (heart rate and blood pressure), especially in the early months following loss. Additional evidence suggests that bereavement interventions have the potential to be of value in instances where sleep disturbance becomes a prolonged feature of complicated grief, but have limited efficacy in maintaining immune function in the normal course of bereavement.

General Practitioners’ experiences of bereavement care and their educational support needs: a qualitative study

“…It is quite applicable to most of the patients you see in general practice you know they go through the denial stage and then they go through anger and then they go through acceptance. And that’s a good framework for me to sometimes think about [ 4 ].…”

“…I think having the person first tap in with a health professional they maybe a GP or the psychologist even it’s important rather than trying to deal with it on their own [ 4 ].…”

“…Most GPs view the provision of bereavement care as an important aspect of their role [ 2 ] and the GP is the health professional that many people turn to when they need support [ 3 ]. Further, patients may visit their GP more frequently following bereavement due to increased morbidity during this time [ 4 , 5 ]. In this context, the role of the GP is twofold; supporting bereaved patients generally, and referring for extra support from a mental health professional when necessary [ 1 , 6 , 7 ].…”

The Psychobiology of Bereavement and Health: A Conceptual Review From the Perspective of Social Signal Transduction Theory of Depression

“…As alluded to previously, the death of spouse is one of the most stressful life events a person can experience ( 59 ). Spousal bereavement due to cancer, for example, is usually preceded by a long illness trajectory, which is associated with high distress due to the spouse's progressive health deterioration, anticipatory grief about the spouse's inevitable death, adoption of supportive responsibilities, financial stressors, and disruption of the caregiver's social and personal life ( 60 ).…”

“…In the context of bereavement, studies have begun to explore bereavement-related alterations in biomarkers of neuroendocrine and immune function. Results from these studies show that within the first 6 months following spousal loss, bereaved individuals exhibit evidence of reduced antibody response to vaccination ( 128 ), HPA-axis dysregulation [e.g., as indexed by higher cortisol levels and flatter diurnal cortisol slopes ( 9 , 59 , 129 – 132 )], heightened systemic inflammation ( 6 , 10 , 49 , 99 , 133 ), and impaired immune responses, as indexed by reduced functional activity of natural killer cells ( 9 , 130 ).…”