Responding to grief

The support of family and extended community networks is usually sufficient for people experiencing grief. For information on supporting families and carers looking after patients with a life-limiting illness, see Family support in palliative care and Support for carers in palliative care. For bereavement support, see Prebereavement and bereavement support. Some individuals require structured support and counselling; consider referring individuals with risk factors for prolonged grief disorder (see Risk factors for prolonged grief disorder (complicated grief) in adults for adults and Risk factors for prolonged grief disorder (complicated grief) in children for children) to specialist bereavement services.
Table 1. Risk factors for prolonged grief disorder (complicated grief) in adults

[NB1]

Personal factors associated with an increased risk of prolonged grief disorder

past experiences (particularly insecure attachments, history of complex trauma or difficulties coping with loss, or past traumatic loss)

social isolation (including limited practical and emotional support for grief) or a family in conflict

multiple concurrent or successive losses

history of a psychiatric disorder (eg depression), disorder of substance use or significant physical illness [NB2]

significant social stressors (eg financial difficulties, insecure housing)

an ambivalent, conflicted or overly interdependent relationship with the deceased

Factors around the patient’s death or illness associated with an increased risk of prolonged grief disorder

traumatic death (eg severe uncontrolled symptoms, distress) or disfiguring disease or treatment

unexpected or sudden death (even in the context of advanced illness)

untimely death (eg death of a child)

violent death (eg suicide, homicide)

death following an extended illness, with associated adverse personal impacts (eg carer burden)

Note:

NB1: For management of prolonged grief disorder, see Prolonged grief disorder (complicated grief).

NB2: Optimal management of medical and psychiatric conditions may reduce the risk of prolonged grief disorder.

Figure 1. Risk factors for prolonged grief disorder (complicated grief) in children
Risk factors described for adults also apply for children, but additional risk factors for prolonged grief disorder in children are:
  • death of a parent or close relative
  • bereavement when younger than 5 years of age
  • bereavement in adolescence
  • exclusion from seeing the dying person or attending the funeral
  • lack of access to appropriate information
  • insecure home environment
  • psychiatric disorder in a surviving parent
  • belief that the deceased sibling was the parents’ favoured child.

Remain alert to signs of distress in patients, family members and carers and for new risk factors of prolonged grief disorder. If the severity or duration of grief symptoms are concerning, assess for depression, anxiety or other complications and, if severe symptoms continue for longer than 12 months, assess for prolonged grief disorder.