Depression and other complications of grief and bereavement

Depression, anxiety, and disorders of alcohol (or other substance) use can occur in conjunction with grief or bereavement. Loss may trigger the first occurrence of such a condition, or a recurrence.

For management of emotional, psychological and behavioural symptoms in patients with palliative care needs, see Overview of emotional, psychological and behavioural symptoms in palliative care.

Be alert to bereavement-related anxiety, depressive disorders or disorders of substance use in family members and carers. Assess for a disorder if symptoms have a significant effect on functioning and continue beyond a few months after the death. Common features of a depressive disorder in bereaved adults lists common features indicative of a depressive disorder in bereaved adults and Features requiring intervention in bereaved children lists features requiring intervention in bereaved children. The Psychotropic guidelines provide advice on assessing a person with depressive symptoms or anxiety.The Addiction guidelines provide advice on assessing substance use and addictive behaviours.

A desire to be reunited with the deceased, and a belief that, by dying, one will be reunited, should raise concerns of suicidal ideation. For information about assessing suicide risk, see the Psychotropic guidelines.

Figure 1. Common features of a depressive disorder in bereaved adults

persistent marked loss of interest

marked withdrawal from others

a protracted mood of depression with difficulty experiencing pleasure or temporary relief from the mood (anhedonia)

predominantly sad, distressing recollections of the deceased that may be coloured by a sense of personal failure or worthlessness and loss of hope for the future

excessive guilt and self-remorse, often focusing on perceived failings in the relationship with the deceased or the care provided

poor self-care

limited range of emotional expression or profound sadness, agitation, anxiety or irritability

persistent unexplained physical symptoms (eg unexplained or vague pains, weight loss, appetite disturbance)

suicidal thoughts

Figure 2. Features requiring intervention in bereaved children

Consider obtaining advice about further intervention for bereaved children who display the following features:

  • persistent aggression, oppositional behaviour or conduct disorder
  • persistent failure to acknowledge the death
  • obvious and persistent deterioration in school performance
  • feelings of worthlessness
  • anhedonia (withdrawal from and lack of interest in friends and activities previously enjoyed)
  • disturbed sleep or frequent nightmares
  • persistent unexplained physical symptoms (eg abdominal pain, headache, limb weakness)
  • anorexia and weight loss (often this improves with time but requires close follow-up)
  • prolonged negative thinking about the future
  • suicidal or self-harming ideation or behaviour (requires immediate attention).