Grief

For information about grief in the palliative care setting, see Loss, grief and bereavement.

Grief is a normal response after a significant loss (eg death of a spouse, loss of employment, loss of independence), severe illness or personal injury. It presents with thoughts and feelings of emptiness and loss, and may be accompanied by a wide variety of symptoms, including insomnia and sadness. Acute grief can be debilitating in the short term but is usually integrated over time, and the person is able to resume their day-to-day functioning. However, the loss of a spouse or loved one can be a trigger for a depressive episode; some of the symptoms may mimic major depression or another psychiatric disorder. Uncomplicated acute grief is not accompanied by feelings of worthlessness or strong suicidal thoughts, and improves with time. If the person has feelings of worthlessness or strong suicidal thoughts, assess for major depression or another depressive disorder (see Assessing a person with depressive symptoms and Assessing suicide risk).

Conventional supports (eg family, social, religious) are usually sufficient to help someone who is acutely grieving. Support from a clinician can also be helpful. There is a limited role for pharmacotherapy in acute grief. Anxiolytics or hypnotics may be trialled to alleviate excessive anxiety or insomnia for a brief period (fewer than 7 days).