Recognizing and Reducing Prolonged Grief

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We need to recognize prolonged grief disorder.

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

If I understood it correctly, a rather concerning public mental health study came out recently,1 and was then highlighted in the July 21, 2023, American Psychiatric Association Psychiatric News Alert.2 It had to do with grief and prolonged grief.

In a survey of mainly bereaved white females, a seemingly unexpected finding was that about a third of them met the DSM criteria for prolonged grief disorder, yet most all felt that their grieving was normal. Apparently, it was not. Moreover, less than 12% reportedly felt that having and knowing a diagnosis of that disorder would be helpful to them, despite impaired functioning up to a decade after a major loss.

Not without controversy, prolonged grief disorder was formally added to DSM-5 TR in March of 2022. There had been years considering whether it should be included or not.

Coincidentally or serendipitously, its approval occurred during the COVID pandemic, a time of increasing significant losses of all types. These losses would not yet have shown up in the study.

In general, following a year after a significant loss, prolonged grief disorder is highlighted by continuous and yearning preoccupation with the loss, accompanied by decreased social functioning over at least another 6 to 12 months. Normal grief can continue indefinitely to some extent, but prolonged grief adds on the continuous disruption of the survivor’s life. The losses most correlated with the prolonged grief were loss of a child and partner.

If the results of this study can be replicated and generalized, it seems that we are left with a major public mental health educational challenge. Whether by lack of knowledge or psychological denial, a large swath of the public may be suffering and not resolving grief normally.

The years of the recent pandemic may even be worsening this problem. Perhaps that is also contributing to the epidemic of loneliness in the United States.

Various resources can help the recognition. One is the surgeon general. Clergy who work with families after loved ones die would be another. Annual health check-ups with physicians, schools, and even workplaces could screen for it. Our own ethical priorities include trying to better the mental health of our communities, and we have developed psychotherapy specifically geared to this disorder.

On the other hand, as discussed in yesterday’s column about for-profit managed care limiting mental health care, will our resources increase to accommodate the need? Our current presidential administration seems to recognize this problem and on Tuesday announced new rules to push insurance coverage to increase coverage of mental health treatments. Since these regulations still need to now include a public comment period and self-study of insurers, it is a conducive time for psychiatry to not only comment, but educate the public on prolonged grief disorders.

Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times.

References

1. Thieleman K, Cacciatore J, Frances A. Rates of prolonged grief disorder: considering relationship to the person who died and cause of death. J Affect Disord. 2023;S0165-0327(23)00945-X.

2. American Psychiatric Association. More than one-third of bereaved may have prolonged grief disorder. Psychiatric News. July 21, 2023. https://alert.psychnews.org/2023/07/more-than-one-third-of-bereaved-may.html

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