The Health Effects of Loss and Grief

Background
Effects of grief on tumor biology
Effects of grief on cardiovascular disease
Prolonged grief disorder
References 
Further reading

Grief is the intense sadness and upset caused by the experience of loss. Most commonly, the loss will be in the form of the death of a loved one, although it can also occur after other losses, such as the end of a relationship. Traumatic grief occurs when the loss is unexpected or sudden; much of the literature focuses on the effects of traumatic grief.

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Background

The period immediately after loss is known as acute grief, which presents as low mood, a loss of pleasure or interest in previously enjoyed activities, and yearning. Through time and sometimes psychological interventions, people begin to experience integrated grief instead, which lessens the associated symptoms. However, in some cases, grief can leave prolonged health effects.

The study of the physical health effects of grief is a relatively emergent field, particularly when compared to the psychological impacts of loss. Despite this, grief's effects on physical health are seemingly heavily intertwined with how it affects psychological health, meaning that one field can inform the other.

Bereavement in itself is not an illness. However, it is positively associated with a heightened risk of mortality and illness presentation, particularly during the acute grief stage. Although this is the case, it is worth bearing in mind that much of the research into the health effects of loss and grief is correlational.

This means this research may not fully establish a causal relationship between grief or loss and health issues.

Effects of grief on tumor biology

Grief has been found to elevate the risk of immune response and inflammation-related illnesses, including a heightened risk of tumor development. Therefore, the literature suggests that some cases may have an elevated cancer risk associated with grief.

Heightened activity in the somatic nervous system can increase the production of hormones that impact oncological processes, such as tumor development. The activation of the bodily nervous system is caused by grief-related stress, which produces epinephrine, norepinephrine, and glucocorticoids.

The production of these hormones is triggered by mechanisms mediated by glucocorticoid and adrenergic pathways. These are activated by behavior in the somatic nervous system. In turn, this may mean that grief is associated with heightened cancer risk.

The psycho-oncological effects of grief are well-studied, but there is not yet a full understanding of the relationship between loss and cancer risks. The mechanisms are complex, so establishing a clear cause-and-effect relationship is difficult.

A range of other variables could also impact the development of tumors, such as genetic vulnerabilities or substance use. Additionally, tumors are not always malignant, as benign tumors can develop. This means that an increased risk of tumor development might not necessarily mean that there is also an increased cancer risk.

Effects of grief on cardiovascular disease

Those who have experienced a major loss may be at a higher risk of cardiovascular disease. This is also because of grief's impact on inflammation and immune responses. What is considered a major loss varies in the literature, but much research focuses on conjugal or child loss.

Chronic low-grade inflammation is also often present in those who have experienced loss. This inflammation also creates a further connection between grief and cardiovascular disease. The inflammation was tested for by measuring C-reactive protein (CRP) levels and circulating Interleukin 6 (IL-6), the former being a major predictor for cardiovascular events.

Increased levels of stress and depression in grieving individuals are thought to be contributing factors to the elevated risk of cardiovascular disease, making grief a psychosocial risk factor. This is because depression and stress are both also predictors of cardiovascular disease.

Prolonged grief disorder

Prolonged Grief Disorder, also known as complicated grief, affects around 7% of adults who have experienced acute distress. This is thought to happen when the recovery from acute grief is interrupted, prolonging the experience of symptoms. 

Prolonged or complicated grief can result in health-related comorbidities. In addition to the health effects that all grief can relate to, such as cardiovascular disease or increased cancer risks, complicated grief is also associated with long-term insomnia and an increased need for health services.

Grief can also be affected by the individual's health-related experiences and vice versa. Severe symptoms of Prolonged Grief Disorder are associated with particular assets of chronic illness.

Researchers at the University of Nevada found that such symptoms were associated with more overnight stays, total nights in the hospital, and emergency room visits.

References

• O'Connor, M. F. (2019). Grief: A brief history of research on how body, mind, and brain adapt. Psychosomatic medicine, 81(8), 731. doi: 10.1097/PSY.0000000000000717.
• Shear, M. K., Ghesquiere, A., & Glickman, K. (2013). Bereavement and complicated grief. Current psychiatry reports, 15, pp. 1-7.
• Prigerson, H. G., Bierhals, A. J., Kasl, S. V., Reynolds, C. F., Shear, M. K., Day, N., ... & Jacobs, S. (1997). Traumatic grief as a risk factor for mental and physical morbidity. American Journal of Psychiatry, 154, pp. 616-623.
• Stroebe, M., Schut, H., & Stroebe, W. (2007). Health outcomes of bereavement. The Lancet, 370(9603), pp. 1960-1973.
• Holland, J. M., Graves, S., Klingspon, K. L., & Rozalski, V. (2016). Prolonged grief symptoms related to loss of physical functioning: examining unique associations with medical service utilization. Disability and Rehabilitation, 38(3). doi: 10.3109/09638288.2015.1031830
• Glozier, N., et al. (2013). Psychosocial risk factors for coronary heart disease. Medical Journal of Australia, 199(3), pp. 179-180.
• Seiler, A., Von Känel, R., & Slavich, G. M. (2020). The psychobiology of bereavement and health: A conceptual review from the perspective of social signal transduction theory of depression. Frontiers in psychiatry, 11, 565239.
• Reali, E., Ferrando-Martinez, S., & Catalfamo, M. (2021). The Interplay Between Immune Activation and Cardiovascular Disease During Infection, Autoimmunity and Aging: The Role of T Cells. Frontiers in Immunology, 12, 719517.

Further reading 

• The health effects of lonliness
• The current challenges of mental health diagnosis
• What is depression?