Although grief is a normal response to loss, it is a complex and multidimensional process that can involve a wide range of distressing symptoms and significantly affect an individual’s functioning. People respond to death in diverse ways, both adaptively and maladaptively, and these reactions are highly personalized.
During this time, bereaved individuals engage in tasks such as accepting the reality of the loss, managing emotional distress, adjusting to life without the deceased, and eventually letting go of the emotional attachment to the person who has died.
sad unhappy woman standing crying pushing face to wall feeling depressed
Key Points
Rationale
Grief is a profound life experience that can lead to complications like depression for bereaved individuals. Depressive symptoms place a heavy burden on societal resources (Moreira et al., 2023).
Previous research has shown significant overlap between grief and depression in terms of symptoms, characteristics, family history, and response to medication (Kendler et al., 2008; Lamb et al., 2010; Zisook & Kendler, 2007; Zisook et al., 2001, 2007).
Increasing evidence indicates losing a loved one can lead to prolonged grief disorder and depressive symptoms/syndromes (Bonanno et al., 2007; Prigerson et al., 2009; Shear et al., 2011).
This systematic review aimed to synthesize findings on depression and grief to identify specificities of depression in grief and factors influencing grief outcomes.
Understanding the distinctions between grief and depression has important implications for the mental and physical health of bereaved individuals.
Method
Thissystematic reviewfollowed PRISMA guidelines. Studies were identified through searching EBSCO, PubMed, and Web of Science databases.
41 studies published between 1939-2021 were included. Two independent reviewers selected studies with almost perfect agreement (Cohen’s κ = .86). Study quality was assessed with the Quantitative Research Assessment Tool.
The search equation used variations of the key terms in the databases:
Results
Studies can be grouped into two categories based on time of loss, namely grief during pregnancy or grief of a close relative
Prenatal
Early Childhood
Childhood/Adolescence
Adults/Elderly
Insight
This review provides insights into the complex relationship between grief and depression after different types of losses.
While there is overlap, they emerge as distinct responses – certain factors uniquely predict grief (e.g., relationship depth, couple-level factors), while others uniquely predict depression (e.g., personal vulnerabilities, less time since loss).
Gender, education level, socioeconomic status, age of the deceased, cause of death, and time since loss are significant factors that influence grief outcomes and the development of depression following bereavement.
Research has shown that women often experience more intense grief and depressive symptoms compared to men, particularly in cases of miscarriage or child loss. Lower levels of education and socioeconomic status have been associated with a higher risk of complicated grief and difficulty coping with loss.
The age of the deceased also plays a role, with the loss of a child or younger individual often leading to more severe grief reactions compared to the loss of an older person.
Sudden, traumatic, or violent causes of death, such as accidents, homicide, or suicide, can result in more complicated grief and depression compared to losses due to natural causes or prolonged illness.
Finally, the time elapsed since the loss is a significant factor, as grief and depressive symptoms tend to decrease over time as individuals adjust to their new reality.
However, for some, grief may remain intense and prolonged, leading to complicated grief or persistent depression. Understanding these factors can help identify individuals at higher risk for adverse grief outcomes and inform targeted interventions.
Future research could further examine how the predictors of grief and depression vary depending on kinship to the deceased and expand to include more diverse causes of death.
Strengths
Limitations
Clinical Implications
The results have significant real-world implications, especially for clinical practice.
Understanding risk factors for intense, prolonged grief and depression can help practitioners identify bereaved clients who may need more support.
For example, those with prior depression/mental health issues, traumatic losses, or fewer coping resources may be more vulnerable.
Distinguishing between grief and depression is important for intervention and treatment, as grief is a normal response while depression may be more likely in individuals with certain vulnerabilities. However, some individuals with vulnerabilities may have a decreased ability to grieve.
The findings also suggest value in dyadic and family interventions since couple/family dynamics can influence grief. Gender differences imply the potential benefits of tailoring treatments.
Broadly, the review underscores the need to recognize the long-term impacts of bereavement, as grief and depressive symptoms can persist for years. Societal resources should be allocated to make bereavement support accessible.
More public education on the range of normal grief responses may help destigmatize the grief experience.
References
Primary reference
Moreira, D., Azeredo, A., Moreira, D. S., Fávero, M., & Sousa-Gomes, V. (2022). Why Does Grief Hurt?.European Psychologist, 28(1), 35–52.https://doi.org/10.1027/1016-9040/a000490
Other references
Bonanno, G. A., Neria, Y., Mancini, A., Coifman, K. G., Litz, B., & Insel, B. (2007). Is there more to complicated grief than depression and posttraumatic stress disorder? A test of incremental validity.Journal of Abnormal Psychology, 116(2), 342–351.https://doi.org/10.1037/0021-843x.116.2.342
Kendler, K. S., Myers, J., & Zisook, S. (2008). Does bereavement-related major depression differ from major depression associated with other stressful life events?American Journal of Psychiatry, 165(11), 1449-1455.https://doi.org/10.1176/appi.ajp.2008.07111757
Lamb, K., Pies, R., & Zisook, S. (2010). The bereavement exclusion for the diagnosis of major depression: To be or not to be.Psychiatry, 7(7), 19-25.
Moreira, D., Azeredo, A., Moreira, D.S., Fávero, M., & Sousa-Gomes, V. (2023). Why does grief hurt? A systematic review of grief and depression in adults.European Psychologist, 28(1), 35-52.https://doi.org/10.1027/1016-9040/a000490
Prigerson, H. G., Horowitz, M. J., Jacobs, S. C., Parkes, C. M., Aslan, M., Goodkin, K., Raphael, B., Marwit, S. J., Wortman, C., Neimeyer, R. A., Bonanno, G. A., Block, S. D., Kissane, D., Boelen, P., Maercker, A., Litz, B. T., Johnson, J. G., First, M. B., & Maciejewski, P. K. (2009). Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11.PLoS Medicine, 6(8), Article e1000121.https://doi.org/10.1371/journal.pmed.1000121
Shear, M. K., Simon, N., Wall, M., Zisook, S., Neimeyer, R., Duan, N., Reynolds, C., Lebowitz, B., Sung, S., Ghesquiere, A., Gorscak, B., Clayton, P., Ito, M., Nakajima, S., Konishi, T., Melhem, N., Meert, K., Schiff, M., O’Connor, M., … Keshaviah, A. (2011). Complicated grief and related bereavement issues for DSM-5.Depression and Anxiety, 28(2), 103–117.https://doi.org/10.1002/da.20780
Zisook, S., & Kendler, K. S. (2007). Is bereavement-related depression different than non-bereavement-related depression?.Psychological Medicine, 37(6), 779-794.https://doi.org/10.1017/S0033291707009865
Zisook, S., Shuchter, S. R., Pedrelli, P., Sable, J., & Deaciuc, S. C. (2001). Bupropion sustained release for bereavement: Results of an open trial.Journal of Clinical Psychiatry, 62(4), 227-230. https://doi.org/10.4088/jcp.v62n0403
Zisook, S., Shear, K., & Kendler, K. S. (2007). Validity of the bereavement exclusion criterion for the diagnosis of major depressive episode.World Psychiatry, 6(2), 102-107.
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Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
