"The notion that a natural psychological response to loss involves an orderly progression through distinct stages of bereavement has been widely accepted by clinicians and the general public," the authors provide as background information in the article. The stage theory of grief (disbelief, yearning, anger, depression and acceptance) has become well-known and generalized to a wide variety of losses. "The identification of the patterns of typical grief symptom trajectories is of clinical interest because it enhances the understanding of how individuals cognitively and emotionally process the death of someone close. Such knowledge aids in the determination of whether a specific pattern of bereavement adjustment is normal or not."

Paul K. Maciejewski, Ph.D., from the Yale University School of Medicine, New Haven, Conn., and colleagues analyzed data collected between January 2000 and January 2003 from 233 individuals participating in the Yale Bereavement Study. The study participants had a family member or loved one who died from natural, not traumatic causes; and had at least one complete assessment of the five grief indicators included in the stage theory of grief within 24 months following the death. The vast majority (83.8 percent) of participants were spouses of the deceased. The remaining participants (16.2 percent) were adult children, parents, or siblings of the deceased.

"Counter to stage theory, disbelief was not the initial, dominant grief indicator," the researchers found. "Acceptance was the most frequently endorsed item and yearning was the dominant negative grief indicator from one to 24 months postloss. In models that take into account the rise and fall of psychological responses, once rescaled, disbelief decreased from an initial high at one month postloss, yearning peaked at four months postloss, anger peaked at five months postloss, and depression peaked at six months postloss." The authors add, "acceptance increased steadily through the study observation period ending at 24 months postloss."

"Identification of the normal stages of grief following a death from natural causes enhances understanding of how the average person cognitively and emotionally processes the loss of a family member," the authors write. "Regardless of how the data are analyzed, all of the negative grief indicators are in decline by approximately six months postloss. The persistence of these negative emotions beyond six months is therefore likely to reflect a more difficult than average adjustment and suggests the need for further evaluation of the bereaved survivor and potential referral for treatment," the authors conclude.

Source: JAMA and Archives Journals