Abstract
Bereavement, one of life’s most difficult experiences, usually triggers acute grief with yearning and longing for the deceased person that is often intense and preoccupying, along with frequent thoughts and memories of the person who died and relatively little interest in anything unrelated to the deceased loved one. Anxiety is a very common feature of grief that is often neglected. Anxiety is a natural response of the attachment system to separation from a loved one, seen in adults as well as children. Confrontation with one’s own death is also a natural trigger of anxiety, though we usually protect ourselves from mortality salience using terror management strategies related to cultural values and self-esteem. In addition, loss of a loved one can trigger the onset of a DSM-IV anxiety disorder that, when present, can derail the mourning process and prolong acute grief. Bereavement-related anxiety disorders need to be recognized and treated.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance
National Institute of Mental Health: Research Domain Criteria (RDoC). Available at http://www.nimh.nih.gov/research-funding/rdoc/index.shtml. Accessed February 2012.
Bonanno G. Grief and emotion: a social-functional perspective. In: Stroebe MS, Hanssen RO, Stroebe W, Schut H, editors. Handbook of bereavement research: consequences, coping, and care.Washington, DC: American Psychological Association; 2001. p. 493–515.
Vezina J, Bourque P, Belanger Y. Spousal loss: depression, anxiety and well-being after grief periods of varying lengths. Can J on Aging. 1988;7:391–6.
Lindstrom TC. Anxiety and adaptation in bereavement. Anxiety Stress Coping. 1995;8:251–61.
Thuen F, Reime MH, Skrautvoll K. The effect of widowhood on psychological wellbeing and social support in the oldest groups of the elderly. J Ment Heal. 1997;6:265–74.
Carr D, House JS, Kessler RC, et al. Marital quality and psychological adjustment to widowhood among older adults: a longitudinal analysis. J Gerontol B Psychol Sci Soc Sci. 2000;55:S197–207.
Carr D, House JS, Wortman C, et al. Psychological adjustment to sudden and anticipated spousal loss among older widowed persons. J Gerontol B Psychol Sci Soc Sci. 2001;56:S237–48.
Carr D. A “Good Death” for whom? Quality of spouse’s death and psychological distress among older widowed persons. J Health Soc Behav. 2003;44:215–32.
Carr D. Black/White differences in psychological adjustment to spousal loss among older adults. Res Aging. 2004;26:591–622.
Kreicbergs U, Valdimarsdottir U, Onelov E, et al. Anxiety and depression in parents 4–9 years after the loss of a child owing to a malignancy: a population-based follow-up. Psychol Med. 2004;34:1431–41.
Ong AD, Bergman CS, Bisconti TL. Unique effects of daily perceived control on anxiety symptomatology during conjugal bereavement. Personal Individ Differ. 2005;38:1057–67.
Wolchik SA, Ma Y, Tein JY, et al. Parentally bereaved children’s grief: self-system beliefs as mediators of the relations between grief and stressors and caregiver-child relationship quality. Death Stud. 2008;32:597–620.
• Mitchell AM, Sakraida TJ, Kim Y, et al. Depression, anxiety and quality of life in suicide survivors: a comparison of close and distant relationships. Arch Psychiatr Nurs. 2009;23:2–10. This paper reports on anxiety experienced by suicide-bereaved individuals. This is an important subgroup of bereaved people whose suffering is often somewhat different from individuals bereaved in other ways.
Rosenberg AR, Baker KS, Syrjala K, Wolfe J. Systematic review of psychosocial morbidities among bereaved parents of children with cancer. Pediatr Blood Canc. 2012;58:503–12.
Kersting A, Brahler E, Glaesmer H, Wagner B. Prevalence of complicated grief in a representative population-based sample. J Affect Disord. 2011;131:339–43.
Gerra G, Monti D, Panerai AE, et al. Long-term immune-endocrine effects of bereavement: relationships with anxiety levels and mood. Psychiatr Res. 2003;121:145–58.
Rosenblatt A, Greenberg J, Solomon S, et al. Evidence for terror management theory: I. The effects of mortality salience on reactions to those who violate or uphold cultural values. J Personal Soc Psychol. 1989;57:681–90.
Pyszczynski T, Greenberg J, Solomon S. A dual-process model of defense against conscious and unconscious death-related thoughts: an extension of terror management theory. Psychol Rev. 1999;106:835–45.
Cox CR, Arndt J, Pyszczynski T. Terror management and adults’ attachment to their parents: the safe haven remains. J Pers Soc Psychol. 2008;94:696–717.
Rutjens BT, Van Der Pligt J, Van Harreveld F. Things will get better: the anxiety-buffering qualities of progressive hope. Pers Soc Psychol Bull. 2009;35:535–43.
• Han S, Qin J, Ma Y. Neurocognitive processes of linguistic cues related to death. Neuropsychologia. 2010;48:3436–3442. This interesting paper supports the idea that thoughts of death are linked to the self concept and also that such thoughts are specifically recognized by the brain as different from other kinds of stressful thoughts.
• Hayes J, Schimel J, Arndt J, Faucher EH. A theoretical and empirical review of the death-thought accessibility concept in terror management research. Psychol Bull. 2010;136:699–739. This paper introduces the reader to the concept of death thought accessibility and to the theory and research related to terror management. These ideas have not reached clinical mental health professionals and are of potential clinical significance.
Maxfield M, Pyszczynski T, Greenberg J, et al. The moderating role of executive functioning in older adults’ responses to a reminder of mortality. Psychol Aging. 2012;27:256–63.
Willis GB, Tapia A-V, Martinez R. I control therefore i am: effects of mortality salience on control attributions. Span J Psychol. 2011;14:765–72.
Cox CR, Arndt J. How sweet it is to be loved by you: the role of perceived regard in the terror management of close relationships. J Pers Soc Psychol. 2012;102:616–32.
Florian V, Mikulincer M. Fear of personal death in adulthood: the impact of early and recent losses. Death Stud. 1997;21:1–24.
End CE, Bond JB. Death anxiety in adolescents: the contributions of bereavement and religiosity. Omega. 2007;55:169–84.
Ghufran MA, Ansari S. Impact of widowhood on religiosity and death anxiety among senior citizens. J Indian Acad Appl Psychol. 2008;34:175–80.
• Azaiza F, Ron P, Shoham M, Tinsky-Roimi T. Death and dying anxiety among bereaved and nonbereaved elderly parents. Death Stud. 2011;35:610–624. This paper introduces the reader to the ideas of death anxiety and dying anxiety, including similarities and differences. The paper helps the reader understand how anxiety about death can contribute to grief after losing a loved one.
Tolskikova K, Fleming F, Chartier B. Grief, complicated grief, and trauma: the role of the search for meaning, impaired self-reference, and death anxiety. Illness Crisis Loss. 2005;13:293–313.
Bowlby J. Some pathological processes set in train by early mother-child separation. J Ment Sci. 1953;99:265–72.
Bowlby J. Separation anxiety. Int J Psychoanal. 1960;41:89–113.
Antonucci TC, Akiyama H, Takahashi K. Attachment and close relationships across the life span. Attach Hum Dev. 2004;6:353–70.
Zisook S, Schneider D, Shuchter SR. Anxiety and bereavement. Psychiatr Med. 1990;8:83–96.
Prigerson HG, Shear MK, Newsom JT, et al. Anxiety among widowed elders: is it distinct from depression and grief? Anxiety. 1996;2:1–12.
Boelen PA, Prigerson HG. The influence of symptoms of prolonged grief disorder, depression, and anxiety on quality of life among bereaved adults: a prospective study. Eur Arch Psychiatry Clin Neurosci. 2007;257:444–52.
Hendrickson KC. Morbidity, mortality, and parental grief: a review of the literature of the relationship between the death of a child and the subsequent health of parents. Palliat Support Care. 2009;7:109–19.
Valdimarsdottir U, Helgason AR, Furst CJ, et al. Awareness of husband’s impending death from cancer and long-term anxiety in widowhood: a nationwide follow-up. Palliat Med. 2004;18:434–43.
Chiu YW, Yin SH, Hsieh HY, et al. Bereaved females are more likely to suffer from mood problems even if they do not meet the criteria for prolonged grief. Psycho-Oncology. 2011;20:1061–8.
Onrust SA, Cuijpers P. Mood and anxiety disorders in widowhood: a systematic review. Aging Ment Health. 2006;10:327–34.
Jacobs S, Hansen F, Kasl S, et al. Anxiety disorders during acute bereavement: risk and risk factors. J Clin Psychiatr. 1990;51:269–74.
Zisook S, Chentsova-Dutton Y, Shuchter SR. PTSD following bereavement. Ann Clin Psychiatr. 1998;10:157–63.
Hagengimana A, Hinton D, Bird B, et al. Somatic panic-attack equivalents in a community sample of Rwandan widows who survived the 1994 genocide. Psychiatr Res. 2003;117:1–9.
Zhang Z, Shi Z, Wang L, Liu M. One year later: mental health problems among survivors in hard-hit areas of the Wenchuan earthquake. Publ Health. 2011;125:293–300.
• Shear MK, Simon N, Wall M, et al. Complicated grief and related bereavement issues for DSM-5. Depress Anxiety. 2011;28:103–117. This paper provides a review of bereavement-related diagnostic issues and helps the reader distinguish between anxiety disorders and bereavement-related anxiety.
Simon NM, Shear KM, Thompson EH, et al. The prevalence and correlates of psychiatric comorbidity in individuals with complicated grief. Compr Psychiatr. 2007;48:395–9.
Acknowledgment
This work was supported by research grants from the National Institute of Mental Health: R01MH060783 and R01MH070741.
Disclosure
No potential conflicts of interest relevant to this article were reported.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Shear, M.K., Skritskaya, N.A. Bereavement and Anxiety. Curr Psychiatry Rep 14, 169–175 (2012). https://doi.org/10.1007/s11920-012-0270-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11920-012-0270-2