Bereaved individuals, or relatives of terminally ill patients with persistent grief symptoms had more primary care visits, higher use of mental health services and psychotropic medications, and increased mortality over a 10-year period, according to a Danish population-based study of 1,735 participants.
Researchers followed relatives of terminally ill patients and assessed grief symptoms using the Prolonged Grief-13 scale before death, 6 months after, and 3 years post-bereavement. Participants were categorized into five grief trajectories. The “high grief trajectory” (HGT) group included 107 individuals (6%) with sustained, high symptom levels. The “low grief trajectory” (LGT) group, with 670 individuals (38%), served as the reference. The study population was primarily female (71%) with a mean age of 62 years. Most were partners (66%) or adult children (27%) of the deceased. Comorbidity and educational level were adjusted for in all analyses.
From years 3 to 7 post-bereavement, HGT participants had significantly more general practitioner contacts than those in the LGT group, including total daytime and face-to-face visits. The difference leveled out after year 7. Use of mental health services was also greater in the HGT group. Twenty of 107 HGT participants accessed talk therapy or saw a psychologist or psychiatrist, with an adjusted odds ratio (OR) of 2.86 (95% CI, 1.58–5.19) compared to the LGT group.
Psychotropic medication use was also elevated. Fifty-two individuals in the HGT group used antidepressants (OR, 5.63; 95% CI, 3.52–9.01), while 41 used anxiolytics or sedatives (OR, 2.60; 95% CI, 1.63–4.14). In comparison, 92 LGT participants used antidepressants and 123 used anxiolytics or sedatives during the follow-up.
Over the 10-year period, 23 HGT participants (21.5%) died, compared with 49 deaths (7.3%) in the LGT group. The adjusted hazard ratio (HR) for mortality in the HGT was 1.88 (95% CI, 1.11–3.21).
Other grief trajectories, such as high/decreasing (HDGT) and late-onset grief (LaGT), also showed increased medication use. For example, the HDGT group had higher use of antidepressants (OR, 1.87; 95% CI, 1.29–2.70) and sedatives (OR, 1.77; 95% CI, 1.26–2.48), and the LaGT group had increased antidepressant use (OR, 2.46; 95% CI, 1.53–3.97).
HGT participants had higher health care use even before the patient’s death, suggesting potential preexisting vulnerabilities. However, the findings indicate that grief symptom patterns may predict long-term health risks and identify individuals who could benefit from early intervention.
“Despite increased use of health care, including mental health services, those in the high grief trajectory (HGT) had a persistently high level of symptoms. Also, the higher use of medication in the group may indicate a need for further intervention,” said Mette Kjærgaard Nielsen of the Department of Mental Health, Research Unit for General Practice, Aarhus University, Denmark, and one of the authors.
The study authors emphasized the importance of systematic grief assessment and long-term support strategies in primary care to address the needs of this high-risk group.
The authors reported no conflicts of interest.
Source: frontiers
