The Costs of Unresolved Grief

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THE COSTS OF UNRESOLVED GRIEF

Prepared August 2015, ©WinterSpring

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Overview:  While death is a normal part of life, our society doesn’t do well with the complications of grief that follows the death of a close loved-one. People often feel alone and unable to move forward in their lives, depending on factors such as the closeness of the relationship, the type of death, their own personality, and the level of life changes required after a death (such as having to move). Children and teens are especially vulnerable, since a family is often in turmoil after a death.  Grief is not a billable diagnosis, yet unresolved grief is implicated as a factor in many behavioral and physical diagnoses, such as depression and recurring illness. Consistent with the ACES study on the impact of adverse childhood experiences, the trauma of loss carries long-range health implications.  When people get bereavement support, many of the socio-economic costs of unresolved grief can be avoided.

WinterSpring offers peer-to-peer group support with trained staff and volunteer facilitators using a companioning model.  We also provide compassionate phone support, individual peer support, education, resources and referrals. Our peer-to-peer groups support adults, children, teens, and parents/guardians. It’s through sharing of stories, connecting with others, and learning tools/techniques for healthy grieving that people are able to heal and embrace life again. Research[1] and our experience shows that group support intervention for both children and parents/guardians, as well as education to the parents and other adults in kids’ lives, can lead to healthy grieving and avoid the costs of unresolved grief as children grow to adulthood.  Adults find that they are better able to adjust to a new and different life after attending our groups.  Many form bonds with others in the groups that last well-beyond their time with WinterSpring, and those bonds become the source of support in their life after loss.

The Cost of Unresolved Grief:  The emotional burden of the loss of a loved one—sadness, anger, stress, guilt, regret, numbness, lack of control, sleep deprivation, fatigue, muddled thinking, memory difficulties, disconnection from others—take a toll on the griever. Time may not always heal deep grief; compassionate group support and tools for healthy grieving can help alleviate these burdens that may otherwise turn into costs to our healthcare system.  Specifically, unresolved grief can lead to:

  • Depression—Many studies document the link between bereavement and depression/anxiety in adults and the need for treatment, especially when PTSD is diagnosed. Links have also been made for bereaved teens and depression, as well as long-term mental health problems for children after the death of a parent.[2]
  • Cardiovascular risk–Heart break can quite literally lead to cardiovascular and immune systems weakness, as several studies show.[3]
  • Complicated grief—The Center for Complicated Grief (www.complicatedgrief.org) defines this as: “a form of grief that takes hold of a person’s mind and won’t let go. People with complicated grief often say that they feel ‘stuck.’”  Factors affecting grief that doesn’t subside include personal characteristics of the bereaved, the type of death, other challenging factors in that person’s life, and the relationship to the person who died.  Often these people need professional intervention.
  • Substance abuse treatment—Youth and adults may turn to alcohol and drugs to mask the pain.  Often these behaviors mask the underlying grief cause.[4]  Adults also turn to numbing substances when the pain is intense.  People call WinterSpring while in treatment because the emotions come back up once they are clean and sober.
  • Recurring illness and increased healthcare costs—Studies in the UK have shown a 30% increase in childhood visits to the doctor after a death, and also lament the lack of grief support services.[5]
  • Decreased workplace productivity—The Grief Recovery Institute estimated the annual cost of workplace grief at $75 billion.[6]  Included in this figure is death of a loved one ($37.5 billion) and pet loss ($2.4 billion).  The Compassionate Friends in Victoria Australia studied parents who had lost children, and found an average leave without pay of 15.5 weeks, as well as a significant impact of their work performance.[7]
  • Longer-term unemployment—Links have been made in the research between the death of a parent and long-term unemployment.[8]
  • Childhood bereavement challenges—One study showed that 1 in 7 children will lose a parent or sibling before the age of 20.[9]  Children are more likely to have behavioral problems, abuse alcohol and drugs, experience anxiety, act out, have social challenges, struggle in school, and/or experience recurring illness and behavioral health challenges.[10]
  • Teen pregnancy—Especially with sudden and traumatic death, bereaved teens are more likely to get pregnant.[11]
  • Developmental challenges in children and teens—Research has found that when a parent has died, especially from a sudden death, adolescents have lower competence in work, peer relations, career planning, and educational aspirations. So-called maladaptive grief in kids can impact social and academic development.[12]
  • Marital strife—Especially with the death of a child, married couples each grieve differently and this often causes challenges in their relationship which could lead to counseling costs and sometimes divorce.[13]
  • Financial decline—Several studies point to loss of financial stability after a death, especially from the loss of a spouse or child.[14]
  • The stigma of a suicide death—Grief is more likely to become complicated because of the guilt, stigma, shame, and feelings of rejection by those left behind.[15]
  • Mortality—Studies looking at early mortality, including from suicide, suggest a higher risk for the bereaved, especially for certain types of loss, such as the death of a child or spouse.[16]
  • Impact on caregivers—Studies have pointed to the impact on health care providers in a professional setting with both emotional and economic cost impacts.[17]

 End Notes:

[1] Morgan and Roberts, Helping Bereaved Children and Adolescents: Strategies and Implications for Counselors, Journal of Mental Health Counseling, 2010; Openshaw, Group interventions in rural schools to assist with a community trauma, Contemporary Rural Social Work, V. 5, 2013; Openshaw,  School-based support groups for traumatized students. School Psychology International, 32, 2011; Werner-Lin and Biank, Holding parents so they can hold their children: Grief work with surviving spouses to support parentally bereaved children, OMEGA 66(1), 2012-2013.

[2] Lannen, Wolfe, Prigerson, Onelov and Kreicbergs, Unresolved grief in a national sample of bereaved parents: impaired mental and physical health 4 to 9 years later, Journal of Clinical Oncology 26(36) 2008; Onrust and Cuijpers, Mood and anxiety disorders in widowhood: As systematic review, Aging and Mental Health 10(4), 2006; Li, Larusen, Precht, Alsen and Morensen, Hospitalization for mental illness among parents after the death of a child.  New England Journal of Medicine. 352(12), 2005; Ribbens-McCarthy and Jessop, Young people, bereavement and loss.  Disruptive transitions? National Children’s Bureau, Open University, 2005; Luecken, Long-term consequences of parental death in childhood: Physiological and psychological manifestations, in Stroebe, Hansson, Shut and Stroebe, Handbook for Bereavement Research and Practice; 21st Century Perspectives, Washington, DC: American Psychological Association Press, 2008.

[3] Gupta, Dr. Sanjay, How grief can make you sick, 3/10/2015, http://www.everydayhealth.com/news/how-grief-can-make-you-sick/, accessed 7/15/2015; Buckley, McKinley, Tofler and Bartrop, Cardiovascular risk in early bereavement: a literature review and proposed mechanisms, International Journal of Nursing Studies 47(2), 2010.

[5] For a summary of the literature, see Birrell, et al., Socio-Economic Costs of Bereavement in Scotland, March 2013.

[6] Grief Recovery Institute and Educational Foundation. The grief index: the “hidden” annual costs of grief in America’s workplace. Sherman Oaks (CA):GRIEF; 2003.

[7] The Compassionate Friends Victoria Inc., Beyond the Death of a Child: Social impact and economic costs following the death of a child, August 2007.

[8] Ribbens-McCarthy and Jessop, Young people, bereavement and loss.  Disruptive transitions? National Children’s Bureau, Open University, 2005.

[10] Fauth, Thompson, and Penny, Associations between childhood bereavement and children’s background, experiences and outcomes.   London:  National Children’s Bureau, 2009;

[11] Barnard, Moreland, and Nagy, Children bereavement and trauma:  Nurturing resilience.  Philadelphia:  Jessica Kingsley Publishers, 1999.

[12] Brent, Melhem, Masten, Porta and Payne, Longitudinal effects of parental bereavement on adolescent developmental competence, Journal of Clinical Child & Adolescent Psychology 41(6), 2012; UCLA Newsroom.

[13] Barrera. O’Connor, D’Agostino, Spencer, Micholas, Jobcecska, Tallet, and Schneiderma, Early parental adjustment and bereavement after childhood cancer death, Death Studies 33, 2009.

[14] Corden and Hirst, Economic Components of Grief, Death Studies (37), 2013; Corden, Sloper, Sainsbury, Financial effects for families after the death of a disabled or shronically ill child: a neglected dimension of bereavement, Child: Care, Health & Development 28(3), 2002; Fox, Cacciatore, Lacasse, Child death in the United States: Productivity and the economic burden of parental grief, Death Studies 0, 2014.

[15] Mitchell, Kim, Prigerson, and Mortimer-Stephens, Complicated grief in survivors of suicide, Crisis: Journal of Crisis Intervention & Suicide 25(1), 2004.

[16] Boyle, Feng, and Raab, Does widowhood increase morality risk?: Testing for selection effects by comparing causes of spousal death, Epidemiology 22(1), 2011; Stroebe, Schut and Stroebe, Health outcomes of bereavement, Lancet 370, 2007.

[17] Genevro and Miller, The emotional and economic costs of bereavement in health care settings, Psychologica Belgica 50, 2010.