Complicated Grief and Mental Health Outcomes

Complicated grief, also termed prolonged grief disorder, is a debilitating condition marked by intense yearning, pervasive preoccupation with the deceased and profound emotional distress that persists well beyond cultural or social norms. Distinguished from normal bereavement by its severity and duration, complicated grief often co-occurs with depression, anxiety and post-traumatic stress symptoms, leading to marked impairment in social, occupational and physical health. Neurobiological studies indicate dysregulation in reward and attachment circuits, while longitudinal surveys point to heightened risks of substance misuse, suicidal ideation and chronic medical conditions. The global burden has been accentuated by mass-casualty events and pandemics, with survivors in diverse settings demonstrating elevated rates of prolonged grief trajectories. Advances in diagnostic classification have led to the inclusion of prolonged grief disorder in the ICD-11 and the recognition of persistent complex bereavement disorder in DSM-5’s emerging measures, creating a framework for targeted assessment and intervention. Evidence supports tailored psychotherapeutic approaches—particularly cognitive–behavioural therapy models that integrate exposure, restoration-oriented tasks and meaning reconstruction—as well as the importance of culturally sensitive rituals and community support in mitigating long-term dysfunction.

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Complicated Grief and Mental Health Outcomes publication trend

The graph below shows the total number of articles in complicated grief and mental health outcomes across all publications each year (not limited to Nature Index journals).

Technical terms

Prolonged Grief Disorder (PGD): A formal diagnosis characterised by intense, persistent grief and functional impairment beyond six months post-loss, as defined in ICD-11.

Persistent Complex Bereavement Disorder (PCBD): A grief condition listed in DSM-5’s emerging measures, involving enduring separation distress, identity disruption and difficulty moving forward.

Acute grief: The early phase of bereavement marked by intense emotional responses, preoccupation with the deceased and initial adaptation challenges.

Cognitive–behavioural therapy (CBT): An evidence-based psychotherapeutic approach addressing maladaptive thoughts and behaviours, adapted for prolonged grief to include exposure to loss reminders and restoration-oriented activities.

References

1. A Web-Based Therapist Training Tutorial on Prolonged Grief Disorder Therapy: Pre-Post Assessment Study. JMIR Medical Education (2023).
2. Prolonged Grief Disorder: Psychometric Validation of Criteria Proposed for DSM-V and ICD-11. PLOS Medicine (2009).
3. The prevalence and correlates of psychiatric comorbidity in individuals with complicated grief. Comprehensive Psychiatry (2007).
4. How do Funeral Practices Impact Bereaved Relatives' Mental Health, Grief and Bereavement? A Mixed Methods Review with Implications for COVID-19. OMEGA - Journal of Death and Dying (2020).
5. Prolonged grief disorder for ICD-11: the primacy of clinical utility and international applicability. European Journal of Psychotraumatology (2017).
6. Grief Before and During the COVID-19 Pandemic: Multiple Group Comparisons. Journal of Pain and Symptom Management (2020).