If grief is still stuck after six months and you can't get through your days, register at a psychiatry or clinical psychology department

If you are thinking about suicide right now, call or text 988. If you are in immediate danger, call 911.

Cost

Registration plus treatment fees. This kind of treatment is given in a course, in the trial an average of 16 sessions over 19 weeks. The hard part is taking the step to register yourself.

What you get

14 studies were pooled, of adults whose relative did not die a violent death and who were not being seen in psychiatry themselves. The prevalence of prolonged grief disorder was 9.8% (95% CI 6.8–14.0), about 10 of every 100 bereaved adults. The rate was higher with older age. Another study tested whether the diagnostic criteria are accurate, with 291 bereaved people interviewed three times, at 0–6, 6–12 and 12–24 months after the loss. The core of the diagnosis is an intense longing for the deceased. At least five of the following nine are also required. The first five are emotional numbness, shock, feeling that life is meaningless, difficulty trusting others, and bitterness over the loss. The last four are difficulty accepting the death, confusion about who you are, avoiding reality, and being unable to carry on with life. These must occur every day, or be so severe that you can't function. And they must still be present at least 6 months after the death and still be affecting daily life. There was also a trial of 95 people randomly assigned to two groups, with 16 sessions of treatment over an average of 19 weeks. Treatment targeted at complicated grief worked for 51%. Ordinary interpersonal psychotherapy worked for 28% (P=0.02, so the difference is unlikely to be chance). The former also worked faster. The number needed to treat was 4.3, meaning that on average, for every 4.3 people treated, one more improves.

Notes

Don't count months on your own. The real test is “it is affecting eating, sleeping, work and looking after children”; if that fits, go register. The department is called psychiatry, psychology or clinical psychology, and public psychiatric specialty hospitals all have one. This diagnosis is called complicated grief in some sources and prolonged grief disorder in others. Different standards also require different durations, some writing 6 months and some 12 months. The 9.8% figure comes from 14 studies whose methods differed considerably, and the authors also caution that it may not carry over to other populations.

Evidence grade

A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.

Sources

1. Lundorff M, et al. (2017). Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2017.01.030
2. Prigerson HG, et al. (2009). Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Medicine. https://doi.org/10.1371/journal.pmed.1000121
3. Shear MK, et al. (2005). Treatment of complicated grief: a randomized controlled trial. JAMA. https://doi.org/10.1001/jama.293.21.2601

Translated from the Chinese original. Original book, section 29, tip 8. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer