Grief After Losing a Parent, Spouse, Child, or Sibling

Grief after a cancer death is not one experience. The National Cancer Institute separates three words that often get mixed together. Grief is "the emotional response to the loss of a loved one." Mourning is how that grief is shown in public, shaped by culture and religion. Bereavement is the period of sadness after the death, when grief and mourning both happen.

NCI lists reactions that are ordinary, not signs that something has gone wrong:

• Feeling numb, or not believing the death happened
• Anxiety about being separated from the person
• Crying, and dreams about the person who died
• Anger
• Sadness and lost sleep
• Changes in appetite, and deep fatigue
• Guilt
• Losing interest in life

NCI also names something many people find frightening until they have a word for it. "Grief bursts or pangs are short periods (20-30 minutes) of very intense distress." A song, a smell, or an empty chair can set one off. They pass.

NCI reports that for most bereaved people, "symptoms lessen between 6 months and 2 years after the loss." The health-professional version adds numbers. Normal or common grief "appears to occur in 50% to 85% of persons after they have experienced a loss."

This distinction matters. Being told to get treated for ordinary grief helps nobody. NCI describes four differences between normal grief and major depression:

• In grief, painful feelings "come and go instead of being constant."
• Grief brings emptiness. Depression brings steady low mood.
• In grief, self-esteem usually stays intact. In depression, it often does not.
• Thoughts of death in grief tend to focus on joining the person who died, rather than on harming yourself.

Death rates among bereaved men and women are higher than among people who have not been bereaved, and "the relative increase in mortality is higher for men than for women."

NCI also reports that men have "greater degrees of depression" after a spouse dies than women do. NCI gives one reason: bereaved men get less social support.

Practical losses stack on top of the emotional one: income, health insurance, the driver, the cook, the person who knew where everything was kept.

NCI reports: "Parents who felt prepared for their child's end of life had improved social functioning in the first 2 years of their bereavement."

NCI also reports that how a family engages at the end of the patient's life appears to matter for later grief. NCI reports that meaningful communication before death, not being present at the moment of death, is linked to better outcomes.

NCI lists these as risk factors for a harder bereavement:

• Being younger than 60
• Feeling that no social support is available
• A history of depression, or depression now
• Lower income
• Pessimistic thinking
• Severe stressful life events

A parent's cancer death often comes after a long stretch of caregiving. When it ends, that can be a loss too.

A sibling has lost a relationship that may have lasted their whole life. If you feel overlooked, it is fine to say so.

Most grief needs time and people, not a diagnosis. A minority needs more. NCI defines complicated grief as grief "when symptoms don't improve and last for a long period of time, cause extreme distress, affect multiple areas of their lives, and decrease the ability to take part in daily activities." NCI estimates that chronic or complicated grief occurs in "about 15% to 30% of bereaved persons."

There are also formal criteria. NCI says prolonged grief disorder is diagnosed when grief lasts at least 12 months after the loss for adults and 6 months for children. The symptoms NCI lists include intense sorrow, yearning for the person who died, disbelief, self-blame, avoiding reminders, feeling alone and feeling life is empty. A clinician makes the diagnosis.

• Call 911 or go to an emergency department if you are thinking about acting on thoughts of death, rather than simply wishing to be with the person who died.
• Call your doctor, or call or text 988, right away if you cannot keep yourself or the people who depend on you fed, medicated, and safe.
• Tell your doctor if alcohol or drugs have become how you get through the evening. The 988 Lifeline also helps with alcohol or drug use concerns.

In the United States, the 988 Suicide and Crisis Lifeline is available "24/7/365" by call, text or chat to 988. It is not only for suicidal crisis. The service says it is there for "mental health struggles, emotional distress, alcohol or drug use concerns."

When grief is severe, the evidence favors grief-specific therapy over general counseling. In trials NCI cites, complicated grief treatment beat interpersonal therapy. One study found response rates of "70.5%" versus "32.0%". Another found "51%" versus "27%". Internet-delivered cognitive behavioral therapy showed significant improvement at the end of treatment.

On medication, NCI is direct. "Antidepressants alone have a limited impact on grief intensity but are critical to reduce depressive symptomatology." Support groups and peer support offer a third thing. That thing is connection.

Ask the oncology team or hospice that cared for your relative whether they run a bereavement program, and how to join it.

• Grief, Bereavement, and Coping With Loss (PDQ), Patient Version — National Cancer Institute
• Grief, Bereavement, and Coping With Loss (PDQ), Health Professional Version — National Cancer Institute
• Bereavement — MedlinePlus
• 988 Suicide and Crisis Lifeline