CrimePsych

Grief is a complex emotion felt by most of us at sometime during our lives, yet there are major individual differences, some appear to be untouched by the loss of a loved one while others become chronically affected to the point where normal day-to-day functioning becomes impossible, while others still experience a delayed onset. Still the question remains; what factors determine the level of grief experienced by a person? The past decades have spawned an immense amount of empirical research and as one would expect with a complicated feeling such as grief, a large number of factors have been proposed in the literature. From the multiple papers examined, all appear to conform to those put forward by James W. Worden.

Firstly, the relationship to the deceased i.e. brother, mother, friend is likely to affect the level of grief experienced. Secondly, the nature of the attachment; this includes attachment strength and security, ambivalence in the relationship, past conflicts with the deceased and the level of dependency the bereaved had on the deceased.

Thirdly, the mode of death is proposed to affect grief level. This factor includes items such as sudden or unexpected death, violent or traumatic death, the proximity to the deceased, multiple deaths at one time or whether the death is perceived as preventable. It also includes stigmatised death in that deaths from things such as AIDS or suicide usually have a certain social stigma attached to them and ambivalent death i.e. a soldier missing in action.

The fourth mediator is that of historical antecedents where a person’s mental health background and previous losses they have experienced could influence how the current death is handled. Unresolved issues from previous losses are likely to compound and exacerbate the current one.

Personality differences are yet another mediator, age and gender, as well as coping and cognitive style (how well a person handles stress and whether they are an optimistic or pessimistic person) are hypothesised to affect a person’s grief response. Other sub-items include the mourners’ attachment style, their ego strength and assumptive world beliefs and values.

The sixth mediator suggested is that of social variables; perceived social and emotional supports as well as satisfaction with the calibre and level of this support are but two sub-items within this group. On a slightly different tangent but still within this mediator a bereaved person’s social role and whether they have another one to fulfil as well as religious beliefs and any ethnic group expectations can also influence how a person grieves.

Lastly concurrent life stressors need to be considered when trying to evaluate the reasons behind a mourner’s level of grief. For example, the death might bring about other financial hardships within a family due to the loss of the primary salary earner and in turn could complicate and influence a person’s ability to deal with their grief in an auspicious manner.

Within such a vast field of study as that of grief, one finds literally hundreds of empirical research studies all with their own results, some of which support the aforementioned factors and others that minimise their impact or deny their affect completely. For example Bonanno et. al. found empirical support for a number of the factors thought to influence a person’s grief reaction. They found that chronic grievers were more likely to have been overly dependent on the deceased, evidence that has been replicated elsewhere (Opperman & Novello) and to have less emotional and social support.

However the idea that people with complicated grief reactions have less emotional and social support is contradicted by other evidence. This same Opperman and Novello paper suggesting there is no significant evidence to suggest that social or emotional support can influence a person’s grief level. Although the sample size in this study was extremely small the participants were all chronic grievers, of whom 77% claimed that the emotional and social support they received from family leading up to and after the burial was ample. Similarly, The Scott and White Grief Study found that the level of social support available had no significant correlation with grief level.

All this taken into consideration, it is likely that these social variables are still valid as there is plenty of other research to suggest that this mediator does make a difference. Curtis and Newman examined nine studies of childhood bereavement, and although the support was only moderate in nature, it was still positive. But as with Opperman and Novello’s study there are a number of contributing factors that bring the results integrity into question including extremely small sample sizes, no control group, high levels of attrition and the short time scales between pre and post-intervention tests.

Probably the largest and most prevalent factor observed in all the papers examined is the age of the decedent, with the onus that the younger a person is when they die, the more intense a bereaved person’s grief will be. Nowhere in any of the empirical studies perused was any contradictory evidence found.

Boyle, Vance, Najman and Thearle found that parents dealing with the loss of a young child are more likely to have an intense grief reaction than other groups. Likewise these results were mimicked in both Phase 1 and Phase 2 of The Scott and White Grief Study but across a range of domains rather than just parents who have lost young children.

The sense of outrage involved with this kind of ‘out of order’ death will be much harder for someone with a rigid world view that lacks plasticity, to assimilate the loss as a part of life, than someone who can accept it and attempt to deal with and move past the grief felt. A mother who loses her child from SIDS is more likely to react in a complicated manner than an elderly man who loses his brother to natural causes.

The age of the bereaved is another element that needs consideration; parentally bereaved children will all react differently based on their age, and significant gender differences have been found between males and females with men more likely to react in aggressive ways.

Another mediator that is quite prevalent in the literature is the mode of death which includes such sub-categories as traumatic, unexpected and stigmatised. Guilt, blame, desire for revenge are all emotions that can be felt by grievers and Weinberg found that the mode of death could influence these and a person’s ability to mourn the loss in a healthy fashion. Evidence suggests that those who experienced an unnatural death of a loved one, or who blamed themselves for the death, would take significantly longer to grieve and experience delayed recovery from bereavement compared with those whose loved one died naturally, or those who didn’t have any self-blame.

Other research also suggests that in children the mode of death of a parent can influence the amount of grief experienced . While in elderly people, Bonanno et. al. found them more likely to fall within the resilient group with 45.9% of their sample being included. It is hypothesised, and supported by the aforementioned paper, that not only do older people begin to mentally prepare themselves for the passing on of friends and family, but that natural deaths of old age are likely easier for people to assimilate and accept as ‘part of life’. This lends support to not only the mode of death mediator but also the idea that age plays a role in grief.

That being said, Gamino, Sewell and Easterling have had contradictory evidence emerge from their work with Phase 2 of their study having support for things in which Phase 1 had no support. Phase 1 found no significant empirical evidence to suggest that sudden, unexpected or traumatic loss would influence grief levels, nor would a lengthy illness, knowledge that death was imminent or believing the death was preventable. Phase 2 on the contrary found significant support for the idea that the traumatic or unexpected nature of a death, as well as the perception of preventability could both influence whether a person would develop chronic grief. Also, although the length of an illness was not significant in either report, in Phase 2 it fell just shy of statistical significance.

This is a prime example of some of the problems encountered in such a delicate field as research into people’s grief, as the problems previously mentioned could have influenced these studies in some way also.

When it comes to ambivalent relationships or relationships with negative connotations attached to them Bonanno et. al. found no significant evidence to support any difference between the chronic grievers and resilient group, however Gamino, Sewell and Easterling did find significant evidence to suggest that those with good quality relationships with the deceased are more likely to experience chronic grief than those without. More research is needed on this area as it is easy to hypothesise reasons why ambivalent relationships or those with negative connotations attached to them would either have difficulty or ease dealing with the death. Some may move on easily as they are, for lack of a better description, happy to see the person go, however others may have difficulty dealing with the situation because of the ambivalence in their relationship or the negative connotations, they may not be able to grieve properly because of the anger and other such emotions within their relationship and subsequently develop complicated grief.

As a final point, religion or having a spiritual nature as a coping tool has been proven to be significant. In reviewing 31 studies about grief and religion, Becker et. al. found that 28 of these studies reported significant positive effects on the bereavement process with only one study reporting a negative effect of religion or spirituality on a mourner’s level of grief.

In summation, all the research papers examined may not label mediators of grief exactly as laid out in this paper, but the labels they have assigned do quite easily integrate into the ones set out here. There are also a number of smaller mediators that have not been examined here, but are all still likely to influence the reasons why one person experiences chronic grief and another is resilient. We found an enormous amount of empirical research, with a large majority of it supporting the aforementioned mediators, and in cases where the evidence was negative in nature, a number of reasons put the validity of their results into question (small sample sizes, short periods between pre and post tests, large attrition rates to name but a few).

Even with this mountain of research that has been conducted already, many questions still remain unanswered. In part due to these contradictory studies and statistical reliability problems that plague even the most experienced researcher, and in part to the nature of grief in and of itself making the process of studying it a very delicate one. However it is quite obvious, that while some factors will play a larger role in predicting chronic sufferers of grief versus resilient people, all the mediators mentioned do play some role. It is unlikely that any time in the near future we will formulate a step by step guide to dealing with grief; it will more likely need to be mouldable to each individuals reactions, like the plasticity these same individuals will need to move on with their lives.