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Cited by 605Grief, Bereavement, and Mental HealthDeath, Funerary Practices, and MourningReligion, Spirituality, and Psychology

An Empirical Examination of the Stage Theory of Grief

Maciejewski, Paul K., Zhang, Baohui, Block, Susan D., Prigerson, Holly G.·2007·JAMA
DOI 10.1001/jama.297.7.716
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Abstract

CONTEXT: The stage theory of grief remains a widely accepted model of bereavement adjustment still taught in medical schools, espoused by physicians, and applied in diverse contexts. Nevertheless, the stage theory of grief has previously not been tested empirically. OBJECTIVE: To examine the relative magnitudes and patterns of change over time postloss of 5 grief indicators for consistency with the stage theory of grief. DESIGN, SETTING, AND PARTICIPANTS: Longitudinal cohort study (Yale Bereavement Study) of 233 bereaved individuals living in Connecticut, with data collected between January 2000 and January 2003. MAIN OUTCOME MEASURES: Five rater-administered items assessing disbelief, yearning, anger, depression, and acceptance of the death from 1 to 24 months postloss. RESULTS: Counter to stage theory, disbelief was not the initial, dominant grief indicator. Acceptance was the most frequently endorsed item and yearning was the dominant negative grief indicator from 1 to 24 months postloss. In models that take into account the rise and fall of psychological responses, once rescaled, disbelief decreased from an initial high at 1 month postloss, yearning peaked at 4 months postloss, anger peaked at 5 months postloss, and depression peaked at 6 months postloss. Acceptance increased throughout the study observation period. The 5 grief indicators achieved their respective maximum values in the sequence (disbelief, yearning, anger, depression, and acceptance) predicted by the stage theory of grief. CONCLUSIONS: Identification of the normal stages of grief following a death from natural causes enhances understanding of how the average person cognitively and emotionally processes the loss of a family member. Given that the negative grief indicators all peak within approximately 6 months postloss, those who score high on these indicators beyond 6 months postloss might benefit from further evaluation.

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  • In normal grieving, negative grief indicators such as disbelief, yearning, anger, and depression peak within approximately 6 months of loss.

    “This study revealed that in normal grieving, negative grief indicators such as disbelief, yearning, anger, and depression peak within approximately 6 months of loss.”

    From Complicated grief after perinatal loss (2012) · cites this paper as [17]

  • Adjustment after bereavement occurs through a sequence of stages.

    “Adjustment after bereavement has been empirically shown to occur through a sequence of stages in a longitudinal study of bereaved individuals.17”

    From Complicated grief after perinatal loss (2012) · cites this paper as [17]

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Authors
Maciejewski, P. K., Zhang, B., Block, S. D., & Prigerson, H. G.
Affiliations
Brigham and Women's Hospital (US)
Corresponding author
Prigerson, Holly G.
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2007-02-21
Volume
297
Issue
7
Pages
716
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.297.7.716
OpenAlex
W2147592659
Cited by
605
References
33
Citations by year
2026: 19 · 2025: 28 · 2024: 25 · 2023: 26 · 2022: 28 · 2021: 37 · 2020: 34 · 2019: 24 · 2018: 25 · 2017: 32 · 2016: 24 · 2015: 50 · 2014: 34 · 2013: 37 · 2012: 30
FWCI
39.54
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institute of Mental Health (R01MH056529, MH-56529, MH-63892, R01MH063892)
  • National Cancer Institute (R01CA106370, CA106370)
  • National Institute of Neurological Disorders and Stroke (NS-044316, K25NS044316)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
  • Social Sciences › Anthropology › Death, Funerary Practices, and Mourning
  • Social Sciences › Health › Religion, Spirituality, and Psychology
Keywords
bereavement, longing, disbelief, anger, depression, acceptance, family bereavement, bereavement adjustment
MeSH terms
Anger, Attitude to Death, Connecticut, Denial, Psychological, Depression, Female, Grief, Humans, Longitudinal Studies, Male, Middle Aged, Psychological Theory, Time Factors

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