Cited by 451Grief, Bereavement, and Mental HealthDeath, Funerary Practices, and MourningReligion, Spirituality, and Psychology

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Grief and bereavement: what psychiatrists need to know

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ZISOOK, SIDNEY, SHEAR, KATHERINE·2009·World Psychiatry

DOI 10.1002/j.2051-5545.2009.tb00217.xPMC PMC2691160

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Abstract

THIS REVIEW COVERS FOUR AREAS OF CLINICAL IMPORTANCE TO PRACTICING PSYCHIATRISTS: a) symptoms and course of uncomplicated (normal) grief; b) differential diagnosis, clinical characteristics and treatment of complicated grief; c) differential diagnosis, clinical characteristics and treatment of grief-related major depression; and d) psychiatrists' reactions to patient suicides. Psychiatrists often are ill prepared to identify complicated grief and grief-related major depression, and may not always be trained to identify or provide the most appropriate course of treatment. Both conditions overlap with symptoms found in ordinary, uncomplicated grief, and often are written off as "normal" with the faulty assumption that time, strength of character and the natural support system will heal. While uncomplicated grief may be extremely painful, disruptive and consuming, it is usually tolerable and self-limited and does not require formal treatment. However, both complicated grief and grief-related major depression can be persistent and gravely disabling, can dramatically interfere with function and quality of life, and may even be life threatening in the absence of treatment; and both usually respond to targeted psychiatric interventions. In addition, patient suicide has been reported as one of the most frequent and stressful crises experienced by health providers, and psychiatrists are not immune to complicated grief or grief-related depression when they, themselves, become survivors. Thus, it is essential for psychiatrists to recognize their own vulnerabilities to the personal assaults that often accompany such losses, not only for their own mental health and well-being, but also to provide the most sensitive and enlightened care to their patients.

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“It Was Worse than My Son Passing Away.” The Experience of Grief in Recovering Crack Cocaine-Addicted Mothers Who Lose Custody of Their Children
Janzen, K. J., & Melrose, S. (2016) · Illness Crisis & Loss · doi:10.1177/1054137316637188 · Cited by 8
The Bereavement Exclusion: the Truth between Pathology and Politics
Iglewicz, A., Seay, K., Vigeant, S., Jouhal, S. K., & Zisook, S. (2013) · Psychiatric Annals · doi:10.3928/00485713-20130605-05 · Cited by 8
Self-citation
O potencial consolador das cartas psicografadas na saúde emocional de enlutados
Hott, M. C. M., & Reinaldo, A. M. D. S. (2020) · Physis Revista de Saúde Coletiva · doi:10.1590/s0103-73312020300220 · Cited by 10
“I Wouldn't Wish It on My Worst Enemy”: Western Australian Fathers’ Perspectives on Their Marital Separation Experiences
Mercadante, C., Taylor, M. F., & Pooley, J. A. (2014) · Marriage & Family Review · doi:10.1080/01494929.2013.879556 · Cited by 8
DSM5 and the Medicalization of Grief: Two Perspectives
FRANCES, A. J., Pies, R. W., & Zisook, S. (2010) · Cited by 8
Self-citation
Bereavement and Support Experiences of Informal Caregivers of Persons with Amyotrophic Lateral Sclerosis: A Qualitative Study
Poppe, C. J., Iseli, L. M., Verwey, M., & Wangmo, T. (2021) · Journal of Social Work in End-of-Life & Palliative Care · doi:10.1080/15524256.2021.1976352 · Cited by 8
“Following Zisook and Shear (2009) in this paper, the term bereavement is used to refer to the fact of having lost someone to death, while the term grief is used to describe the emotional, cognitive, functional and behavioral responses to such a loss.”
Illness, Injury, and the Phenomenology of Loss: A Dialogue
Cole, J., & Ratcliffe, M. (2022) · Journal of Consciousness Studies · doi:10.53765/20512201.29.9.150 · Cited by 8
Grief as Attention
Cholbi, M. J. (2022) · Journal of Consciousness Studies · doi:10.53765/20512201.29.9.063 · Cited by 7
“(Zisook and Shear 2009) This is not surprising if such introspection and withdrawal are emblematic of attention.”
Background
Treating Complicated Grief in a Teenager With Autism: When the Client’s Limitations Prevent Engagement in Therapy
Zakreski, M. J. (2017) · Clinical Practice in Pediatric Psychology · doi:10.1037/cpp0000191 · Cited by 7
“…such as hopelessness, low mood, changes in sleep and appetite, irritability, nightmares, and low energy, all of which lasted beyond expected grief reactions, which would be less than 1 year of overt symptoms in a typical teenager (Cohen et al., 2006; Melhem et al., 2007; Zisook & Shear, 2009).”
FATHERS’ EXPERIENCE AND PERCEPTIONS OF PARENT ALIENATION IN HIGH-CONFLICT DIVORCE
Bosch-Brits, E., Wessels, C., & Roux, A. (2018) · Social Work/Maatskaplike Werk · doi:10.15270/54-1-617 · Cited by 7
“…(Chung, Farmer, Grant, Newton, Payne, Perry & Stone, 2002; Lee, Sabarra, Mason & Law, 2011, Lucas, 2005; Waller, 2007; Wyder, Ward & De Leo, 2009; Zizook & Shear, 2009) comes to the conclusion that the results of a high-conflict divorce unleashes separation anxiety, which leads to social…”
Background
How can we know what we don’t know? An exploration of professionals’ engagement with complicated grief
Dodd, A., Guérin, S., Delaney, S., & Dodd, P. C. (2021) · Patient Education and Counseling · doi:10.1016/j.pec.2021.09.014 · Cited by 7
Luto pela morte de um filho: utilização de um protocolo de terapia cognitivo-comportamental
Silva, A. C. D. O. E., & Nardi, A. E. (2010) · Revista de Psiquiatria do Rio Grande do Sul · doi:10.1590/s0101-81082010000300008 · Cited by 7
A multi-level framework to guide mental health response following a natural disaster
Wade, D., Forbes, D., Nursey, J., & Creamer, M. C. (2012) · Bereavement Care · doi:10.1080/02682621.2012.740285 · Cited by 8
“…most will eventually accommodate the loss of a loved one and return to enjoyable and productive activities after an initial period of acute grief (Zisook & Shear, 2009), despite the fact that a gradual return to better functioning can be complicated by media exposure, prolonged coronial and…”
Background
Psychiatric Disorders in Patients Who Lost Family Members to Cancer and Asked for Medical Help: Descriptive Analysis of Outpatient Services for Bereaved Families at Japanese Cancer Center Hospital
Ishida, M., Onishi, H., Wada, M., Tada, Y., Ito, H., Narabayashi, M., Sasaki, Y., Nomura, S., & Uchitomi, Y. (2010) · Japanese Journal of Clinical Oncology · doi:10.1093/jjco/hyq213 · Cited by 7
“Untreated major depression after bereavement carries the extra burden of prolonging the pain and suffering associated with grief (32).”
Background
Communication Disparity Between the Bereaved and Others: What Hurts Them and What Is Unhelpful? A Nationwide Study of the Cancer Bereaved
Ishida, M., Onishi, H., Morita, T., Uchitomi, Y., Shimizu, M., Tsuneto, S., Shima, Y., & Miyashita, M. (2018) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2017.12.493 · Cited by 7
Deuil compliqué selon les cultures : défis diagnostiques et limites des classifications internationales
Ben-Cheikh, I., Rachédi, L., & Rousseau, C. (2020) · Frontières · doi:10.7202/1072750ar · Cited by 7
Psychological sequelae in suicide survivors: A brief overview
Halder, S., & Chakraborty, S. (2018) · Indian Journal of Social Psychiatry · doi:10.4103/ijsp.ijsp_57_17 · Cited by 9
Meaningfulness and grief: you don’t know what you got till it’s gone
Matey, J. (2023) · Synthese · doi:10.1007/s11229-023-04333-w · Cited by 6
“But others, Zisook and Shear (2009) noted that symptoms of grief are often different from those of depression and moreover, in cases where they are the same it is more appropriate to diagnose a subject with both grief and major depression.”
Background
Why did God let this Happen? Assessing the Spiritual Impacts of Sexual Addiction on Intimate Female Partners: A Qualitative Investigation
Aghamiri, F. S., Luetz, J. M., & Hills, K. (2024) · Sexuality & Culture · doi:10.1007/s12119-024-10221-3 · Cited by 10
“…trauma symptoms, complex melancholy, humiliation, a profound sense of guilt or blame, and a ruminative need to rationalise or explain their identity and reality can all be experienced simultaneously by a grieving intimate partner (Seyed Aghamiri, 2023a, 2023b; Weiss, 2019; Zisook & Shear, 2009).”
Narrative review of the potential for psychedelics to treat Prolonged Grief Disorder
Ehrenkranz, R. C., Agrawal, M., Penberthy, J. K., & Yaden, D. B. (2024) · International Review of Psychiatry · doi:10.1080/09540261.2024.2357668 · Cited by 6
“Overlapping symptoms between PGD and depression include: low mood, social withdrawal, sleep disturbances, rumination, and suicidal ideation (Jordan & Litz, 2014; Kristensen et al., 2017; Zisook & Shear, 2009).”
Grief Reactions in the Suicide Bereaved
Iglewicz, A., Tal, I., & Zisook, S. (2017) · Springer eBooks · doi:10.1007/978-3-319-65241-2_7 · Cited by 6
Self-citation
“Thoughts Can Kill You”: Characterization of Mental Health Symptoms by Ugandan Grandparent–Caregivers in the HIV/AIDS Era
Matovu, S. N., Dawson-Rose, C. S., Weiss, S. J., & Wallhagen, M. L. (2019) · Issues in Mental Health Nursing · doi:10.1080/01612840.2018.1553001 · Cited by 6
“Following the anticipatory grief, they noted acute grief characterized by intensive psychological pain in the early aftermath of the loss of their loved ones (Zisook & Shear, 2009).”
Background
Komplizierte Trauer erfassen: Ein systematischer Review
Müller, H., Berthold, D., Bongard, S., Gramm, J., Hauch, H., & Sibelius, U. (2020) · PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie · doi:10.1055/a-1144-3705 · Cited by 6
Caring Existentially and Spiritually for Young Children and Close Grandchildren of Life-Threatened Cancer Patients in Secularized Denmark
Viftrup, D. T., & Voetmann, S. S. (2023) · Seminars in Oncology Nursing · doi:10.1016/j.soncn.2023.151484 · Cited by 6
Mending the heart and mind during times of loss: a review of interventions to improve emotional well-being during spousal bereavement
Shahane, A. D., Fagundes, C. P., & Denny, B. T. (2018) · Bereavement Care · doi:10.1080/02682621.2018.1493640 · Cited by 6
“…will be used to refer to the fact of loss, while the term grief will refer to the emotional, cognitive, and behavioural responses to death (Zisook & Shear, 2009). while bereavement in different manifestations may occur in relation to the death of many important individuals in one’s life…”
Bereavement and grief
Glorioso, D., Iglewicz, A., & Zisook, S. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-800136-3.00018-1 · Cited by 7
Self-citation
Complicated Grief
Zisook, S., & Reynolds, C. F. (2017) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.154s14 · Cited by 6
Self-citation
Depression in the Context of Chronic and Multiple Chronic Illnesses
Stanners, M. N., & Barto, C. (2012) · InTech eBooks · doi:10.5772/38470 · Cited by 6
Pastoral approach to the African Christian woman affected by grief due to the loss of her spouse
Choabi, T. E. (2015) · Boloka Institutional Repository (North-west University) · Cited by 6
A scoping review on the use of social media for personal grief
Liang, A. G., Tan, K. H. E., See, J. C., & Kuek, J. H. L. (2025) · Death Studies · doi:10.1080/07481187.2025.2585928 · Cited by 5
Care of Bereaved Persons
Ahluwalia, S. C., Bandini, J. I., Maglione, M., Miles, J. N. V., O’Hollaren, K., Zhang, D., Yedavalli, M. S., Yagyu, S., Motala, A., & Hempel, S. (2026) · Annals of Internal Medicine · doi:10.7326/annals-24-03679 · Cited by 6
Definition of Grief, Gender Differences and Religious and Cultural Differences in Dealing with Death and Grief
Skrozic, A., & Kijamet, D. (2022) · Springer eBooks · doi:10.1007/978-3-662-64297-9_2 · Cited by 5
Grief Coach , a Text-Based Grief Support Intervention: Acceptability Among Hospice Family Members
Levesque, D. A., Lunardini, M. M., Payne, E. L., & Callison-Burch, V. (2023) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228231159450 · Cited by 5
“Translation, cultural adaptation, and validation of perinatal grief scale in Urdu: Addressing a gap in the research of perinatal loss in Pakistan–Cross‐sectional validation study”
Nisa, M., Laila, S., Muzzamil, M., Ghafoor, A., Zakir, N., Zulfiqar, T., Malik, A., & Malikzai, A. (2024) · Health Science Reports · doi:10.1002/hsr2.1999 · Cited by 5
Depression symptoms and suicidal ideation among HIV infected Rwandans: the mediating and moderating effects of complicated grief and substance abuse
Uwiringiyimana, A., Niyonsenga, J., Kéthina, L. G., Bugenimana, A., Mutabaruka, J., & Nshimiyimana, A. (2024) · AIDS Research and Therapy · doi:10.1186/s12981-024-00628-1 · Cited by 6
“Depression involves persistent low mood and loss of interest, while grief encompasses a broad range of emotions in response to loss, including sadness and anger [39, 53].”
Background

Authors: ZISOOK, S., & SHEAR, K.
Affiliations: University of California San Diego (US)
ORCID: ZISOOK, SIDNEY
Venue: World Psychiatry
Publisher: Wiley
Published: 2009-06
Volume: 8
Issue: 2
Pages: 67-74
ISSN: 1723-8617 (ISSN-L)
2051-5545
DOI: 10.1002/j.2051-5545.2009.tb00217.x
PMC: PMC2691160
OpenAlex: W1495198831
Semantic Scholar: 84d101b3e06ad49e4d800b6e58086f4f836be83f
Cited by: 451
References: 64
Citations by year: 2026: 34 · 2025: 48 · 2024: 38 · 2023: 29 · 2022: 40 · 2021: 40 · 2020: 35 · 2019: 25 · 2018: 19 · 2017: 32 · 2016: 17 · 2015: 19 · 2014: 13 · 2013: 15 · 2012: 21
FWCI: 16.24
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor, 1380 d)
Locations: World Psychiatry (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
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: complicated grief, normal grief, bereavement, suicide, differential diagnosis, grief therapy

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Grief and bereavement: what psychiatrists need to know

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