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Cited by 398Grief, Bereavement, and Mental HealthMental Health Treatment and AccessPosttraumatic Stress Disorder Research

The burden of loss: unexpected death of a loved one and psychiatric disorders across the life course in a national study

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Keyes, Katherine M., Pratt, Charissa, Galea, Sandro, McLaughlin, Katie A., Koenen, Karestan C., Shear, M. Katherine·2014·American Journal of Psychiatry
DOI 10.1176/appi.ajp.2014.13081132PMC PMC4119479
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Abstract

OBJECTIVE: Unexpected death of a loved one is common and associated with subsequent elevations in symptoms of multiple forms of psychopathology. Determining whether this experience predicts novel onset of psychiatric disorders and whether these associations vary across the life course has important clinical implications. The authors examined associations of a loved one's unexpected death with first onset of common anxiety, mood, and substance use disorders in a population-based sample. METHOD: The relation between unexpected death of a loved one and first onset of lifetime DSM-IV disorders was estimated by using a structured interview of adults in the U.S. general population (analytic sample size=27,534). Models controlled for prior occurrence of any disorder, other traumatic experiences, and demographic variables. RESULTS: Unexpected death of a loved one was the most common traumatic experience and most likely to be rated as the respondent's worst, regardless of other traumatic experiences. Increased incidence after unexpected death was observed at nearly every point across the life course for major depressive episode, panic disorder, and posttraumatic stress disorder. Increased incidence was clustered in later adult age groups for manic episode, phobias, alcohol use disorders, and generalized anxiety disorder. CONCLUSIONS: The bereavement period is associated with elevated risk for the onset of multiple psychiatric disorders, consistently across the life course and coincident with the experience of the loved one's death. Novel associations between unexpected death and onset of several disorders, including mania, confirm multiple case reports and results of small studies and suggest an important emerging area for clinical research and practice.

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Crossref · 10.1176/appi.ajp.2014.13081132

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  • Loving romantic relationships can last throughout a lifetime, requiring continued commitment and communication to maintain, and when these relationships end, they can pose threats to psychological and physiological well-being.

    “Loving romantic relationships can last throughout a lifetime, requiring continued commitment and communication to maintain, and when these relationships end, they can pose threats to psychological and physiological well-being [75].”

    From The Neurobiology of Love and Pair Bonding from Human and Animal Perspectives (2023) · cites this paper as [75]

    The Introduction and Discussion link the death of a loved one, including a romantic partner, to psychological distress and psychiatric disorders; the Discussion also mentions physical and biological effects of bereavement. The paper does not address the need for commitment or communication to maintain romantic relationships, and it leaves open whether losses other than death have similar effects. Page numbers are unavailable in our copy. (LLM, conf=0.87)

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  • The loss of one's partner is linked to the onset of a variety of psychiatric conditions, including major depressive episodes, panic disorder, and post-traumatic stress disorder.

    “The loss of one’s partner is linked to the onset of a variety of psychiatric conditions, including major depressive episodes, panic disorder, and post-traumatic stress disorder [75].”

    From The Neurobiology of Love and Pair Bonding from Human and Animal Perspectives (2023) · cites this paper as [75]

    The Abstract Results and Discussion link unexpected death of a loved one to increased onset of major depressive episodes, panic disorder, and PTSD. But the Discussion states that the study did not record the deceased person’s relationship to the respondent, so it cannot establish those findings specifically for the loss of a partner. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • Bereavement is associated with an increased risk of depression, anxiety, and substance use disorder.

    “As for mental health, findings suggest an increased risk of depression, anxiety, and substance use disorder after bereavement (Keyes et al., 2014).”

    From Prolonged grief disorder treatment: An approach to COVID-19 grief (2023) · cites this paper as Keyes et al., 2014

    The Results (page unavailable) associate unexpected death of a loved one with increased odds of depressive episodes, several anxiety disorders, and alcohol use disorders. The citing sentence broadens this to bereavement generally and substance use disorders generally; the study examined unexpected deaths and reports alcohol use disorders, not substance use disorders as a whole. (LLM, conf=0.86)

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  • The increased incidence of major depression, panic disorder, and posttraumatic stress disorder linked to bereavement and profound grief after the loss of a partner are at least partially mediated by OXT.

    “As such, it seems likely that the increased incidence for major depression, panic disorder and posttraumatic stress disorder (Keyes et al., 2014), as well as the substantially increased risk of acute myocardial infarction (Mostofsky et al., 2012) linked to bereavement and profound grief after the loss of a partner, are also at least partially mediated by a”

    From Hormonal contraceptives suppress oxytocin-induced brain reward responses to the partner’s face (2016) · cites this paper as Keyes et al., 2014

  • The loss of affectionate bonds is associated with agonizing distress and elevated risk for the onset of multiple psychiatric disorders.

    “The loss of such affectionate bonds is associated with agonizing distress and elevated risk for the onset of multiple psychiatric disorders (4), suggesting that OXT signaling has a pivotal role in sustaining mental health.”

    From Dissecting the Role of Oxytocin in the Formation and Loss of Social Relationships (2016) · cites this paper as [4]

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Research works printed but not linked: 1

  1. [22]Bourgeois M Degeilh B Mourning mania: Clinical characteristics and meaning Annales me dico psychologiques 1987 145 1 72 77 3605931

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Authors
Keyes, K. M., Pratt, C., Galea, S., McLaughlin, K. A., Koenen, K. C., & Shear, M. K.
Affiliations
Boston Children's Hospital (US)
ORCID
Venue
American Journal of Psychiatry
Publisher
American Psychiatric Association Publishing
Published
2014-08
Volume
171
Issue
8
Pages
864-871
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
DOI
10.1176/appi.ajp.2014.13081132
PMC
PMC4119479
OpenAlex
W2111636212
Cited by
398
References
49
Citations by year
2026: 28 · 2025: 33 · 2024: 47 · 2023: 55 · 2022: 45 · 2021: 50 · 2020: 41 · 2019: 30 · 2018: 25 · 2017: 15 · 2016: 14 · 2015: 10 · 2014: 5
FWCI
17.31
Type
journal article
Language
en
Open access
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (5r01mh093612-03, MH093612)
  • National Institute on Alcohol Abuse and Alcoholism (AA-021511, K01AA021511)
  • National Institute of Mental Health (MH093612, MH-092526, R01MH070741, R01MH078928, MH60783, R01-MH093612, MH-078928, MH70741, R01MH060783, K01MH092526)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Keywords
bereavement, life course, major depressive episode, manic episodes, panic disorder, post-traumatic stress disorder, phobia, generalized anxiety disorder, alcoholism, substance use disorders, traumatic events, DSM-IV disorders
MeSH terms
Age Factors, Mental Disorders, Bereavement, Death, Humans, United States, Incidence, Cost of Illness

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