 |
|
An Empirical Examination of the Stage Theory of Grief
Paul K. Maciejewski, PhD;
Baohui Zhang, MS;
Susan D. Block, MD;
Holly G. Prigerson, PhD
JAMA. 2007;297:716-723.
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.
Author Affiliations: Department of Psychiatry, Women's Health Research, and Magnetic Resonance Research Center, Yale University School of Medicine, New Haven, Conn (Dr Maciejewski); Center for Psycho-Oncology and Palliative Care Research, Dana-Farber Cancer Institute, Boston, Mass (Ms Zhang and Drs Block and Prigerson); and Department of Psychiatry, Brigham and Women's Hospital, and Harvard Medical School Center for Palliative Care, Boston, Mass (Drs Block and Prigerson).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED LETTERS
The Stage Theory of Grief
Roxane Cohen Silver and Camille B. Wortman
JAMA. 2007;297(24):2692.
EXTRACT
| FULL TEXT
The Stage Theory of Grief
Joseph S. Weiner
JAMA. 2007;297(24):2692-2693.
EXTRACT
| FULL TEXT
The Stage Theory of Grief
George A. Bonanno and Kathrin Boerner
JAMA. 2007;297(24):2693.
EXTRACT
| FULL TEXT
The Stage Theory of Grief—Reply
Paul K. Maciejewski, Baohui Zhang, Susan D. Block, and Holly G. Prigerson
JAMA. 2007;297(24):2693-2694.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Psycho-Oncology: A Review for the General Psychiatrist
Meyer et al.
Focus 2009;7:317-331.
ABSTRACT
| FULL TEXT
Bereavement Practices of Physicians in Oncology and Palliative Care
Chau et al.
Arch Intern Med 2009;169:963-971.
ABSTRACT
| FULL TEXT
Unresolved Grief in a National Sample of Bereaved Parents: Impaired Mental and Physical Health 4 to 9 Years Later
Lannen et al.
JCO 2008;26:5870-5876.
ABSTRACT
| FULL TEXT
Grief and acceptance as opposite sides of the same coin: setting a research agenda to study peaceful acceptance of loss
Prigerson and Maciejewski
Br. J. Psychiatry 2008;193:435-437.
ABSTRACT
| FULL TEXT
Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement Adjustment
Wright et al.
JAMA 2008;300:1665-1673.
ABSTRACT
| FULL TEXT
Integrating Palliative and Critical Care: Evaluation of a Quality-Improvement Intervention
Curtis et al.
Am. J. Respir. Crit. Care Med. 2008;178:269-275.
ABSTRACT
| FULL TEXT
Encountering Patient Suicide: Emotional Responses, Ethics, and Implications for Training Programs
Coverdale et al.
Acad. Psychiatry 2007;31:329-332.
FULL TEXT
The Stage Theory of Grief
Silver and Wortman
JAMA 2007;297:2692-2692.
FULL TEXT
The Stage Theory of Grief
Bonanno and Boerner
JAMA 2007;297:2693-2693.
FULL TEXT
The Stage Theory of Grief
Weiner
JAMA 2007;297:2692-2693.
FULL TEXT
Is the Stage Theory of Grief Empirically Valid?
JWatch Psychiatry 2007;2007:1-1.
FULL TEXT
|
