When Grief May Not Be Normal: Approach in Primary Healthcare

Abstract

Grief is the natural response to the loss of a loved one, which affects the population universally. Acute grief reactions are normal and expected and should not be diagnosed as a disease. In more complex situations, complications may occur that prevent or delay the adaptation to the loss, leading to the development of prolonged grief. This entity can only be diagnosed at least six months after the loss, but the family physician, due to established proximity, can identify earlier and more accurately individuals at risk.
The aim of this work is to create a screening tool to assess the risk of developing long-term grief disorder before six months after the loss.
A search for scientific articles published in Medline/PubMed, using the terms “Grief”, “Bereavement”, “Risk assessment” and “Primary care”, and clinical guidelines, in English and Portuguese, in the last 10 years, was performed. Their selection was based on the relevance of the title, reading the abstract and full text.
Diagnostic tools for prolonged grief disorder, validated for the Portuguese population, should be applied only after six months of the loss, but immutable risk factors, present since the loss, may be identified early. Therefore, a pilot screening tool is proposed in this work, to be applied in the first 6 months after the loss, guiding the need for reassessment or referral to specialized care.
In the future, it is intended that this tool can be disseminated, applied and ideally validated in primary health care, with prognostic benefit for bereaved individuals.