Dealing with grief has been a significant mental health problem that psychiatrists and psychologists are being approached with. But when do feelings of grief transform or lead to Depression? Can grief and bereavement be a cause of Mania? To answer these questions, defining and comprehending grief and bereavement becomes extremely important.
Grief may be triggered by several events, including the sudden death of a loved one, separation or divorce, the loss of a feeling of security or predictability, or the loss of one’s home/community to natural disasters. For weeks or months, most people’s emotions, thoughts, and behaviors would be dominated by grief. Bereavement is a period in experiencing grief, where feelings of intense agony and the absence of the deceased are more significant during the initial stages (Cherry, K. 2021).
Mood Disorders are defined by a significant affect fluctuation that influences an individual’s social, occupational, and daily functioning. This is considered one of the main characteristics of mood disorders, also called Affective Disorders (Youn, J., & Ellenbroek, B. 2016). Under the broad spectrum of Mood Disorders, there are various disorders such as Bipolar Mood Disorders (where only Mania or Mania with Depression exists), and Unipolar Mood disorders, where the individual undergoes depression or Major Depressive Disorder (MDD). Depression is experienced in varying degrees: Mild Depressive Episode, Moderate Depressive Episode, and Severe Depressive Episode.
Significance of The Association
In the premise of Covid – 19 elicited pandemic, death rates have drastically increased recently. Millions have experienced interpersonal loss and continue to grieve for their loved ones. Being aware of how a psycho-social issue of the sudden death of a loved one could, directly and indirectly, affect a psychological disorder becomes elemental. Only then would individuals be well aware of when to seek professional help. Through the theoretical framework of the biopsychosocial model, grief and bereavement could be considered crucial responses to a significant life event; here, the sudden death of a loved one could lead to the development of a mood disorder. The biopsychosocial model proposed by George Engel in 1977 asserts that different biological, psychological, and social factors collectively contribute to developing the psychopathology of mental disorders (Alarcos Cieza, Jerome E. Bickenbach. 2015).
Grief, Bereavement and Mood Disorders
Many learn to manage their grief and continue functioning by following their routines. According to recent statistics, approximately 20 per cent of the population requires professional help dealing with grief and bereavement (Grief | APS, n.d.). In longitudinal research, widowed participants were chosen to be the subject of several long-term follow-up studies on bereavement. After one month of the demise, most participants reported weeping, low mood, sleep difficulties, lack of appetite, restlessness, exhaustion, impaired memory, and loss of interest (Clayton et al., 1974). It is important to note that while these widows were grieving, they also experienced symptoms of MDD.
According to an interesting study, a loss can start or worsen psychological diseases such as MDD and PTSD. It could lead to manic episodes called ‘funeral mania’ and ‘bereavement mania.’ While funeral mania occurs as a hypomanic episode right after a week, bereavement mania is a type of ‘psychogenic mania’ experienced shortly after the demise. Evidence suggests that due to the overlapping symptoms of grief and depression, such as anhedonia (loss of interest), extreme levels of sadness, and feelings of worthlessness (emphasized much through Beck’s cognitive triad), people who may experience grief and bereavement may develop a diathesis for MDD and Manic episodes (Carmasso, C. et al. 2020). Hence, despite DSM-V (Diagnostic Statistical Manual) categorization of different Grief Disorders that possess a potential for complete cure and sustaining healthy mental states, Mood Disorders could manifest through grief and bereavement that could be relatively progressive since there is no ‘cure’ for MDD. Additionally, comorbidity of generalized anxiety disorder, manic episodes, and MDD are prevalent in grieving late adults (Keyes, M., K. et al., 2014).
Although bereavement was excluded from the criterion for required symptoms in DSM IV for depressive disorders under mood disorders, the evidence does not support the loss of a loved one from other stressors in terms of the likelihood that symptoms are spontaneous. DSM V was modified, and bereavement is considered a severe psychological stressor to cause Major Depressive Disorder. The symptoms that follow bereavement match the criteria of Major Depressive Episode in DSM V as they experience suffering, feel worthless, and may have suicidal ideation (Pies, R. 2014).
Research indicates that an increase in inflammatory biomarkers and cortisol levels among bereaving respondents are also associated with depressive psychopathology. Systemic inflammation could increase chronic physiological conditions and the degree of experiencing a Major Depressive Episode (Peña-Vargas, C. et al. 2021). Evidence suggests that expanded adrenocortical movement and adjusted insusceptible capacity following interpersonal loss are observed in depression psychopathology. Since yearning and naturally inevitable reminders of those who passed away primarily stay during bereavement, these emotional responses are influenced by cerebral synapses, adding to mental distress. In itself, and along with these biological implications, grief could posit as a diathesis for MDD in women more than men (Picardi & Biond, n.d.). Individuals experience physical symptoms of fatigue, breathlessness, high heart rate, and sweating which are also identified as symptoms of panic disorder.
Psychological elements that overlap grief and depressive symptomatology have presented themselves as precipitating factors of MDD. Examinations utilizing the Kubler-Ross model contend that depressive feelings could also be a resulting stage of grief (Peña-Vargas, C. et al., 2021). Bereavement and grief could worsen an existing condition or facilitate the development of a new condition, especially MDD, as symptoms like fatigue, panic attacks, and suicidal thoughts may occur. Fear, helplessness, worthlessness, perceived guilt for the death of a loved one are inevitable psychological repercussions that bereaving adults experience when they are simultaneously experiencing a Major Depressive Episode (Carmasso, C. et al. 2020).
When investigating the social part of the biopsychosocial model, there exists an association between the absence of social support when grieving and MDD. For instance, a review led by college understudies who had experienced a colossal loss showed that members with lower apparent social help had higher delayed depressive episodes and despondency side effects (Peña-Vargas, C. et al. 2021). Thus, lack of social support (a defensive indicator in depressive symptomatology) while grieving could act as a precipitating cause for the development of MDD.
By fathoming a psychosocial issue – death, and its relationship with MDD as a psychology student, exploring the different ways in which the two could present themselves in individuals becomes essential in understanding and developing stable mental health and resilience. This is highly relevant since we are exposed to interpersonal loss, familial loss, and loss on a state level. The entire state of Karnataka mourned the sudden demise of an actor named Puneeth Rajkumar; even though lakhs of people did not associate with him and his family is an excellent example of grief experienced in the masses. Understanding such sensitive information is crucial to help oneself and others identify and suggest when grieving becomes ‘abnormal’ and leads to depression that would require psychological help.
Image by Keenam Constance
References
APS. (n.d.). Grief | APS. Retrieved 2021, from https://psychology.org.au/for-the-public/psychology-topics/grief
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Carmassi, C., M. Shear, K., Corsi, M., Antonio Bertelloni, C., Dell’Oste, V., & Dell’Oste, L. (2020, May 6). Mania Following Bereavement: State of the Art and Clinical Evidence. Frontiers. Retrieved 2021, from https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00366/full
Cherry, K. (2021, September 22). What Does Bereavement Mean? Verywell Mind. Retrieved 2021, from https://www.verywellmind.com/bereavement-definition-symptoms-causes-traits-treatment-5197038
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Clayton, P. J., Herjanic, M., Murphy, G. E., & Woodruff, R. (1974). Mourning and Depression: Their Similarities and Differences. Canadian Psychiatric Association Journal, 19(3), 309–312. https://doi.org/10.1177/070674377401900312
Ellenbroek, B., & Youn, J. (2016, January 1). Affective Disorders. ScienceDirect. https://www.sciencedirect.com/science/article/pii/B9780128016572000070
Keyes, K., Pratt, C., Galea, S., McLaughlin, K. A., Koenen, K. C., & Shear, M. K. (2014, August 1). The Burden of Loss: Unexpected Death of a Loved One and Psychiatric Disorders Across the Life Course in a National Study. The American Journal of Psychiatry. Retrieved 2021, from https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2014.13081132
Peña-Vargas, C.; Armaiz-Peña, G.; Castro-Figueroa, E. A Biopsychosocial Approach to Grief, Depression, and the Role of Emotional Regulation. Behav. Sci. 2021, 11, 110. https://doi.org/10.3390/bs11080110
Pies, R. (2014). The Bereavement Exclusion and DSM-5: An Update and Commentary. The National Center for Biotechnology Information (NCBI). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204469/
