Losing a close family member to a serious illness can significantly affect both physical and mental health. It increases healthcare usage and mortality risk. Research has identified different grief trajectories, with some individuals experiencing continuous or delayed high levels of grief. Those exhibiting a high grief trajectory (HGT) tend to have a greater use of general practitioners, psychotropic medications, and psychological therapy even before the bereavement.
This study examined how different grief patterns influence the long-term healthcare usage and mortality throughout 3 to 10 years. It was hypothesized that people in the HGT group would have higher healthcare requirements and an increased mortality risk compared to those with low grief symptoms. This study aimed to determine whether grief trajectory patterns are linked to long-term healthcare utilization and mortality, using individuals with a low grief trajectory (LGT) as the control group.
This prospective cohort study was carried out in Denmark from 2012 to 2022 and assessed the long-term health outcomes in bereaved relatives of terminally ill patients. Relatives were invited to participate when the patient received drug reimbursement for a terminal illness and completed the grief symptoms questionnaire at 3 time points: baseline, 6 months, and 3 years after bereavement. Grief was evaluated using the PG-13 scale, and five grief trajectories were detected.
Healthcare data on the general practice contacts, mental health service, mortality, and psychotropic prescriptions were collected and were linked to unique personal identifiers from national health registries. Statistical analyses involved negative binomial regression for GP visits, Cox proportional hazards modelling for mortality, and logistic regression for the mental health service use and medication. Models were adjusted for gender, age, education, comorbidities, and relationship to the deceased.
The majority of 1735 bereaved participants were females (71%) and deceased spouses (66%) with a mean age of 62 years. Around 26% had limited education, and 17% had at least one comorbidity. People in the HGT, late grief trajectory (LaGT) groups, and high/decreasing trajectory (HDGT) groups had more general practice contacts in the first years after bereavement, specifically from 4 to 7 years post-loss, as compared to the LGT group.
The HGT group was significantly associated with high mental health service (95% confidence interval [CI]: 1.58 to 5.19, odds ratio [OR]: 2.86], sedatives and anxiolytics (95% CI: 1.63 to 4.14, OR: 2.60) and usage of antidepressants (95% Ci: 3.52 to 9.01, OR: 5.63) as compared to LGT groups in adjusted logistic regression. Usage of antidepressants was also elevated in the HDGT (95% CI: 1.29 to 2.70, OR: 1.87) and LaGT (95% CI: 1.53 to 3.97, OR: 2.46), and usage of sedative and anxiolytics was increased in HDGT (95% CI: 1.26 to 2.48, OR: 1.77) compared to LGT. 186 (10.7%) died in 3 to 10 years after the death of the patient. HGT was highly linked to mortality (95% CI: 1.11 to 3.21, OR: 1.88) compared to the LGT group.
This study has several limitations, such as a lack of the general population for comparison, possible underestimation of grief in the highly educated participants, and a relatively limited sample size. Healthcare use variation diminished after 7 years because of mortality in the HGT group. Despite elevated healthcare engagement, HGT individuals continued to experience severe symptoms, which highlights the necessity for early, tailored mental health therapy. Clinical practice must incorporate a systemic assessment of grief symptoms.
Future research must be tested for structured and early intervention in both digital and in-person settings and seek to optimize the intersectoral mental health pathways. Overall, this study underscores the persistent vulnerability of HGT individuals and emphasizes the need for a long-term and proactive care strategy.
References: Nielsen MK, Pedersen HS, Sparle Christensen K, et al. Grief trajectories and long‑term health effects in bereaved relatives: a prospective, population‑based cohort study with ten‑year follow‑up. Front Public Health. 2025;13:1619730. doi:10.3389/fpubh.2025.1619730
