As Debbie Reynolds reminded us, grief can make us sick

The idea that grief can kill is not new. But the recent death of actress Debbie Reynolds just a day after the death of her daughter, Carrie Fisher, was a dramatic reminder of the links between grief, health and well-being that researchers have been attempting to understand for the past several decades.

Reynolds, by all reports, fit a pattern well-known to such researchers: She died of a stroke in the early throes of her loss. Studies show heart attacks and strokes surge in the 30 days after the death of a close loved one. Such reactions are distinct from so-called “broken heart syndrome,” another well-documented phenomenon in which spiking stress hormones cause part of the heart to temporarily enlarge, often producing chest pain and shortness of breath.

“There may be literally a shock to the system,” in the first days after a death, says S.V. Subramanian, a professor of population health and geography at Harvard University. People who already are in poor health or stressed by months or years of care-giving may be at especially high risk, he says.

But the fallout from grief doesn’t end there. Women who lose spouses die at higher-than-expected rates for three to six months after their losses; for men, the risk remains heightened for a year, Subramanian says.

And while grief is not depression — one is a normal reaction to loss, while the other is an illness — some mourners also become depressed, suffering from hopelessness and unrelenting sadness. Others experience an especially prolonged, painful, life-disrupting form of grief that goes by various names, including prolonged grief disorder and complicated grief. Exactly how and how soon after a loss health care professionals should identify and help such people is a great source of debate.

“Grief is a complex, multifaceted reaction that has features that are really unique to each individual and also has some commonalities,” says M. Katherine Shear, a professor of psychiatry at Columbia University.

Studies show many mourners experience initial disbelief, along with waves of sadness and yearning. Anger also is common. But research also shows that many people feel some level of acceptance from the earliest days after a death and that those feelings typically increase over time, says Paul Maciejewski, an associate professor of biostatistics in radiology at Weill Cornell Medical College. When that shift does not occur, some people cannot get on with their lives.

“As early as six months you can pick out who is going to have long-term problematic symptoms,” says Holly Prigerson, a professor of sociology in medicine and co-director, with Maciejewski, of a research center on end-of-life care at Weill Cornell.

Shear, Maciejewski and Prigerson are engaged in a long-running debate over exactly which symptoms of prolonged or unusual grief should trigger concern and be included in psychiatry’s official diagnostic manual.

Other experts worry about what they see as efforts to put time limits on mourning.

“It’s been 22½ years since my daughter died and I still have moments when I feel deep grief,” says Joanne Cacciatore, an associate professor of social work at Arizona State University who lost an infant in 1994. She works with other families who have lost children or lost loved ones to suicide or homicide. “In Western culture, we believe in brief grief, but I’m not a fan. There are some things we can accelerate but grief is not one of them.”

There is evidence that people who suffer the most prolonged and intense grief continue to suffer mental and physical health consequences. In one study, Prigerson and colleagues found that intense grief lasting more than six months was linked with increases in smoking, blood pressure, cardiovascular illness and suicidal thoughts and behavior. Other studies have found increases in drug and alcohol use and unhealthy changes in weight and diet.

Here are some thing mourners can do to protect their health:

►Make getting enough sleep, nutritious food and exercise a priority, right from the start, even if you don’t feel much like taking good care of yourself.

►Seek out social support. One study found widowed men and women who lived in neighborhoods with many other widowed people were less likely to die prematurely, possibly because of better social support (including from potential new mates), Subramanian says.  No matter where you live, you may need to “force yourself to get out and see people and do things,” Prigerson says.

►Remember that “grieving is a stressful life event, but most people do adjust,” Prigerson says. She and Maciejewski say that describes about 90% of mourners. Adjusting does not mean forgetting or never yearning for the lost loved one, they say, but it does mean regaining everyday mental, physical and social functioning.

For those who do continue to struggle, appropriate professional help remains in short supply, the experts agree. Shear has developed a psychotherapy program that shows promise in studies. Maciejewski and Prigerson are working on an online intervention that could make support more widely available. Cacciatore and colleagues are training professionals to work with families suffering especially traumatic losses.