Bereavement -- Copyright -- Acknowledgments -- Contents -- Introduction -- CHAPTER 1 Introduction -- MANDATE AND PROCESS OF THE STUDY -- REPORT OVERVIEW -- BEREAVEMENT AND STRESS THEORY -- DEFINITIONS -- REFERENCES -- FOOTNOTE -- Epidemiologic Perspectives on the Health Consequences of Bereavement -- CHAPTER 2 Epidemiologic Perspectives on the Health Consequences of Bereavement -- THE QUESTION OF OUTCOMES -- THE CONSTELLATION OF DISTRESS AND GRIEF -- ADVERSE HEALTH CONSEQUENCES OF BEREAVEMENT -- Mortality -- Morbidity and Health Care Utilization -- Possible Consequences Beyond the First Year -- RISK FACTORS -- Characteristics of Bereaved Individuals -- Relationship to the Deceased -- Nature of the Death -- Risk Factors Appearing After the Death -- CONCLUSIONS AND RECOMMENDATIONS -- REFERENCES -- Adults' Reactions to Bereavement -- CHAPTER 3 Adults' Reactions to Bereavement -- THE PHENOMENOLOGY OF GRIEF -- Changes in Emotions and Thought Processes -- Behavioral Changes -- Interpersonal and Social Changes -- Physical Complaints -- THE END OF THE BEREAVEMENT PROCESS -- Favorable Outcomes -- Pathological Outcomes -- EXPLANATORY MODELS OF THE BEREAVEMENT PROCESS -- Classical Psychoanalytic Theory -- Current Psychodynamic Perspectives -- Interpersonal and Attachment Theory Models -- Crisis Theory -- Cognitive and Behavioral Theories -- CONCLUSIONS AND RECOMMENDATIONS -- REFERENCES -- Reactions to Particular Types of Bereavement -- CHAPTER 4 Reactions to Particular Types of Bereavement -- DEATH OF A SPOUSE -- DEATH OF A CHILD -- Stillbirths -- PERINATAL DEATH -- Sudden Infant Death -- The Death of an Older Child -- Problems in Grieving for a Child -- DEATH OF A PARENT DURING ADULT LIFE -- DEATH OF A SIBLING DURING ADULT LIFE -- BEREAVEMENT FOLLOWING SUICIDE -- The Social Stigma of Suicide -- Assisting Survivors of Suicide -- Research Issues.

CONCLUSIONS -- REFERENCES -- Bereavement During Childhood and Adolescence -- CHAPTER 5 Bereavement During Childhood and Adolescence -- DEVELOPMENTAL CONSIDERATIONS -- METHODOLOGICAL ISSUES -- OUTCOMES OF CHILDHOOD BEREAVEMENT -- Immediate Reactions -- Intermediate Effects -- Long-Term (Delayed) Effects -- Conclusions About Outcomes -- THE GRIEVING PROCESS IN CHILDREN -- Shifts in Self-Concepts Following Bereavement -- The Role of Identification in Grieving -- Common Thoughts, Concerns, and Fantasies -- Common Defensive Strategies -- Conclusions About the Grieving Process -- VARIABLES AFFECTING PROCESSES AND OUTCOMES -- Child's Age, Developmental Stage, and Emotional Stability at the Time of Bereavement -- Quality of Preexisting Relationship with the Deceased -- Sex of Deceased Parent and Bereaved Child -- Quality of the Child's Support System -- Remarriage of the Surviving Parent -- Cultural Background -- Circumstances of the Death -- Summary of Risk Factors in Childhood Bereavement -- INTERVENTION STRATEGIES -- Anticipating Parental Death -- Helping Parents to Help Their Children -- Talking to Children About a Family Member's Death -- Attending the Funeral -- Anniversary Reactions: A Normal Long-Term Consequence -- When to Seek Professional Help -- Conclusions About Interventions -- RECOMMENDATIONS FOR FUTURE RESEARCH -- REFERENCES -- Toward a Biology of Grieving -- CHAPTER 6 Toward a Biology of Grieving -- ANIMAL MODELS -- BIOLOGIC STUDIES OF BEREAVED HUMAN BEINGS -- PROMISING RESEARCH APPROACHES -- Clues from the Symptomatology of Bereavement -- Clues from the Epidemiology of Bereavement -- Clues from the Endocrinology and Biochemistry of Depression and Anxiety States -- Clues from Current Knowledge of Neuroregulatory Mechanisms -- GRIEF AS AN ADAPTATION IN A "PSYCHONEUROIMMUNOENDOCRINE SYSTEM" -- CONCEPTUAL FRAMEWORKS -- Bereavement as a Stressor.

Social Relationships as Biological Regulators -- Grief and Depression on a Neurobiological Continuum -- CONCLUSIONS -- REFERENCES -- Monkeys' Responses to Separation and Loss -- CHAPTER 7 Monkeys' Responses to Separation and Loss -- VARIATIONS IN THE RESPONSE TO LOSS -- PHASES OF REACTION TO LOSS -- The "Protest" Phase -- Despair/Depression Phase -- Detachment Phase -- PRESEPARATION INFLUENCES -- The Nature of the Attachment Bond -- Artificial Mother Surrogates -- Response of Older Subjects to Loss -- EFFECTS OF THE SEPARATION ENVIRONMENT -- Social Environment -- Physical Environment -- Suggestions from the Environmental Data -- RESEARCH RECOMMENDATIONS -- REFERENCES -- Sociocultural Influences -- CHAPTER 8 Sociocultural Influences -- THE SOCIETAL CONTEXT -- Social Support -- THE CULTURAL BACKDROP -- Mourning Rituals -- CONCLUSIONS AND RECOMMENDATIONS -- REFERENCES -- Roles of Health Professionals and Institutions -- CHAPTER 9 Roles of Health Professionals and Institutions -- ROLES DURING THE DYING PERIOD -- PRACTICES AROUND THE TIME OF DEATH -- The Special Problems of Sudden Death -- Autopsy Requests -- CONTINUING RESPONSIBILITIES OF HEALTH PROFESSIONALS AND INSTITUTIONS -- ENHANCING THE WORK OF HEALTH PROFESSIONALS -- Institutional Support -- Education of Health Professionals -- CONCLUSIONS AND RECOMMENDATIONS -- REFERENCES -- Bereavement Intervention Programs -- CHAPTER 10 Bereavement Intervention Programs -- THE MUTUAL SUPPORT APPROACH -- The Widow-to-Widow Model -- Efficacy of the Mutual Support Approach -- HOSPICES -- The Impact of Hospice Bereavement Programs -- PSYCHOTHERAPEUTIC INTERVENTIONS FOR THE BEREAVED -- The Impact of Psychotherapy with the Bereaved -- THE ROLE OF MEDICATIONS -- Anti-Anxiety Drugs -- Hypnotics -- Antidepressants -- Theoretical Issues -- Recommendations for Clinical Practice -- Recommendations for Research.

SUMMARY AND CONCLUSIONS -- Should All Bereaved People Be in an Intervention Program? -- Which Programs Are Appropriate for Whom ? And When? -- How Effective Are the Various Interventions? -- Recommendations for Future Preventive Intervention Research -- REFERENCES -- Conclusions and Recommendations -- CHAPTER 11 Conclusions and Recommendations -- WHAT CAN BE CONCLUDED FROM AVAILABLE RESEARCH EVIDENCE ABOUT THE HEALTH CONSEQUENCES OF BEREAVEMENT? -- ARE THERE PREVENTIVE INTERVENTIONS THAT SHOULD BE MORE WIDELY ADOPTED IN THE HEALTH CARE SYSTEM? -- Practice Recommendations -- Public Education -- WHAT FURTHER RESEARCH WOULD BE ESPECIALLY PROMISING TO PURSUE? -- Research on the Processes and Outcomes of Bereavement -- Research on Intervention Strategies -- Subject Index.