The Grief Study aims to estimate the prevalence of poor mental health outcomes among people who have suffered a bereavement. To do this, we will combine data from the Northern Ireland Longitudinal Study, the Northern Ireland Mortality Study and the Electronic Prescribing Database. The Northern Ireland Longitudinal Study (NILS) is a random anonymised sample of 28% of the Northern Ireland population whose responses to the 2001 UK Census have been held and linked to GP registration information. Like all of us, a proportion of this sample will have lost someone close to them since the beginning of the study. It is possible to identify those who have lost someone living at the same address as them, and to compare their mental health outcomes to the rest of the population.
Our proxy measure for poor mental health is prescription of anti-depressant or anxiolytic drugs in the post-bereavement period. This Distinct Linkage Project (DLP) allows for comparison of mental health outcomes between bereaved and non-bereaved individuals and for extensive analysis of particular populations of interest. The following five research questions illustrate the scope of the project and the particular bereaved groups whose experiences we want to better understand.
1. Does bereavement lead to an increased risk of poor mental health?
2. Does the likelihood of poor mental health following bereavement vary according to the cause of death?
3. To what extent do individual, household, and area characteristics mitigate or compound the risk of poor mental health following bereavement?
4. Does the ‘risk profile’, in terms of the magnitude of risk conferred by individual, household and area characteristics, differ between those bereaved following an expected death, sudden death, violent death or suicide?
5. To what extent does bereavement confer an increased risk of mortality, particularly when accompanied by poor mental health?
Question 1: Does bereavement lead to an increased risk of poor mental health?
Evidence suggests that bereavement is a major life event and considered a major stressor. Losing a loved one can hasten one’s own death, but we don’t know to what extent this is preceded by suffering which is significantly greater than that of the general population at large. By comparing the additional likelihood of being prescribed anti-depressant or anxiolytic drugs following a bereavement, we can attempt to measure how much suffering bereavement causes.
Question 2: To what extent do individual, household, and area characteristics mitigate or compound the risk of poor mental health following bereavement?
Grief reactions won’t be the same for everyone. By comparing bereaved individuals who have poor mental health outcomes with other bereaved individuals, we can develop a profile of individual characteristics and social factors which dispose someone to a more intense grief reaction. For example, we will be looking at whether grief reaction is more or less severe depending on sex, age, area deprivation and whether the bereaved individual provided care to the deceased.
Question 3: Does the likelihood of poor mental health following bereavement vary according to the cause of death?
The circumstances of an individual’s bereavement and the nature of the death of their loved one has potentially huge impact on their ability to cope. For example, there is widespread public concern over how a person copes after the sudden death of a young or middle-aged member of their family, particularly where the person has died by suicide. This concern reflects an appreciation for how the circumstances of death can potentially confer severe risk on a bereaved person.
Question 4: Does the ‘risk profile’, in terms of the magnitude of risk conferred by individual, household and area characteristics, differ between those bereaved following an expected death, sudden death, violent death or suicide?
This is an exploratory question to which studies to date give no satisfactory answer. If question 2 asks whether different some categories of person are differently affected by bereavement and question 3 asks whether some categories of death cause people to be differently affected, question 4 asks whether those particular deaths have a greater effect on everyone or only on particular categories of person. For example, we look at whether the extra mental ill-health suffered after a suicide is more pronounced for women or for men; whether better education protects against suffering following particular types of death, but not others.
Question 5: To what extent does bereavement confer an increased risk of mortality, particularly when accompanied by poor mental health?
Mortality is the more commonly studied outcome from bereavement, and several studies indicate that a bereaved person will die sooner than someone of the same age and physical health. However, none of these studies have had the measures available to examine why a bereaved person is at risk of dying and whether this risk is due to mental health deterioration.
We’re grateful to the Grief Study’s Knowledge Exchange Working Group for their input to date on these questions. If you would like more information about any of these research questions, please leave a comment, send us a tweet (John_ICCR ; Aideen_ICCR ; Mark_ICCR) or email j.moriarty [AT] qub.ac.uk. If you have information or insight which you think could be of value to the team, please share it with us.