Is it possible to die of grief? Science confirms that intense bereavement raises the risk of death
Prolonged sadness after the loss of a loved one nearly doubles the likelihood of death within 10 years, although the risk is higher in the first six months
The death, attributed to grief, of the cartoonist and filmmaker Marjane Satrapi, author of Persepolis, has brought back a recurring and widely studied question in the public imagination: is it possible to die of grief? Regardless of Satrapi’s personal circumstances — which remain unknown for now — science points to yes, while reframing the romantic idea within a biological explanation. For example, intense bereavement can worsen mental health, trigger cardiovascular problems and, ultimately, raise the risk of death. Satrapi’s family said on Tuesday that she died “of sadness a little more than a year after the death of Mattias Ripa, her husband and the love of her life.” They gave no further details.
Juan Carlos Pascual Mateo, a psychiatrist and member of the executive committee of the Spanish Society of Psychiatry and Mental Health, dismisses the epic rhetoric that comes with the notion of dying of grief or of love, and points to a biological interpretation instead: “Emotional states have physical effects. There is an impact on the hypothalamic–pituitary–adrenal axis [a neuroendocrine system that regulates the body’s stress response]; cortisol levels increase and this can affect the immune system, making it more depressed and vulnerable. All of that predisposes you to die from some disease. You do not die of sadness, but of another medical cause.”
This happens, for example, with events that favor a depressive clinical picture, such as bereavement. That condition, in turn, can cause other illnesses — depression is associated with poorer cardiovascular and metabolic health, obesity, immune system alterations — and it also raises the risk of suicide, Pascual Mateo illustrates.
Grief after the death of someone who was close is natural; it is part of an adaptation process. It is normal to feel sadness and despondency. The problem arises when those emotions become entrenched and disabling. A Danish study of more than 1,700 people who had lost loved ones found that those with more intense and prolonged grief symptoms visited the doctor more often, used more psychotropic medication (anxiolytics and antidepressants), and had up to an 88% higher risk of death over a 10-year period.
Those entrenched sorrows have a name in medical parlance. Guillermo Lahera, professor of psychiatry at the University of Alcalá, writes in an article in EL PAÍS that “when the grieving process ceases to be adaptive, is persistent and prevents the person from recovering functionality,” it is called prolonged grief disorder. “Its clinical presentation is very similar to major depression and, sometimes, to post-traumatic stress disorder; like those conditions, it is associated with higher mortality from physical causes. The key is not the intensity or duration of the pain, it is its rigidity. Because the transformation implied by adaptive grieving has not occurred, the inner world remains ‘fixed’ on the presence of the absent person, and healing implies ‘betraying’ the deceased,” he says.
The scientific literature on mortality risk among people in grief is mixed. Some studies, like the Danish one, do find an increased likelihood of death and others do not see it as clearly. The Danish authors attribute these discrepancies to the “heterogeneous” profile of bereaved relatives and to multiple risk factors that add to or reduce vulnerability: for example, caregiving for a close person can buffer stress in those experiencing a loss; by contrast, if someone in grief is also suffering distress because of their own physical illness, that may increase vulnerability.
A review in The Lancet found that the probability of mortality is also higher in the first six months after the loved one’s death and declines over time, although in some cases (parents who lose a child, for example) that risk can remain elevated for years.
When the loss is of a partner — most studies focus on that particular scenario — the mortality risk is higher among younger people and among widowed men. Causes of death that were observed range from accidents, violent causes and alcohol-related illnesses to cardiovascular problems and suicide. “Mortality associated with grief is largely attributed to the so-called broken heart. That is, the psychological distress caused by the loss, such as loneliness; and the secondary consequences of that death, such as changes in social ties, living arrangements, eating habits and financial support,” the authors add.
The suffering associated with grief encompasses physical, emotional, cognitive and social dimensions. But not everyone is equally vulnerable to developing pathological grief. According to the Danish study’s authors, a history of mental health problems and a low level of education are risk factors for long-term psychological distress in bereaved relatives.
‘Broken heart syndrome’
The death of a loved one is, in itself, a highly stressful situation. And the emotional burden can also have organic repercussions beyond the impact on mental health. In cardiology, for example, there is a condition closely linked to life events with major impact: Takotsubo syndrome, colloquially known as broken heart syndrome. According to the Spanish Heart Foundation, this condition resembles a myocardial infarction, but, unlike a heart attack, there are no blocked arteries in the heart to explain the cardiac dysfunction.
“Eighty-five percent of reported cases are postmenopausal women [at this stage they have lost the cardiovascular protection provided by estrogens], with sudden and unexpected emotional or physical stress causing an excessive release of adrenaline, which can temporarily damage the heart in some people,” the scientific organization explains. Common triggers include news of an unexpected death of a loved one, a frightening medical diagnosis or stressful situations such as public performance, divorce or natural disasters. Pascual Mateo admits that in three decades of his career he has encountered only one case.
There are many trajectories of grief and most are adaptive, experts remind us. Lahera stresses, in fact, that in the majority of cases this life event should not be treated with medication or therapy, but simply lived through: “Grief is not a linear process, nor a series of phases to be checked off, nor a transient depression caused by mere biochemical imbalance. It is a disorder of time and of the body.”
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