"There is a strong need for more evaluation of the efficacy of psychotherapeutic intervention programs for bereaved people, to better establish: (1) what type of help is [most] effective; (2) who precisely benefits from it; and (3) under what circumstances positive results are most likely to occur," said study author Margaret Stroebe, special chair of the Research Institute for Psychology and Health at Utrecht University in the Netherlands, in association with the Dutch Association for Grief Counseling. "Bereavement intervention is not indicated for all bereaved persons, just on the grounds that they have suffered the loss of a loved person... We need to increase understanding and channel resources to those who do need and are likely to benefit from professional help."

Even in the 21st century, grief carries with it a stigma that is hard to erase.

"So often in our society, grief is still viewed as something abnormal. You have to go back to work within two days, if you're lucky, five days," said Rebekah Lancto, bereavement coordinator at Metropolitan Jewish Hospice and Metropolitan Jewish Palliative Care, in New York City. "It doesn't go away six months later. In fact, that may be when grief really hits you, but life goes on, and people ask you why aren't you happy."

According to this article, death of a spouse is highly stressful and ranks as the life event needing the most "readjustment."

Others point to the difficulty of losing a spouse, especially during the first year.

"You may frequently see spouses engaging in leisure activities that they previously engaged in such as horseback riding or car racing or skiing that they might do now in a more dangerous way," said Rhoda Goldstein, a bereavement care coordinator for the Lippincott Family Hospice at Fox Chase Cancer Center in Philadelphia. "I frequently hear spouses say immediately after a death, 'My life has no meaning any more.' Many people have passive suicidal ideation, not that they intend to do anything deliberate to act on it, but they wish they wouldn't wake up in the morning."

According to Goldstein, some spouses may drink more heavily or use more prescription medications. And some spouses may have neglected their own health while taking care of an ailing husband or wife, leading to their own death.

The authors of the Lancet paper went through the available literature on grief and bereavement, focusing on papers published after 1997. Here are their main points:

• Most of the studies report gender differences in death rates after bereavement, with widowers (men) having a higher risk of dying after a loss than widows (women).
• The risk of dying appears to be higher for younger people who have lost a spouse than for their older counterparts.
• The risk of dying for widowed people is highest in the early months after the loss.
• The risk of death from suicide is also greater, with one study finding a 66-fold increased risk in the first week of bereavement for widowers and 9.6-fold for widows.

• Widows and widowers are more likely to have physical health problems, especially soon after the loss. Complaints include headaches, dizziness, indigestion and chest pain, and they result in higher rates of disability, drug use and hospitalizations.
• Research is starting to reveal biological links between bereavement and these physical ailments. For instance, bereavement can affect the immune system.
• Bereavement is also associated with different psychological symptoms and illnesses, including depression, anxiety, insomnia and social dysfunction.
• In extreme cases, losing a loved one can result in clinical depression or even post-traumatic stress disorder.
• Bereavement can also involve memory problems, loss of appetite and difficulty with concentration.
• Responses to a loss can range from mild and relatively short-term to more extreme and long-lasting, persisting for months or years.

In general, however, the authors stated, grief is a normal, natural process and "professional psychological intervention is generally neither justified nor effective for uncomplicated forms of grief."

"We try to educate people before they go through a death that this is healthy, normal response and being able to talk about it is a healthy, normal thing to do," Lancto said.

More information

The National Cancer Institute has more on loss, grief and bereavement.