Yearning Most Salient Feeling Following A Loss

Contrary to accepted theory, yearning and acceptance are the two most salient emotions individuals experience after a significant loss, according to a Yale School of Medicine study in this week's Journal of the American Medical Association.

The study is believed to be the first to empirically assess the stage theory of grief commonly attributed to Elizabeth Kubler-Ross, a Swiss physician, and relied upon heavily in medical education. The study examined disbelief, yearning, anger, depression and acceptance.

"We found that disbelief was not the initial, dominant grief indicator," said lead author Paul Maciejewski, assistant professor of psychiatry and director of the Statistical Modeling Core of Women's Health Research at Yale. "Acceptance is the norm in the case of natural deaths, even soon after the loss. And yearning, not depression, was the most common potentially adverse psychological response."

Maciejewski said yearning is the defining feature of grief and is an emotion that most clearly reflects the absence of the deceased. "Yearning is a longing for reunion with the deceased loved one, heartache about an inability to reconnect with this person. Individuals may cognitively accept the death of a loved one, but they may still pine for them and experience pangs of grief (i.e. yearning)."

According to the study, disbelief, anger, and depression were not as prominent as yearning and acceptance in absolute terms. However, each grief indicator varied as a function of time post-loss. In partial support of the stage theory, disbelief reached its peak immediately following the loss. Yearning anger and depression reached their respective peaks at four, five and six months post-loss, and acceptance reached its peak beyond six months post-loss.

These feelings peak and begin to decline by six months in the case of a natural death, the researchers said. Those who experienced the loss were more likely to be accepting of the death if it occurred within six months or longer after a diagnosis. More problematic are deaths due to trauma or that occur within six months or less of diagnosis.

"The persistence of negative emotions beyond six months following the death reflect a more difficult than average adjustment and suggests a need for evaluation by a mental health professional and potential referral for treatment," Maciejewski said.

The study was based on interviews with 233 bereaved individuals living in Connecticut between January 2000 and January 2003. The vast majority were spouses of the deceased and the remaining were adult children, parents, or siblings of the deceased.

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Co-authors include Baohui Zhang, Susan Block and Holly Prigerson, all of Harvard.

The work was supported by grants from the National Institute of Mental Health, the National Cancer Institute, the National Institute of Neurological Disorders and Stroke, Dana-Farber Cancer Institute, and Women's Health Research at Yale.

JAMA 297: February 21, 2007

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