By Ginette G Ferszt RN, CS, CT, PHD Associate Professor and
Mary Leveillee RN, CS, MS Assistant Clinical Professor
GRIEF IS A NORMAL experience, often with intense emotional pain, that commonly follows a significant loss such as the death of a loved one. Most grieving people integrate their loss over time, but some are more vulnerable to developing a depressive disorder during this difficult period.
Although everyone grieves differently, grief and depression share several common characteristics. Both may include intense sadness, fatigue, sleep and appetite disturbances, low energy, loss of pleasure, and difficulty concentrating. The key difference is that a grieving person usually stays connected to others, periodically experiences pleasure, and continues functioning as she rebuilds her life.
With depression, a connection with others and the ability to experience even brief periods of pleasure are generally missing. Sometimes people describe feeling as if they have fallen into a black hole and fear they may never climb out. Overwhelming emotions interfere with the ability to cope with everyday stressors.
Red flags for depression
When problems such as fatigue, insomnia, and indecisiveness persist from 2 weeks to several months and impair the bereaved person's functioning, depression may be responsible. Other red flags include inability to experience enjoyment, a grim outlook for the future, and a persistent, uncharacteristic negative self-view. Inappropriate guilt and remorse may dominate the person's life. He may feel as if a veil or a wall separates him from others.
Ironically, being with other people can reinforce feelings of separateness and aloneness.
If you suspect that a grieving patient is depressed, pay attention to how family and friends respond to his sadness. Typically, people willingly support someone who's grieving. If you sense a lack of support, consider if they're reacting to his ongoing depression. When their continued support doesn't help their loved one feel better, they may feel helpless and want to flee from his persistent negative view. Overwhelmed by emotions and unable to see any solution to suffering, he may consider suicide his only option to end the pain and lighten his family's burden.
History helps unravel the mystery
A history of trauma, accumulated losses, and concurrent stressors in someone experiencing grief increases the risk of depression. You can develop a detailed personal and family history, assessing for such risk factors as a parent's death at an early age, a history of childhood abuse, an eating disorder, and a family or personal history of mood disorders or alcoholism. Here are some ways to approach these sensitive topics.
Asking about family history. Ask if the patient remembers any family member going through periods when he slept a lot, couldn't function in his daily life, and needed to have others care for him?
Assessing for alcohol abuse. Ask about family history, consider that relatives who abused alcohol also may have had undiagnosed depression. Ask the patient about her own use of drugs or alcohol, which could escalate depression and put her at greater risk for suicide.
Tallying stressors. Ask the patient to describe past losses he or she has experienced, such as family deaths, divorce, assault, loss of a pet, and even possessions lost in a natural disaster. Find out when the losses occurred, how he dealt with them, whether other people supported him, and how. Then ask about current stressors in his life.
Listening to the language. When your patient describes her grief, does she focus on herself, with talk of self-blame or past wrongs? Does he express feelings of overwhelming guilt and an increasing sense of hopelessness? All these factors point to depression rather than grief alone, and call for an assessment by a mental health professional.
Getting help
If a mental health provider assesses your patient and diagnoses depression, she may prescribe medication to manage the symptoms. Some grief therapists believe that such intervention can interfere with grieving, but poor sleep or high anxiety levels compromise anyone's ability to cope. Medication may give your patient the energy needed in the grieving process.
For more information about depression, visit: www.namiflagstaff.org
Source: LPN2009 May/June 2009, Volume 5 Number 3