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Complicated bereavement: A national survey of potential risk factors

Cleveland Clinic, The Cleveland Clinic Foundation, Cleveland Ohio

Kristine A. Nelson, MD

Cancer Treatment Research Foundation, Arlington Heights, Illinois

Declan Walsh, MSc, FACP, FRCP (Edin)

The Cleveland Clinic Foundation, Cleveland Ohio

We developed a Bereavement Risk Questionnaire to rate 19 possible factors for assessing complicated bereavement. A four-point scale was used (0 = no risk, 3 = significant risk). The questionnaire was mailed nationwide in the United States to 508 hospice bereavement coordinators, and 262 responded. Most rated the following as significant risks: perceived lack of caregiver social support (70 percent), caregiver history of drug/alcohol abuse (68 percent), caregiver poor coping skills (68 percent), caregiver history of mental illness (67 percent), and patient is a child (63 percent). Overall, 61 percent chose perceived lack of social support, and 47 percent chose poor coping skills, as one of the top three risk factors. There was no relationship between professional discipline and responses. We found a consensus among bereavement professionals regarding important indicators in assessing bereavement risk. We conclude that it is possible to assess bereavement risk in caregivers of seriously ill patients, prior to the death of the patient. This would allow palliative care teams to allocate resources and services to those at the greatest risk for complicated bereavement.

Key Words: complicated bereavement • grief • palliative care • risk factors

American Journal of Hospice and Palliative Medicine®, Vol. 20, No. 2, 114-120 (2003)
DOI: 10.1177/104990910302000209


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