Stages of Grief Theory Put to the Test

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"The five stages have been accepted as gospel and truth without study. There's been no previous empirical research," said Prigerson.

And, that's where this study comes in. To test the five stages of grief, renamed in this study as the five indicators of grief, Prigerson and colleagues from Yale University School of Medicine recruited 233 adults living in Connecticut who had recently lost a loved one to participate in the study.

The study participants were predominantly white (97 percent), mostly spouses of the deceased (84 percent) and were an average of almost 63 years old. All of their loved ones had died of natural causes and had non-traumatic deaths. According to the study authors, this population represents the typical bereaved person in America.

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The study volunteers were interviewed at about six, 11 and 20 months after the loss of the loved one.

The researchers devised a grief indicator scale of one through five to indicate how strongly a grief emotion was being felt. A score of five meant that emotion was felt very strongly.

In the first six months after the loss, the average score for acceptance was 4.11, and yearning was 3.77. Depression was the next most common emotion with a score of 2.29, followed by disbelief with 2.27 and anger at 1.87.

During the next six months, all of the negative grief indicators, with the exception of depression, went down, and the level of acceptance went up. Depression scores stayed the same in the six- to 12-month period following the loss. During the next 12 months, all of the negative grief indicators declined, while acceptance continued to rise.

"Negative grief indicators peak at six months post-loss," said Prigerson.

"The expression of grief is a very complex phenomenon with a great deal of individual variability," said Shirley Otis-Green, a senior research specialist at City of Hope National Medical Center in Duarte, Calif.

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