Wendy Lichtenthal, Ph.D., FT, FAPOS, Director of the Center for the Advancement of Bereavement Care at Sylvester Comprehensive Cancer Center, leads research focused on bereavement and the psychological needs of cancer patients and their families.

Distinguishing of Grief and Depression

Grief is a natural, expected response to a significant interpersonal loss. It is not pathological to grieve, but because grief impacts individuals emotionally, cognitively, behaviorally, physiologically, and socially, grievers may question if something is wrong with them. Periods of sadness and disinterest in activities that are characteristic of depression may come and go. These kinds of transient signs of grief are typical and not definitive symptoms of clinical depression or prolonged grief disorder, a syndrome characterized by protracted and debilitating grief.  

Using terms like “symptoms” to describe typical grief, which is commonly used to describe indicators of disease, can be misleading. Several studies have empirically distinguished symptoms of depression and prolonged grief disorder.

Dr. Lichtenthal and colleagues summarized distinctions between typical grief, prolonged grief disorder, and depression in the supplement of a 2020 paper in the Annals of Internal Medicine.

Typical grief involves yearning for the person who died and sadness that comes in waves. It tends to be more intense in the immediate wake of the loss, surging when the griever is faced with reminders of their loss.

“The griever learns to co-exist with their grief and adapts to the physical absence of the person who died over time. Individuals who might be considered for a diagnosis of prolonged grief disorder experience grief symptoms that do not diminish in intensity over time and are debilitated by their grief,” explained Dr. Lichtenthal, who is also a professor, pending rank, in the Department of Public Health Sciences at the University of Miami Miller School of Medicine.

Both typical and prolonged grief can be distinguished from depression, as the former is centered around the relationship. With depression, on the other hand, the sadness and loss of interest in activities are more pervasive, and depressive thoughts and feelings focus more on the self and other relationships, the world, and the future.

Such symptoms can co-occur; one meta-analysis, Co-occurrence of prolonged grief symptoms and symptoms of depression, anxiety, and posttraumatic stress in bereaved adults: A systematic review and meta-analysis, found that 63% of bereaved adults with prolonged grief disorder also had comorbid depressive symptoms.

Dr. Lichtenthal and colleagues discussed the challenges of diagnosing depression in the context of grief and bereavement in their paper, “The HAM-D6 Through the Lens of Grief.” Although a persistent loss of interest in things that one normally enjoys can be a sign of depression, grieving people may lose interest in social activities due to realistic concerns about how other people will react (or not respond) to their grief rather than because they are depressed. These nuances are critical to consider.

“Grief and periods of depressed mood often coexist,” explains Dr. Lichtenthal. “Yet it is crucial to understand the distinction between the natural grieving process and clinical depression to ensure patients and their families receive the appropriate care.”

Pioneering Psychosocial Interventions: From the Hospital to the Community

Dr. Lichtenthal’s groundbreaking work focuses on addressing the psychological needs of grieving individuals. She and her colleagues have pioneered interventions that aim to empower grievers and help them find meaning in their lives after loss.

These approaches are transdiagnostic, targeting both grief and depressive symptoms. Her research focuses on evaluating these interventions to help build an evidence base of effective support for grievers. It has become clear, however, that many healthcare professionals, and mental health providers in particular, do not receive training in evidence-based grief support. Dr. Lichtenthal is committed to changing this.

Addressing Depression in Bereavement: A Critical Public Health Issue

Beyond individual care, Dr. Lichtenthal’s research has broader public health implications. One of her primary areas of focus is developing models of psychosocial care that bridge the gap between hospital-based care and community-based support. She and her colleagues have advocated for a transitional bereavement care model, which highlights the importance of both developing institutionally-based resources for grievers as well as bolstering support in the community based on their level of need. This model is the cornerstone of the Center for the Advancement of Bereavement Care at Sylvester.

 “The public health model of bereavement highlights that different individuals need different levels of support after the loss of someone significant in their lives –– while everyone could use support, not everyone needs professional support,” said Dr. Lichtenthal.

“For those individuals who are experiencing depression, though, it may be beneficial to find professional support. And ideally, mental health providers who are supporting grievers experiencing depression have training in evidence-based bereavement interventions,” she continued.

This October, Depression Awareness Month offers an important opportunity to reflect on the mental health challenges met by individuals facing loss. Dr. Lichtenthal’s research provides valuable insights into how we can better support these individuals, ensuring that their mental health needs are recognized and addressed.

Written by Deycha Torres Hernández, published on October 30, 2024.