The death of a loved one is recognized as one of life’s greatest stresses and has long been associated with increased health risk, especially for the surviving spouse or parent, although this is sometimes considered to be incidental rather than bereavement-related. In 1963, a follow-up of 4486 widowers, comparing their mortality to that of married men,1 reported a 40% increased mortality rate in the first 6 months of bereavement, with little differential thereafter. This finding, demonstrating a relationship between spousal bereavement and adverse health, has been confirmed.2-4 In a recent study2 bereaved Inhibitors,research,lifescience,medical participants had a higher risk than nonbereaved

participants of dying from any cause (RR 1.27; 95% CI 1.2 to 1.35) including cardiovascular disease, coronary heart disease, stroke, all cancer, smoking-related cancer, and accidents Inhibitors,research,lifescience,medical or violence. In one 10-year follow-up study, it was shown that increased health risk may continue for many years after bereavement, especially in surviving spouses (Figure Inhibitors,research,lifescience,medical 1).5 Figure 1. Distribution

of total morbidity rates per 1 00 person/ years in bereaved and control cohorts in a 10-year follow-up of bereaved spouses: A bereaved cohort and B control cohort. The difference between groups in morbidity rates arose from a general elevation … While the increased health Inhibitors,research,lifescience,medical risk in bereavement is well documented, the mechanism remains largely unexplained, possibly due to the perceived difficulties in conducting research at a time of great distress. Proposed explanations for the increased risk in bereaved individuals include Inhibitors,research,lifescience,medical the tendency of unfit people to marry similarly unfit spouses, and the possibility that the spouses may share with the bereaved the same pathogenic environment

and dietary and social factors.6,7 However, the increased risk among the bereaved persists after adjustment for spousal covariates,8 bias from common socioeconomic environmental and common lifestyles, Adenosine accidents shared with spouses,7 age, ethnicity, and see more education.3 It is therefore plausible that much of the increased health risk in bereavement stems from the impact of psychological grief reactions on, or in conjunction with, physiological responses, resulting in the early phases of bereavement becoming a vulnerable period for the bereaved person. The aim of this review is to document the evidence to date, identify physiological changes in the early bereaved period, and evaluate the impact of bereavement interventions on such physiological responses, where they exist. Neuroendocrine response Neuroendocrine response during early bereavement has been evaluated in several studies.