Traumatic loss: Mental health consequences and implications for treatment and prevention

Figures & data

Table 1. Hypothetical staging, profiling, and stepped care model for grief.

Stage	Characteristics	Clinical characteristics	Risk and protective factors	Interventions
0	Confronted with bereavement with signs of acute grief	Distress and disability: Low	Personal: Moderate-high socioeconomic status (SES); Loss: Low-risk (single, timely natural loss); Social context: Supporting	None, community support
1a	Undifferentiated symptoms of grief, sadness, dysphoria, anxiety	Distress and disability: Low–Mild	Personal: Moderate–high SES; some vulnerable personality traits; Loss: Low-risk; Social context: Supporting	Self-help; psycho-education; watchful waiting
1b	Subsyndromal signs of PCBD/PGD	Distress and disability: Mild–Moderate	Personal: Some vulnerable personality traits; Loss: Low-risk with additional stressors or high-risk (sudden, untimely, and/or traumatic loss); Social context: Supporting	Non-assisted online interventions; counselling; social work
2	First episode of full-threshold PCBD/PGD	Distress and disability: Moderate–Severe	Personal: Vulnerable personality, previous loss experiences; Loss: High-risk Social context: Impaired support	Psychotherapy (e.g. cognitive behavioural therapy, complicated grief treatment, brief eclectic psychotherapy, EMDR)
3	Persistent symptoms which may fluctuate with ongoing impairment: (i) Incomplete remission of first episode; (ii) Recurrence and/or persistent impairments; (iii) Multiple relapses or worsening following incomplete treatment response	Distress and disability: Severe (any serious impairment in functioning)	Personal: Vulnerable personality, previous loss experiences, migration, low SES; Loss: High-risk, traumatic, and multiple Social context: Lack of support	Psychotherapy; Day patient treatment; Medication
4	Unremitting PCBD/PGD of increasing chronicity with substantial comorbidity (depressive disorders, posttraumatic stress disorder)	Distress and disability: Very severe (major impairment in several areas)	Personal: Vulnerable personality, previous loss experiences, migration, low SES, childhood adversity Loss: High-risk, traumatic, and multiple Context: Lack of social support, low SES	Day patient/inpatient treatment; Medication