On bereavement and acceptance: Yale study of grief process

February 22, 2007



Denial. Anger. Bargaining. Depression. Acceptance.

Originally formulated in 1973 by Elisabeth Kübler-Ross, these five stages are well-known to many as the "Five Stages of Grief". However, despite their familiarity, the five-stage theory had remained untested empirically, until Paul K. Maciejewski, Ph.D., assistant professor of psychiatry at the Yale University School of Medicine and the Yale Bereavement Study completed several years of research, findings for which were published in the February 21 issue of the Journal of the American Medical Association (JAMA).

According to Dr. Kübler-Ross's theory, denial is the first and most defining indicator of grief. The Yale Bereavement Study's findings, in contrast, show acceptance to be the most common indicator, and yearning the strongest negative indicator.

The authors explain, "Disbelief decreased from an initial high at one month postloss, yearning peaked at four months postloss, anger peaked at five months postloss, and depression peaked at six months postloss. Acceptance increased steadily through the study observation period ending at 24 months postloss.”

Study author Holly Prigerson, associate professor of psychiatry at Harvard Medical School and director of the Dana-Farber Cancer Institute's Center for Psycho-Oncology and Palliative Care Research, says, "This would suggest that people who have extreme levels of depression, anger or yearning beyond six months would be those who might benefit from a better mental health evaluation and possible referral for treatment."

The Yale Bereavement Study followed the progress of 233 participants from January 2000 through January 2003 who had lost family, most often a spouse, and was funded by the National Institute of Mental Health, the National Cancer Institute, the National Institute of Neurological Disorders and Stroke, the Center for Psycho-Oncology and Palliative Care Research, Dana-Farber Cancer Institute, and Women’s Health Research at Yale University.