The biology of grief

Losing a loved one can be a critical life event and one of life's most painful experiences. Competency in grief support is multidimensional, and paramedics not only need to be competent in supporting patients in the initial stages of bereavement, but also in recognising and supporting patients who are experiencing what is referred to as complicated grief. Paramedics should be able to identify the behavioural, physical and cognitive symptoms of someone experiencing complicated grief (Cicchetti et al, 2016).

The differentiation between grief, complicated grief and depression is essential, as treatment pathways are significantly different (Schneider, 1980).

Complicated grief can include recurrent painful emotions and preoccupation with thoughts of the deceased accompanied by yearning, longing and searching (Boelen and van den Bout, 2005).

Grief is considered a normal reaction to a significant loss; sadness, loneliness and exhaustion are common occurrences. However, these symptoms are generally self-limiting. The initial symptoms of grief are the same as complicated grief; however, unlike normal grief, which gradually subsides, those of complicated grief persist and can be intensified. In comparison, depression is characterised by a broad range of feelings, thoughts and physical manifestations, including low self-esteem, suicidal thoughts, pessimism, and feelings of dejection and hopelessness (Schneider, 1980). Grief and depression have certain similarities; however, Table 1 demonstrates the key differences.