Risk assessment and
It has long been thought that grief is associated with illness, to the extent that some people may even die of a 'broken heart'. Research provides some support to these beliefs. Stroebe and Stroebe (1987), in a comprehensive review of the empirical research, conclude that there is substantial evidence that bereavement is associated with serious health risks. However, experiences of bereavement vary and while health is frequently affected in the short term, only a minority of people suffer lasting poor health. One line of enquiry has focused on identifying the factors that influence the course of grief. If it is possible to predict those whose health may be 'at risk', then it may be possible to intervene to prevent 'pathological' grief, a concept that is framed in terms of health deterioration. In this chapter, I explore the concept of risk in relation to bereavement, risk factors and their use in palliative care. Is it possible to predict those who may need help? If so, what are the implications for bereavement services and how transferable are methods of risk assessment pioneered in palliative care?
The relationship between health and illness is increasingly explained in terms of risk (Petersen and Lupton 1996). A major focus has been on identifying personal characteristics, behaviour and environments that predispose individuals to ill health. The health consequences of bereavement are well documented. Bereaved people frequently experience short-term health problems arising from changes in everyday behaviour, such as loss of sleep, altered nutrition and increased use of alcohol and tobacco. Bereavement may also affect the endocrine (Kim and Jacobs 1993) and immune systems (Bartrop et al. 1977; Schleifer et al. 1983), particularly among those who are depressed (Irwin and Pike 1993). A substantial minority of bereaved people