A Phenomenological Investigation of Support Seeking Among Older Adults with Complicated Grief

Background and Purpose: Complicated grief (CG) is a recently recognized mental health condition affecting about 7% of bereaved individuals; older adults are at greater risk for the condition than younger adults (Kersting, 2010). CG is gaining increasing public recognition as it is considered for inclusion in the next addition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5). Though there is evidence that specialized therapeutic interventions can reduce CG symptoms, little is known about how and why older adults with CG seek professional support for their grief. Greater understanding of treatment-seeking experiences is needed for targeting efforts to engage those with CG in effective care.

Methods: In this qualitative study, using the descriptive phenomenological method, eight adults aged 62 to 88 who had completed participation in a larger NIMH-funded randomized controlled trial of CG treatment, the Complicated Grief Treatment in Older Adults (CGTOA) study, were interviewed. Purposeful sampling was used to select participants who varied by gender, ethnicity, and type of loss. Topics covered included: the process of identifying themselves as having CG, barriers to professional treatment-seeking, types of treatment sought, and the influence of natural social supports on treatment-seeking. Interviews were audio-recorded, transcribed, and analyzed by the author. Master themes were identified via a close review of transcriptions, coding of “meaning units” of the support-seeking experience, processes of reflection and imaginative variation, and synthesis of meaning units into a consistent description of the support-seeking experience.

Results: Several master themes arose in analyses, which were experienced by all participants in their support-seeking process: 1) Observing that their grief was causing a great deal of emotional distress and role impairment 2) A realization that grief was not meeting their own or others expectations of what grief “should be”, 3) The role of social support- both a failure of existing social support and being told by others that they needed help, 4) A lack of effectiveness of support groups and/or care from mental health professionals seen before the CGTOA study; and 5) Reactions to the label of “complicated grief” and a sense that CG-specific treatment could be of help. Most providers encountered before CGTOA study entry were unfamiliar with CG and none were trained in its treatment. However, all participants felt that their CG required specialized care. Participants also sought support for CG in a non-linear fashion, with family and friends, physicians, and other mental health professionals influencing decisions to seek care.

Conclusions and Implications: The research presents the first qualitative study of treatment seeking among older adults who sought care specifically for CG. For most participants, finding effective care was a lengthy and complex process. Increasing awareness of CG and its treatment among providers, the general public, and bereaved older adults may help simplify treatment seeking in older adults with CG. Future research is also needed to better understand potential variability in help seeking by cultural factors, and on the intersection of internal processes and external social or cultural influences in CG support-seeking.