It has been estimated that a third of all major bereavements result in problems where professional help may be required (Raphael, 1983). For example, conjugal bereavement, when there is intense loneliness, appears to increase health risk, often resulting in the death of the surviving spouse (M. Stroebe & Stroebe, this volume; Maddison & Viola, 1968; Parkes & Brown, 1972). Similarly, the death of a child is associated with high morbidity in surviving parents (Fish, 1986; Rando, 1983; Sanders, 1986). Other factors, such as sudden death, lack of perceived support, or reduced material resources, have also been implicated as associated with high health risk. This chapter focuses on high-risk factors for poor outcome of bereavement, separating them into four general categories: biographical/demographic factors, individual factors, type and mode of death, and circumstances following the loss. It pays particular attention to the interaction and overlapping of these factors, which can cause greatly increased health risk.

It must be noted from the outset that a variety of methodological concerns cloud the interpretation of available data on bereavement research. For example, generalizability must be questioned when samples are composed of women primarily. Too, because of the private nature of grief in our culture and the inaccessibility of subjects, only those individuals who “volunteer” to participate can be included. This bias in subject selection introduces the possibility that a significant section of the population might evidence differing forms of grief than the ones described in the current literature.