Grief is a natural response to loss. It is not a disorder. At the same time, grief can sometimes deepen into depression that needs treatment. Knowing where one ends and the other begins is part of taking grief seriously.
Quick view
- Acute grief is universal and is not a mental disorder.
- About 7 to 10 percent of bereaved adults develop prolonged grief disorder, a separate DSM-5-TR diagnosis added in 2022 (Lundorff et al., J Affect Disord, 2017).
- Grief and a major depressive episode can co-occur; both can be present at once and both deserve attention.
- Suicidal thoughts during grief are not normal grief and are a reason for prompt evaluation.
DSM-5-TR diagnostic criteria
Prolonged grief disorder was added to the DSM-5-TR in 2022. It requires the death of a close person at least 12 months ago in adults (six months in children and adolescents), with persistent yearning or longing for the deceased and/or preoccupation with thoughts or memories of the deceased. At least three of the following must be present in the past month and most days, with clinically significant distress or functional impairment: identity disruption, marked sense of disbelief, avoidance of reminders, intense emotional pain, difficulty re-engaging with life, emotional numbness, sense that life is meaningless, and intense loneliness. The duration and severity exceed expected social, cultural, or religious norms.
Major depressive disorder can occur alongside grief. The DSM-5 removed the bereavement exclusion in 2013, recognizing that a major depressive episode can develop in the setting of loss and benefits from the same treatment as depression in any other context. The clinical task is to distinguish acute grief from a depressive episode layered on top of it, since the two often overlap.
Epidemiology
Approximately 50 to 85 percent of adults experience the death of someone close in any given decade. A meta-analysis of 14 studies estimates that about 7 to 10 percent of bereaved adults develop prolonged grief disorder (Lundorff et al., J Affect Disord, 2017). Risk factors include sudden, violent, or unexpected loss; loss of a child or spouse; close kinship; prior depression or anxiety; and limited social support. Suicide risk is elevated in the first months after a major loss, particularly the loss of a spouse or a child.
What grief usually looks like
Waves of sadness, often tied to reminders. Periods of laughter and connection between the waves. A capacity to remember the person or thing lost, to feel love, to feel anger, to feel relief, often all in the same day. The sharp pain softens over months, though it can return on anniversaries and milestones. Grief is not linear; the "stages" are descriptions of common features, not a required sequence.
When grief becomes depression
Self-criticism that is global and persistent. Hopelessness that does not lift between reminders. Thoughts of suicide. A sense of worthlessness that goes beyond the loss. An inability to function in core areas of life for months. Pervasive anhedonia rather than focused longing for the deceased. These features point toward a depressive episode layered on grief, which can be treated.
How it shows up in different people
- In adults, grief and depression frequently coexist after the loss of a spouse or a parent.
- In adolescents and children, the criteria use a six-month threshold and the presentation often includes school avoidance and irritability.
- In older adults, bereavement after the loss of a long-term spouse carries elevated mortality risk and warrants close follow-up.
- In men, grief is sometimes expressed primarily as anger or as withdrawal into work; underreported sadness can delay care.
- After perinatal loss (miscarriage, stillbirth, neonatal death), grief is often disenfranchised and undersupported despite high rates of subsequent depression and anxiety.
Screening
The PHQ-9 captures depressive symptoms regardless of context. The Brief Grief Questionnaire and the PG-13-R are validated tools for prolonged grief disorder. A clinician asks about the time since the loss, the nature of the relationship, and whether thoughts of joining the deceased or of suicide are present.
When to seek same-day care
Suicidal thoughts with intent or a plan, thoughts of joining the deceased that include intent, inability to keep yourself safe, or new psychotic symptoms are reasons for same-day care. Call 988, call 911, or go to the nearest emergency department.
What helps
Time, contact, and routines. Most acute grief does not require formal treatment. Social contact, gentle return to routines, sleep, movement, and rituals that honor the loss are protective.
Therapy. When symptoms persist or meet criteria for prolonged grief disorder, complicated grief therapy (a structured 16-session protocol with strong evidence) and cognitive behavioral therapy for prolonged grief are the best-studied options (Shear et al., JAMA, 2005).
Medication. When a co-occurring major depressive episode is present, the same treatments used for depression apply, with adjustments for the context. Medication does not "treat grief" but can help when depression has layered on top.
Sources
- American Psychiatric Association. DSM-5-TR. 2022.
- Lundorff M, et al. Prevalence of prolonged grief disorder in adult bereavement: a systematic review and meta-analysis. J Affect Disord. 2017.
- Shear K, et al. Treatment of complicated grief: a randomized controlled trial. JAMA. 2005.
- National Institute of Mental Health. Depression overview. Accessed 2026.
- American Psychiatric Association. Prolonged grief disorder. Accessed 2026.
Related
Major depressive disorder. Living with depression. Treatment.
