BACKGROUND: Bereavement after the death of someone close is universal, and clinicians may be uncertain if or what interventions may be beneficial.
PURPOSE: To synthesize effects of health care interventions for bereaved children and adults.
DATA SOURCES: Eight databases were searched from inception in September 2025, supplemented with screening reviews, guidelines, federal register entries, and expert input.
STUDY SELECTION: Dual independent reviewers selected randomized controlled trials (RCTs) comparing interventions for bereaved or soon-to-be bereaved persons with usual care, no intervention, or an alternative intervention.
DATA EXTRACTION: Outcomes were evaluated using the abstractor-checker model. Risk of bias was assessed; random-effects meta-analysis was used for effect estimates; multiple effect modifiers were explored; and applicability, generalizability, and strength of evidence (SoE) were determined.
DATA SYNTHESIS: A total of 169 RCTs reported in 303 publications evaluated psychotherapy; expert-facilitated support groups; pharmacotherapy; peer support; self-help interventions; writing, music, and art therapy; enhanced provider contact; and integrative medicine for bereaved persons. Risk of bias was substantial, and only 15 RCTs included children. There was moderate SoE that individual psychotherapy improves grief disorder, grief, and depression symptoms and low SoE that expert-facilitated support groups and enhanced contact with health care providers may improve depression symptoms. Other interventions showed conflicting results, indicated no benefit, or had insufficient SoE.
LIMITATIONS: Research focused on grief in adults, study populations were complex, and the review may have missed culturally specific interventions.
CONCLUSION: Psychotherapy can improve key outcomes in bereaved adults, and expert-facilitated support groups and enhanced provider contact may also provide benefits. Evidence for other bereavement interventions, approaches for children, and outcomes beyond general grief or grieving, grief disorder, and depression symptoms is limited.
PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality. (PROSPERO: CRD42023466057).
| Discipline Area | Score |
|---|---|
| Public Health |  |
| Family Medicine (FM)/General Practice (GP) | |
| FM/GP/Mental Health | |
| General Internal Medicine-Primary Care(US) | |
| Psychiatry | |
Excellent review of an always hot topic: how to better help people suffering from the death of a loved one. Relevant in all areas of clinical practice.
This complex study looked at grief disorder and tried to see which parts of the process could benefit the resolution of grief. They discovered that only physiciatric counseling would lead to a measurable and reliable relief. The other treatments like self help, spiritual counseling, or art therapy did not produce any measurable improvement in grief.
A really good study on a very important topic.
Primary care clinicians may know that therapy is helpful for grief, but not to the level of detail or evidence provided by this review.
Reviews that are this massive can provide an overview of where prior research exists (and reveal gaps); however, they do not shed much light that is useful to clinicians. To be more specific, the authors lump together normal and pathologic grief, which I find problematic. An obvious question not addressed is: why should treatment be an intervention for normal grief?
As a geriatric psychiatrist, this systematic review provides evidence to support the potential benefit of individual therapy as well as expert-led group therapy for treating symptoms associated with bereavement. The finding that the evidence was stronger for individual therapy may change my clinical practice when seeing relevant patients; that is, prioritizing grief-focused individual therapy as an essential intervention, followed by group therapy.
These results suggest a stressor-related disorder described as persistent complex bereavement disorder, according to the DSM - 5 [ F43.8]. These researchers indicate the benefits of psychotherapy, cognitive behavioral therapy, and expert facilitated support groups as useful interventions for patients with this disorder based on the I-squared proportions above 75% and the statistically significant standard mean differences of less than 1. In sum, I agree and support more clinically-oriented research on prolonged grief disorder or persistent complex bereavement disorder by clinicians like me who have access to patients in each of the three clinical settings studied by the researchers: outpatient clinics, inpatient-hospital settings, and hospice or long-term care / residential settings.
