Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Dr. Scott Vrana


There has been growing support for the idea that complicated grief symptoms following bereavement are independent of symptoms of depression and anxiety. However, the loss of a loved one is not the only or the most frequent type of loss to be encountered. The onset of an insidious medical illness may trigger a mourning process for the lost function or body part that is posited to also involve feelings of grief. While the risk of depression is high among a medical or rehabilitative population, the impact of grief over functional losses has never been empirically investigated as a contributing factor in the patient's emotional and physical functioning following illness. Currently, many assume that grief and depression are part of the same condition within the medical context. However, it may be that symptoms conceptualized as grief in the bereavement literature can be identified and distinguished from depressive symptoms within a medically ill population.The aims of the current study were to: (1) investigate the reliability and validity of the Loss Inventory (Niemeier, Kennedy, McKinley, & Cifu, 2004), a newly-developed measure used to assess intrapersonal grief, (2) explore the relationship between grief and depression, and their distinction from one another, using principal components analysis among their respective symptom items, and (3) examine the unique and added contribution of grief on concurrent and prospective emotional and physical health outcomes (i.e. self-esteem, intrusive thoughts and avoidant behavior, global well-being, sleep quality, state anxiety, activities of daily living, and number/severity of co-morbid illnesses).Two hundred and ten Parkinson's disease and Essential Tremor patients recruited from a VAMC Hospital completed questionnaires at baseline and five to six months later. The Loss Inventory proved to be a reliable and a valid measure of intrapersonal grief. Principal components analysis supported the distinction between intrapersonal grief and depression symptoms as measured by symptoms from the Loss Inventory and Zung SDS. Finally, grief symptoms significantly predicted several concurrent and prospective emotional and physical health outcomes after controlling for disease stage, disability, and depression. In sum, the present findings lend support to the hypothesis that bereavement-related symptoms can occur and are meaningful after functional losses from medical illness.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

June 2008

Included in

Psychology Commons