Hidden grief reactions on a psychiatric consultation service

Assessment of the family and social relationships of 123 medical and surgical patients consecutively referred to the psychiatric consultation-liaison service revealed that acute or unresolved grief was present in 15% of patients. Patients with unresolved grief often presented with depression and/or conflict with the medical or nursing staff. The referring physician in most cases recognized the presence of acute grief; however, all cases of unresolved grief presented as "hidden" grief reactions. Patients with acute grief rarely had associated psychiatric illness, whereas all patients with unresolved grief had concurrent psychiatric disorders. The management of acute and unresolved grief in hospitalized medical or surgical patients is discussed, and illustrative cases are presented.