Grief-Related Chest Pain: A Review, Conceptual Analysis, and Integrative Model

Although the death of a loved one is a ubiquitous experience with chest pain a commonly reported symptom, grief-related chest pain and particularly its physiological mechanisms remain under-investigated. To address this gap, we adopted Rodger's approach to concept analysis to explore the psychoneuroimmunological mechanisms potentially linking bereavement to chest pain and subsequent health outcomes. A PubMed search, followed by a systematic review of existing literature and clinical observations, yielded 220 articles, of which 49 were included in the conceptual analysis. Notably, only four empirical studies specifically examined grief-related chest pain, but without underlying physiological mechanisms, while 45 studies explored psychoneuroimmune processes more broadly in the context of loss, grief, and bereavement. Based on these findings, we propose a theoretical model of grief-related chest pain. The model integrates insights from studies on autonomic, hemodynamic, musculoskeletal, respiratory, neuroendocrine, and immune changes during grief. It summarizes antecedents, attributes, and consequences of grief-related chest pain, highlighting the putative interrelated roles of physiological, neuroendocrine, and immune pathways. Our model suggests that grief-related chest pain may constitute a key physical symptom of grief, arising from physiological responses to acute emotional distress and loss. A deeper understanding of the psychobiological mechanisms underlying this phenomenon may provide prognostic insights, inform disease prevention, improve patient care, and guide the development of targeted interventions. Building on this perspective, we also propose a toolkit to facilitate the assessment of grief-related chest pain in future empirical studies.