29 After a major blow

1985 patients with an acute heart attack, comparing different stretches of time in the same person, before and after the attack. Of them, 270 (13.6%) had lost an important person in the 6 months before the attack, and 19 had lost that person within 1 day before the heart attack. Within 24 hours after an important person died, the rate of acute heart attack was 21.1 times higher (95% CI 13.1–34.1, and the true multiple sits roughly between 13 and 34). After that it fell day by day. In actual counts: among people with a decade-long heart-attack risk of 5%, each 1394 people who had just lost a relative produced 1 extra case. Among people with a risk of 20%, each 320 people produced 1 extra case. Another study in Britain compared 30447 widowed people aged 60 to 89 with 83588 controls in similar circumstances. Within 30 days after the death of the spouse, a heart attack or a stroke occurred in 50 people on the widowed side (0.16%) and in 67 people on the control side (0.08%). The IRR was 2.20 (1.52–3.15), that is, the chance of the event was about 2.2 times the control group. Of that, heart attack was 2.14 (1.20–3.81), about 2.1 times. Stroke was 2.40 (1.22–4.71), about 2.4 times. After 30 days it weakened. Within 90 days they also looked at further illnesses. The first was acute coronary syndrome that was not a heart attack (an acute problem with the blood supply to the heart that still falls short of a heart attack), IRR 2.20 (1.12–4.29). The other was pulmonary embolism (a clot blocking a blood vessel in the lung), IRR 2.37 (1.18–4.75). The British National Health Service (NHS) lists the signs for which you should call the emergency number at once. A heart attack is pain in the chest as if it were being pressed or squeezed. The pain can spread to the arm, the neck, or the jaw, and there is also shortness of breath. A stroke is a side of the face drooping, an arm or a side of the body weak or numb, and slurred speech.

Data from Sweden’s national registers tracked over 6.07 million people (6,073,240 individuals) from 1991 to 2006. Compared with cancer-free controls, the relative risk of suicide in the first week after diagnosis was 12.6 (95% CI 8.6–17.8), meaning roughly 12.6 times higher. The true value lies somewhere between 8.6 and 17.8. The incidence rate during that week was 2.50 per 1,000 person-years — about 2.5 cases per 1,000 people each year. By the end of the first year this fell to 3.1 (2.7–3.5; 0.60 per 1,000 person-years), or roughly 3.1 times higher. Cardiovascular mortality in the first week was 5.6 (about 5.6 times higher) (5.2–5.9; 116.80 per 1,000 person-years), and over the first four weeks it remained at 3.3 times higher (3.1–3.4; 65.81 per 1,000 person-years). This elevated risk declines rapidly within the first year; the effect is more pronounced for cancers with poorer prognoses. Comparisons of the same patients over time yielded consistent results.

Data from 42 studies involving over 20 million participants and 235 mortality risk estimates show that, after adjusting for age and other factors, unemployed individuals face an average HR of 1.63 for all causes of death — meaning their risk is about 60% higher than that of employed people. This effect is more pronounced in men and in people early or midway through their careers, and smaller late in a career. Risk is highest in the first 10 years of follow-up and falls after that. In the part of the studies that also took health behaviors such as smoking and drinking into account, the average HR was 24% lower, that is, the calculated rise was about a quarter smaller.

A national registry in Denmark followed 6700000 adults, from 1980 to 2014, more than 136000000 person-years in all (the years each person was followed, added up). For people widowed because a spouse died by suicide, the risk of a newly diagnosed mental disorder within 5 years, compared with other people, was an IRR of 1.8 for men (95% CI 1.6–2.0), that is, about 80% higher. For women it was 1.7 (1.6–1.8), that is, about 70% higher. Compared with people widowed by other causes of death, the IRR was 1.7 for men (1.5–1.9) and 2.0 for women (1.9–2.2), that is, 70% higher up to double. In this group, suicidal behavior, mortality, and the share who needed municipal assistance were also higher. Physical illnesses such as cirrhosis and sleep disorders were higher as well. Another 57 studies were summarized separately, without pooling the arithmetic. Bereavement by suicide is linked to the following. A partner's risk of suicide is higher. After a child dies by suicide, the parents' risk of admission to a psychiatric ward is higher. After an adult child dies by suicide, the mother's risk of suicide is higher. After a parent dies by suicide, the child's risk of depression is higher. Compared with people bereaved by other violent deaths, people bereaved by suicide more often say they are kept at a distance and feel shame.

15 studies that registered people first and then followed them, 2,263,888 people taken together. When the spouse had been dead for less than 6 months, the mortality RR was 1.41 (95% CI 1.26–1.57), that is, the chance of dying in that same stretch was about 40% higher than for people who had not lost a spouse. After 6 months it was 1.14 (1.10–1.18), down to about 15% higher. For men the RR was 1.23 (1.18–1.28), about 23% higher. For women it was 1.04 (1.00–1.08, not statistically significant, that is, this small gap may only be a coincidence). Under 65 and 65 or older showed no clear difference. Another analysis pooled 123 papers, 1377 risk estimates, and over 500,000,000 people. After the differences in circumstances were leveled, the HR was 1.23 (1.19–1.28), that is, about 23% higher overall. Men were still higher than women. Men 1.27 (1.19–1.35), 27% higher. Women 1.15 (1.08–1.22), 15% higher.

44573 outpatients, each with a risk or a history of atherothrombosis (plaque in the vessels, the kind of trouble that a clot can block). Doctors in many countries registered them into the international project REACH and followed them. They were enrolled from December 2003 to December 2004, and followed for 4 years. Of them, 8594 (19%) lived alone. Over those 4 years, death from all causes together was 14.1% for people living alone and 11.1% for people living with others. Cardiovascular death was 8.6% against 6.8%. Both log-rank P<0.01, so the difference is unlikely to be chance. The gap was not the same at every age (interaction P=0.03). From 45 to 65, death for living alone against living with others was 7.7% against 5.7%. After other circumstances were leveled, the HR was 1.24 (95% CI 1.01–1.51), that is, about 24% higher. From 66 to 80 it was 13.2% against 12.3%, HR 1.12 (1.01–1.26), about 10% higher. At 80 or older it was 24.6% against 28.4%, HR 0.92 (0.79–1.06), and no rise was seen. A 2022 opinion of 10 departments including the Ministry of Civil Affairs (民政) says visit-and-care services are to be carried out. The people covered are elders who live alone, elders in an empty nest, elders left behind, elders who have lost the ability to care for themselves, elders with a severe disability, and elders in a special family-planning household. The service is "regular visits into the home, telephone or video, and remote monitoring." The township (or subdistrict) does the survey, and the villagers' committee or the residents' committee assists. They keep basic information and "willingness to receive visit-and-care services," and bring the person into grassroots grid management (a named person watches each patch). By the end of 2025, "make sure the monthly visit rate for elders in special difficulty reaches 100%," and "for elders in special difficulty who have lost the ability to care for themselves, visit-and-care is no less than once a month." The document also encourages the household to set up a smart call system, a smart electricity meter and water meter, health-monitoring products, and an elder-care monitoring device, so that "once monitoring is abnormal, a warning can be given in time, and a prompt is sent to the emergency contact at the same moment." If service staff find an urgent problem, they "shall help call the emergency number right away."

Everyone born in Denmark from 1968 to 2008, and everyone born in Sweden from 1973 to 2006, was counted in. Added to that was 89.3% of people born in Finland from 1987 to 2007. Together, over 7,300,000 people. Of them, 189094 lost a parent before 18. Mortality from all causes together in these children was 50% higher than in people who had not been bereaved (mortality ratio 1.50, 95% CI 1.43–1.58, that is, about 1.5 times). When the parent died of an unnatural cause such as an accident or suicide, it was 1.84 (1.71–2.00), about 80% higher. When the parent died of a natural cause such as illness, it was 1.33 (1.24–1.41), about 30% higher. It was highest when the child's cause of death and the parent's cause of death were the same class. A 2016 clinical report from the American Academy of Pediatrics, written for pediatricians, requires that a talk with a bereaved child state clearly what happened and what it means, and correct wrong information and misunderstandings the child has heard. The report also gives advice on how to support the child in attending the funeral and other farewell rites.

Fourteen studies involving adults whose loved ones died of non-violent causes and who were not themselves in psychiatric care reveal that prolonged grief disorder affects 9.8% of this group (95% CI 6.8–14.0), meaning about 10 out of every 100 bereaved adults are impacted. The rate rises with age. Another study tested the diagnostic criteria on 291 bereaved individuals through interviews at 0–6, 6–12, and 12–24 months after loss. The core symptom is intense longing for the deceased; at least five of nine additional criteria must also be present. The first five criteria are emotional numbness, shock, feeling life lacks meaning, distrust of others, and distress caused by the loss. The remaining four are difficulty accepting the loss, trouble defining one’s own identity, avoidance of reality, and an inability to carry on daily life. All these symptoms must appear daily or be severe enough to impair functioning, and they must persist at least six months after the death and still be affecting daily life. A randomized trial of 95 participants receiving 16 therapy sessions over 19 weeks on average found a 51% success rate for treatment aimed at complicated grief versus 28% for standard interpersonal psychotherapy (P = 0.02, a difference unlikely to be chance). The former also started to work sooner. The number needed to treat is 4.3: on average, for every 4.3 people treated, one more improves.

61 controlled studies taken together. Giving psychological intervention to bereaved people in general shows a very small benefit just when treatment ends, and looking again after an interval shows no benefit left. Interventions that enroll only bereaved people who "already clearly cannot adapt" work as well as psychological treatment for other psychological problems. Studies that do no screening beforehand come out poorly, because the group that got no intervention would also have eased on its own over time. Another 14 trials that assigned people by lot, taken together: treatment for people who already had a problem was clearly better than the control both after treatment and at later visits, and after an interval the effect was still growing. Preventive intervention given in general to people who did not yet have a problem did not work. Another study followed 205 people from before the spouse died through 6 and 18 months after. That study separated 5 paths. They were ordinary grief, prolonged grief, prolonged depression, getting better during the bereavement, and resilience (able to hold up). Resilience was the most common. Ordinary grief was relatively uncommon.

32 studies that registered people first and then followed them, taken together, covering over 6,500,000 people, 160000 deaths, over 755000 divorces, and 11 countries. Compared with people who were still married, separated or divorced adults had a clearly higher risk of dying early. For men, and for people who were younger, the rise was clearer than for women and for older people. The authors discuss possible paths. The first is social selection: people whose health or circumstances were already different are more likely to reach a divorce. The second is resources cut off: income and coverage stop. The third is a change in health behavior: tobacco, alcohol, and the daily schedule get worse. The fourth is chronic psychological stress (tight for a long time).

A 2026 plan jointly issued by 25 government departments including the National Health Commission calls for improving operational rules for the 12356 mental health helpline. Goals include ensuring stable service delivery, raising call connection rates, developing a provincial-level digital platform for 12356, and strengthening coordination between 12356 and other emergency hotlines such as 110. The plan also aims to expand and optimize the 12355 youth support service, coordinating it with 12356. By 2030, three key targets must be met: over 80% of administrative villages and urban communities must have mental health counseling rooms or social work rooms offering relevant services; public psychiatric hospitals at every level, and at least 1 hospital in each county (or district), must provide psychology clinic services; and all provinces must have their own provincial 12356 platforms. The mental health crisis response and support workforce includes psychiatrists, psychotherapists, counselors, social workers, and volunteers. The plan also specifies three groups who must stay alert to early warning signs of mental health risks: community grid workers, social workers, and volunteers. They are tasked with promptly identifying situations such as family crises, job loss, or school dropout. (Source: National policy document issued March 2026)

Avoid making a property disposal you cannot undo, in the stretch just after the blow, when judgment is at its worst. This kind of thing includes selling a home, quitting a job, investing a death benefit or a compensation payment all at once, remarrying in a hurry, and standing guarantee for someone. The amount of this kind of decision is usually on the scale of several tens of thousands of yuan up to a home, so the benefit is set at medium. Official documents likewise list "a family blow, job loss, and dropping out of school" as psychological-crisis risks that the community should go and look for on its own initiative. The state of this stretch is already treated as a state that needs an outsider to lend a hand. The grief guide of the US National Institute on Aging (NIA) lists "making decisions is hard" as a common feature of grief. It suggests: if you can choose, push major life decisions back until you feel better. While you are grieving and may not be able to think clearly, it is better not to make a large change such as selling a home or quitting a job. A study ran 3 experiments. The researchers assigned people at random, put some of them into a sad state, and then had them choose "take the money now" or "take the money after 3 months." Compared with people in a calm mood, sad people were willing to take 13% to 34% less money so they would not have to wait 3 months. This was sadness brought on in an experiment, not a real bereavement. In 2023 the US Federal Trade Commission (FTC) warned about a scam: someone poses as a funeral home and tells the family that if they do not pay more at once, the funeral will be cancelled. The first step it gives is to resist the pressure to "do it right now." A proper business will give you time to decide.

Article 44 of the Insurance Law governs contracts that pay the insurance money on the condition that the insured person dies. Counted from the day the contract is formed, or from the day the contract's effect is restored, if the insured person dies by suicide within 2 years, the insurer does not bear the duty to pay the insurance money. This does not apply when the insured person, at the time of the suicide, is a person with no capacity for civil conduct, that is, a person the law does not treat as responsible for their own acts. In that case the insurer shall refund the cash value of the policy as the contract provides, that is, only the small sum that can be refunded from the policy, not the insured amount. Life-insurance cover is usually on the order of several hundred thousand yuan, so the benefit is set at large. Item 3 of Article 16 of the Regulations on Work Injury Insurance provides: self-harm or suicide shall not be recognized as a work injury, or as deemed a work injury. The three work-death benefits in Article 39 then all fall through. The first is a funeral subsidy, paid as 6 months of the previous year's local average monthly wage of employees. The second is a pension for relatives who were supported by the deceased. The third is a lump-sum work-death subsidy, equal to 20 times the previous year's national per capita disposable income of urban residents. Article 1159 of the Civil Code provides: when the estate is divided, the taxes and debts the deceased legally owed shall be paid, that is, the estate pays the taxes and the debts first, and only what is left is divided. Article 1161 provides: an heir pays only up to the actual value of the estate they received, that is, they use only the part they inherited and do not put in more of their own money. A person who gives up the inheritance need not bear the duty to pay.

The National Health Commission's Standard for the Diagnosis and Treatment of Mental Disorders (2020 edition) states that on average about 8% of people who go through a psychological trauma go on to post-traumatic stress disorder. The core features are these. Nightmares and flashbacks: the scene of the event keeps coming back. Avoidance: staying away from topics, places, and people connected with the event. Constant watchfulness: easily startled, and insomnia. The diagnosis is made only when the symptoms last more than 1 month and seriously affect family, study, or work. In the section on acute stress disorder, the standard says most people return to normal through their own adjustment or through crisis intervention in the acute period. The treatment effect is in a 2020 pooled analysis: 114 trials that assigned people by lot, 8171 people. Trauma-focused cognitive behavioral treatment, compared with waiting for treatment or with usual care, had an SMD of -1.32 (95% CI -1.57 to -1.08, the range the true value likely sits in), and the evidence quality was moderate. Eye-movement desensitization and reprocessing (EMDR) was -1.23 (-1.69 to -0.76), and the evidence quality was low. SMD and d are the same ruler. 0.8 or above counts as large, and both of these are past that line. Ordinary supportive counseling, compared with waiting, showed no difference (-0.43, -0.90 to 0.04). A 2013 Cochrane review by the same group of authors had 70 trials and 4761 people, and pointed the same way. Trauma-focused cognitive behavioral treatment was -1.62 (-2.03 to -1.21). EMDR was -1.17 (-2.04 to -0.30). The evidence quality rated that time was very low. The British NICE 2018 guideline arranges it this way. For an adult whose symptoms are already severe within a month of the event, offer individual trauma-focused cognitive behavioral treatment. For someone diagnosed after a month, or whose symptoms are obvious, offer the same, usually 8 to 12 sessions. If the trauma was not caused by war and it is still not better after a full 3 months, also offer EMDR. If the symptoms are light and do not reach a diagnosis, watch through the first month, and arrange a review within that month. The psychological treatments listed in the domestic standard are the same kinds: prolonged exposure, cognitive processing therapy, and EMDR. A single-session debriefing done right after the event is covered in the 3 sources that follow. A 2002 Cochrane review pooled 11 trials. A single individual debriefing did not lighten the distress, and it did not prevent post-traumatic stress disorder. At 3 to 5 months the OR was 1.22 (0.60–2.46), no difference. A trial among them followed people to 1 year, and the people who had the debriefing had a higher risk of the illness instead. The OR was 2.88 (1.11–7.53), about 2.9 times. The authors' conclusion was: stop forcing a debriefing on people who have been traumatized. Another trial enrolled patients hospitalized after a traffic crash, assigned by lot. At 3 years, the debriefing group was clearly worse on psychiatric symptoms, anxiety while riding in a car, pain, physical problems, overall ability to live, and money problems. People whose flashbacks and avoidance were already severe at the start still had symptoms 3 years later if they had the debriefing. Those who did not have it recovered. The NICE guideline states plainly: do not offer a psychologically led debriefing to prevent or to treat post-traumatic stress disorder. The reason is that neither doing it individually nor doing it in a group showed a benefit, and there are signs of being worse than not doing it.