Background: Increasing evidence supports the role of emotional stress in the onset of cardiovascular disease. Although bereavement is a major emotional stress with both acute and more long-term features, the mechanism of its association with cardiovascular risk is not well understood, in particular because of limited studies of acute bereavement. The aim of the study was to identify psychological and behavioural changes in acute bereavement and potential modifiers of these changes. Methods: Bereaved (n = 62) and non-bereaved individuals (n = 50) were evaluated within 2 weeks and at 6 months following loss using the Centre for Epidemiologic Studies - Depression, Spielberger State Anxiety and Anger, Social Support Questionnaire and changes in appetite, cigarette and alcohol consumption, cortisol and lipids. Results: Compared with non-bereaved, acutely bereaved had increased symptoms of depression (26.7 ± 1.7 vs 5.9 ± 0.7, P < 0.001), anxiety (47.4 ± 2.0 vs 28.2 ± 1.4, P < 0.001) and anger (median 16.0 vs 15.0, P < 0.001). Greater depressive symptoms were associated with being unprepared for the death, decreased sleep duration and younger age. Acutely, bereaved slept less than non-bereaved (5.8 ± 0.2 vs 7.2 ± 0.2 h, P < 0.001). Reduced sleep time was associated with increased anger and depression and decreased satisfaction with social support. Compared with the non-bereaved, the acutely bereaved had higher cortisol (median 306 vs 266, P = 0.003), reduced appetite (P < 0.001) and lower total cholesterol (median 4.9 vs 5.4, P = 0.006) and low-density lipoprotein (median 2.4 vs 2.9, P < 0.001). Conclusion: These results offer insight into the psychological, behavioural and physical changes that may contribute to cardiovascular risk in bereavement.