Potential risk factors for acute grief during the COVID-19 pandemic: The mediating role of avoidance processes

Navigating grief in unprecedented times: risk factors in the wake of pandemic loss and end-of-life care

Coronavirus is an infectious disease that has left tens of millions of deaths around the world, and which has had social, economic, emotional, and psychological consequences. To mitigate the spread of the virus, several countries have adopted restrictive measures that impacted the way people experienced the end-of-life and the death of their loved one. This study aimed to identify the variables associated with prolonged grief symptoms in the context of both pandemic-related losses and the unique challenges related to end-of-life care. An anonymous online survey was disseminated widely through various channels including local press, social media, professional networks and hospitals. Socio-demographic information was collected, as well as information related to loss (cause of death, place of end-of-life care and death) and bereavement, and on the impact of the restrictions imposed by the pandemic. The participants were 163 bereaved who lost a loved one who received end-of-life care during the pandemic in Portugal. Most participants were female, married, professionally active and had lost their grandparents. A hierarchical multiple regression was performed to determine the factors associated with prolonged grief symptoms. The results showed that more prolonged grief symptoms were associated with less social support, worsening of the financial situation, greater psychological impact of restrictions on communicating with the deceased, and the deceas having received end-of-life care in a hospital. The early identification based on these factors of individuals at higher risk for more prolonged grief symptoms could allow for targeted interventions and support services.This study unveils crucial factors contributing to heightened grief amid pandemic-related losses and challenges in end-of-life care, which provide practical insights for healthcare practitioners. Highlight the importance of personalized interventions to fortify social connections, address financial challenges, and offer compassionate alternatives to hospital-centric care. Policymakers can leverage this information to optmise grief management during public health crises.

Impact of the contextual factors regarding the COVID-19 pandemic on bereavement: an integrative review of the literature from a bioethical perspective

The advent of the COVID-19 pandemic has profoundly transformed grief around the world. What are the impacts of context factors regarding the COVID-19 pandemic on dysfunctional symptoms of grief? This is a study with a qualitative approach, integrative review, whose article data collection was carried out in the following databases: Biblioteca Virtual de Saúde (BVS), Portal Brasileiro de Publicações e Dados Científicos em Acesso Aberto (Oasisbr), United States National Library of Medicine (PubMed), Scientific Electronic Library (SciELO) and Web of Science. Thirty-three articles were selected for the analysis. The studies showed different results when the risk factors were detailed individually. However, the pandemic context proved to be a complex element that created vulnerability associated with grieving. Bioethics presents itself as a locus of interdisciplinary discussion for a more profound understanding of the complex specificities and, based on the social and political responsibility of Protection Bioethics to protect vulnerable populations, it is recommended to mental health professionals who intentionally explore the impacts of the pandemic on the grieving process. The suffering of people bereaved during the pandemic must be publicly recognized, offering safe spaces for reception and sharing.

Are Mediators of Grief Reactions Better Predictors Than Risk Factors? A Study Testing the Role of Satisfaction With Rituals, Perceived Social Support, and Coping Strategies

The present study aimed to assess the mediating role of adjustment processes in known risk factors associated with prolonged grief disorder. Data were collected in March-April 2021 through an online survey of 542 Canadian adults bereaved since March 2020. The mediating role of satisfaction with funeral rituals, bereavement support, and coping strategies on grief outcomes was tested using structural equation modeling. Results showed that such adjustment processes played a significant role in the grief process and that they were better predictors than risk factors alone. Since they are more amenable determinants of grief reactions, they should be further studied using a longitudinal design.

Grief and coping among relatives of patients who died of COVID-19 in intensive care during the height of the COVID-19 pandemic

BACKGROUND

The grief of relatives of patients who died of COVID-19 in an intensive care unit (ICU) has exacted an enormous toll worldwide.

AIMS

To determine the prevalence of probable prolonged grief disorder (PGD) at 12 months post-loss and beyond. We also sought to examine circumstances of the death during the COVID-19 pandemic that might pose a heightened risk of PGD, and the associations between probable PGD diagnosis, quality of life and social disconnection.

METHOD

We conducted an observational, cross-sectional multicentre study of the next of kin of those who died of COVID-19 between March 2020 and December 2021. Participants were recruited from ICUs in South-East London. The Prolonged Grief Disorder Scale (PG-13-R), Quality-of-Life Scale (QOLS) and Oxford Grief-Social Disconnection Scale (OG-SD) were used.

RESULTS

A total of 73 relatives were recruited and assessed, all of them over a year after their loss. Twenty-five (34.2%; 95% CI 23.1-45.4%) relatives of patients who died in the ICU met the criteria for PGD. Those who met the criteria had significantly worse quality of life (QOLS score mean difference 26; 95% CI 17-34; P < 0.001) and endorsed greater social disconnection (OG-SD score means difference 41; 95% CI 27-54; P < 0.001).

CONCLUSIONS

The findings suggest that rates of PGD are elevated among relatives of patients who died of COVID-19 in the ICU. This, coupled with worse quality of life and greater social disconnection experienced by those meeting the criteria, suggests the need to attend to the social deprivations and social dysfunctions of this population group.

Potential risk factors for acute grief during the COVID-19 pandemic: The mediating role of avoidance processes

Bereavement during the COVID-19 pandemic may have some unique characteristics that become potential risk factors (e.g., absence of grief rituals, no opportunity to say goodbye to the deceased and loneliness caused by social distancing) for acute grief. Avoidance processes could be significant mediators in the context of the pandemic. The current study aimed to investigate whether and how these COVID-19-related risk factors were related to acute grief severity. Bereaved adults (n = 319) who lost significant others during the COVID-19 pandemic completed a self-report questionnaire package measuring COVID-19-related factors, grief severity and depressive and anxious avoidance. Regression analyses suggested that among the three potential risk factors (loneliness, grief rituals and opportunity to say goodbye), loneliness was significantly associated with acute grief after controlling for basic demographic and loss-related information. Structural equation models suggested that depressive avoidance and anxious avoidance partially mediated the associations of loneliness with acute grief severity. The findings indicate that dealing with loss during the COVID-19 pandemic warrants further exploration concerning how potential environmental risk factors may impede adaptation to loss. Depressive and anxious avoidance processes may play important roles in grief interventions for isolated and lonely bereaved people.