The efficacy and usability of an unguided web-based grief intervention for adults who lost a loved one during the COVID-19 pandemic: A Randomized Controlled Trial

BACKGROUND

The death of a loved one was a challenge many people faced during the COVID-19 pandemic within a context of extraordinary circumstances and great uncertainty. Grief is an unavoidable part of life and for most people, feelings of grief decrease naturally over time. However, for some people, grieving can become a particularly painful process with clinical symptoms which may require professional help to resolve. To provide psychological support to people who had lost a loved one during the COVID-19 pandemic, an unguided web-based psychological intervention was developed.

OBJECTIVE

The main objective of this study was to evaluate the efficacy of the web-based treatment, Grief COVID (Duelo COVID in Spanish), in reducing clinical symptoms of complicated grief, depression, post-traumatic stress, hopelessness, anxiety, and suicidal risk in adults. A secondary aim was to validate the usability of the self-applied intervention system.

METHODS

We used a randomized controlled trial (RCT) with an intervention group (IG) and a waitlist control group (CG). The groups were assessed three times (prior to beginning the intervention, upon completing the intervention, and three months post-intervention). The intervention was delivered online in an asynchronous format through the webpage Duelo COVID-19. Participants created an account that could be used on their computers, smartphones, or tablets. The evaluation process was automated as part of the intervention.

RESULTS

A total of 114 participants were randomly assigned to the IG or CG and met criteria for inclusion in the study (n=45 finished the intervention and n=69 completed the waitlist time period). The majority of participants were women (n=103, 90.4%). Results indicated that the treatment significantly reduced baseline clinical symptoms in the IG for all variables, with larger effect sizes for depression, hopelessness, grief, anxiety, and risk of suicide (all effect sizes ≥0.5). The follow-up evaluation showed that symptom reduction was maintained at three months post-intervention. Results from the CG showed that participants experienced significantly decreased levels of hopelessness after completing the time on the waitlist, but their suicidal risk scores increased. Regarding the usability of the self-applied intervention system, results indicated a high level of satisfaction with Grief COVID.

CONCLUSIONS

The self-applied web-based intervention Grief COVID was effective in reducing symptoms of anxiety, depression, hopelessness, risk of suicide, post-traumatic stress disorder, and complicated grief disorder. Grief COVID was evaluated by the participants, who reported that the system was easy to use. These results affirm the importance of developing additional online psychological tools to help reduce clinical symptoms in people experiencing grief due to the loss of a loved one during a pandemic.

CLINICALTRIAL

The study is registered in Clinical trials (NCT04638842).

Theta power and functional connectivity as neurophysiological markers of executive functions in individuals with cognitive complaints in daily life

Impairments in executive functions (EFs) are common across psychological disorders. Research into the neural oscillations underlying EFs has the potential to help understand these impairments and contribute to the development of interventions. The aim of this study is to assess theta power and functional theta connectivity in the sensor space of the regions of the superordinate network for the core EFs: conflict monitoring, response inhibition, set-shifting, and working memory updating. We recruited adults with self-reported everyday EFs complaints and formed two groups: one with attention deficit hyperactivity disorder (ADHD) (n=27) and another without any diagnosis (n=22), and compared them to controls (n=21) on the Stroop, Stop-signal, Switching, and N-back task using EEG. Power and functional connectivity analyses were conducted for four regions of interest: frontal-midline, frontolateral left and right, and parietal region. For all four EFs, the groups showed a dynamical increase in theta power over time in the four regions of interest, as well as in functional theta connectivity between these regions. Group differences were found especially for conflict monitoring, with differences in theta power in the frontal-midline and frontolateral right region. These neural markers are also associated with behavioural performance and complaints in daily life. For set-shifting, group differences were less pronounced and for response inhibition and working memory updating no group differences were observed.

Biodistribution of mixed fluorocarbon-hydrocarbon dowel molecules used as stabilizers of fluorocarbon emulsions: a quantitative study by fluorine nuclear magnetic resonance (NMR)

19F NMR spectroscopy was used to determine quantitatively the organ distribution and organ retention time in rats of the mixed fluorocarbon-hydrocarbon dowel molecule C6F13CH = CHC10H21 (F6H10E), which stabilizes highly concentrated injectable fluorocarbon emulsions destined for in vivo oxygen transport and delivery. The only fluorine resonances detected in the 19F NMR spectra of the organs analyzed were those of the F6H10E dowel itself, indicating that metabolites, if present, have very low concentrations (< 10(-4) M, limit of our assay). The F6H10E content in the liver peaked 1 day after administration (7 days for the spleen). At a dose of 3.6 g/kg body weight, the half-life of F6H10E in the liver was 25 +/- 5 days.

Biodistribution and excretion of a mixed fluorocarbon-hydrocarbon "dowel" emulsion as determined by 19F NMR

To investigate the biodistribution, possible metabolism and excretion of mixed fluorocarbon-hydrocarbon "dowel" molecules used as stabilizers of fluorocarbon emulsions, we have prepared a 25% w/v emulsion of such a molecule, and quantitatively evaluated, by means of 19F NMR, its behavior in the blood and reticuloendothelial system (RES) of rats. C6F13CH = CHC10H21 (F6H10E) was emulsified using egg yolk phospholipids (EYP). The emulsion (F6H10E/EYP: 25/6% w/v) was injected intravenously into 33 Sprague Dawley female rats at a 3.6 g/kg body weight dose of F6H10E. The animals were sacrificed at regular intervals of time. 24 hours after the injection, 70% of the injected dose was located in the liver, 17% in the spleen, 4% in the lungs, 2% in the kidneys and 2% in the blood. The half-time retention of the dowel molecule in the liver was estimated to be 25 +/- 5 days. None of the 33 treated animals died prior to the planned sacrifice date. The dowel molecule F6H10E proved to be well tolerated, and excreted reasonably fast, without metabolism. This appears to warrant the use of such molecules as stabilizers in injectable fluorocarbon emulsions destined to serve as oxygen carriers, contrast agents or drug delivery systems.

Comparison of tissue-cultured bovine endothelial cells from aorta and saphenous vein

Endothelial cells were harvested from bovine aorta and saphenous vein with collagenase and cultured in McCoy's 5a medium (modified GIBCO) supplemented with 10% fetal bovine serum. The cells were subcultured through 17 passages over 4 to 5 months. The growth properties in culture of the two cell types were compared. Morphological comparisons included phase microscopy and scanning and transmission electron microscopy. Comparisons with cultured aortic smooth-muscle cells were made using phase and scanning electron microscopy. No differences were found between cultured endothelial cells from aorta and saphenous vein. Differences in growth patterns in culture clearly distinguished both endothelial cell types from smooth-muscle cells. The presence of Weibel-Palade bodies identified the cells from both sources as endothelial.

Endothelial cell culture on dacron fabrics of different configurations

The growth of tissue-cultured aortic endothelial cells from the calf using 12 different configurations of Dacron polyester (U.S. Catheter and Instrument Co.) as substrates was studied. Scanning electron microscopy showed maximum cell coverage on tightly knit configurations, whereas loose knits and velours did not support cell growth.

Growth of cultured calf aortic smooth muscle cells on cardiovascular prosthetic materials

The growth of cultured calf aortic smooth muscle cells on cardiovascular biomaterials was investigated, using native and oxidized polyacrylonitrile (orlon) fabrics, dacron velour, and Parylene-C coated polypropylene microfabric as substrates. By light microscopic evaluation, surface cell coverage was most complete on microfabric, followed by native orlon, dacron velour, and oxidized orlon. Native orlon supported the greatest total cell growth, as determined by chemically extractable protein, followed by oxidized orlon, dacron velour, and the microfabric. The observed differences appear to be related to the pore size and fiber thickness of the different substrates.