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Background: The coronavirus disease 2019 (COVID-19) pandemic is associated with an increase in mortality rates globally. Given the high numbers of deaths and the potentially traumatic characteristics of COVID-19 deaths, it is expected that grief-related distress levels are higher in COVID-19 bereaved (compared to non-COVID-19 bereaved) people. This living systematic review (LSR) investigates the empirical evidence regarding this claim. More specifically, this LSR summarizes studies evaluating prevalence and correlates of positive and negative psychological effects of COVID-19 bereavement. This iteration synthesizes evidence up to July 2022. Methods: Systematic searches were conducted in PsychInfo, Web of Science, and Medline by two independent reviewers. Eligible studies included quantitative peer-reviewed articles reporting on positive and/or negative psychological outcomes, using validated measures, in COVID-19 bereaved adults. The primary outcome was prolonged grief symptoms (PG). Results: Searches identified 9871 articles, whereof 12 studies met the inclusion criteria. All studies included prevalence rates and/or symptom-levels of psychological outcomes after COVID-19 losses. Prevalence rates of psychological outcomes were primarily reported in terms of (acute) PG, pandemic grief, depression, anxiety, and functional impairment, and varied widely between studies (e.g., ranged between 29% and 49% for acute PG). No studies reported on prevalence rates of positive psychological outcomes. Closer kinship to the deceased, death unexpectedness, and COVID-19 stressors were identified as correlates of increased psychological symptoms. Conclusions: Due to the small number and heterogeneity of studies, knowledge about psychological effects of COVID-19 bereavement is limited. This LSR offers a regular synthesis of up-to-date research evidence to guide clinicians, policy makers, public health professionals, and future research on the psychological effects of COVID-19 bereavement.

Objective: This randomized controlled trial is the first study examining short-term effects of an unguided online grief-specific cognitive behavioral therapy (CBT) (compared to waitlist controls) in reducing early persistent complex bereavement disorder (PCBD), posttraumatic stress disorder (PTSD), and depression symptoms in adults bereaved during the COVID-19 pandemic. Method: Sixty-five Dutch adults, bereaved at least three months earlier during the COVID-19 pandemic, with clinically relevant early PCBD, PTSD, and/or depression symptoms, were randomly allocated to an immediate treatment (n = 32) or waitlist condition (n = 33). Telephone interviews were conducted to assess PCBD, PTSD, and depression symptoms (measured with the Traumatic Grief Inventory-Clinician Administered, PTSD Checklist for DSM-5, and Patient Health Questionnaire-9, respectively) at baseline, post-treatment, and post-waiting period. Participants received an eight-week unguided online grief-specific CBT including exposure, cognitive restructuring, and behavioral activation assignments. Analyses of covariance were performed. Results: Intention-to-treat analyses indicated that people in the intervention condition showed significantly lower PCBD (d = 0.90), PTSD (d = 0.71), and depression (d = 0.57) symptom-levels post-treatment relative to waitlist controls post-waiting period, while taking baseline symptom-levels and the use of professional psychological co-intervention into account. Completers analyses yielded similar results for PCBD and PTSD, but no significant between-group effect was found for depression. Conclusions: The online CBT proved to be an effective intervention, reducing PCBD, PTSD, and depression symptoms. Pending replication of these findings, online interventions may be more widely implemented in clinical practice to improve treatment options for emotionally distressed recently bereaved people.