Bereavement outcomes in family members of those who died in acute care hospitals before and during the first wave of COVID-19: A cohort study

Abstract

Background: The COVID-19 pandemic has caused millions of deaths worldwide, leading to symptoms of grief among the bereaved. Neither the burden of severe grief nor its predictors are fully known within the context of the pandemic. Aim: To determine the prevalence and predictors of severe grief in family members who were bereaved early in the COVID-19 pandemic. Design: Prospective, matched cohort study. Setting/Participants: Family members of people who died in an acute hospital in Ottawa, Canada between November 1, 2019 and August 31, 2020. We matched relatives of patients who died of COVID (COVID +ve) with those who died of non-COVID illness either during wave 1 of the pandemic (COVID −ve) or immediately prior to its onset (pre-COVID). We abstracted decedents’ medical records, contacted family members >6 months post loss, and assessed grief symptoms using the Inventory of Complicated Grief-revised. Results: We abstracted data for 425 decedents (85 COVID +ve, 170 COVID −ve, and 170 pre-COVID), and 110 of 165 contacted family members (67%) consented to participate. Pre-COVID family members were physically present more in the last 48 h of life; the COVID +ve cohort were more present virtually. Overall, 35 family members (28.9%) had severe grief symptoms, and the prevalence was similar among the cohorts ( p = 0.91). Grief severity was not correlated with demographic factors, physical presence in the final 48 h of life, intubation, or relationship with the deceased. Conclusion: Severe grief is common among family members bereaved during the COVID-19 pandemic, regardless of the cause or circumstances of death, and even if their loss took place before the onset of the pandemic. This suggests that aspects of the pandemic itself contribute to severe grief, and factors that normally mitigate grief may not be as effective.

Self-guided online treatment of disturbed grief, posttraumatic stress, and depression in adults bereaved during the COVID-19 pandemic: A randomized controlled trial

“…Losing a loved one during the COVID-19 pandemic is considered a potentially traumatic loss, likely resulting in high rates of symptoms of disturbed grief, PTSD, and depression ( Eisma et al, 2020 ; Kokou-Kpolou et al, 2020 ). Indeed, preliminary results of several studies have confirmed that the prevalence of disturbed grief is relatively high in people (recently) bereaved during the COVID-19 pandemic ( Breen et al, 2022 ), compared to people bereaved before the COVID-19 pandemic ( Downar et al, 2022 ; Eisma & Tamminga, 2020 ). The elevated risk of psychopathology following the loss of a loved one during the COVID-19 pandemic might be explained by several stressors that may apply to all people bereaved during the pandemic, including being unable to engage in traditional grieving rituals and/or social deprivation due to quarantine measures (cf., Boelen et al, 2006 ; Brooks et al, 2020 ; Cao et al, 2020 ; Lobb et al, 2010 ).…”

Prevalence and correlates of positive and negative psychological effects of bereavement due to COVID-19: A living systematic review

“…Another study revealed that the inability to say goodbye appropriately explained differences in higher PG levels between people bereaved by COVID-19 and natural causes (Eisma & Tamminga, 2022). Lastly, Downar et al (2022) reported that physical presence in the final 48 hours of life of the deceased and intubation of the deceased were not associated with PG symptom-levels.…”

“…Based on the SAQOR criteria, six studies were assessed as high quality (Breen et al, 2021;Downar et al, 2022;Eisma & Tamminga, 2022;Gang et al, 2022;Tang et al, 2021;Yaghoubi et al, 2021), and six studies as moderate quality (Bovero et al, 2022;Breen et al, 2022aBreen et al, , 2022bChen & Tang, 2021;Eisma et al, 2021;Tang & Xiang, 2021). In Table 1 more detailed information is presented with respect to the quality assessment of the twelve studies.…”

“…Another study focused on a UK sample (n = 183), all bereaved through COVID-19 with most deaths (56%) occurring over 6 months ago (Breen et al, 2022b). Lastly, people (n = 121) bereaved through COVID-19 (n = 30), non-COVID-19 illness during the pandemic (n = 46) and pre-pandemic (n = 45) at least 6 months ago were the subjects of a study in Canada (Downar et al, 2022). No details were provided about the time since death.…”

“…COVID-19 stressors: Differences in symptom-levels and/or probable caseness of negative psychological outcomes according to COVID-19 stressors were evaluated in six studies (Bovero et al, 2022;Breen et al, 2021Breen et al, , 2022aBreen et al, , 2022bDownar et al, 2022;Eisma & Tamminga, 2022). Bovero et al (2022) found that being single or widowed during lockdown was associated with probable PG caseness.…”