Case Report: Parental Loss and Childhood Grief During COVID-19 Pandemic

Abstract

The coronavirus disease 2019 (COVID-19) pandemic is an unprecedent public health crisis, transforming many aspects of our daily life. Protection measures, such as social distancing, nationwide lockdowns, and restrictions on hospital visits and funerals have a serious impact on how people mourn their loved ones. The grieving process during childhood and adolescence evolves along the developmental stages and is a dynamic, non-linear process that needs time. Parental death increases the risk for psychopathology in the short and long term. We present a case of an 11-year-old girl referred to child psychiatry-liaison service by her neurologist due to peer relationship problems and sadness. Fifteen days before her first psychiatric consultation, her father suffered a myocardial infarction complicated with hypoxic ischemic encephalopathy, and he was hospitalized in the intensive care unit. Positive coping mechanisms and adaptive emotional expression strategies were explored during her consultations. Her father died 2 weeks after emergency state and nationwide lockdown was declared in Portugal, during the first COVID-19 outbreak. The family did not have the opportunity for a proper farewell, the funeral obeyed strict rules, and the patient and her family were at home, due to social distancing and school closure policies. Consultations were maintained by telephone calls and, less frequently, by face-to-face appointments. Adaptive and helpful strategies to grieve were shared with the patient and her mother. Intervention with the mother alone was also helpful. Death circumstances related to COVID-19, confinement policies, and social–economical stressors can intensify the grief experience, increasing the risk for complicated grief. Although psychiatric teleconsultation is essential during COVID-19 pandemic, it poses various limitations. Non-verbal communication clues may not be totally apprehended; it may represent a problem in the therapeutic relationship, and access to technology can be difficult for psychiatric patients and clinicians. COVID-19 pandemic policies should include mental health protection measures, which should facilitate adjusted grief responses for those who lose a loved one during this pandemic.

The Many Faces of Grief: A Systematic Literature Review of Grief During the COVID-19 Pandemic

“…Bereavement at such distressing times could also result in delayed grief. Santos et al (2021) have made a further distinction in the grief experience of preschool children and school-age children. According to these authors, an important point that distinguishes the experience of grief among preschool children and children is the knowledge of the irreversibility of death.…”

“…Adolescence. Santos et al (2021) write that adolescents understand death as "irreversible, universal, and nonfunctional" (p. 2). The grieving process of adolescence resembles that of adults.…”

The Kyoto Conference on Arts, Media and Culture 2022: Official Conference Proceedings

“…This unresolved condition may occur in children due to a lack of coping skills throughout the bereavement experience, which may contribute to developing mental health issues. Children of preschool age may not comprehend that death is irreversible, and their unique magical and egocentric thought processes may lead them to believe that their actions, words, or thoughts caused the death (Santos et al, 2021). The children must recognize that their parents' deaths are not their fault.…”

The mental health of children and young people living in big cities in a revolving postpandemic world

“…Furthermore, the impacts of economics were intertwined with the impacts of covid-19, as social and health outcomes were more severely imposed upon the disadvantaged [105][106][107]. This includes a higher tax of mortality [108][109][110], exposing children in poverty to grief and potential loss of a financial provider [111,112]. In the slums, vulnerabilities were once more put in evidence.…”