Risk factors for dysfunctional grief and functional impairment for all causes of death during the COVID-19 pandemic: The mediating role of meaning

Abstract

The COVID-19 pandemic, coupled with significant social changes due to legislative and public health requirements, has changed the way in which people experience grief. We examined whether dysfunctional grief symptoms, disrupted meaning, risk factors, and functional impairment differed between people bereaved from COVID-19 and from other natural or violent causes in this same period. A sample of 409 participants (67.73% male; M = 37.54 years) completed an online survey in June 2021. There were no statistically significant differences between the three groups on any of the outcome variables; all three groups manifested clinical levels of functional impairment equal to or greater than bereaved groups diagnosed with complicated or prolonged grief disorder prior to the pandemic.Disrupted meaning partially mediated the relationship between risk factors on the one hand and functional impairment and dysfunctional grief symptoms on the other. Findings indicate that deaths during COVID-19, rather than deaths from COVID-19, may precipitate symptoms of significant clinical concern.As of mid-August 2021, there have been over 207 million confirmed cases of COVID-19 and over 4.3 million deaths (World Health Organization, 2021). Each death is estimated to affect an average of 9 people (Verdery, Smith-Greenaway, Margolis, & Daw, 2020). Based on these projections, nearly 40 million people are mourning the loss of a close person from COVID-19. Early in the pandemic, commentators predicted an increased risk of deleterious grief outcomes due to sudden/unexpected death, multiple co-occurring stressors, inability to be by the bedside to comfort the dying and say goodbye, limited opportunities for mourning rituals, and increased social isolation (

Bereavement during the Covid-19 pandemic in the UK: What do we know so far?

“…Restricted funeral and memorialisation practices, inability to support one another and mourn collectively also made it difficult to find closure and begin to grieve (Torrens-Burton et al, 2021). These grief difficulties are consistent with the quantitative findings of a US pandemic study, that 'disrupted meaning' contributed to worse grief outcomes, and that higher levels of functional impairment occurred for all deaths during Covid19 compared with pre-pandemic times (Menzies et al, 2020;Breen et al, 2021).…”

‘It was brutal. It still is’: a qualitative analysis of the challenges of bereavement during the COVID-19 pandemic reported in two national surveys

“…Another study observed higher levels of functional impairment for all deaths during COVID-19 compared to pre-pandemic times, but no differences between COVID-19 and other types of deaths. 12 Quantitative and qualitative studies have identified difficult experiences of end-of-life care, such as lack of communication and contact with healthcare staff and patients prior to the death. 1 , 13 – 16 Where bereaved people struggled to make sense of such experiences, ‘disrupted meaning’ was found to cause functional impairment and dysfunctional grief symptoms.…”

Factors associated with higher levels of grief and support needs among people bereaved during the pandemic: Results from a national online survey

“…The higher levels of grief observed in this sample compared with pre-pandemic studies may be due to stressors universally experienced during the pandemic rather than specific to COVID-19 bereavements, including disruptions to the meaning-making process following a death (Breen et al ., 2021b). (Eisma and Tamminga, 2020) found that people in the Netherlands who recently experienced a non-COVID-19 death during the pandemic reported higher levels of acute grief than those recently bereaved before the pandemic.…”

“…(Eisma and Tamminga, 2020) found that people in the Netherlands who recently experienced a non-COVID-19 death during the pandemic reported higher levels of acute grief than those recently bereaved before the pandemic. (Breen et al ., 2021b) found that among people bereaved during the COVID-19 pandemic in the USA (N=409), there were no statistically significant differences in grief outcomes or functional impairment according to cause of death. Further research is required to establish which experiences and symptomatology are specific to the COVID-19 bereaved and which apply to the broader population of people bereaved during the pandemic.…”

“…To inform clinicians and bereavement support providers and direct resource allocation, evidence is needed to identify groups at particular risk of difficulties in their grief and high levels of support needs. To date, three relevant studies have been published, one in China (Tang and Xiang, 2021, Tang et al ., 2021) and two in the USA (Breen et al ., 2021a, Breen et al ., 2021b, Neimeyer and Lee, 2021). The first study, in China, examined risk factors for prolonged grief disorder among people bereaved by COVID-19, but did not examine the impact of pandemic-related circumstances such as social isolation.…”