'Feeling disconnected' - risk factors for PGD and themes in grief counselling during the COVID-19 pandemic. A mixed-method study.

Background: Due to its high death toll and measures to curb the pandemic, COVID-19 has affected grieving experiences and may contribute to risk factors for Prolonged Grief Disorder (PGD). Persons at risk for PGD often seek support from grief counselling.Objective: To explore whether pandemic-associated risk factors have become more important topics in counselling in a mixed-method design.Method: German grief counsellors (n = 93) rated whether pre-defined risk factors had become more important in grief counselling and indicated additional important themes in an open format.Results: The counsellors indicated that all pre-defined risk factors had become more important, though differing significantly in their frequency. Most frequently endorsed risk factors were lack of social support, limited possibilities to accompany a dying loved one and absence of traditional grief rituals. Qualitative analysis identified three additional themes: the societal impact of the pandemic, its impact on bereavement support and health care, and a chance for personal growth.Conclusions: The pandemic has affected bereavement experiences and grief counselling. Counsellors should monitor grief processes and specific risk factors to provide the best possible care for bereaved people when needed.

Pandemic-associated risk factors for PGD have become more important topics in grief counselling during COVID-19.Risk factors include especially a lack of social support, limited possibility to accompany a dying significant other and absence of traditional grief rituals.Future research is needed to investigate whether monitoring and addressing these risk factors can improve bereavement care.

Predictors of Prolonged Grief Disorder in a German Representative Population Sample: Unexpectedness of Bereavement Contributes to Grief Severity and Prolonged Grief Disorder.

Most people adapt to bereavement over time. For a minority, the grief persists and may lead to a prolonged grief disorder (PGD). Identifying grievers at risk of PGD may enable specific prevention measures. The present study examined the extent to which the subjective unexpectedness of the death predicted grief outcomes above and beyond known sociodemographic and objective loss-related variables in a sample drawn from a population-representative investigation. In our sample (n = 2,531), 811 participants (M age 55.1 ± 17.8 years, 59.2% women) had experienced the loss of a significant person six or more months ago. Participants provided demographic and loss-related information, perceptions of the unexpectedness of the death and completed the Prolonged Grief Disorder-13 + 9 (PG-13 + 9). The PG-13 + 9 was used to determine PGD caseness. A binary logistic regression investigated predictors of PGD caseness, and a linear regression predictors of grief severity. ANCOVAs compared PGD symptoms between the groups who had experienced an "expected" vs. "unexpected" loss, while controlling for the relationship to the deceased and time since loss. The loss of a child (OR = 23.66; 95%CI, 6.03-68.28), or a partner (OR = 5.32; 95%CI, 1.79-15.83), the time since loss (OR = 0.99; 95%CI, 0.99-1.00) and the unexpectedness of the death (OR = 3.58; 95%CI, 1.70-7.69) were significant predictors of PGD caseness (Nagelkerke's R2 = 0.25) and grief severity. Participants who had experienced the loss as unexpected (vs. expected) reported higher scores on all PGD symptoms. Unexpectedness of the death emerged as significant risk factor for PGD, even after controlling for demographic and other loss-related variables. While our findings replicate previous research on the importance of the relationship to the deceased as a risk factor for PGD, they also highlight the importance of assessing the subjective unexpectedness of a death and may help to identify risk groups who can profit from preventive interventions.

Psychotherapists' Reports regarding the Impact of the COVID-19 Pandemic on Their Patients: A Cross-National Descriptive Study Based on the Social-Ecological Model (SEM).

The COVID-19 outbreak has raised questions about how vulnerable groups experience the pandemic. Research that focuses on the view of individuals with pre-existing mental health conditions is still limited, and so are cross-country comparative surveys. We gathered our sample of qualitative data during the first lockdown after governmental measures against the spread of the SARS-CoV-2 virus came into force in Austria, Czechia, Germany, and Slovakia. A total of n = 1690 psychotherapists from four middle European countries answered the question of how the COVID-19 pandemic was addressed in sessions by their patients during the early stage of unprecedented public health conditions. We employed a descriptive qualitative methodology to determine themes following levels of the social-ecological model (SEM) regarding how the COVID-19 pandemic affected patients. At the public policy level, stressful environmental conditions concerned the governmental mitigation efforts. At the level of community/society, reported key themes were employment, restricted access to educational and health facilities, socioeconomic consequences, and the pandemic itself. Key themes at the interpersonal level regarded forced proximity, the possibility of infection of loved ones, childcare, and homeschooling. Key themes at the individual level were the possibility of contracting COVID-19, having to stay at home/isolation, and a changing environment. Within the SEM framework, adaptive and maladaptive responses to these stressors were reported, with more similarities than differences between the countries. A quantification of word stems showed that the maladaptive reactions predominated.

The German Translation of the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) Scale: Results from Healthcare Workers during the Second Wave of COVID-19.

Healthcare workers (HCW) are among those most directly affected by the COVID-19 pandemic. Most research with this group has used ad hoc measures, which limits comparability across samples. The Stress and Anxiety to Viral Epidemics-9 scale (SAVE-9) is a nine-item scale first developed in Korea, and has since been translated into several languages. We report on data collected from 484 German HCW between November 2020 and March 2021, during the "second wave" of coronavirus infections. We conducted item analysis, confirmatory factor analysis on the previously found factor solutions of the SAVE-9, examined correlations with established measures of depression, generalized anxiety, and insomnia, and compared scores between different groups of HCW. The psychometric properties of the German SAVE-9 were satisfactory and comparable to previous findings from Korea and Russia. Correlations with mental health measures were positive, as expected. We found some significant differences between groups of HCW on the SAVE-9 which were consistent with the literature but did not appear on the other mental health measures. This suggests that the SAVE-9 taps into specifically work-related stress, which may make it a helpful instrument in this research area.

Provision of Psychotherapy during the COVID-19 Pandemic among Czech, German and Slovak Psychotherapists.

Psychotherapists around the world are facing an unprecedented situation with the outbreak of the novel coronavirus disease (COVID-19). To combat the rapid spread of the virus, direct contact with others has to be avoided when possible. Therefore, remote psychotherapy provides a valuable option to continue mental health care during the COVID-19 pandemic. The present study investigated the fear of psychotherapists to become infected with COVID-19 during psychotherapy in personal contact and assessed how the provision of psychotherapy changed due to the COVID-19 situation and whether there were differences with regard to country and gender. Psychotherapists from three European countries: Czech Republic (CZ, n = 112), Germany (DE, n = 130) and Slovakia (SK, n = 96), with on average 77.8% female participants, completed an online survey. Participants rated the fear of COVID-19 infection during face-to-face psychotherapy and reported the number of patients treated on average per week (in personal contact, via telephone, via internet) during the COVID-19 situation as well as (retrospectively) in the months before. Fear of COVID-19 infection was highest in SK and lowest in DE (p < 0.001) and was higher in female compared to male psychotherapists (p = 0.021). In all countries, the number of patients treated on average per week in personal contact decreased (p < 0.001) and remote psychotherapies increased (p < 0.001), with more patients being treated via internet than via telephone during the COVID-19 situation (p < 0.001). Furthermore, female psychotherapists treated less patients in personal contact (p = 0.036), while they treated more patients via telephone than their male colleagues (p = 0.015). Overall, the total number of patients treated did not differ during COVID-19 from the months before (p = 0.133) and psychotherapy in personal contact remained the most common treatment modality. Results imply that the supply of mental health care could be maintained during COVID-19 and that changes in the provision of psychotherapy vary among countries and gender.