Mourning in a Pandemic: The Differential Impact of Widowhood on Mental Health During COVID-19.

OBJECTIVES: The death of a spouse is an established predictor of mental health decline that foreshadows worsening physical health and elevated mortality. The millions widowed by COVID-19 worldwide may experience even worse health outcomes than comparable pre-pandemic widows given the particularities of dying, mourning, and grieving during a pandemic defined by protracted social isolation, economic precarity, and general uncertainty. If COVID-19 pandemic bereavement is more strongly associated with mental health challenges than pre-pandemic bereavement, the large new cohort of COVID-19 widow(er)s may be at substantial risk of downstream health problems long after the pandemic abates. METHODS: We pooled population-based Survey of Health, Ageing and Retirement in Europe data from 27 countries for two distinct periods: (1) pre-pandemic (Wave 8, fielded October 2019 to March 2020; N = 46,266) and (2) early-pandemic (COVID Supplement, fielded June to August 2020; N = 55,796). The analysis used a difference-in-difference design to assess whether a spouse dying from COVID-19 presents unique mental health risks (self-reported depression, loneliness, and trouble sleeping), compared to pre-pandemic recent spousal deaths. RESULTS: We find strong associations between recent spousal death and poor mental health before and during the pandemic. However, our difference-in-difference estimates indicate those whose spouses died of COVID-19 have higher risks of self-reported depression and loneliness, but not trouble sleeping, than expected based on pre-pandemic associations. DISCUSSION: These results highlight that the millions of COVID-19 widow(er)s face extreme mental health risks, eclipsing those experienced by surviving spouses pre-pandemic, furthering concerns about the pandemic's lasting impacts on health.

Bereavement & mental health: The generational consequences of a grandparent's death

The COVID-19 pandemic has left millions of children and adolescents grieving the sudden death of a grandparent. Yet, we lack knowledge of the mental health implications of a grandparent's death for youth. This study uses longitudinal data to examine if the loss of a grandparent increases adolescent grandchildren's likelihood of experiencing their mothers' major depressive disorder, and of having depressive symptoms themselves. Using data from the Fragile Families and Child Wellbeing Study, a population-based cohort study of children born in 20 U.S. cities between 1998 and 2000, we estimate associations between the death of a maternal grandparent in mid-childhood and adolescents', and their mothers', depressive outcomes when the adolescent is roughly age 15 (in 2014–17), net of a robust set of covariates, including pre-bereavement depression. Adjusted regression models show no elevated depression risk associated with a grandfather's death—neither for adolescents nor their mothers. A grandmother's death within the previous seven years is associated with a higher likelihood of adolescents having a depressed mother compared to both non-bereaved adolescents (odds ratio (OR) = 2.42;95% confidence interval (CI) = 1.17, 5.01) and those whose grandmother died more than seven years ago (OR = 3.78;95% CI = 1.54, 9.31). Furthermore, adolescent boys have a 50% increase in their depressive symptoms following a grandmother's death relative to their non-bereaved peers—an increase that operates independently from the influence of the death on their mother. Together, the results show the death of a grandmother is an underappreciated, persistent risk factor for adolescents experiencing maternal major depressive disorder, and for adolescent boys experiencing depressive symptoms personally.

Cross-National Analysis of Bereavement From COVID-19 and Depressive Symptoms Among Older Adults in Europe

The COVID-19 pandemic has left older adults around the globe grieving the sudden death of relatives and friends. We examine if COVID-19 bereavement corresponds with older adults’ depressive symptoms in 27 countries, and test for variation by gender and country context. We analyzed the Survey of Health, Ageing and Retirement in Europe (SHARE) COVID-19 data collected from N=51,383 older adults (age 50–104) living in 27 countries between June-August 2020, of whom 1,363 reported the death of a relative or friend from COVID-19. We estimated pooled-multilevel logistic regression models to examine if COVID-19 bereavement was associated with depressive symptoms and worsening depressive symptoms for older men and women, and we tested whether the national COVID-19 mortality rate in their country had an additive, or multiplicative, influence. COVID-19 bereavement from the death of a relative or friend is associated with significantly higher odds of reporting depressive symptoms, and reporting that these symptoms have recently worsened since the outbreak of COVID-19. Net of personal loss, living in a country with the highest COVID-19 mortality rate corresponds further with women’s depressive symptoms;however, living in the midst of more COVID-19 deaths does not alter the implications of personal loss for depressive symptoms. COVID-19 deaths have lingering mental health implications for surviving older adults. Even as the collective toll of the crisis is apparent, bereaved older adults are in particular need of mental health support.

Bereavement From COVID-19, Gender, and Reports of Depression Among Older Adults in Europe.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has left older adults around the world bereaved by the sudden death of relatives and friends. We examine if COVID-19 bereavement corresponds with older adults' reporting depression in 27 countries and test for variations by gender and country context. METHOD: We analyze the Survey of Health, Ageing and Retirement in Europe COVID-19 data collected between June and August 2020 from 51,383 older adults (age 50-104) living in 27 countries, of whom 1,363 reported the death of a relative or friend from COVID-19. We estimate pooled multilevel logit regression models to examine if COVID-19 bereavement is associated with self-reported depression and worsening depression, and we test whether national COVID-19 mortality rates moderate these associations. RESULTS: COVID-19 bereavement is associated with significantly higher probabilities of both reporting depression and reporting worsened depression among older adults. Net of one's own personal loss, living in a country with the highest COVID-19 mortality rate is associated with women's reports of worsened depression but not men's. However, the country's COVID-19 mortality rate does not moderate associations between COVID-19 bereavement and depression. DISCUSSION: COVID-19 deaths have lingering mental health implications for surviving older adults. Even as the collective toll of the crisis is apparent, bereaved older adults are in particular need of mental health support.

Tracking the reach of COVID-19 kin loss with a bereavement multiplier applied to the United States.

The coronavirus disease 2019 (COVID-19) pandemic has led to a large increase in mortality in the United States and around the world, leaving many grieving the sudden loss of family members. We created an indicator-the COVID-19 bereavement multiplier-that estimates the average number of individuals who will experience the death of a close relative (defined as a grandparent, parent, sibling, spouse, or child) for each COVID-19 death. Using demographic microsimulation-based estimates of kinship networks in the United States, the clear age gradient in COVID-19 mortality seen across contexts, and several hypothetical infection prevalence scenarios, we estimate COVID-19 bereavement multipliers for White and Black individuals in the United States. Our analysis shows that for every COVID-19 death, approximately nine surviving Americans will lose a grandparent, parent, sibling, spouse, or child. These estimates imply, for example, that if 190,000 Americans die from COVID-19, as some models project, then ∼1.7 million will experience the death of a close relative. We demonstrate that our estimates of the bereavement multiplier are stable across epidemiological realities, including infection scenarios, total number of deaths, and the distribution of deaths, which means researchers can estimate the bereavement burden over the course of the epidemic in lockstep with rising death tolls. In addition, we provide estimates of bereavement multipliers by age group, types of kin loss, and race to illuminate prospective disparities. The bereavement multiplier is a useful indicator for tracking COVID-19's multiplicative impact as it reverberates across American families and can be tailored to other causes of death.