World Assumptions and Coping Related to Trauma as Predictors of General Mental Health and Acute Stress Symptoms Among Iranian Muslims During the COVID-19 Outbreak

The COVID-19 outbreak is a new potentially traumatic event that may have some unknown effects on mental health. The aim of this study was to examine how two theoretical frameworks related to coping with trauma, including shattered assumptions and coping with trauma, could explain mental health and acute stress symptoms among the general population during the COVID-19 outbreak. The participants included 212 Iranian Muslims who filled out the online survey. Women and people with non-fixed jobs reported more mental health deterioration and acute stress symptoms. There were no significant differences between people with or without COVID-19 in terms of mental health symptoms, experiencing acute stress symptoms, and world assumptions. Results showed that world assumption and forward-focused coping could predict mental health symptoms and acute stress symptoms beyond COVID-19 specific stress. Assumptions related to the meaningfulness of the world and trauma-focused coping were associated with a higher score in general mental health symptoms and acute stress, but assumptions related to the benevolence of the world, self-worth, and forward-focused coping were associated with lower mental health and acute stress symptoms. This could suggest that world assumptions could buffer or endanger mental health during crises such as the pandemic. In addition, it seems that forward-focus coping is effective for managing new life challenges during the COVID-19 outbreak. In contrast, the more people address the negative and catastrophic effects of COVID-19 (such as trauma-focused coping), the more they are prone to developing mental health symptoms. This study showed that among Iranian Muslims, some world assumptions (for example, the meaningfulness of world) and some kinds of coping (for example, trauma-focused coping) were not as protective factor as in non-Muslim countries.

The Association of Grief with Mental Health and the Role of Loneliness during the Covid-19 Pandemic

Previous research found that bereavement is associated with several pathological responses affecting both physical and mental health. During the COVID-19 pandemic, and the socially disruptive measures implemented, losses of close contacts have occurred under exceptional circumstances, and it is reasonable to expect that many bereaved people would be unable to overcome their loss adaptively, resulting in dysfunctional grief leading to mental health alterations. Loneliness, which has increased during the pandemic, has been identified as a significant risk factor for mental health that is common when people grieve. In this study, we aimed to gauge the effects of the process of bereavement on mental health in the context of the COVID-19 pandemic and to explore the mediating role of loneliness on the relationship between grief and mental health alterations by surveying a representative sample of 2000 Spanish adults interviewed by phone during the pandemic (February-March 2021). Logistic regressions were performed to examine the effects of grief levels on depression, anxiety, panic attacks, post-traumatic stress disorder, substance abuse, and suicidal thoughts and behaviors. Our results confirmed that how the loss of a loved one is processed is associated with our mental health. Dysfunctional grief was significantly linked to all mental health conditions, particularly depression (OR = 14.28) and anxiety (OR = 11.61). As predicted, loneliness accounted for a substantial percentage (8-30 %) of the impact of dysfunctional grief on mental health outcomes. Our results suggest that in dealing with the mental health consequences of the COVID-19 pandemic, professionals should take into consideration the role of dysfunctional grief and loneliness as targets for assessment and intervention.

Care and support for the covid - 19 bereaved family members: The counselor's role

Worldwide, COVID-19 outbreak has been impacting people. The death toll from Covid-19 has reached 57,50,868 globally, with 39,72,59,234 verified cases. In India, there are 4,24,10,976 confirmed cases of COVID-19, and the death toll has risen to 5,05,279. Everyone experiences bereavement at some point during their lifetime. It is a universal sensation. Many find that when they adjust and integrate their loss into their daily life, their level of sadness lessens over time. The grievers or carers may go through deep, persistent, and crippling grief that satisfies the DSM V criteria for Prolonged Grief Condition, a recognised mental disorder. The majority of people adjust after a loss, with two-thirds saying that their financial, emotional, and physical conditions remained unchanged. Severe dyspnea, patient seclusion, visitation limitations, death in intensive care units, anguish of patients/family members, and disruption of relatives' social support networks are the mourning risk factors. The following psychological interventions will be used in this study to attempt to illustrate the treatment, emotional support, and counselling available to bereaved family members and caregivers (Cognitive Behavior Therapy, Acceptance and Commitment Therapy, Art based therapy, Group Therapy, Traumatic Grief Therapy, Complicated Grief Therapy).Copyright © 2023, Anka Publishers. All rights reserved.

Simultaneous Individual Complicated Grief Treatment With a Couple

Persistent complex bereavement/complicated grief occurs when, after a period of 12 months following a death, there remains an ongoing intense yearning and sorrow for the deceased, preoccupation with the death and its circumstances, difficulty accepting its reality, and disruption in personal identity. This case study illustrates the successful application of Complicated Grief Treatment (CGT), a manualized research-supported intervention, with a husband and wife each receiving individual therapy simultaneously with separate clinicians. The core of CGT involves graded completion of imaginal and situational revisiting (i.e., exposure) exercises. To target maladaptive rumination and counterfactual thinking more explicitly, strategies from a research-based treatment for trauma, Cognitive Processing Therapy, were also incorporated for one member of the couple. To our knowledge, CGT has not been examined with couples receiving individual therapy delivered simultaneously. As such, practitioners have little information about how to proceed with cases where multiple members of the same family are experiencing complicated grief. We will detail the treatment provided, outlining the course of care for each member of the couple, highlighting unique adjustments made to tailor implementation to each individual and to deliver the intervention simultaneously. Quantitative and qualitative data show the effects of treatment on symptoms of complicated grief, depression, and relationship satisfaction.Copyright © The Author(s) 2022.

Complicated Grief Processing and Bereavementassociated Psychopathology in First-Degree Relatives of Deceased Covid-19 Patients

Introduction: The number of patients hospitalized and deceased from COVID-19 during the first and second pandemic waves is exceedingly high. Health restriction policies have prevented relatives of ICU patients from being close to their loved ones, especially during the last moments of life. Furthermore, the possibilities of celebrating funerary rites have been radically restricted. Several authors have argued that these circumstances negatively affect the grief process for losses experiencing during the pandemic, leading to the development of severe grief reactions or complicated bereavement. The present work aims to propose a qualitative analysis of the experience and characteristics of mourning, complicated grief, and bereavement linked to the COVID-19 pandemic observed in first degree relatives of deceased COVID-19 patients. The interest in this topic arises from the clinical observations of unique characteristics of COVID-19-related grief and bereavement that emerged during the months of lockdown and restrictions, with an emphasis on pain persistence and unprocessed mourning. Method(s): This work is based on a qualitative research process that analyzed ten clinical cases of complicated grief. People who have lost a loved one during the first two pandemic waves were involved in a remote brief psychotherapy program consisting of eight weekly sessions. Case reports will be presented as a means to illustrate distinct presentations of COVID-related complicated grief. Result(s): Clinical cases are described according to the initial medical history, psychopathological description, and areas of suffering emerged during the process of therapeutic support. Consistently with qualitative studies recently published on the same topic, the authors identified common features in the patients' narratives, which typically involved the dynamics and condition of the infection, the end of life of the loved one, the patient's experience of isolation in intensive unit, and the relative's experience of isolation at home, the lack of final farewell, and the absence or disruption of funerary rites. The sense of guilt about having infected their loved one is a feeling frequently endorsed by patients. The inability to see and speak with the loved one has resulted in feelings of high and persistent anxiety, with moments of despair. Conclusion(s): Death cir- cumstances, isolation of hospitalized patients and domiciled relatives, absence of in-person final farewells all had a strong psychological impact on the way of experiencing the suffering associated with bereavement. Future research should focus on early detection and treatment of enduring psychopathological symptoms associated with complicated grief and bereavement among first-degree relatives of deceased COVID-19 patients.

It's Complicated-Adolescent Grief in the Time of Covid-19.

Presently, there is a real possibility of a second pandemic occurring: a grief pandemic. There are estimated to be over 1 million children and young people experiencing bereavement because of Covid-19. Adolescent grief is unique due to bio-psycho-social factors such as increased risk-taking, identity-formation, and limited capacity for emotional regulation. In this article, we will argue that adolescents are at increased risk of developing complicated grief during the Covid-19 pandemic, and that it is vital that services are improved to recognize and address this need before secondary problems emerge, including anxiety, depression, and substance abuse. Complicated grief in adolescents is widely underrecognized and often misdiagnosed as a range of mental health problems, addictions, and offending behavior. For example, 25% of <20 year olds who commit suicide have experienced childhood bereavement, whilst 41% of youth offenders have experienced childhood bereavement; this is in comparison with only 4% of the general population. Many of the broader risk factors for complicated grief were already increasing prior to the Covid-19 pandemic, including increased loneliness amongst young people, and the collapse of collective structures to help people manage grief. We propose that this pandemic could be a catalyst for mental health professionals to support and nurture the caring communities emerging in this time as an essential resource to prevent the onset of a grief pandemic.

Erratum: COVID-19 Suicide Survivors-A Hidden Grieving Population.

[This corrects the article DOI: 10.3389/fpsyt.2020.626807.].

COVID-19 Suicide Survivors-A Hidden Grieving Population.

Present time has been dominated by the COVID-19 pandemic. People are grieving several non-death related situations: the loss of a job, of a status, of a role, of their life. Restrictive measures and uncertainty about the future makes individuals vulnerable to feelings of hopelessness and helplessness. Mental health support has been hindered and teams are reinventing themselves to reach people in need. Nevertheless, decompensation of previous psychiatric disorders, increasing levels of depression and anxiety, economical handicaps and fear of the infection, are prompting several cases of COVID-19 related suicides worldwide. Every suicide affects between 5 and 80 individuals, which are known as suicide survivors. Suicide grief is particularly challenging, with rates of complicated grief as high as 40%. Suicide survivors are at increased risk of developing depression, anxiety disorders and of suicidal behaviors. Moreover, feelings of guilt and shame, as well as social stigma, are major obstacles for them to reach form help. This article aims to review the existing literature on COVID-19 related suicides, complicated grief in suicide survivors and highlight modifiable risk factors for both conditions, as well as propose some public health measures to reduce the impact of the pandemic context on self-inflicted harm and its consequences on families, friends and the community. Obstacles to access to mental health support need to be overcome through the use of technology. Technicians should actively approach populations more vulnerable to develop suicidal ideation. Social media have the obligation to provide accurate an non-sensationalistic information. Families and friends should maintain social proximity, despite the need for physical distancing. When a suicide death occurs, police forces and health staff should be prepared to share the news with the family using an empathic and humane approach and providing psychological support. Funerals, memorials and other services should be held as much as possible. Closer contacts should be signalized and closely followed in order to detect the need for specific interventions. Help seeking behaviors should be promoted. Additionally, people should be educated on suicide and its impacts, in order to reduce stigma.

The Efficacy and Usability of an Unguided Web-Based Grief Intervention for Adults Who Lost a Loved One During the COVID-19 Pandemic: Randomized Controlled Trial.

BACKGROUND: The death of a loved one was a challenge many people faced during the COVID-19 pandemic within the context of extraordinary circumstances and great uncertainty. Grief is an unavoidable part of life, and for most people, feelings of grief decrease naturally over time. However, for some people, grieving can become a particularly painful process with clinical symptoms that may require professional help to resolve. To provide psychological support to people who had lost a loved one during the COVID-19 pandemic, an unguided web-based psychological intervention was developed. OBJECTIVE: The main objective of this study was to evaluate the efficacy of the web-based treatment, Grief COVID (Duelo COVID in Spanish; ITLAB), in reducing clinical symptoms of complicated grief, depression, posttraumatic stress, hopelessness, anxiety, and suicidal risk in adults. The secondary aim was to validate the usability of the self-applied intervention system. METHODS: We used a randomized controlled trial with an intervention group (IG) and a waitlist control group (CG). The groups were assessed 3 times (before beginning the intervention, upon completing the intervention, and 3 months after the intervention). The intervention was delivered on the web in an asynchronous format through the Duelo COVID web page. Participants created an account that could be used on their computers, smartphones, or tablets. The evaluation process was automated as part of the intervention. RESULTS: A total of 114 participants were randomly assigned to the IG or CG and met criteria for inclusion in the study (n=45, 39.5% completed the intervention and n=69, 60.5% completed the waitlist period). Most participants (103/114, 90.4%) were women. The results indicated that the treatment significantly reduced baseline clinical symptoms in the IG for all variables (P<.001 to P=.006), with larger effect sizes for depression, hopelessness, grief, anxiety, and risk of suicide (all effect sizes ≥0.5). The follow-up evaluation showed that symptom reduction was maintained at 3 months after the intervention. The results from the CG showed that participants experienced significantly decreased levels of hopelessness after completing the time on the waitlist (P<.001), but their suicidal risk scores increased. Regarding the usability of the self-applied intervention system, the results indicated a high level of satisfaction with the Grief COVID. CONCLUSIONS: The self-applied web-based intervention Grief COVID was effective in reducing symptoms of anxiety, depression, hopelessness, risk of suicide risk, posttraumatic stress disorder, and complicated grief disorder. Grief COVID was evaluated by the participants, who reported that the system was easy to use. These results affirm the importance of developing additional web-based psychological tools to help reduce clinical symptoms in people experiencing grief because of the loss of a loved one during a pandemic. TRIAL REGISTRATION: ClinicalTrials.gov NCT04638842; https://clinicaltrials.gov/ct2/show/NCT04638842.

COVID-19, natural, and unnatural bereavement: comprehensive comparisons of loss circumstances and grief severity.

Background: Acute grief appears more severe after COVID-19 deaths than natural deaths. Prolonged grief disorder (PGD) also appears prevalent following COVID-19 deaths. Researchers hypothesize that specific loss characteristics and pandemic-related circumstances may precipitate more severe grief following COVID-19 deaths compared to (other) natural deaths. Systematic research on these hypotheses may help identify those most at risk for severe grief reactions, yet it is scant. Objective: To compare loss characteristics, loss circumstances, and grief levels among people bereaved due to COVID-19, natural, and unnatural causes. Methods: Adults bereaved through COVID-19 (n = 99), natural causes (n = 1006), and unnatural causes (n = 161) completed an online survey. We administered self-report measures of demographic variables (i.e., age, gender), loss characteristics (i.e., time since loss, relationship with the deceased, intensive care admission, expectedness of death), loss circumstances (i.e., saying goodbye appropriately, COVID-19 infection, quarantine, financial setbacks, social support satisfaction, altered funeral arrangements, funeral satisfaction), and prolonged grief symptoms. Results: COVID-19 deaths (vs. other deaths) more often were parental deaths and less often child deaths. COVID-19 deaths (vs. natural deaths) were more often unexpected and characterized by an inability to say goodbye appropriately. People bereaved due to COVID-19 (vs. other deaths) were more often infected and quarantined. COVID-19 deaths (vs. other deaths) more often involved intensive care admission and altered funeral arrangements. COVID-19 deaths yielded higher grief levels than natural deaths (but not unnatural deaths). Expectedness of the death and the inability to say goodbye appropriately explained this effect. Conclusions: Bereavement due to COVID-19 is characterized by a unique set of loss characteristics and circumstances and elevated grief levels. Improving opportunities to say goodbye before and after death (e.g., by means of rituals) may provide an important means to prevent and reduce severe grief following COVID-19 deaths. HIGHLIGHTS: COVID-19 deaths have unique loss characteristics and circumstances and elicit more severe grief than natural deaths.Death expectedness and the ability to say goodbye appropriately appear important in understanding, preventing and treating grief following COVID-19 deaths.

Antecedentes: El duelo agudo es más severo después de las muertes por COVID-19 que las muertes naturales. El trastorno de duelo prolongado (PGD, por sus siglas en inglés) también parece ser prevalente después de las muertes por COVID-19. Los investigadores plantean la hipótesis de que las características específicas de la pérdida y las circunstancias relacionadas con la pandemia pueden precipitar un duelo más severo después de las muertes por COVID-19 en comparación con las muertes naturales. La investigación sistemática sobre estas hipótesis puede ayudar a identificar a las personas con mayor riesgo de sufrir reacciones de duelo graves, pero es escasa.Objetivo: Comparar las características de la pérdida, las circunstancias de la pérdida y los niveles de duelo entre las personas en duelo debido al COVID-19, causas naturales y no naturales.Métodos: Adultos en duelo por COVID-19 (n = 99), causas naturales (n = 1006) y causas no naturales (n = 161) completaron una encuesta en línea. Administramos medidas de autoinforme de variables demográficas, características de la pérdida (es decir, ingreso en cuidados intensivos, muerte inesperada), circunstancias de la pérdida (es decir, despedirse adecuadamente, infección por COVID-19, cuarentena, contratiempos financieros, satisfacción con el apoyo social, arreglos funerarios alterados, satisfacción con el funeral), y síntomas de trastorno de duelo prolongado.Resultados: Las muertes por COVID-19 (frente a otras muertes) fueron con mayor frecuencia muertes de padres y menos muertes de niños. Las muertes por COVID-19 (frente a las muertes naturales) fueron más a menudo inesperadas y se caracterizaron por la incapacidad de despedirse adecuadamente. Las personas en duelo debido al COVID-19 (frente a otras muertes) más frecuentemente se infectaron y tuvieron que hacer cuarentena. Las muertes por COVID-19 (en comparación con otras muertes) involucraron con mayor frecuencia la admisión a cuidados intensivos y la alteración de arreglos funerarios. Las muertes por COVID-19 produjeron niveles de duelo más altos que las muertes naturales (pero no las muertes no naturales). La expectativa de la muerte y la incapacidad de decir adiós explicaron apropiadamente este efecto.Conclusiones: El duelo por COVID-19 se caracteriza por un conjunto único de características y circunstancias de pérdida y niveles elevados de duelo. Mejorar las oportunidades para decir adiós antes y después de la muerte (p. ej., mediante rituales) puede proporcionar un medio importante para prevenir y reducir el duelo después de las muertes por COVID-19.

Caring for Terminally Ill Clients in Hospices and Social Services Facilities during the Peak of the Covid-19 Pandemic, with a Focus on the Experience of Relatives Regarding This Situation

Background: The COVID-19 pandemic is one of the worst public health crises in a century, with an expected death toll of several million worldwide and an even greater number of bereaved. Methods: We conducted qualitative research in the form of semi- structured interviews, using a consensus qualitative research method. We approached 16 participants who had a relative die from COVID-19 in hospice care or in a social services facility in Slovakia, or whose relative died during the peak of the pandemic of another lethal disease. Results: By analysing the interviews with the participants, we developed six main domains that formed the core themes of the testimonies, namely: the course of the disease, experiencing placement during the anti-pandemic measures, the attitude of the staff, experiences of other family members, the last moments of life, and experiencing the grieving period.The main difference in comparing the testimonies of relatives who had a family member in hospice and those who had a family member in a social services facility was the perception of communication by health professionals.Relatives of the deceased in social services facilities subjectively described communication and the transmission of health information as having been inadequate, while relatives of the deceased in hospices reported a positive experience and no negative comments were observed. Another difference was that relatives with family members in hospices were more prepared and reconciled with the death of their family member compared to relatives with a family member in a social services facility. Conclusion: Exploring the experience of bereaved relatives provides valuable insight into how families coped and adapted when their family member was dying during the COVID-19 pandemic. This can help to better know and understand the needs of patients and their relatives in health and social care facilities, as well as the needs of the bereaved.

Grief during the COVID-19 pandemic: A crosssectional online survey in university students

Introduction: Almost 5 million people worldwide have lost their lives due to SARS-CoV-2 (source: WHO coronavirus (COVID-19) dashboard, data of 1.10.2021;https://covid19.who.int/) and therefore, globally, there is an increase of people in grief due to the death of a significant other. Objective(s): To study psychological correlates of grief during the COVID-19 pandemic. Method(s): 591 university students, with a mean age of 23.84+/-7.95 years (range 18-65 years;76.8% women;91.2% Portuguese) completed an online questionnaire during the second COVID-19 confinement (from 15.02 to 13.03.2021), with sociodemographic questions, the Pandemic Stress Index, the Mental Health Inventory, Insomnia Scale, questions on physical/ psychological health, and social isolation. Result(s): Students bereaving the death of a significant other (n=93, 15.7%;n=25, 26.9% reported cause was SARS-CoV-2;time since death: < 3 months to 1-year), compared to those who did not (n= 498;84.3%), described poorer psychological health, higher psychological distress (depression, anxiety, lack of control) and sleep difficulties, higher levels of stress (higher impact of COVID pandemic in daily life, and higher behavior changes in response to COVID-19) and more social isolation. Conclusion(s): COVID-19 pandemic-related stress is a source of additional stress for bereaved students. Grief is also associated with social isolation, poor mental health (depression, anxiety, lack of control) and sleep difficulties. Screening efforts, guidance, and counseling from professionals of mental health care, primary health care, and universities health care services during and after the COVID-19 pandemic could be extremely beneficial for bereaved students, particularly for those at higher risk of developing prolonged grief disorder.

"Complicated grief during COVID-19: An international perspective": Correction to Khoury et al., 2022

Reports an error in "Complicated grief during COVID-19: An international perspective" by Brigitte Khoury, Oscar Barbarin, German Gutierrez, Martina Klicperova-Baker, Prakash Padakannaya and Ava Thompson (International Perspectives in Psychology: Research, Practice, Consultation, 2022, Vol 11[3], 214-221). In the article (https://doi.org/10.1027/2157-3891/a000055) the article incorrectly started with the second part of the Impact and Implications statement. The Impact and Implications statement and the beginning of the article should be as follows in the erratum. (The following of the original article appeared in record 2022-85486-010.) Cultures across the globe have evolved time-tested rituals to honor those who die and offer solace and support to survivors with the goal of helping them to accept the reality of the death, cope with the feelings of loss, adjust to life without the deceased, and find ways to maintain a connection to the memory of the deceased. The COVID-19 pandemic has disrupted these rituals and brought significant changes to the way we mourn. Specifically, public health responses to COVID-19 such as social distancing or isolation, delays or cancellations of traditional religious and cultural rituals, and shifts from in-person to online ceremonies have disrupted rituals and thus made it more difficult to access support and complete the psychological tasks typically associated with bereavement. This paper conceptualizes the common bereavement tasks including emotion-focused coping, maintaining a connection to the deceased, disengagement and reframing death and loss, and problem-focused coping. It provides examples of how the COVID-19 pandemic has altered mourning rituals across several cultures and religions and contributed to prolonged grief disorder as defined by the ICD-11 that includes depressive symptoms and post-traumatic stress. Early evidence suggested that the suddenness of loss, the social isolation, and the lack of social support often associated with COVID-19-related death are salient risk factors for complicated grief. As a consequence, psychological assessments, grief counseling, and mental health support are needed by families of patients who died from COVID-19. These services must be essential components of any comprehensive public health response to the pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

PANDEMIC GRIEF STUDY (PANGS): ACUTE GRIEF OF BEREAVED RELATIVES FOLLOWING DEATHS DURING COVID-19

Background: The COVID-19 pandemic has led to the death of over 700,000 Americans, with each death leaving 9 surviving Americans (i.e., over 6 million bereaved). One harsh reality of the pandemic has been that survivors have often not been able to care for their dying loved ones, and grieve for them in traditional ways (e.g., wakes, funerals), due to social distancing. The present study used semi-structured clinical interviews to investigate acute grief during the pandemic. Methods: Participants were interviewed by phone, including the Center for Epidemiological Studies-Depression scale, a 20-item measure of depression;the Prolonged Grief Disorder scale, a 13-item measure of prolonged grief disorder;the Work and Social Adjustment Scale (WSAS), a 5-item measure assessing for adjustment after major life events;the Post-Traumatic Growth (PTG) scale, a 10-item measure of growth following a traumatic event such as the death of a loved one;the Utrecht Grief Rumination Scale (UGRS), a 15-item scale measuring various aspects of grief-related rumination;the Interpersonal Support Evaluation List (ISEL), a 12-item measure assessing for social support following a major life event. Results: Participants (N = 51, 74.5% White, 80.4% non-Hispanic) had an average age of 51 (SD = 15.9) and were mostly female (76.5%). 53.0% said they were unable to provide support for their dying loved one, 45.1% said they were not able to say good-bye, 47.1% said they were not prepared, 45.1% said they should have been present for the death. The sample experienced sub-clinical depressive symptoms (M = 10.04, SD = 7.03), and moderate prolonged grief symptoms (M = 23.0, SD = 9.15). Participants had a mean of 7.61 (SD = 10.02) on the WSAS, 23.24 (SD = 13.50) on the PTG, 17.31 (SD = 14.50) on the UGRS, and 30.25 (SD = 4.63) on the ISEL. Conclusion: Despite feeling unprepared for the death of their loved ones during the pandemic, depression and grief scores suggest that many individuals are resilient, given their moderate prolonged grief and sub-clinical depression scores on average. The scores for the WSAS suggest that people are adjusting to work and social life following the death of their loved ones. Clinical intervention should focus on the small proportion who are not adjusting during pandemic bereavement.

Complicated Grief: The Lived Experiences of Those Bereaved By COVID-19.

The morbidity and mortality rates of COVID-19 pandemic are increasing, and many families have lost their loved ones. This study explored the experiences of families living in Iran who lost a loved one to COVID-19. The researchers apply a descriptive phenomenological approach and draw on in-depth interviews with 18 family members who had lost at least one family member because of COVID-19. Data were analyzed using Colaizzi's method. After reviewing and comparing the consistency of the codes, crisis in crisis, circumstances of death and its consequences, and lack of preservation of patient dignity were extracted as main categories. Neglecting grieving families and related issues can lead to delays and difficulties in the process of recovery and intensification of their psychosocial pressures. Acquiring more knowledge about different impacts of COVID-19 will be helpful for providing timely and better rehabilitation.

Complicated Grief during COVID-19: An International Perspective

Cultures across the globe have evolved time-tested rituals to honor those who die and offer solace and support to survivors with the goal of helping them to accept the reality of the death, cope with the feelings of loss, adjust to life without the deceased, and find ways to maintain a connection to the memory of the deceased. The COVID-19 pandemic has disrupted these rituals and brought significant changes to the way we mourn. Specifically, public health responses to COVID-19 such as social distancing or isolation, delays or cancellations of traditional religious and cultural rituals, and shifts from in-person to online ceremonies have disrupted rituals and thus made it more difficult to access support and complete the psychological tasks typically associated with bereavement. This paper conceptualizes the common bereavement tasks including emotion-focused coping, maintaining a connection to the deceased, disengagement and reframing death and loss, and problemfocused coping. It provides examples of how the COVID-19 pandemic has altered mourning rituals across several cultures and religions and contributed to prolonged grief disorder as defined by the ICD-11 that includes depressive symptoms and post-traumatic stress. Early evidence suggested that the suddenness of loss, the social isolation, and the lack of social support often associated with COVID-19-related death are salient risk factors for complicated grief. As a consequence, psychological assessments, grief counseling, and mental health support are needed by families of patients who died from COVID-19. These services must be essential components of any comprehensive public health response to the pandemic. © 2022 Hogrefe Publishing.

BEREAVEMENT AND COVID-19: PREVALENCE, COMORBIDITY, AND ASSOCIATED FEATURES AMONG UKRAINIAN SAMPLE.

OBJECTIVE: The aim: To examine the features of experiences of bereavement reactions and the severity of comorbid mental health problems in persons who lost loved ones during the pandemic. PATIENTS AND METHODS: Materials and methods: 191 volunteers aged 18-60 years participated in this study. All participants were tested during 2018-2020. To assess the mental health problems was used International Neuropsychiatric Interview (MINI) and a set of IAPT scales; to the psycho-emotional distress severity associated with loss of loved ones - Inventory of Complicated Grief, with verification of symptoms of complicated grief based on an independent assessment of two experts; and the quality of life satisfaction was assessed by the Quality of Life Enjoyment and Satisfaction Questionnaire, Short Form. RESULTS: Results: The results show an association between the severity of symptoms of depression, general anxiety, social avoidance, and loss during the pandemic. The level of psycho-emotional distress was associated with the experience of bereavement as a traumatic event for a group of participants who experienced loss during the pandemic and, at the same time, before the pandemic was associated with the severity of depression. Regardless of the time of loss, people who demonstrated signs of complicated grief have a more pronounced comorbid psychopathology, a higher level of psycho-emotional distress, and a lower level of satisfaction with life quality. CONCLUSION: Conclusions: It has been established that a person's ability to experience loss as a traumatic experience and grieve during the pandemic is modified with the context of the life situation and reflects those challenges that impose quarantine restrictions.

Transnational Caregiving and Grief: An Autobiographical Case Study of Loss and Love During the COVID-19 Pandemic.

This article examines grief while providing transnational caregiving during the COVID-19 pandemic. There are an estimated 275 million migrants living in their destination homeland which is 3.5% of the global population. The transnational family strives to maintain solidarity, intergenerational ties, and cultural values while sustaining family structure across international borders. Transnational caregiving is the exchange of support and care across distance and international borders. The devastating assault of COVID-19 on older adults impacted caregiving significantly, especially transnational caregiving. A qualitative case study method was selected to examine a participant's understanding and experience of transnational caregiving during the COVID-19 pandemic. Through the interviews and writing of the narrative summary, five themes emerged related to transnational caregiving and COVID-related losses -exposure to sudden and unexpected death, isolation, guilt, loss and change of traditions, and lack of closure.

Descriptive Study of an Emotional Support Program for Relatives of Patients Hospitalized with COVID-19 in the Puerta de Hierro Hospital in Madrid

The first wave of the COVID-19 crisis dramatically affected the global population. Madrid was one of the most severely affected regions in Spain. For public health reasons, family visits to hospitalized patients were restricted, preventing relatives from accompanying them. This article details the descriptive study that we carried out on the emotional support program offered to relatives of patients admitted during the first wave at Hospital Puerta de Hierro. A total of 456 relatives (mostly female, usually spouses or sons or daughters of patients) were contacted. Relatives of ICU patients and female relatives required broader levels of support. Increasing the perception of care through an emotional support program can be important for family members. Nevertheless, we consider additional studies to be necessary to explore the specific psychological benefits that these interventions provide.

Grieving During the COVID-19 Pandemic: In-Person and Virtual "Goodbye".

This study examined the relationship between having an opportunity to say goodbye to a dying family member or friend in person or virtually, as well as attending their funeral services in person or virtually, and the bereaved individuals' psychological distress and complicated grief during the COVID-19 pandemic. Five hundred and nineteen US adults who had lost a family member or a friend between January 2020 and June 2021 completed an online survey for this study. Only a small proportion of participants were able to say goodbye to their dying family member or friend in person, and saying goodbye virtually was associated with higher levels of complicated grief and psychological distress. Those who physically attended a formal, in-person funeral or memorial service reported lower levels of psychological distress. The findings suggest a complicated process of saying goodbye in different formats during the pandemic.