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

ABSTRACT

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.