This study aims to explore the differences in prolonged grief (PDG), posttraumatic stress (PTSD), and depression symptoms (MDD) following the loss of a loved one before and after the COVID-19 pandemic. Using a cross-sectional design, 888 bereaved individuals were classified on different groups according to the cause of death. Results indicate that participants who experienced a loss during the pandemic, regardless of the cause, presented higher levels of prolonged grief, posttraumatic stress and depression when compared to those who lost a loved one before the pandemic. This study sheds light on the environmental influences (ex: the COVID-19 pandemic) on the grieving process, emphasizing the need to take the context into account when tailoring interventions in bereavement and mental health care.
BlevinsC. A.WeathersF. W.DavisM. T.WitteT. K.DominoJ. L. (2015). The posttraumatic stress disorder checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation: Posttraumatic stress disorder checklist for DSM-5. Journal of Traumatic Stress, 28(6), 489–498. https://doi.org/10.1002/jts.22059
3.
BoelenP. A.LenferinkL. I. M. (2020). Comparison of six proposed diagnostic criteria sets for disturbed grief. Psychiatry Research, 285, Article 112786. https://doi.org/10.1016/j.psychres.2020.112786
4.
BoelenP. A.ReijntjesA.DjelantikA. A. A. M. J.SmidG. E. (2016). Prolonged grief and depression after unnatural loss: Latent class analyses and cognitive correlates. Psychiatry Research, 240, 358–363. https://doi.org/10.1016/j.psychres.2016.04.012
5.
BoelenP. A.SmidG. E. (2017). Disturbed grief: Prolonged grief disorder and persistent complex bereavement disorder. BMJ, 357, j2016. https://doi.org/10.1136/bmj.j2016
6.
BolaséllL. T.PizónJ. H.BoelenP. A.KristensenC. H. (2023). The Traumatic Grief Inventory Self-Report (TGI-SR) as a clinical measure to identify Brazilians with prolonged grief disorder and persistent complex bereavement disorder. Trends in Psychology, 1–19. https://doi.org/10.1007/s43076-023-00316-5
7.
BoveroA.PidincheddaA.ClovisF.BerchiallaP.CarlettoS. (2022). Psychosocial factors associated with complicated grief in caregivers during COVID-19: Results from a preliminary cross-sectional study. Death Studies, 46(6), 1433–1442. https://doi.org/10.1080/07481187.2021.2019144
8.
BreenL. J.LeeS. A.NeimeyerR. A. (2021). Psychological risk factors of functional impairment after COVID-19 deaths. Journal of Pain and Symptom Management, 61(4), e1–e4. https://doi.org/10.1016/j.jpainsymman.2021.01.006
9.
BreenL. J.ManciniV. O.LeeS. A.PappalardoE. A.NeimeyerR. A. (2022). Risk factors for dysfunctional grief and functional impairment for all causes of death during the COVID-19 pandemic: The mediating role of meaning. Death Studies, 46(1), 43–52. https://doi.org/10.1080/07481187.2021.1974666
10.
CastroP. R. M.SouzaS. C. d.DamascenoR. A.NascimentoG. M. d.FariasR. R. S. d. (2021). Impactos psicológicos em adultos durante a pandemia de COVID-19: uma revisão integrativa. Research, Society and Development, 10(11), Article e195101118546. https://doi.org/10.33448/rsd-v10i11.18546
CostaM. d. A.KristensenC. H.DreherC. B.ManfroG. G.SalumG. A. (2022). Habituating to pandemic anxiety: Temporal trends of COVID-19 anxiety over sixteen months of COVID-19. Journal of Affective Disorders, 313, 32–35. https://doi.org/10.1016/j.jad.2022.06.077
13.
DjelantikA. A. A. M. J.RobinaughD. J.KleberR.SmidG. E.BoelenP. A. (2020a). Symptomatology following loss and trauma: Latent class and network analyses of prolonged grief disorder, posttraumatic stress disorder, and depression in a treatment-seeking trauma-exposed sample. Depression and Anxiety, 37(1), 26–34. https://doi.org/10.1002/da.22880
14.
DjelantikA. M. J.SmidG. E.MrozA.KleberR. J.BoelenP. A. (2020b). The prevalence of prolonged grief disorder in bereaved individuals following unnatural losses: Systematic review and meta regression analysis.Journal of affective disorders, 265, 146–156.
15.
DjelantikA. A. A. M. J.SmidG. E.KleberR.J.BoelenP. A. (2017). Symptoms of prolonged grief, post-traumatic stress, and depression after loss in a Dutch community sample: A latent class analysis. Psychiatry Research, 247, 276–281. https://doi.org/10.1016/j.psychres.2016.11.023
16.
EismaM. C.StroebeM. S. (2021). Emotion regulatory strategies in complicated grief: A systematic review. Behavior Therapy, 52(1), 234–249. https://doi.org/10.1016/j.beth.2020.04.004
17.
EismaM. C.TammingaA. (2020). Grief Before and During the COVID-19 Pandemic: Multiple Group Comparisons. Journal of Pain and Symptom Management, 60(6), e1–e4. https://doi.org/10.1016/j.jpainsymman.2020.10.004
18.
EismaM. C.TammingaA. (2022). COVID-19, natural, and unnatural bereavement: Comprehensive comparisons of loss circumstances and grief severity. European Journal of Psychotraumatology, 13(1), Article 2062998. https://doi.org/10.1080/20008198.2022.2062998
19.
EismaM.C.TammingaA.SmidG. E.BoelenP. A. (2021). Acute grief after deaths due to COVID-19, natural causes and unnatural causes: An empirical comparison. Journal of Affective Disorders, 278, 54–56. https://doi.org/10.1016/j.jad.2020.09.049
20.
FieldA. P. (2018). Discovering statistics using IBM SPSS statistics (5th ed.). Sage.
21.
GangJ.FalzaranoF.SheW. J.WinokerH.PrigersonH. G. (2022). Are deaths from COVID-19 associated with higher rates of prolonged grief disorder (PGD) than deaths from other causes?Death Studies, 46(6), 1287–1296. https://doi.org/10.1080/07481187.2022.2039326
22.
GesiC.CarmassiC.CerveriG.CarpitaB.CremoneI. M.Dell’OssoL. (2020). Complicated grief: What to expect after the coronavirus pandemic. Frontiers in Psychiatry, 11, 489. https://doi.org/10.3389/fpsyt.2020.00489
23.
GoveasJ. S.ShearM. K. (2020). Grief and the COVID-19 pandemic in older adults. American Journal of Geriatric Psychiatry, 28(10), 1119–1125. https://doi.org/10.1016/j.jagp.2020.06.021
24.
HamidW.JahangirM. S. (2022). Dying, death and mourning amid COVID-19 pandemic in kashmir: A qualitative study. Omega (Westport), 85(3), 690–715. https://doi.org/10.1177/0030222820953708
25.
HeekeC.StammelN.HeinrichM.KnaevelsrudC. (2017). Conflict-related trauma and bereavement: Exploring differential symptom profiles of prolonged grief and posttraumatic stress disorder. BMC Psychiatry, 17(1), 118. https://doi.org/10.1186/s12888-017-1286-2
26.
JoaquimR. M.PintoA. L.GuatimosimR. F.de PaulaJ. J.Souza CostaD.DiazA. P.da SilvaA. G.PinheiroM. I.SerpaA. L.MirandaD. M.Malloy-DinizL. F. (2021). Bereavement and psychological distress during COVID-19 pandemics: The impact of death experience on mental health. Current Research in Behavioral Sciences, 2, Article 100019. https://doi.org/10.1016/j.crbeha.2021.100019
27.
Kokou-KpolouC. K.Fernández-AlcántaraM.CénatJ. M. (2020). Prolonged grief related to COVID-19 deaths: Do we have to fear a steep rise in traumatic and disenfranchised griefs?Psychological trauma: Theory, research, practice, and policy, 12(S1), S94–S95. https://doi.org/10.1037/tra0000798
28.
Komischke-KonnerupK. B.ZachariaeR.JohannsenM.NielsenL. D.O’ConnorM. (2021). Co-Occurrence of prolonged grief symptoms and symptoms of depression, anxiety, and posttraumatic stress in bereaved adults: A systematic review and meta-analysis. Journal of Affective Disorders Reports, 4, Article 100140. https://doi.org/10.1016/j.jadr.2021.100140
29.
KroenkeK.SpitzerR. L.WilliamsJ. B. W. (2001). The PHQ-9. Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
30.
LeeS. A.NeimeyerR. A. (2022). Pandemic grief scale: A screening tool for dysfunctional grief due to a COVID-19 loss. Death Studies, 46(1), 14–24. https://doi.org/10.1080/07481187.2020.1853885
31.
LenferinkL. I. M.BoelenP. A. (2023). DSM-5-TR prolonged grief disorder levels after natural, COVID-19, and unnatural loss during the COVID-19 pandemic. Journal of Affective Disorders Reports, 12, Article 100516. https://doi.org/10.1016/j.jadr.2023.100516
32.
LenferinkL. I. M.NickersonA.de KeijserJ.SmidG. E.BoelenP. A. (2020). Trajectories of grief, depression, and posttraumatic stress in disaster-bereaved people. Depression and Anxiety, 37(1), 35–44. https://doi.org/10.1002/da.22850
33.
LimaE. d. P.VasconcelosA. G.BergerW.KristensenC. H.NascimentoE. d.FigueiraI.MendlowiczM. V. (2016). Cross-cultural adaptation of the posttraumatic stress disorder checklist 5 (PCL-5) and life events checklist 5 (LEC-5) for the Brazilian context. Trends in Psychiatry & Psychotherapy, 38(4), 207–215. https://doi.org/10.1590/2237-6089-2015-0074
34.
LimaO. F.MendesA.CrippaJ. A.LoureiroS. R. (2009). Study of the discriminative validity of the PHQ-9 and PHQ-2 in a sample of Brazilian women in the context of primary health care. Perspectives in Psychiatric Care, 45(3), 216–227. https://doi.org/10.1111/j.1744-6163.2009.00224.x
35.
LundorffM.BonannoG. A.JohannsenM.O’ConnorM. (2020). Are there gender differences in prolonged grief trajectories? A registry-sampled cohort study. Journal of Psychiatric Research, 129, 168–175. https://doi.org/10.1016/j.jpsychires.2020.06.030
36.
LundorffM.HolmgrenH.ZachariaeR.Farver-VestergaardI.O’ConnorM. (2017). Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis. Journal of Affective Disorders, 212, 138–149. https://doi.org/10.1016/j.jad.2017.01.030
37.
Pereira-LimaK.LoureiroS. R.BolsoniL. M.Apolinario da SilvaT. D.OsórioF. L. (2019). Psychometric properties and diagnostic utility of a Brazilian version of the PCL-5 (complete and abbreviated versions). European Journal of Psychotraumatology, 10(1), Article 1581020. https://doi.org/10.1080/20008198.2019.1581020
38.
PrigersonH. G.HorowitzM. J.JacobsS. C.ParkesC. M.AslanM.GoodkinK.RaphaelB.MarwitS. J.WortmanC.NeimeyerR. A.BonannoG.BlockS. D.KissaneD.BoelenP.MaerckerA.LitzB. T.JohnsonJ. G.FirstM. B.MaciejewskiP. K. (2009). Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Medicine, 6(8), Article e1000121. https://doi.org/10.1371/journal.pmed.1000121
39.
ReitsmaL.BoelenP. A.de KeijserJ.LenferinkL. I. M. (2023). Self-guided online treatment of disturbed grief, posttraumatic stress, and depression in adults bereaved during the COVID-19 pandemic: A randomized controlled trial. Behaviour Research and Therapy, 163, Article 104286. https://doi.org/10.1016/j.brat.2023.104286
40.
RosnerR.ComtesseH.VogelA.DoeringB. K. (2021). Prevalence of prolonged grief disorder. Journal of Affective Disorders, 287, 301–307. https://doi.org/10.1016/j.jad.2021.03.058
41.
SelmanL. E.SowdenR.BorgstromE. (2021). ‘Saying goodbye’during the COVID-19 pandemic: A document analysis of online newspapers with implications for end of life care. Palliative Medicine, 35(7), 1277–1287. https://doi.org/10.1177/02692163211017023
42.
SimonN. M.ShearM. K.ReynoldsC. F.CozzaS. J.MauroC.ZisookS.SkritskayaN.RobinaughD. J.MalgaroliM.SpandorferJ.LebowitzB. (2020). Commentary on evidence in support of a grief-related condition as a DSM diagnosis. Depression and Anxiety, 37(1), 9–16. https://doi.org/10.1002/da.22985
43.
SmidG. E.KleberR. J.de la RieS. M.BosJ.B. A.GersonsB. P. R.BoelenP. A. (2015). Brief Eclectic Psychotherapy for Traumatic Grief (BEP-TG): Toward integrated treatment of symptoms related to traumatic loss. European Journal of Psychotraumatology, 6(1), Article 27324. https://doi.org/10.3402/ejpt.v6.27324
44.
StroebeM.SchutH. (2020). Bereavement in times of COVID-19: A review and theoretical framework. Omega (Westport), 82(3), 500–522. https://doi.org/10.1177/0030222820966928
45.
TangS.XiangZ. (2021). Who suffered most after deaths due to COVID-19? Prevalence and correlates of prolonged grief disorder in COVID-19 related bereaved adults. Globalization and Health, 17(19), 1–9. https://doi.org/10.1186/s12992-021-00669-5
46.
Torrens-BurtonA.GossS.SuttonE.BarawiK.LongoM.SeddonK.CarduffE.FarnellD. J. J.NelsonA.ByrneA.PhillipsR.SelmanL. E.HarropE. (2022). ‘It was brutal. It still is': A qualitative analysis of the challenges of bereavement during the COVID-19 pandemic reported in two national surveys. Palliative Care and Social Practice, 16, Article 26323524221092456. https://doi.org/10.1177/26323524221092456
47.
TremlJ.BrählerE.KerstingA. (2022). Prevalence, factor structure and correlates of DSM-5-TR criteria for prolonged grief disorder. Frontiers in Psychiatry, 13, Article 880380. https://doi.org/10.3389/fpsyt.2022.880380
48.
VerderyA. M.NewmyerL.WagnerB.MargolisR. (2021). National profiles of coronavirus disease 2019 mortality risks by age structure and preexisting health conditions. The Gerontologist, 61(1), 71–77. https://doi.org/10.1093/geront/gnaa152
49.
WeathersF. W.MarxB. P.FriedmanM. J.SchnurrP. P. (2014). Posttraumatic stress disorder in DSM-5: New criteria, new measures, and implications for assessment. Psychological Injury and Law, 7(2), 93–107. https://doi.org/10.1007/s12207-014-9191-1
50.
ZouX.XuX.TangR.JiaoK.QianW.ShenX.WangJ. (2023). Potential risk factors for acute grief during the COVID-19 pandemic: The mediating role of avoidance processes. Clinical Psychology & Psychotherapy, 30(1), 202–212. https://doi.org/10.1002/cpp.2794
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
