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Abstract

This study, involving 16 students, examines college bereavement support, revealing five key themes: (1) the impact of the college transition on support; (2) deficiencies in staff support; (3) the significance of visibility to college staff; (4) student challenges during college bereavement; and (5) student expectations for support. The transition from elementary to college, compounded by bereavement, poses unique challenges. College support often prioritizes attendance management, neglecting emotional needs and fostering isolation. Recommendations include: (1) establishing clear support frameworks in a comprehensive bereavement response policy; (2) assigning a dedicated staff member with bereavement expertise; and (3) providing training for all staff to create an empathetic and supportive college environment for grieving students. These enhancements aim to address the identified deficiencies and ensure holistic support throughout the college experience.

Keywords

bereavement college staff support students death

Introduction

Losing a close family member usually affect individuals profoundly, regardless of their age. However, when such a loss occurs during childhood or adolescence, its consequences can be particularly profound and enduring. Extensive research on the consequences of childhood bereavement reveals its profound influence on social well-being, mental health, and educational achievement (Dyregrov et al., 2022; Lytje & Dyregrov, 2019). It elicits a spectrum of emotional reactions, including fear, anger, guilt, and regression, accompanied by various physical and mental symptoms such as insomnia, intrusive thoughts, apathy, and psychosomatic manifestations (Bylund-Grenklo et al., 2016; Dowdney, 2000; Dyregrov, 2008). Notably, a well-established body of research underscores the heightened risk of depression associated with such loss (Balk, 2008; Taub & Servaty-Seib, 2008).

Furthermore, children experiencing parental loss face an elevated vulnerability that persists into adolescence and adult age, contributing to heightened risks such as increased all-cause mortality and engagement in high-risk behaviors (Li et al., 2014; Nielsen et al., 2012; Rostila & Saarela, 2011). These findings underscore the profound consequences of familial loss during pivotal formative years. Importantly, when such losses occur during college, these challenges may also impact academic performance, heightening the risk of dropout. Numerous studies (e.g., Cox et al., 2015; Høeg et al., 2019) have investigated the repercussions of bereavement during higher education on student success, revealing a decrease in the likelihood of obtaining a degree. Servaty-Seib and Hamilton (2006) identified an increased risk of dropout among bereaved college students, and a register study by Høeg et al. (2019) revealed significantly lower attainment rates for bereaved adolescents (males: 22%; females: 26%) compared to non-bereaved peers, underscoring the gravity of this issue.

As a consequence, in the face of transformative life events such as family bereavement, college students require support not only from their familial and social networks but also from the educational institutions to which they belong. While primary and secondary schools in Scandinavia have a tradition of offering support during challenging times (Lytje, 2016a; Lytje et al., 2021), there is a gap in our current understanding of the support extended by colleges to bereaved students and whether these initiatives achieve their intended outcomes.

This article seeks to address this gap by delving into the experiences and support preferences of college students coping with the loss of a close family member. Our objective is to enhance comprehension and support mechanisms for college students navigating the complexities of bereavement.

The Danish College System

In Denmark, the college system is an integral part of the country's educational framework, providing complimentary education to those aged 16 to 20, akin to the high school system in the U.S. and sixth form college in the UK. The primary objective of this system is to prepare students for advanced studies while imparting essential academic and life skills. Diverse programs are offered to cater to various academic interests, such as STX (General Student Line), HTX (Higher Technical Examination), HHX (Higher Commercial Examination), and HF (Higher Preparatory Examination). A key aspect of this system is the emphasis on support and guidance, with study counselors readily available to assist students in both their academic pursuit and personal development.

Methods

This study is positioned within a pragmatic paradigm and employs focus group interviews (FGIs) as the primary method of data generation. The selection of FGIs is based on the endorsement by Ravitch and Carl (2019), who advocate for this methodology, particularly in investigations focused on capturing perspectives, sentiments, and experiences within specific settings or demographics. The interviews adhered to a semi-structured format (Brinkmann & Kvale, 2014). This format allowed the interviewers to utilize an interview guide as a foundational framework while also permitting flexibility to deviate as necessary.

Participant Recruitment

Sixteen college students, all enrolled in the STX program across various colleges in Denmark, were recruited for this study as part of an effort to investigate how colleges offer bereavement support and identify areas for improvement. This collaborative initiative involved conducting separate interviews with key stakeholders, including Heads of colleges, Student Support Services personnel, teachers, and students.

To streamline the recruitment process and ensure a diverse representation of colleges, collaboration agreements with seven different colleges, covering all five regions of Denmark, were established to streamline recruitment and ensure diversity. The research team briefed colleges on the study's nature, participant requirements, and ethical considerations, leaving the actual recruitment to the colleges. While this approach simplified recruitment, it introduced uncertainty about the number of interviewees per college. Given the extensive data collected, this article will solely focus on the insights derived from student participants.

To be eligible for participation, students were required to have experienced the loss of a close family member, encompassing parents, siblings, or individuals of a similar significance in their lives. The definition of “similar important role” was left to the discretion of potential participants. Additionally, participants needed to have experienced the loss within 1 year of commencing or attending college studies. All participants were aged between 16 and 18 years.

Procedure

The interviews were conducted on college campuses during daylight hours, utilizing suitable interview rooms provided by the colleges. This location choice aimed to establish a familiar and secure environment, facilitating participants in comfortably discussing their experiences. Simultaneously, it served to minimize the time and resources required by both staff and students to engage in the study. Three proficient interviewers, each with a demonstrated track record in conducting interviews, were appointed for the research project. Prior to initiating the data generation process, a uniform strategy for all interviews was designed and agreed upon. This measure aimed to minimize the risk of individual interviewers introducing significant deviations from the established protocol.

At the onset of each interview, the interviewer clarified the purpose of their presence, outlined participants’ rights, and obtained signed consent forms. While specific themes guided each session, the conversations generally adhered to an open and lightly moderated format, enabling participants to explore the topics they found most significant. The interviews concluded with a discussion about participants’ experiences in the study. The interview sessions typically lasted for 60 to 90 min and were audio-recorded for subsequent analysis.

Ethical Considerations

This study adhered to established ethical guidelines within the field of psychology, specifically aligning its research design and implementation with the ethical framework for good practice in counseling and psychotherapy outlined by Bond and Griffin (2013). The application of this framework ensured that participants were fully informed about procedures for providing and withdrawing consent, with efforts made during interviews to minimize potential discomfort or distress.

Conducted within Denmark, the study strictly followed robust data protection regulations stipulated in the European General Data Protection Regulation (GDPR), as detailed in the official legal text (General Data Protection Regulation (GDPR) – Official Legal Text, n.d.). To safeguard participant confidentiality and anonymity, consistent pseudonyms were used throughout the research process. The study underwent a comprehensive internal ethics review before formal approval. Notably, following guidelines by the National Scientific Committee (2020, p. 20), projects not involving the collection of biological material are not required to seek approval from an external ethics committee in Denmark.

Moreover, the study prioritized post-interview support mechanisms, ensuring ready accessibility for all participants. This included providing access to a qualified psychologist through the Danish Cancer Society, emphasizing the study's commitment to participants’ ongoing well-being beyond the data collection phase. Additionally, participants had access to internal support mechanisms provided by student support services at individual colleges.

Data Analysis

For data analysis, we employed a thematic analytical approach, known for its flexibility and proficiency in providing detailed insights into data (Nowell et al., 2017). The analysis adhered to the steps outlined by Braun et al., (2006), including:

Familiarization with research data

Generation of initial codes

Identification of themes

Review and refinement of themes

Definition and naming of themes

Report writing

The initial stage involved an in-depth review and immersion in the transcribed data. Subsequently, all data were imported into QSR NVivo 12, a software program facilitating the documentation of the analytical process and offering tools for organizing the data into meaningful categories. This preliminary review resulted in the identification of 11 initial themes.

The analytical process unfolded as follows:

One researcher conducted the initial analysis and performed a round of revisions.

Two secondary researchers independently reviewed the dataset and the analysis, providing feedback on theme selection and naming.

The primary researcher incorporated this feedback, presenting a final set of themes and quotations for approval by the other researchers.

This iterative process resulted in consolidating the initial 11 themes into five overarching themes: (1) the transition to college and its impact on support; (2) deficiencies in support provided by college staff; (3) the importance of being seen by college staff; (4) student challenges when experiencing loss at college; and (5) student desires for college support.

All FGIs were conducted, transcribed, and analyzed in Danish. Subsequently, selected quotations were translated into English, capturing the intended meaning rather than strictly adhering to a word-for-word translation.

Results

The Transition to College and its Impact on Support

The transition from elementary school to college signifies a pivotal moment for students, marked by a notable reduction in available support. College serves as a crucible where students embark on their journey towards adulthood, often encountering a decrease in readily accessible support compared to their prior experiences in the elementary school system. This shift is exemplified through the experiences of individuals like Carmen, who noted a stark contrast:

College doesn't take care of you in the same way your elementary school teachers did. It's not as personal. And my classmates aren't necessarily my friends. They're just my classmates here. You might not get along as well with everyone.—Carmen, Student

The decrease in support from college staff, compared to the assistance students received in prior schools, proved challenging. This abrupt change in support levels left students grappling with difficulties while navigating a new education system. Dicte discussed this:

The notion that you can now manage on your own just because you're in college is a bit skewed. I believe one becomes even more bewildered. I mean, you enter an entirely new class, and well… it's an entirely new way of attending school. There's just so much to handle. All of this makes it exceptionally challenging to determine what steps to take.—Dicte, Student

While some students yearn for the support structure they were accustomed to in elementary school, others, especially those who have previously grappled with bereavement before entering college, perceive this transition as an opportunity for a fresh start. Relying primarily on alternative sources such as friends and family for their support, college becomes a potential sanctuary, as articulated by Alam:

I think maybe it's a mix, because I don't think I've needed it. But yeah, I also think I've had some good friends and family support, so when I came to school, it was more like my sanctuary, where I didn't focus so much on it but instead had fun.—Alam, Student

However, this variability also means that several students, particularly those in need of support following the loss of a family member, may not perceive college staff readily available. Mila's account highlights this issue:

I would give college a failing grade. It's not because I've been here for so long, but those who knew about it haven't really done anything about it. What I wanted most was for the teachers to keep an eye on you, for instance, if they see that I'm a bit absent in class… have those small conversations, just make sure you're okay.—Mila, Student

Generally, students want to be met by both student counselors and teachers, who can help them navigate college, while also struggling with a loss. However, the majority of interviewed students never felt that the college staff provided such support.

Deficiencies in Support Provided by College Staff

During the interviews, several students highlighted noteworthy concerns regarding the support provided by student counseling services. In numerous instances, when students disclosed alterations in their life situations to the counseling staff, the response was often limited to notifying their college teachers, with minimal additional support offered. Subsequently, the responsibility to initiate additional discussions for ongoing support or request specific assistance fell upon the individual student. Katja's experience serves as an illustration of this:

Support was something you had to seek out yourself. The academic counselor received it well, and promised to write my teachers, but there was no follow-up. I don't even know if the teachers received the message because none of them ever approached me if they could see I was having a bad day or showed any interest. I mean, there wasn't that kind of welcome where it's okay that you're feeling bad or that something is bothering you. So you felt that even though you had said it, you were still alone with it.—Katja, Student

In addition to lackluster responses from student counselors, many students faced situations where sympathetic counselors initially promised support and understanding towards taking time off, only to later receive written threats of sanctions due to perceived excessive absence levels. Vita shared her experience:

I reached out to the principal, explaining my need to get away from Denmark, so I went to England. I had communicated this to everyone, and they indicated understanding. However, upon my return, I discovered a written warning in my email, the type you receive before facing disciplinary action. Consequently, I had a meeting with a student counselor, primarily centered on attendance. I felt pressured to decrease my absence, or the consequence would be expulsion. Instead of prioritizing my well-being during a difficult time, I found myself compelled to focus on minimizing absenteeism due to the heightened emphasis they placed on it.—Vita, Student

In various cases, students proactively informed student support services about their circumstances. Unfortunately, beyond the initial conversation, student support services did not consistently respond until the impact of the loss manifested in the student's attendance record. Consequently, engagement frequently centered on attendance rather than addressing the fundamental issues the student faced. Asta's experience illustrates this:

My initial conversation went something like this: ‘I'm sorry to hear that,’ but it quickly circled back to the issue of attendance. I didn't feel like saying anything more about it; I had given up. The last time, he [the counselor] suggested we have a conversation right in the middle of the hallway, with thousands of people passing by—seriously.—Asta, Student

While support from student support services is crucial, several students emphasized the significance of receiving support from classroom teachers. Mille shared her experience of her loss going unrecognized:

I haven't really confided in many people at college because this [the loss] was before I even started. However, I distinctly remember during the introduction weeks, we were asked to write about ourselves and what we had done during the summer vacation. I mentioned that I had lost my father. My teacher promised to read everyone's submissions to get to know us. I expected her to do so, but she never really reached out to me. I became uncertain whether she had read it or not because I anticipated her approaching me and inquiring about it. It felt as though she didn't care. I'm somewhat unsure if she even read it.—Mille, Student

Issues like these often surfaced when students had experienced a loss before entering college. Students who initially disclosed such circumstances to their teachers did not always receive a response which was swiftly interpreted as a signal that the teacher is uninterested, leading to the absence of a meaningful connection within a supportive environment.

The Importance of Being Seen by College Staff

Many students found it challenging to secure appointments with the student counselors due to their busy schedules, being responsible for multiple classes simultaneously. However, students did not necessarily perceive that the counselors were unwilling or unable to help. Jenine articulated this:

But unfortunately, I thought, especially at our school, the student counselors didn't have much time, and it was rare that you could actually talk to them when you needed to. They may not have been able to help as much as they would have liked to and in the areas where they would have liked to help you.—Jenine, Student

Students acknowledged the genuine time constraints faced by student support services, understanding that it hindered their ability to carry out desired work. However, the scarcity of time posed challenges as students perceived conversations to primarily focus on retention rather than addressing individual challenges.

Many students were also frustrated by not feeling seen by their teachers in the classroom and lacking an understanding of their situation. Freya expressed this:

I had told the teachers what had happened, so they knew. But there was nothing from the student counselor, who was also my teacher. She didn't really come and talk to me. But there was a moment in the second year where I struggled a bit, and she asked me if I wanted to drop out of college, which I didn't want. So, I just stopped talking to her.—Freya, Student

Despite informing school staff about their situations, several students felt unsupported and unapproached. Actions often only materialized when students faced challenges in class or increased absenteeism, and this was considered too late and falling short of meeting students’ expectations and support needs. However, some students experienced significant differences when met by empathetic teachers. Frida discussed this:

There was a time when a teacher showed a somewhat intense film, but she quietly said to me, not in front of everyone, but she was understanding if it was too intense. It was very caring, which was lovely.—Frida, Student

Being met by considerate teachers had a profound impact on students, whether related to an intense film or a student expressing a lack of motivation in class. Several students emphasized the importance of how they were approached, being seen as individuals rather than merely pieces in the system.

Student Challenges When Experiencing Loss at College

When dealing with grief, many students found that the loss and ensuing grief affected their performance, hindering them from achieving the same academic level as before. Mille elaborated on this:

It mostly affected my concentration because I have always been quite good at keeping up in class and paying attention. But after all this with my father, it often happens that I forget to keep up because I'm thinking about all sorts of other things, like my memories with my father, etc.

In pursuing a college degree while coping with loss, students perceived a lack of general support, coupled with a heavy emphasis on minimizing absenteeism and improving grades, as significantly detrimental to their mental well-being. Riva highlighted the strain of feeling she had to be in class no matter how she was feeling:

I have a very specific example where I really couldn't stay in class anymore because I felt unwell and had to go home. Here, one of my classmates said, ‘Why don't you save it for when you're actually sick?’ That's literally how it is, and how we perceive it. It's just not nice when you're already in a stressful situation. Riva, Student.

Some students observed that while the framework for attendance, assignments, and grades theoretically became more flexible during grief it still centered mainly around attendance. They felt the focus shifted quickly, with staff expecting the grief to be over, and the student to fully return to schoolwork. Magnus expressed this:

Their [teachers] focus is not on informing you about what going to happen, but more on the fact that you have to start showing up. But at the same time, you're told to take some time for yourself. But the focus is just on how we can get back to school more. It quickly shifts from the grieving aspect to how quickly we can return to school.—Magnus, Student

Difficulties in concentration, exclusion from the class community, and challenges in finding a space for grief emphasize that the experience of grief is not parked or vanishes upon the student's return to college. This was discussed by Asta.

I wrote a message to my teacher after my exam, explaining that I couldn't concentrate. I informed him that I knew the exam hadn’t gone well because I couldn't focus due to being sick, lacking sleep, and feeling really bad. I didn't mention it was because of having lost my mom because I don't want to bring that up every time, as they perceive it as an excuse. I was just trying to let them know that I was exacerbated, not feeling well. The response I received was very cold; he replied that I also wrote that after the last exam. That exam happened just at the time when I had lost my mom. Back then, he tried to be understanding, but does he really believe that grief disappears after a few months?—Asta, Student´

As highlighted by Asta, support and understanding from staff is something students need for a long time following a loss, and not just in the preceding few months.

Student Desires for College Support

Most students perceived a lack of clear support frameworks in the college environment. The absence of structured information on how the college deals with death often left students uncertain about the support they could expect. Magnus expressed a desire for clearer information:

Yeah, that was so true. I was really left in a fog, not knowing anything. Then those threats came in, which were filled with things that made you wonder. So, more information about what the college's thoughts is on this.—Magnus, Student

From this perspective, the college's approach was often perceived as opaque. Therefore, students desired a more explicit supporting role from the college with support that acknowledged them as individuals rather than mere components in the system. Asta articulated this:

In general, show more support. If you get a bad grade on the midterm, it's not because you're a terrible student, it's because you're struggling with something. Just that they understand you, they didn't do that here. They only thought about damn absences and grades.—Asta, Student

While addressing these challenges was important, students wanted to be seen in their grief and difficult life situations. They wanted to be met by staff who genuinely cared about their mental well-being. Alexander highlighted this:

Perhaps the college could have created some kind of program when someone experienced a loss and have had real conversations with the person about their needs. Asking me if they want to drop out of school, just worsened my mental health.—Alexander, Student

Students desired a college where the support structures were clear, expectations for support were defined, and where they were recognized as competent adolescents navigating a difficult experience, rather than primarily focusing on absences.

Discussion

Transitioning from elementary school to college is a daunting challenge for most students. Coping with a loss during this period can further complicate the journey, potentially leading to declining grades or premature departure. It is imperative for children, no matter their age to receive support from their educational institutions during this difficult time (Lytje, 2016b; Lytje et al., 2022). Although colleges offer support services, students often find these services markedly different from their experiences in elementary school, feeling more distant from their daily lives than support from a primary school teacher would be. Nevertheless, this study underscores that adolescents’ needs for support and guidance persist.

Unfortunately, students seeking support from colleges often encounter a lack of responsiveness. Our research reveals instances of overburdened student counseling services, hampered by time constraints that hinder their ability to provide the desired assistance. Moreover, students report incidents of support services inadequately responding when they reach out for help. These challenges in support services are not a new finding, and neither are they isolated to a Danish context. Similar issues, such as the perception of unhelpfulness, have been documented in the U.S. by Cox et al. (2015). Additionally, Balk et al. (1993) found that students often hesitate to seek support from colleges due to the institutions’ dual role of fostering social performance, coupled with an implicit message encouraging them to “get over it.”

When students do receive support, several issues related to its delivery become apparent. The primary concern raised by students is that student support services and teachers tend to focus on reducing absence rather than recognizing them as individuals with unique challenges and support needs. Despite expressing a desire to offer support, many student support services simultaneously send automated emails to students about their increasing absence, potentially leading to a loss of study grants or expulsion. Such threats, coupled with the burden of dealing with a significant loss, are exceptionally distressing for students, and might lead to an increased risk of not getting a college degree (Høeg et al., 2019; Servaty-Seib & Hamilton, 2006). Many students also perceive the available support as unclear, leading to uncertainty about the support's nature and availability, the colleges’ expectations, and the post-bereavement scenario. Similar findings have been noted by other researchers investigating college bereavement structures (e.g., Bistricean & Shea, 2021; Cox et al., 2015). Balk (2008) highlighted that a significant percentage, ranging from 22% to 30%, of college students undergo bereavement during their first year. This underscores the imperative for establishing explicit policies to provide support, a recommendation not consistently implemented. Similar recommendations for policy have been made more recently by Servaty-Seib and Liew (2019) and Cupit et al. (2022).

Out of the 16 conducted interviews, only two students expressed satisfaction with the received support. The majority perceived the system lacking the necessary knowledge and structures needed to help them navigate their loss and reintegrate into college life. For these students, the emphasis on absence and ensuing threats portrayed college as more of an adversary than a potential source of support, fostering a feeling of misunderstanding. This is concerning, as research indicates that perceived social support among college students is positively associated with psychological and physical well-being (Jay & D’Augelli, 1991), while negatively associated with depression, suicide and stress (Ruthig et al., 2009). However, it also raises an important question: why do colleges fail to act more appropriately?

Why Colleges Fail to Respond

A recently published study by Lytje and Dyregrov (2024) delves into the challenges faced by college teachers in handling bereavement. The primary difficulties outlined by teachers appear to revolve around disorganization and a deficit in knowledge. Concerning disorganization, teachers expressed uncertainty about their roles in college when faced with bereavement, questioning whether they were expected to support the student or if this responsibility solely fell on college counseling services. This uncertainty sometimes resulted in inaction, a finding echoed in lower-level schools, as reported by Holland (2008) and Holland et al. (2005) in two British studies. Additionally, a lack of knowledge about how to support students can lead to inaction or the initiation of incorrect steps, potentially causing misunderstandings and fostering mistrust in students.

Implications

While most bereaved students expressed dissatisfaction with the support received from colleges, few attributed this to the perceived indifference of staff members within student support services. Instead, the shortcomings in support were often attributed to these services lacking the necessary time and knowledge to address the specific needs of bereaved students. In light of these findings, the study presents three recommendations:

Establish clear support structures: Colleges can greatly benefit from implementing structured frameworks for providing support, clearly delineating the responsibilities of staff members involved. This includes defining support roles for both teachers and support services and outlining protocols for collaboration. Such efforts can be incorporated into a comprehensive bereavement response policy to ensure no student is overlooked in their time of need. As recommended by Servaty-Seib and Liew (2019), a vital component of such a policy could be the incorporation of a Bereavement Leave Policy.

Designate a staff member: Student support services should consider designating at least one staff member with specialized knowledge about the unique support requirements of bereaved students. This individual can serve as a valuable resource for other staff members when seeking guidance on effectively engaging with and assisting bereaved students.

Train all staff: It is essential to establish general qualifications for all staff members, which may involve training courses or themed workshops. These initiatives aim to equip every staff member with the fundamental skills and understanding needed to fulfill their roles when encountering bereaved students and effectively engage with them.

Similar recommendations have been put forth in international research (e.g., Balk et al., 2011; Cupit et al., 2022; Dorney, 2016).

Conclusion

The transition from elementary school to college presents a challenge for students, and when coupled with the experience of bereavement, it becomes even more formidable. Our discussion sheds light on the complexities and shortcomings of the support systems available to these grieving students in the college environment. College staff frequently prioritize addressing absences over the unique emotional needs of bereaved students, resulting in feelings of isolation and frustration. This study emphasizes the pressing need for transparent, proactive, and individually tailored support systems to facilitate the reintegration of bereaved students into college life.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Martin Lytje

Atle Dyregrov

Author Biographies

Martin Lytje, PhD, is on associate professor at the Center for Crisis Psychology, University of Bergen, Norway. Martin focuses his research on how to develop and implement institutional bereavement responses and support childcare staff working with grieving children. He has written numerous articles and books on the topic.

Atle Dyregrov, PhD, is a professor emeritus at The Center for Crisis Psychology, University of Bergen and is also a clinical psychologist at The Clinic for Crisis Psychology. He has authored more than 15 books and numerous journal articles. Atle is a founding member of the European Society for Traumatic Stress Studies and the Children and War Foundation. In 2014 Atle was awarded The Royal Norwegian Order of St. Olav for his contribution to the crisis and disaster field.

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Navigating Bereavement in College: Insights From Student Experiences

Abstract

Keywords

Introduction

The Danish College System

Methods

Participant Recruitment

Procedure

Ethical Considerations

Data Analysis

Results

The Transition to College and its Impact on Support

Deficiencies in Support Provided by College Staff

The Importance of Being Seen by College Staff

Student Challenges When Experiencing Loss at College

Student Desires for College Support

Discussion

Why Colleges Fail to Respond

Implications

Conclusion

Footnotes

Declaration of Conflicting Interests

Funding

ORCID iDs

Author Biographies

References