Complicated Grief During COVID-19 : An International Perspective

Abstract

Abstract. 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.

Impact and Implications.

During the COVID-19 pandemic, many families lost their loved ones suddenly and unexpectedly and due to safety measures were isolated from social interactions and all rituals for grieving which exist in every culture. These circumstances can put certain family members at risk of developing complicated grief, which is longer and more impactful on their life than the normal course of grief. Good health is the third SDG 3 put together by the United Nations for the next 10 years. Mental health is an essential part of well-being and good health. It is thus imperative to include mental health support and grief counseling for any family which lost a loved one during the COVID-19 pandemic.