Bereavement and psychological distress during COVID-19 pandemics: The impact of death experience on mental health

Joaquim, Rui Mateus; Pinto, Antônio Carlos Guedes; Guatimosim, Rafaela Ferreira; Paula, Jonas Jardim de; Costa, Danielle de Souza; Diaz, Alexandre Paim; Silva, Antônio Geraldo da; Pinheiro, Mayra Isabel Correia; Serpa, Alexandre L.O.; Miranda, Débora Marques de; Malloy-Diniz, Leandro Fernandes

doi:10.1016/j.crbeha.2021.100019

Cited by 82 publications

(60 citation statements)

References 21 publications

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“…Given the risks associated with unexpected deaths, discussions with next of kin should happen early, with the risk of death explained clearly and compassionately. Partners bereaved due to an unexpected COVID-19 death in hospital may be at particular risk of poor outcomes and need additional follow-up and support, particularly when they live alone or have a previous history of mental disorders 37 . However, many challenges were experienced by people bereaved by non-COVID-19 deaths, and difficulties across the bereaved population should not be minimised.…”

Section: Discussionmentioning

confidence: 99%

Place, cause and expectedness of death and relationship to the deceased are associated with poorer experiences of end-of-life care and challenges in early bereavement: Risk factors from an online survey of people bereaved during the COVID-19 pandemic

Selman

Farnell

Longo

et al. 2021

Preprint

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Objectives: To identify clinical and demographic risk factors for sub-optimal end-of-life care and pandemic-related challenges prior to death and in early bereavement. Design: Online open national survey of adults bereaved in the UK from 16 March 2020-5 January 2021, recruited via media, social media, national associations and organisations. Setting: General population, UK. Participants: 711 participants, mean age 49.5 (SD 12.9, range 18-90). 395 (55.6%) had experienced the death of a parent, 152 (21.4%) a partner. 628 (88.6%) were female and 33 (4.7%) from a minority ethnic background. The mean age of the person who died was 72.2 (SD 16.1, range miscarriage to 102 years). 311 (43.8%) deaths were from confirmed/suspected COVID-19, and 410 (57.8%) deaths occurred in hospital. Main outcome measures: End-of-life care experiences (six items, e.g. involvement in care decisions) and pandemic-related challenges before and after death (six items, e.g. unable to visit prior to death). Results: Deaths in hospital/care home increased the likelihood of: unable to visit prior to death, unable to say goodbye as wanted, limited contact in last days of life (all P<0.001). Deaths in hospice/at home increased the likelihood of: involved in care decisions (P<0.001), well supported by healthcare professionals (HCPs) after the death (P=0.003). Hospice deaths increased the likelihood of being given bereavement support information, which was least likely for care home deaths (P<0.001). Hospital deaths decreased the likelihood of knowing the contact details for the responsible care professional (P=0.001). Bereavement due to COVID-19 decreased the likelihood of: involvement in care decisions (P<0.001), feeling well supported by HCPs after the death (P<0.001), and increased the likelihood of: being unable to say goodbye (OR=0.348; 95% CI: 0.2 to 0.605), social isolation and loneliness (OR=0.439; 95% CI: 0.261 to 0.739), limited contact with relatives/friends (OR=0.465; 95% CI: 0.254 to 0.852). Expected deaths were associated with higher likelihood of feeling involved, informed, and well supported by HCPs (all P<0.001). The deceased being a partner or child increased the likelihood of knowing the contact details for the responsible care professional (P=0.001), being able to visit (P<0.001) and given bereavement support information (P<0.001). Being a bereaved partner strongly increased odds of social isolation and loneliness, e.g. OR = 0.092 (95% CI: 0.028 to 0.297) partner versus distant family member. Conclusions: Four clear risk factors were found for poorer end-of-life care and pandemic-related challenges in bereavement: place, cause and expectedness of death, and relationship to the deceased.

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Section: Discussionmentioning

confidence: 99%

Place, cause and expectedness of death and relationship to the deceased are associated with poorer experiences of end-of-life care and challenges in early bereavement: Risk factors from an online survey of people bereaved during the COVID-19 pandemic

Selman

Farnell

Longo

et al. 2021

Preprint

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“…So, the presence of signs of hypoxia and thoracic pain became the highest known risks to develop trauma. Directly related to this pandemic was identifying the loss of someone close as a risk factor for trauma, which amplifies the negative psychological effects 20 , 40 . Besides the particularities of the pandemic condition, the fear to transmit to family mimics the risks identified in individuals who had a trauma related to motor vehicle accidents.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent meta-analysis about 20% of health care professionals reported PTSD 19 . Also, people who face the death of people from their network present a high risk for psychological distress 20 .…”

Section: Introductionmentioning

confidence: 99%

Increased risk of health professionals to feel traumatized during the COVID-19 pandemic

Pinto

Serpa

Paula

et al. 2021

Sci Rep

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Health professionals may be a vulnerable group to posttraumatic stress symptoms (PTSS) during the Coronavirus disease 2019 (COVID-19) pandemic. To investigate how health professionals who experienced a traumatic event are expressing PTSS and factors related to risk for higher PTSS symptomatology can inform how health professionals are facing their role in this crisis. This was an Internet cross-sectional survey. Participants were 49,767 Brazilian health professionals who have ever faced a traumatic event, which was about 25.9% of an initial sample of health professionals. PTSS symptoms were assessed using the Impact of Event Scale-Revised (IES-R) and latent profile analysis (LPA) explored subpopulations within participants based on their scores. Distinct profiles were compared for psychological distress (e.g., depression and anxiety) and quality of life. Multinomial logistic regression analysis was conducted to investigate the relationship between IES-R profiles and COVID-19 related experiences, thoughts, and perceptions. A two-profile model was the most appropriate for the IES-R data pointing out a group with a high level of PTSS (named high-PTSS; n = 10,401, 20.9%) and another expressing a low level of symptoms (named low-PTSS; n = 39,366, 79.1%). The high-PTSS profile demonstrated worse psychological scores (global psychological distress, somatization, depression, and anxiety) and worse quality of life (physical, psychological, social, and environmental) with moderate magnitudes. Small but significant predictors of the high-PTSS profile included sociodemographic characteristics and COVID-19 related experiences, thoughts, and perceptions. Most individuals who experienced a traumatic event were not in the high-PTSS profile. For those who were, however, psychological and quality of life measures were much worse. During the initial phase of the COVID-19 pandemic, several characteristics emerged as risks to report trauma.

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“…In other words, the social distancing requirements and policy-induced variation in early life caused by responses to the COVID-19 outbreak produced harsher consequences for those aged 16–34 years, who, before the pandemic had enjoyed more frequent and intense social relationships outside of the home—that is, at school, at work, at the neighbourhood level, and so on. Another possible explanation is that young people were the most deeply concerned about their future—because of crushed employment opportunities, possible financial hardship, or fears over not being able to have children and form stable families—or were the most exposed to the fear of or to the actual course of illness and death of close family members or friends [ 34 ]. These were all variables that could not be controlled for in the models.…”

Section: Discussionmentioning

confidence: 99%

Differential effects of COVID-19 and containment measures on mental health: Evidence from ITA.LI—Italian Lives, the Italian household panel

Lucchini

Gerosa

Pancheva³

et al. 2021

PLoS ONE

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This study used a subsample of a household panel study in Italy to track changes in mental health before the onset of COVID-19 and into the first lockdown period, from late April to early September 2020. The results of the random-effects regression analyses fitted on a sample of respondents aged 16 years and older (N = 897) proved that there was a substantial and statistically significant short-term deterioration in mental health (from 78,5 to 67,9; β = -10.5, p < .001; Cohen’s d -.445), as measured by a composite index derived from the mental component of the 12-item Short-Form Health Survey (SF-12). The findings also showed heterogeneity in the COVID-related effects. On the one hand, evidence has emerged that the pandemic acted as a great leveller of pre-existing differences in mental health across people of different ages: the decrease was most pronounced among those aged 16–34 (from 84,2 to 66,5; β = -17.7, p < .001; Cohen’s d -.744); however, the magnitude of change reduced as age increased and turned to be non-significant among individuals aged 70 and over. On the other hand, the COVID-19 emergency widened the mental health gender gap and created new inequalities, based on the age of the youngest child being taken care of within the household.

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Bereavement and psychological distress during COVID-19 pandemics: The impact of death experience on mental health

Cited by 82 publications

References 21 publications

Place, cause and expectedness of death and relationship to the deceased are associated with poorer experiences of end-of-life care and challenges in early bereavement: Risk factors from an online survey of people bereaved during the COVID-19 pandemic

Place, cause and expectedness of death and relationship to the deceased are associated with poorer experiences of end-of-life care and challenges in early bereavement: Risk factors from an online survey of people bereaved during the COVID-19 pandemic

Increased risk of health professionals to feel traumatized during the COVID-19 pandemic

Differential effects of COVID-19 and containment measures on mental health: Evidence from ITA.LI—Italian Lives, the Italian household panel

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