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Mourning in the time of coronavirus: Examining how grief differs in those who lost loved ones to COVID-19 vs. natural causes in Iran

Published online by Cambridge University Press:  27 March 2024

Hajar Aliyaki ,
Fereshteh Momeni ,
Behrouz Dolatshahi ,
Samaneh Hosseinzadeh ,
Shahab Yousefi Open the ORCID record for Shahab Yousefi [Opens in a new window]  and
Fatemeh Abdoli
Hajar Aliyaki
Affiliation:
Department of Clinical Psychology, University of Social Welfare and Rehabilitation, Tehran, Iran
Fereshteh Momeni
Affiliation:
Department of Psychology, University of Social Welfare and Rehabilitation, Tehran, Iran
Behrouz Dolatshahi
Affiliation:
Department of Psychology, University of Social Welfare and Rehabilitation, Tehran, Iran
Samaneh Hosseinzadeh
Affiliation:
Department of Biostatistics, University of Social Welfare and Rehabilitation, Tehran, Iran
Shahab Yousefi*
Affiliation:
Department of Clinical Psychology, School of Behavioral Science and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Science, Tehran, Iran
Fatemeh Abdoli
Affiliation:
Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
*
Corresponding author: Shahab Yousefi; Email: shahabyousefin@gmail.com
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Abstract

Objectives

Our study aimed to analyze and compare the grief experiences of individuals in Iran who lost family members to COVID-19 and those who lost loved ones to other natural causes.

Methods

In this study, telephone interviews were conducted with 640 first-degree relatives, and finally, a total of 395 people remained in the research. Participants answered the Prolonged Grief Questionnaire (PG-13-R) and Grief Experience Questionnaire.

Results

The results showed that the most common symptoms and features of grief were feeling guilt, searching for an explanation, somatic reactions, and rejection, with no significant difference observed between the 2 death groups. However, the average scores for these symptoms were higher in the COVID-19 death group. Moreover, the majority of bereaved reported signs and symptoms of prolonged grief, with a higher percentage in the COVID-19 death group, although there was no significant difference between the 2 death groups in terms of the distribution of symptoms and signs of prolonged grief. These findings suggest that the bereavement process can be challenging, and losing a loved one to COVID-19 may lead to more intense experiences of grief.

Significance of results

The study reveals high levels of guilt, searching for meaning, somatic reactions, and rejection among COVID-19 grievers. Losing loved ones to the pandemic appears linked to more intense, prolonged grief symptoms.

Keywords

Prolonged grief disorderDSM-5-TRCOVID-19bereavementgrief experience
Type
Original Article
Information
Palliative & Supportive Care , Volume 22 , Issue 4 , August 2024 , pp. 801 - 810
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Copyright
© The Author(s), 2024. Published by Cambridge University Press.

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References

Albuquerque, S, Teixeira, AM and Rocha, JC (2021) COVID-19 and disenfranchised grief. Frontiers in Psychiatry 12, . doi:10.3389/fpsyt.2021.638874CrossRefGoogle ScholarPubMed
Ashouri, A and Yousefi, S (2023) Validation of the Persian Traumatic Grief Inventory-Self Report Plus (TGI-SR+) to assess prolonged grief severity. Omega-Journal of Death and Dying. Advance online publication. doi:10.1177/00302228231162730CrossRefGoogle ScholarPubMed
Ashouri, A, Yousefi, S and Prigerson, HG (2023) Psychometric properties of the PG-13-R scale to assess prolonged grief disorder among bereaved Iranian adults. Palliative Support Care, 1–8. doi:10.1017/s1478951523000202Google Scholar
Assare, M, Firouz Kohi Moghadam, M, Karimi, M, et al. (2014) Complicated grief: A descriptive cross-sectional prevalence study from Iran. Shenakht Journal of Psychology and Psychiatry 1(2), 40–46.Google Scholar
Bastan, R, Kasiri, N and Eskandari, N (2020) Recent findings of coronavirus: The pathogenesis and treatment. Journal of Isfahan Medical School 38(567), 154–164. doi:10.22122/jims.v38i567.12889Google Scholar
Baud, D, Qi, X, Nielsen-Saines, K, et al. (2020) Real estimates of mortality following COVID-19 infection. The Lancet Infectious Diseases 20(7), 773. doi:10.1016/S1473-3099(20)30195-XCrossRefGoogle ScholarPubMed
Boelen, PA, Djelantik, AMJ, de Keijser, J, et al. (2019) Further validation of the Traumatic Grief Inventory-Self Report (TGI-SR): A measure of persistent complex bereavement disorder and prolonged grief disorder. Death Studies 43(6), 351–364. doi:10.1080/07481187.2018.1480546CrossRefGoogle ScholarPubMed
Boelen, PA, Eisma, MC, Smid, GE, et al. (2020) Prolonged grief disorder in section II of DSM-5: A commentary. European Journal of Psychotraumatology 11(1), . doi:10.1080/20008198.2020.1771008CrossRefGoogle ScholarPubMed
Boelen, PA and Lenferink, LI (2020) Comparison of six proposed diagnostic criteria sets for disturbed grief. Psychiatry Research 285, .CrossRefGoogle ScholarPubMed
Boelen, PA and Lenferink, LIM (2020) Comparison of six proposed diagnostic criteria sets for disturbed grief. Psychiatry Research 285, . doi:10.1016/j.psychres.2020.112786CrossRefGoogle ScholarPubMed
Boelen, PA and Lenferink, LI (2022) Prolonged grief disorder in DSM-5-TR: Early predictors and longitudinal measurement invariance. Australian & New Zealand Journal of Psychiatry 56(6), 667–674. doi:10.1177/00048674211025728CrossRefGoogle ScholarPubMed
Bolden, LA (2007) A review of on grief and grieving: Finding the meaning of grief through the five stages of loss. Counseling and Values 51(3), 235–238. doi:10.1002/j.2161-007X.2007.tb00081.xCrossRefGoogle Scholar
Breen, LJ, Mancini, VO, Lee, SA, et al. (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. doi:10.1080/07481187.2021.1974666CrossRefGoogle ScholarPubMed
Burrell, A and Selman, LE (2022) How do funeral practices impact bereaved relatives’ mental health, grief and bereavement? A mixed methods review with implications for COVID-19. OMEGA - Journal of Death and Dying 85(2), 345–383. doi:10.1177/0030222820941296CrossRefGoogle Scholar
Calhoun, LG, Selby, JW and Abernathy, CB (1984) Suicidal death: Social reactions to bereaved survivors. The Journal of Psychology 116(2), 255–261. doi:10.1080/00223980.1984.9923645CrossRefGoogle ScholarPubMed
Cardoso, ÉADO, Silva, BCDAD, Santos, JHD, et al. (2020) The effect of suppressing funeral rituals during the COVID-19 pandemic on bereaved families. Revista Latino-americana de Enfermagem 28. doi:10.1590/1518-8345.4519.3361CrossRefGoogle ScholarPubMed
Castle, J and Phillips, WL (2003) Grief rituals: Aspects that facilitate adjustment to bereavement. Journal of Loss and Trauma 8(1), 41–71. doi:10.1080/15325020305876CrossRefGoogle Scholar
Chakraborty, I and Maity, P (2020) COVID-19 outbreak: Migration, effects on society, global environment and prevention. Science of the Total Environment 728, . doi:10.1016/j.scitotenv.2020.138882CrossRefGoogle ScholarPubMed
Corpuz, JCG (2021) Beyond death and afterlife: The complicated process of grief in the time of COVID-19. Journal of Public Health 43(2), e281–e282. doi:10.1093/pubmed/fdaa247CrossRefGoogle ScholarPubMed
de Souza, CP and de Souza, AM (2019) Funeral rituals in the process of mourning: Meaning and functions. Psicologia: Teoria e Pesquisa.Google Scholar
Diolaiuti, F, Marazziti, D, Beatino, MF, et al. (2021) Impact and consequences of COVID-19 pandemic on complicated grief and persistent complex bereavement disorder. Psychiatry Research 300, . doi:10.1016/j.psychres.2021.113916CrossRefGoogle ScholarPubMed
Djelantik, AMJ, Smid, GE, Mroz, A, et al. (2020) 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. doi:10.1016/j.jad.2020.01.034CrossRefGoogle ScholarPubMed
Downar, J, Parsons, HA, Cohen, L, et al. (2022) Bereavement outcomes in family members of those who died in acute care hospitals before and during the first wave of COVID-19: A cohort study. Palliative Medicine 36(8), 1305–1312. doi:10.1177/02692163221109711CrossRefGoogle ScholarPubMed
Dyregrov, A, Kristensen, P, Fjærestad, A, et al. (2023) Loss of a child during a pandemic. A mixed method study of parents’ experiences of interference with rituals and grief. Journal of Loss and Trauma 28(8), 651–676. doi:10.1080/15325024.2023.2226799CrossRefGoogle Scholar
Eisma, MC, Boelen, PA and Lenferink, LI (2020) Prolonged grief disorder following the Coronavirus (COVID-19) pandemic. Psychiatry Research 288, . doi:10.1016/j.psychres.2020.113031CrossRefGoogle ScholarPubMed
Eisma, MC and Tamminga, A (2020) Grief before and during the COVID-19 pandemic: Multiple group comparisons. Journal of Pain and Symptom Management 60(6), e1–e4. doi:10.1016/j.jpainsymman.2020.10.004CrossRefGoogle ScholarPubMed
Eisma, MC, Tamminga, A, Smid, GE, et al. (2021) Acute grief after deaths due to COVID-19, natural causes and unnatural causes: An empirical comparison. Journal of Affective Disorders 278, 54–56. doi:10.1016/j.jad.2020.09.049CrossRefGoogle Scholar
Fauci, AS, Lane, HC and Redfield, RR (2020) Covid-19—Navigating the uncharted. New England Journal of Medicine 382, 1268–1269. doi:10.1056/NEJMe2002387CrossRefGoogle ScholarPubMed
Gamino, LA, Easterling, LW, Stirman, LS, et al. (2000) Grief adjustment as influenced by funeral participation and occurrence of adverse funeral events. OMEGA - Journal of Death and Dying 41(2), 79–92. doi:10.2190/QMV2-3NT5-BKD5-6AAVCrossRefGoogle Scholar
Gang, J, Falzarano, F, She, WJ, et al. (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. doi:10.1080/07481187.2022.2039326CrossRefGoogle ScholarPubMed
Gesi, C, Carmassi, C, Cerveri, G, et al. (2020) Complicated grief: What to expect after the coronavirus pandemic. Frontiers in Psychiatry 11, . doi:10.3389/fpsyt.2020.00489CrossRefGoogle ScholarPubMed
Gómez-Salgado, J, Andrés-Villas, M, Domínguez-Salas, S, et al. (2020) Related health factors of psychological distress during the COVID-19 pandemic in Spain. International Journal of Environmental Research & Public Health 17(11), . doi:10.3390/ijerph17113947CrossRefGoogle ScholarPubMed
Gonçalves Júnior, J, Moreira, MM and Rolim Neto, ML (2020) Silent cries, intensify the pain of the life that is ending: The COVID-19 is robbing families of the chance to say a final goodbye. Frontiers in Psychiatry 11, . doi:10.3389/fpsyt.2020.570773CrossRefGoogle Scholar
Hall, BJ, Bonanno, GA, Bolton, PA, et al. (2014) A longitudinal investigation of changes to social resources associated with psychological distress among Kurdish torture survivors living in Northern Iraq. Journal of Traumatic Stress 27(4), 446–453. doi:10.1002/jts.21930CrossRefGoogle ScholarPubMed
Hauksdóttir, A, Valdimarsdóttir, U, Fürst, C-J, et al. (2009) Health care-related predictors of husbands’ preparedness for the death of a wife to cancer – A population-based follow-up. Annals of Oncology: Official Journal of the European Society for Medical Oncology/ESMO 21, 354–361. doi:10.1093/annonc/mdp313CrossRefGoogle Scholar
Holland, JM and Neimeyer, RA (2010) An examination of stage theory of grief among individuals bereaved by natural and violent causes: A meaning-oriented contribution. OMEGA - Journal of Death and Dying 61(2), 103–120. doi:10.2190/OM.61.2.bCrossRefGoogle Scholar
Horowitz, MJ, Siegel, B, Holen, A, et al. (2003) Diagnostic criteria for complicated grief disorder. Focus 1(3), 290–298. doi:10.1176/foc.1.3.290CrossRefGoogle Scholar
Jordan, AH and Litz, BT (2014) Prolonged grief disorder: Diagnostic, assessment, and treatment considerations. Professional Psychology: Research and Practice 45(3), . doi:10.1037/a0036836Google Scholar
Kaplow, JB, Saunders, J, Angold, A, et al. (2010) Psychiatric symptoms in bereaved versus nonbereaved youth and young adults: A longitudinal epidemiological study. Journal of the American Academy of Child & Adolescent Psychiatry 49(11), 1145–1154. doi:10.1016/j.jaac.2010.08.004Google Scholar
Kersting, A, Brähler, E, Glaesmer, H, et al. (2011) Prevalence of complicated grief in a representative population-based sample. Journal of Affective Disorders 131(1–3), 339–343. doi:10.1016/j.jad.2010.11.032CrossRefGoogle Scholar
Lenferink, L and Boelen, PA (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, . doi:10.1016/j.jadr.2023.100516CrossRefGoogle Scholar
Lobb, EA, Kristjanson, LJ, Aoun, SM, et al. (2010) Predictors of complicated grief: A systematic review of empirical studies. Death Studies 34(8), 673–698. doi:10.1080/07481187.2010.496686CrossRefGoogle ScholarPubMed
Lundorff, M, Holmgren, H, Zachariae, R, et al. (2017) Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis. Journal of Affective Disorders 212, 138–149. doi:10.1016/j.jad.2017.01.030CrossRefGoogle ScholarPubMed
Maercker, A, Brewin, CR, Bryant, RA, et al. (2013) Proposals for mental disorders specifically associated with stress in the International Classification of Diseases-11. Lancet (London, England) 381(9878), 1683–1685. doi:10.1016/S0140-6736(12)62191-6CrossRefGoogle ScholarPubMed
Mehdipour, S, Shahidi, S, Roshan, R, et al. (2009) Determining the reliability and validity of the Grief Experience Questionnaire (GEQ) in the Iranian sample. Clinical Psychology and Personality 13, 35–48. in Persian.Google Scholar
Mein, SA (2020) COVID-19 and health disparities: The reality of “the Great Equalizer”. Journal of General Internal Medicine 35(8), 2439–2440. doi:10.1007/s11606-020-05880-5CrossRefGoogle Scholar
Mitima-Verloop, HB, Mooren, TT and Boelen, PA (2021) Facilitating grief: An exploration of the function of funerals and rituals in relation to grief reactions. Death Studies 45(9), 735–745. doi:10.1080/07481187.2019.1686090CrossRefGoogle ScholarPubMed
Morris, SE, Moment, A and Thomas, JD (2020) Caring for bereaved family members during the COVID-19 pandemic: Before and after the death of a patient. Journal of Pain and Symptom Management 60(2), e70–e74. doi:10.1016/j.jpainsymman.2020.05.002CrossRefGoogle Scholar
Nakajima, S (2018) Complicated grief: Recent developments in diagnostic criteria and treatment. Philosophical Transactions of the Royal Society B: Biological Sciences 373(1754), . doi:10.1098/rstb.2017.0273CrossRefGoogle Scholar
Nasri, E, Yousefi, S, Mayeli, P, et al. (2023) Psychometric properties of the Persian version of the pandemic grief scale. Bereavement 2. doi:10.54210/bj.2023.1087CrossRefGoogle Scholar
Nelson, L (1976) AFTER SUICIDE. By Samuel E. Wallace. New York: Wiley, 1973. 269 pp. $7.95. In The University of North Carolina Press.CrossRefGoogle Scholar
Norton, MI and Gino, F (2014) Rituals alleviate grieving for loved ones, lovers, and lotteries. Journal of Experimental Psychology: General 143(1), 266–272. doi:10.1037/a0031772CrossRefGoogle ScholarPubMed
Prigerson, HG, Boelen, PA, Xu, J, et al. (2021) Validation of the new DSM‐5‐TR criteria for prolonged grief disorder and the PG‐13‐Revised (PG‐13‐R) scale. World Psychiatry: Official Journal of the World Psychiatric Association (WPA) 20(1), 96–106. doi:10.1002/wps.20823CrossRefGoogle ScholarPubMed
Rosner, R, Comtesse, H, Vogel, A, et al. (2021) Prevalence of prolonged grief disorder. Journal of Affective Disorders 287, 301–307. doi:10.1016/j.jad.2021.03.058CrossRefGoogle ScholarPubMed
Santos, S, Crespo, C, Canavarro, MC, et al. (2018) Family rituals when children have cancer: A qualitative study. Journal of Family Psychology 32(5), 643–653. doi:10.1037/fam0000419CrossRefGoogle ScholarPubMed
Shahini, N, Abbassani, S, Ghasemzadeh, M, et al. (2022) Grief experience after deaths: Comparison of COVID-19 and non-COVID-19 causes. Journal of Patient Experience 9, . doi:10.1177/23743735221089697CrossRefGoogle ScholarPubMed
Shear, MK, McLaughlin, KA, Ghesquiere, A, et al. (2011) Complicated grief associated with Hurricane Katrina. Depression and Anxiety 28(8), 648–657. doi:10.1002/da.20865CrossRefGoogle ScholarPubMed
Tang, S and Xiang, Z (2021) Who suffered most after deaths due to COVID-19? Prevalence and correlates of prolonged grief disorder in COVID-19 related bereaved adults. Globalization & Health 17(1), 1–9. doi:10.1186/s12992-021-00669-5CrossRefGoogle ScholarPubMed
Tanoue, Y, Nomura, S, Yoneoka, D, et al. (2020) Mental health of family, friends, and co-workers of COVID-19 patients in Japan. Psychiatry Research 291, . doi:10.1016/j.psychres.2020.113067CrossRefGoogle ScholarPubMed
Tull, MT, Edmonds, KA, Scamaldo, KM, et al. (2020) Psychological outcomes associated with stay-at-home orders and the perceived impact of COVID-19 on daily life. Psychiatry Research 289, . doi:10.1016/j.psychres.2020.113098CrossRefGoogle ScholarPubMed
WHO (2023) Organization. WH. ICD-11 for Mortality and Morbidity Statistics: 6B42 Prolonged grief disorder. https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1183832314 (accessed 14 March 2023).Google Scholar
Yousefi, S and Ashouri, A (2023) The role of emotion regulation difficulties and intrusive and deliberate rumination in the association between insecure attachment and prolonged grief. OMEGA - Journal of Death and Dying, . doi:10.1177/00302228231189539CrossRefGoogle ScholarPubMed
Yousefi, S and Jafari, A (2023) Psychometric properties of the Persian version of the Grief Impairment Scale. Death Studies, 1–7. doi:10.1080/07481187.2023.2285932Google ScholarPubMed
Yousefi, S, Mayeli, P and Ashouri, A (2022) Psychometric properties of the Persian version of the inventory of complicated grief. OMEGA - Journal of Death and Dying, . Advance online publication. doi:10.1177/00302228221102687Google ScholarPubMed
Yun, YH, Kim, KN, Sim, J-A, et al. (2019) Correction to: Priorities of a “good death” according to cancer patients, their family caregivers, physicians, and the general population: A nationwide survey. Supportive Care in Cancer 27(10), 3921–3926. doi:10.1007/s00520-019-04985-wCrossRefGoogle ScholarPubMed