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Lapenskie J, Anderson K, Lawlor PG, Kabir M, Noel C, Heidinger B, Parsons HA, Cohen L, Gratton V, Besserer E, Adeli S, Murphy R, Warmels G, Bruni A, Bhimji K, Dyason C, Enright P, Desjardins I, Wooller K, Arsenault-Mehta K, Webber C, Bedard D, Iyengar A, Bush SH, Isenberg SR, Tanuseputro P, Vanderspank-Wright B, Downar J. Long-term 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. Palliat Med 2024; 38:264-271. [PMID: 38229211 PMCID: PMC10865760 DOI: 10.1177/02692163231223394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Severe grief is highly distressing and prevalent up to 1 year post-death among people bereaved during the first wave of COVID-19, but no study has assessed changes in grief severity beyond this timeframe. AIM Understand the trajectory of grief during the pandemic by reassessing grief symptoms in our original cohort 12-18 months post-death. DESIGN Prospective matched cohort study. SETTINGS/PARTICIPANTS Family members of decedents who died in an acute care hospital between November 1, 2019 and August 31, 2020 in Ottawa, Canada. Family members of patients who died of COVID (COVID +ve) were matched 2:1 with those who died of non-COVID illness (COVID -ve) during pandemic wave 1 or immediately prior to its onset (pre-COVID). Grief was assessed using the Inventory of Complicated Grief (ICG). RESULTS Follow-up assessment was completed by 92% (111/121) of family members in the initial cohort. Mean ICG score on the 12-18-month assessment was 19.9 (SD = 11.8), and severe grief (ICG > 25) was present in 28.8% of participants. One-third (33.3%) had either a persistently high (>25) or worsening ICG score (⩾4-point increase between assessments). Using a modified Poisson regression analysis, persistently high or worsening ICG scores were associated with endotracheal intubation in the deceased, but not cause of death (COVID +ve, COVID -ve, pre-COVID) or physical presence of the family member in the final 48 h of life. CONCLUSIONS Severe grief is a substantial source of psychological morbidity in the wake of the COVID-19 pandemic, persisting more than a year post-death. Our findings highlight an acute need for effective and scalable means of addressing severe grief.
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Affiliation(s)
- Julie Lapenskie
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Koby Anderson
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Peter G. Lawlor
- Bruyère Research Institute, Ottawa, ON, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Bruyère Continuing Care, Ottawa, ON, Canada
| | - Monisha Kabir
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Chelsea Noel
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Brandon Heidinger
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Henrique A. Parsons
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
| | - Leila Cohen
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
| | - Valérie Gratton
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Samantha Adeli
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Rebekah Murphy
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Bruyère Continuing Care, Ottawa, ON, Canada
- Queensway-Carleton Hospital, Ottawa, ON, Canada
| | - Grace Warmels
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
- Queensway-Carleton Hospital, Ottawa, ON, Canada
| | - Adrianna Bruni
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
- Queensway-Carleton Hospital, Ottawa, ON, Canada
| | - Khadija Bhimji
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
- Queensway-Carleton Hospital, Ottawa, ON, Canada
| | - Claire Dyason
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
| | - Paula Enright
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
| | - Isabelle Desjardins
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
| | - Krista Wooller
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Colleen Webber
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | | | | | - Shirley H Bush
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Bruyère Continuing Care, Ottawa, ON, Canada
| | - Sarina R Isenberg
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Bruyère Continuing Care, Ottawa, ON, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
| | - Brandi Vanderspank-Wright
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - James Downar
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Bruyère Continuing Care, Ottawa, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
- Australian Centre for Health Law Research, Queensland University of Technology School of Law, Brisbane, QLD, Australia
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Bird MJ, Li G, MacNeil A, Jiang Y, de Groh M, Fuller-Thomson E. Pandemic-Induced Depression Among Older Adults with a History of Cancer During the COVID-19 Pandemic: Findings from the Canadian Longitudinal Study on Aging. Cancer Manag Res 2023; 15:937-955. [PMID: 37700810 PMCID: PMC10493151 DOI: 10.2147/cmar.s421675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/08/2023] [Indexed: 09/14/2023] Open
Abstract
Purpose The objectives of this study were to identify the prevalence of, and factors associated with, incident and recurrent depression in a sample of older adults with a history of cancer during the COVID-19 pandemic. Materials and Methods Data were drawn from four waves of the Canadian Longitudinal Study on Aging Comprehensive Cohort (n=2486 with cancer). The outcome of interest was a positive screen for depression based on the CES-D-10 during the autumn of 2020. Results Among older adults with cancer and no pre-pandemic history of depression (n=1765), 1 in 8 developed first onset depression during the pandemic. Among respondents with cancer and a history of depression (n=721), 1 in 2 experienced a recurrence of depression. The risk of both incident and recurrent depression was higher among those who were lonely, those with functional limitations, and those who experienced an increase in family conflict during the pandemic. The risk of incident depression only was higher among older women, those who did not engage in church or religious activities, those who experienced a loss of income during the pandemic, and those who became ill or had a loved one become ill or die during the pandemic. The risk of recurrent depression only was higher among those who felt isolated from others and those whose income did not satisfy their basic needs. Conclusion Health care providers should continue to screen and provide mental health support to their cancer patients and those with a lifetime history of cancer, with consideration for those with the aforementioned vulnerabilities.
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Affiliation(s)
- Meghan J Bird
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, ON, Canada
| | - Grace Li
- Department of Sociology, University of Victoria, Victoria, BC, Canada
| | - Andie MacNeil
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, ON, Canada
| | - Ying Jiang
- Applied Research Division, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Margaret de Groh
- Applied Research Division, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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Afifi RA, Calderon JL, Pham H, Teahen P, Zarate-Sada S, Sewell DK, Vander Weg MW. Ignored and distressed: a cross-sectional study of the impact of COVID-19 on last responders. BMC Public Health 2023; 23:1637. [PMID: 37633898 PMCID: PMC10463888 DOI: 10.1186/s12889-023-16565-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 08/20/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND Last responders constitute an occupational category that includes all those that are involved in the postmortem care of deceased persons and their families. Last responders are exposed to several categories of work-related stressors that affect their health and well-being. COVID-19 exacerbated these stressors. Research to understand the consequences of COVID-19 on the health and wellbeing of last responders is nascent. This study aimed to assess COVID-19 related stress, coping and wellbeing among last responders in the United States. METHODS We conducted a national cross-sectional survey of last responders in July through September of 2020. The survey measured wellbeing, stress, coping, and stigma; COVID-19 experiences, and socio-demographics. A ridge regression model was fit for the outcome variables. RESULTS Analysis was conducted on 366 respondents from 43 states. Respondents were male (55.4%), age 50 + (57.4%), and White non-Hispanic (90.3%); 54% reported moderate-high stress and 41% endorsed mild-severe anxiety. Seventy-seven percent had experienced at least one form of stigma related to their occupation. Variables associated with higher perceived stress and anxiety included gender (female), shorter length of employment, perceiving a higher impact from COVID-19 on everyday life, and increased perceived stigma. CONCLUSIONS Last responders are a critical part of the health care system. Throughout this pandemic, last responders have been frequently ignored and not prioritized for protection and support. Interventions to support last responders cope with stress, and to decrease anxiety are urgently needed. There is also a critical need to challenge community stigma towards last responders.
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Affiliation(s)
- Rima A Afifi
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N Riverside Drive, Iowa City, Iowa, N416, USA.
| | - Jorge Luis Calderon
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N Riverside Drive, Iowa City, Iowa, N416, USA
| | - Hanh Pham
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Peter Teahen
- Teahen Funeral Home, Cedar Rapids, Iowa, USA
- Clinical Mental Health Counseling, College of Education, University of Iowa, Iowa City, Iowa, USA
| | - Sydney Zarate-Sada
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N Riverside Drive, Iowa City, Iowa, N416, USA
| | - Daniel K Sewell
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Mark W Vander Weg
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N Riverside Drive, Iowa City, Iowa, N416, USA
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