Bereavement during the COVID-19 Pandemic: Impact on Coping Strategies and Mental Health

The COVID-19 coronavirus has caused 5.4 million deaths worldwide, including over 800,000 deaths in the United States (as of December 2021). In addition to these staggering statistics, an even greater number of individuals have died from other causes during the COVID-19 pandemic. As a result, a large portion of the global population has faced bereavement during the COVID-19 pandemic and resulting quarantine. The often rapid and unexpected nature of COVID-19 deaths and the presence of pandemic-related stressors and living restrictions make it more difficult for individuals bereaved during the pandemic to implement effective strategies for coping with the loss compared to non-pandemic periods. Quarantine-related constraints (e.g., social distancing, availability of and access to resources) impede coping strategies that have been found to be adaptive after a loss, such as supportive (e.g., seeking emotional and instrumental support) and active (e.g., problem-focused and cognitive reframing) coping, and they augment avoidant strategies (e.g., substance use, denial, and isolation) that have been found to be maladaptive. Poorer mental health outcomes (including prolonged grief disorder; PGD) have been associated with less healthy coping. This article reviews research findings regarding bereavement during the COVID-19 pandemic, discusses the effects of pandemic-related stressors on bereavement coping strategies, and proposes how different types of coping during the pandemic may account for the poorer mental health outcomes described in recent reports. Interventions for promoting adaptive coping strategies and minimizing maladaptive coping strategies are also outlined.

Coping Strategies and Considering the Possibility of Death in Those Bereaved by Sudden and Violent Deaths: Grief Severity, Depression, and Posttraumatic Growth

BACKGROUND

Bereavement by sudden and violent deaths can lead to increased grief severity, depression, and reduced posttraumatic growth compared to those bereaved by natural causes. These outcomes can be affected by coping strategies and whether a survivor had been "prepared" for the death. The present study examined the effect of coping and considering the possibility of death on grief severity, depression, and posttraumatic growth in those bereaved by sudden deaths.

METHODS

Participants bereaved by suicide, accident, or combat deaths completed an online survey about demographics (including the cause of death), coping, grief severity, depression, and posttraumatic growth. A factor analysis of the coping measure yielded factors representing three coping strategies: avoidant coping, supportive coping, and active coping. These three strategies, the causes of death and considering the possibility of death were used as predictors of either grief severity, depression, or posttraumatic growth in multivariate linear regression models.

RESULTS

Each coping strategy and cause of death was differentially associated with grief severity, depression, and posttraumatic growth. Specifically, supportive coping and active coping were each only associated with higher posttraumatic growth. In contrast, avoidant coping was associated with all outcomes (higher grief severity and depression and lower posttraumatic growth). In addition, accidents and suicides (compared to combat deaths) had independent effects on grief severity and posttraumatic growth. Considering the possibility of death interacted with avoidant coping and also with supportive coping to predict grief severity in combat-loss survivors.

DISCUSSION

Findings highlight the differential contributions of coping strategies and their complex relationships with cause of death in contributing to grief severity, depression, and posttraumatic growth. Avoidant coping contributed to negative outcomes and inhibited posttraumatic growth, suggesting its importance as a target for therapeutic intervention. Although supportive and active coping facilitated posttraumatic growth, they had less of a role in mitigating grief severity or depression in this study. Although considering the possibility of death appeared to mitigate negative outcomes among survivors of combat death, avoidance of that possibility is likely protective for the majority of family members whose loved ones return home safely.

Self-perception of adaptation among homicidally bereaved individuals following a psychoeducational intervention: a UK longitudinal qualitative study

OBJECTIVE

Research on homicidal bereavement has focused on postloss impact and coping. Less is known about how individuals perceive their adjustment posthomicide. Adverse experiences are likely to leave individuals with an increased risk of developing severe psychological difficulties, such as depression, Post-traumatic stress (PTSD), anxiety and complicated grief. This study aimed to explore how individuals perceive their change and progression posthomicide and post-psychoeducational intervention.

DESIGN

Semistructured qualitative interviews were conducted both as part of a prospective study and retrospectively to allow for a longer follow-up period.

SETTING

Homicidally bereaved individuals who participated in a residential psychoeducational intervention offered by a national charity (Escaping Victimhood (EV)).

PARTICIPANTS

Twenty-nine individuals (mainly females) took part: 14 as part of a 6-9-month follow-up (short-term trajectory group (STG) individuals-mean age 45.25) and 15 individuals (long-term trajectory group (LTG) individuals-mean age 48.50), retrospectively, 2 to 5 years postintervention.

RESULTS

Interviews were analysed using an inductive Thematic Analysis method. Three main themes and nine subthemes emerged, and applied to both groups, as follows: (1) actual changes perceived by the participants (increased understanding, improved coping strategies and positive self-change), (2) barriers to recovery (severe psychological difficulties over time, need for further support, reminders and close relationships with both victim and perpetrator), and finally perceived future progression (living day by day, hope and hopelessness). The only significant differences between the two groups related to the reported self-growth among LTG individuals and the perceived increased informal support among STG individuals by keeping in touch in other EV participants.

CONCLUSION

This unique study provides insight into how homicidally bereaved individuals perceive their bereavement paths and helped to identify elements that appear to contribute for their adjustment. Importantly, it has highlighted that positive changes can also be an outcome.

Understanding How Bereaved Parents Cope With Their Grief to Inform the Services Provided to Them

Our objective was to develop a rich description of how parents experience their grief in the first year after the death of their child, and how various bereavement follow-up and support services helped them during this time, with the aim of informing follow-up and support services offered to bereaved parents. Our findings situated parents' individual experiences of coping within the social and institutional contexts in which they grieved. In the first year after the death of their child, parents regulated their intense feelings of grief through loss-oriented, restoration-oriented, and/or meaning reconstruction strategies. Often, parents' relationships with others and many of the bereavement follow-up and support services helped them in this regard. This article also explores how the results may aid service providers in accompanying parents in a way that optimizes outcomes for these parents.

Responding to Homicide

After a homicide, family members of the victim must cope with their loss and find ways to continue on with their lives. Research suggests that as “secondary victims,” this group may experience grief and cope in ways unique from other victims. Using focus group data, this article examines the impact of homicide on surviving family members. Our findings highlight the divergent ways in which individuals respond to homicide as well as the varying coping strategies families implement. Practical applications of these findings are discussed.

The Effectiveness of Coping Resources and Strategies Used by Bereaved Parents 1 and 5 Years after the Violent Deaths of Their Children

In this study, we examined the effectiveness of the coping resources and coping strategies by following 173 bereaved parents prospectively for five years after their children's deaths by accident, suicide, homicide, or undetermined violence. Using hierarchical multiple regression procedures, we examined how three predictors influenced parents' mental distress and PTSD: self-esteem, active/affective coping, and repressive coping. The results showed that at one and five years postdeath, self-esteem was a significant predictor of mental distress and PTSD. After controlling for self-esteem, the use of active/affective coping strategies predicted less mental distress for fathers but not for mothers. Active/affective coping strategies were not significant predictors of lowered PTSD symptoms for either mothers or fathers. Rather, repressive coping strategies were significant predictors of higher PTSD symptoms for both mothers and fathers at both one and five years postdeath. The findings suggest the need for interventions that target both gender and outcomes as unique aspects of the violent death bereavement transition.

Coping with grief responses among African American family members of homicide victims

Research relevant to coping with grief for African American family members of homicide victims is limited. This retrospective study was conducted to determine the effects of gender, length of time since death, the traumatic impact of experiencing the homicide of a loved one, and the use of coping strategies to current grief reactions of African American family members of homicide victims (N = 44). Multiple regression analysis results suggest that gender and level of traumatic stress, related to posttraumatic stress symptomatology, predict current symptoms of grief. Women reported higher levels of current grief symptoms than men. Family members of homicide victims who reported higher levels of posttraumatic stress symptomology reported higher levels of current grief. Implications for research and recommendations for practitioners are discussed.

Acceptance of spousal death: the factor of time in bereaved older adults' search for meaning

Response to the death of a spouse was examined by focusing on acceptance, which was conceptualized as both a process and an outcome. Grounded theory was applied to analyze the experience of 15 bereaved Hong Kong Chinese older adults. The main theme that emerged was time. Acceptance of spousal death was found to be related to the search for meaning in 2 time-related themes: timing of spousal death and paradoxical time perception. For paradoxical time perception, 2 subthemes were identified: truncation and daily isolation in time. For bereaved older adults, time-related meaning seeking may be best fostered by self-transcendence, (e.g., participation in volunteer work and social activities).

Coping and complicated grief in survivors of homicide and suicide decedents

This article summarizes a comprehensive literature review and explores research of coping strategies used by survivors of homicide and suicide decedents. The relationship of these survivors' coping strategies to the development of complicated grief is also examined.

Interventions for suicide survivors: a review of the literature

Mourning after suicide is frequently a difficult experience. Research suggests that suicide survivors may be at elevated risk for several psychiatric and somatic complications. Despite this, very little research has focused on developing and empirically evaluating clinical interventions for this population. This paper attempts to stimulate interest in intervention research by reviewing three relevant areas: (a) studies of the perceived needs of survivors; (b) implications of the research on general bereavement interventions for work with survivors; and (c) research documenting the efficacy of specific interventions for adult survivors. Recommendations for future studies are discussed.