It's Complicated-Adolescent Grief in the Time of Covid-19

Assessment Tools for Children who Experience Traumatic Loss: A Systematic Review

Children who experience the traumatic (i.e., violent and/or unexpected) death of a loved one are at risk for a range of adverse developmental and mental health problems, including pathological processes of grief. Over the last decades, conceptualizations of maladaptive grief have varied, resulting in a range of assessment tools and no "gold standard" measure to assess symptoms of prolonged grief in children. The current paper is a systematic review of studies that measured grief in children who experienced traumatic loss in order to determine the measures currently used in the literature with children who experience traumatic loss. Searches were conducted according to the preferred reporting items for systematic reviews and meta-analyses in PUBMED, PsycINFO, and OVID and through hand searches of relevant reference lists. Two authors reviewed each study yielded by searches and conducted data extraction on included studies. Studies were included if they were peer-reviewed, included a measure of grief, and consisted of samples of children (age 18 and younger) whereby at least a portion experienced traumatic loss. Thirty-nine studies met inclusion criteria, from which 17 measures were identified. The most commonly used measure was the Inventory of Complicated Grief (n = 10 studies) followed by the Extended Grief Inventory (n = 6). Most studies used different measures and variations of the same measures to assess similar constructs. All but one measure relied on child self-report. More standardization of measurement across studies is needed, along with parent and/or teacher reported measures.

COVID-19 Bereavement in Ten Latin American Countries: Measurement Invariance of the Pandemic Grief Scale and Its Relation to Suicidal Ideation

The present study aimed to evaluate the cross-cultural measurement invariance of the Pandemic Grief Scale (PGS) in ten Latin American countries. A total of 2,321 people who had lost a family member or other loved one due to COVID-19 participated, with a mean age of 34.22 years old (SD = 11.99). In addition to the PGS, a single item of suicidal ideation was applied. The unidimensional model of the PGS had adequate fit in most countries and good reliability estimates. There was evidence of measurement invariance by country and gender. Also, a one-point increase in the PGS was associated with an almost twofold increase in the odds of suicidal ideation. Scores greater than or equal to 4 on the PGS are proposed as a cut off to identify individuals with suicidal ideation. Strong evidence of the cross-cultural validity of the PGS is provided.

COVID-19 and children's behavioral health: An overview

The paper reviews the impact of the COVID-19 pandemic on children's and adolescents' well-being. A trauma-informed framework is employed to discuss the emerging evidence of notable changes in youth's psychological, developmental, academic, and social well-being since the start of the COVID-19 pandemic. Children and adolescents have been uniquely affected based on their age at the start of the pandemic. Despite multiple resiliency factors, COVID-19 and its ramifications have had an adverse effect on youth in general and have exacerbated preexisting racial and socioeconomic disparities. This review concludes with recommendations for child health clinicians.

A co-designed systematic review and meta-analysis of the efficacy of grief interventions for anxiety and depression in young people

BACKGROUND

Grief in young people is common and associated with symptoms of anxiety and depression, yet grief interventions for this age group are under-researched.

METHOD

We conducted a systematic review and meta-analysis to examine the efficacy of grief interventions in young people. The process was co-designed with young people and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PsycINFO, Medline, and Web of Science databases were searched in July 2021 (updated December 2022).

RESULTS

We extracted results from 28 studies of grief interventions with young people (14-24 years) that measured anxiety and/or depression (N = 2803 participants, 60 % girls/women). Cognitive behavior therapy (CBT) for grief demonstrated a large effect for anxiety and medium effect for depression. Meta-regression indicated that CBT for grief that included a higher degree of CBT strategies, was not trauma focused, had >10 sessions, offered on an individual basis, and did not involve parents, was associated with larger effect sizes for anxiety. Supportive therapy had a moderate effect for anxiety and a small-moderate effect for depression. Writing interventions were not effective for anxiety or depression.

LIMITATIONS

Studies are limited in number and there were few randomized controlled studies.

CONCLUSIONS

Findings indicate that CBT for grief is an effective intervention for reducing symptoms of anxiety and depression in young people experiencing grief. CBT for grief should be offered as the first line treatment for grieving young people experiencing anxiety and depression.

PROTOCOL REGISTRATION

PROSPERO (registration number CRD42021264856).

Crisis Response and Suicidal Behaviors of Essential Workers and Children of Essential Workers During the COVID-19 Pandemic

OBJECTIVE

The COVID-19 pandemic has put unprecedented stress on essential workers and their children. Limited cross-sectional research has found increases in mental health conditions from workload, reduced income, and isolation among essential workers. Less research has been conducted on children of essential workers. We examined trends in the crisis response of essential workers and their children from April 2020 through August 2021.

METHODS

We investigated the impact during 3 periods of the pandemic on workers and their children using anonymized data from the Crisis Text Line on crisis help-seeking texts for thoughts of suicide or active suicidal ideation (desire, intent, capability, time frame), abuse (emotional, physical, sexual, unspecified), anxiety/stress, grief, depression, isolation, bullying, eating or body image, gender/sexual identity, self-harm, and substance use. We used generalized estimating equations to study the longitudinal change in crisis response across the later stages of the pandemic using adjusted odds ratios (aORs) for worker status and crisis outcomes.

RESULTS

Results demonstrated higher odds of crisis outcomes for thoughts of suicide (aOR = 1.06; 95% CI, 1.00-1.12) and suicide capability (aOR = 1.14; 95% CI, 1.02-1.27) among essential workers than among nonessential workers. Children of essential workers had higher odds of substance use than children of nonessential workers (aOR = 1.33; 95% CI, 1.08-1.65), particularly for Indigenous American children (aOR = 2.76; 95% CI, 1.35-5.36). Essential workers (aOR = 1.17; 95% CI, 1.07-1.27) and their children (aOR = 1.18; 95% CI, 1.07-1.30) had higher odds of grief than nonessential workers and their children.

CONCLUSION

Essential workers and their children had elevated crisis outcomes. Immediate and low-cost psychologically supportive interventions are needed to mitigate the mental health impacts of the COVID-19 pandemic on these populations.

Spatio-Temporal Clustering of Adolescent Bereavement in the United States During the Extended Response to COVID-19: A Follow-Up Study

PURPOSE

This follow-up study investigated the spatio-temporal clustering of adolescent bereavement during the extended response to COVID-19 from October 2020-January 2022 in the continental United States.

METHODS

Deidentified and anonymized bereavement data from Crisis Text Line (CTL), a text-based crisis intervention service, and SaTScan cluster analysis were used to identify space-time clustering of bereavement among adolescents, aged 24 years and less, during the COVID-19 pandemic.

RESULTS

Clustering of bereavement conversations occurred during waves of high COVID-19 case and death counts, with the highest risk occurring in the Southeastern United States during the fall of 2020 (relative risk: 5.86, confidence interval: 3.48-8.24). Of the CTL texters who shared their demographic information, Indigenous American, Black, male, and female adolescents were more likely to seek help for bereavement when compared to the other CTL users.

DISCUSSION

Findings show an increased need for bereavement counseling resources during periods of high COVID-19 cases and deaths.

The Many Faces of Grief: A Systematic Literature Review of Grief During the COVID-19 Pandemic

Coronavirus disease 2019 (COVID-19) pandemic has halted life all around the world. The disease, along with quarantine, social distancing, unemployment, and displacement, has led to myriad losses. There is a rising concern for the epidemic of grief that can result from these multiple losses. The present study aimed to investigate how grief is understood and discussed in the extant literature during the COVID pandemic. A systematic literature review was conducted using PsycArticles, Web of Science, and Scopus databases. The qualitative synthesis of 33 articles indicates that grief can be manifested at various levels such as grief for self, relational grief, collective grief, and ecological grief. Another theme emphasizes some of the factors that could intensify the grief process leading to prolonged grief disorder. A third theme relates to the focus of grief processes as experienced by individuals in different developmental periods from childhood to senescence. The study contributes theoretically by expanding our perception and understanding of varied forms of grief.

Parental perspectives on the grief and support needs of children and young people bereaved during the COVID-19 pandemic: qualitative findings from a national survey

Background

During the COVID-19 pandemic, many children and young people have experienced the death of close family members, whilst also facing unprecedented disruption to their lives. This study aimed to investigate the experiences and support needs of bereaved children and young people from the perspective of their parents and guardians.

Methods

We analysed cross-sectional qualitative free-text data from a survey of adults bereaved in the UK during the pandemic. Participants were recruited via media, social media, national associations and community/charitable organisations. Thematic analysis was conducted on free text data collected from parent/guardian participants in response to a survey question on the bereavement experiences and support needs of their children.

Results

Free-text data from 104 parent/guardian participants was included. Three main themes were identified: the pandemic-related challenges and struggles experienced by children and young people; family support and coping; and support from schools and services. Pandemic-challenges include the impacts of being separated from the relative prior to their death, isolation from peers and other family members, and disruption to daily routines and wider support networks. Examples were given of effective family coping and communication, but also of difficulties relating to parental grief and children’s existing mental health problems. Schools and bereavement organisations’ provision of specialist support was valued, but there was evidence of unmet need, with some participants reporting a lack of access to specialist grief or mental health support.

Conclusion

Children and young people have faced additional strains and challenges associated with pandemic bereavement. We recommend resources and initiatives that facilitate supportive communication within family and school settings, adequate resourcing of school and community-based specialist bereavement/mental health services, and increased information and signposting to the support that is available.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-022-01066-4.

Adolescent Resilience during the COVID-19 Pandemic: A Review of the Impact of the Pandemic on Developmental Milestones

This review explores the literature regarding the ways in which the COVID-19 pandemic has affected the navigation of developmental milestones among adolescents, specifically those in late adolescence, across several domains of their lives. The exploration is contextualized globally, focusing on five key areas: mental health, physical health, education, peer relationships, and family relationships. Implications for practice and interventions are explored in each key area to provide recommendations for those working with adolescents, as well as future research. The changes brought about by the pandemic and the readjustment to what some have referred to as the “new normalcy” will undoubtedly have lasting effects on all areas of life for this cohort of adolescents, who have shown remarkable resilience navigating this new and unfamiliar world. These changes are synthesized, with the aim to highlight differences and similarities of the shared experiences of the pandemic globally. After exploring the current realities, this chapter goes on to outline the ways in which the experience of such a significant developmental period of one’s life during the COVID-19 pandemic will have an impact on adolescents for years to come. Although it is still impossible to comprehend the long-term effects, in examining proximal effects, we can postulate distal implications and potential future effects, as well as possible ways to mitigate these implications as we transition back to more of what was experienced pre-pandemic life, from a post-pandemic experience.

The Impact of COVID-19 on Young People's Mental Health in the UK: Key Insights from Social Media Using Online Ethnography

There is increasing evidence of the psychological impact of COVID-19 on various population groups, with concern particularly focused on young people's mental health. However, few papers have engaged with the views of young people themselves. We present findings from a study into young people's discussions on social media about the impact of COVID-19 on their mental health. Real-time, multi-platform online ethnography was used to collect social media posts by young people in the United Kingdom (UK), March 2020-March 2021, 1033 original posts and 13,860 associated comments were analysed thematically. Mental health difficulties that were described as arising from, or exacerbated by, school closures, lost opportunities or fraught family environments included depression, anxiety and suicidality. Yet, some also described improvements to their mental health, away from prior stressors, such as school. Young people also recounted anxiety at the ramifications of the virus on others. The complexities of the psychological impact of COVID-19 on young people, and how this impact is situated in their pre-existing social worlds, need recognising. Forging appropriate support necessitates looking beyond an individualised conceptualisation of young people's mental health that sets this apart from broader societal concerns. Instead, both research and practice need to take a systemic approach, recognising young people's societal belonging and social contexts.

Beyond a traumatic loss: The experiences of mourning alone after parental death during COVID-19 pandemic

Millions of adolescents around the world lost their loved ones due to the COVID-19 pandemic; at the same time, health protocols in many countries do not allow mourners to practice their familiar rituals around death and dying. This study explored the experience of 15 Iranian adolescents who had lost their parent(s) during the pandemic through a phenomenological approach. Two main themes including distress in a shattered life and crisis in crisis were extracted from the interviews. Findings highlight the importance of immediate and alternative ways of support for adolescents who lost their parents during the pandemic.

An Ethnography Study of a Viral YouTube Educational Video in Ecuador: Dealing With Death and Grief in Times of COVID-19

In Western societies, death is a social and educational taboo. Poor education about death and mourning processes and overprotective family and social attitudes move children away from death to avoid "unnecessary suffering." The COVID-19 outbreak highlighted these shortcomings and the difficult management of grief's complexity under sudden and unexpected scenarios. The need for immediate and constant updates related to COVID-19 benefited from social media coverage's immediacy. The use of YouTube as a digital platform to disseminate/search for knowledge exploded, raising the need to conduct ethnographic studies to describe this community's people and culture and improve the booming social media's educational capacity and quality. The present virtual ethnography studied 255,862 YouTube views/users and their behavior related to "Vuela Mariposa, Vuela," a children's story available online since 2009 (not monetized) about the cycle of life, death, and disenfranchised grief (not acknowledged by society) that went viral (+>999%) on May. To our knowledge, this case study is the first original research that explores the ethnography of (i) a viral video, (ii) on death and grief taboo topics, (iii) for prescholars, and (iv) before and during the COVID pandemic. The quantitative and qualitative analyses identified a change in the users' profiles, engagement, and feedback. During the previous 11 years, the users were 35-44 years old Mexican and Spanish women. Those in grief used narrative comments to explain their vital crisis and express their sorrow. In the pandemic, the analysis pointed to Ecuador as the virality geographical niche in a moment when the tragic scenarios in its streets were yet unknown. The timeline match with the official records confirmed the severity of their pandemic scenario. The viral video reached a broad population, with normal distribution for age, and including male gender. Engagement by non-subscribers, direct search (traffic sources), and mean visualization times suggested educational purposes as confirmed by the users' feedback with critical thinking referring to the cycle of life's meaning and societal mourning. For the youngest users, the video was part of academic assignments. The ethnography pointed at YouTube as a flexible education resource, immediately reaching diverse users, and being highly sensitive to critical events.