The Mourning After COVID-19: Consequences and Care Following Loss During the COVID-19 Pandemic

Abstract

This dissertation examined the psychological consequences of, and psychological care after the loss of a loved one during the COVID-19 pandemic. Due to the high number of deaths and the potentially traumatic characteristics of deaths during the pandemic, a rise in grief-related distress was expected after such losses. Based on the findings of a systematic review that included 21 studies on the psychological effects of bereavement due to COVID-19, we cautiously concluded that people who recently lost a loved one due to COVID-19 experience higher early prolonged grief (PG) symptoms compared to those bereaved due to natural causes, but not compared to losses from unnatural causes. Yet, due to the small number and heterogeneity of studies it is imperative that definitive inferences cannot be made. A latent class analytic study among 266 Dutch adults bereaved during the pandemic, identified four classes of early PG and mental well-being: a low PG/high well-being (32%), low PG/moderate well-being (24%), moderate PG/high well-being (23%), and high PG/low well-being class (21%). We found that identifying as female, having a practical education level, being a nuclear family member of the deceased, currently having a mental disorder, and reporting a bad self-reported current health status increased the probability of membership of the poorer mental health classes. These correlates predispose people bereaved during the pandemic to develop poor mental health outcomes. In contrast with the presumed high risk of PG after loss during the pandemic, our findings indicated that most people adjust well to loss during the pandemic. Findings from a trajectory study among 266 Dutch bereaved adults identified three PG trajectories: a Low/decreasing PG symptoms (74%), Mild/stable PG symptoms (18%), and High/decreasing PG trajectory (8%). People who lost a nuclear family member, have a poor self-rated health status, and currently have a mental disorder increased were more likely to evidence trajectories with elevated PG symptoms (compared to the lower PG symptom trajectories). We found that the majority of people bereaved during the pandemic finds a way to cope with the loss. However, a small but significant minority of people may experience high PG and therefore need professional support. These people may benefit from an early grief treatment, such as online cognitive-behavioral therapy (CBT). We developed and evaluated the potential effectiveness of an online grief-specific CBT for people with elevated distress-levels bereaved at least three months earlier during the COVID-19 pandemic. Based on a randomized controlled trial among 65 Dutch adults, we concluded that early self-guided online CBT proved to be an effective treatment approach, coinciding with considerably stronger declines in symptoms compared to being on a waitlist. A controlled trial comparing the short- and long-term effectiveness of therapist-guided (vs. self-guided) online CBT among 131 Dutch adults, indicated that both online CBTs can effectively alleviate symptoms in recently bereaved people with elevated distress-levels. Both online CBTs yielded large effects with superior effects of therapist-guided online CBT, indicating that these relatively low-threshold accessible treatments can successfully aid adults in coping with challenges early in their grief process.