Pandemics like COVID-19 can negatively impact grief and bereavement

Mayland CR, Harding AJ, Preston N, Payne S. Supporting adults bereaved through COVID-19: A rapid review of the impact of previous pandemics on grief and bereavement Journal of Pain and Symptom Management. 2020.

Review question

•      What can we learn from previous infectious disease outbreaks regarding the effect of pandemics on bereavement?

Background

•      Due to social isolation measures and lack of usual support structures, the global COVID-19 pandemic is likely to have a major impact on the individual and societal experience of death, dying, and bereavement.

•      Specific factors associated with COVID-19, such as the unexpected timing of death, may increase the risk of adverse outcomes in bereavement, such as more intense or prolonged grief reactions.

•      The aim of this systematic review is to explore how infectious disease outbreaks impact grief and bereavement in an effort to guide current care to support families bereaving deaths from COVID-19.

How the review was done

•      Review authors conducted a detailed search of five research databases for articles suitable for inclusion in this review.

•      Key terms used in the search included bereavement, grief, mourning, pandemics, and epidemics.

•      Reference lists of included studies were screened manually for additional suitable articles.

•      A total of 218 articles were retrieved from the initial search, of which 6 were included in this review.

•      This research did not receive any specific grant. Catriona R. Mayland is funded by Yorkshire Cancer Research, United Kingdom. The authors declare no conflicts of interest.

What the researchers found

•      The overarching theme of the systematic review was the idea of “multiplicity of loss,” which refers to the experience of loss at many different levels. Three subthemes identified under this idea include uncertainty, disruption of connectiveness, and factors influencing bereavement outcomes.

•      During a pandemic, the bereavement process is multifactorial as it involves not only the death of a particular family member, but also the experience of witnessing other individuals dying, the loss of familiar ways of life, changes in cultural practices, and disruptions of usual social connections.

•      Review authors found that uncertainty surrounding a novel infectious disease prognosis and confusion about the illness can also complicate the bereavement process.

•      Multifaceted disruptions can also affect the ability of patients, family caregivers, and healthcare professionals to connect. Physical barriers and isolation are created by the mandatory usage of personal protective equipment and the limitation in visiting and physical contact. Usual social support mechanisms are lost because of the inability of family members to visit the patient. In addition, family members are also limited in their ability to directly support each other through their grief.

•      Finally, review authors found that responses to loss during outbreaks can vary, with important influences including the ability to find meaning and make sense of the loss within an individuals’ existing worldview.

•      Strategies that can reduce the risk of complicated grief include: 1) promoting connection and communication between the patient, family caregiver, and healthcare team whenever possible; 2) ensuring that individualized care is practised in decision-making, advanced care planning, and supporting beliefs and wishes; and 3) discussing opportunities for future memorialization.

Conclusion

•      The multiplicity of loss associated with pandemics can impact cultural norms, rituals, and usual social practices related to death and mourning, potentially increasing the risk of complicated grief.

•      A focus on promoting connection with people before and after the death, adapting rituals and mourning practice in a respectful manner, and planning for a coordinated response to post-bereavement support is recommended by review authors.