COVID-19, natural, and unnatural bereavement: comprehensive comparisons of loss circumstances and grief severity.

Background: Acute grief appears more severe after COVID-19 deaths than natural deaths. Prolonged grief disorder (PGD) also appears prevalent following COVID-19 deaths. Researchers hypothesize that specific loss characteristics and pandemic-related circumstances may precipitate more severe grief following COVID-19 deaths compared to (other) natural deaths. Systematic research on these hypotheses may help identify those most at risk for severe grief reactions, yet it is scant. Objective: To compare loss characteristics, loss circumstances, and grief levels among people bereaved due to COVID-19, natural, and unnatural causes. Methods: Adults bereaved through COVID-19 (n = 99), natural causes (n = 1006), and unnatural causes (n = 161) completed an online survey. We administered self-report measures of demographic variables (i.e., age, gender), loss characteristics (i.e., time since loss, relationship with the deceased, intensive care admission, expectedness of death), loss circumstances (i.e., saying goodbye appropriately, COVID-19 infection, quarantine, financial setbacks, social support satisfaction, altered funeral arrangements, funeral satisfaction), and prolonged grief symptoms. Results: COVID-19 deaths (vs. other deaths) more often were parental deaths and less often child deaths. COVID-19 deaths (vs. natural deaths) were more often unexpected and characterized by an inability to say goodbye appropriately. People bereaved due to COVID-19 (vs. other deaths) were more often infected and quarantined. COVID-19 deaths (vs. other deaths) more often involved intensive care admission and altered funeral arrangements. COVID-19 deaths yielded higher grief levels than natural deaths (but not unnatural deaths). Expectedness of the death and the inability to say goodbye appropriately explained this effect. Conclusions: Bereavement due to COVID-19 is characterized by a unique set of loss characteristics and circumstances and elevated grief levels. Improving opportunities to say goodbye before and after death (e.g., by means of rituals) may provide an important means to prevent and reduce severe grief following COVID-19 deaths. HIGHLIGHTS: COVID-19 deaths have unique loss characteristics and circumstances and elicit more severe grief than natural deaths.Death expectedness and the ability to say goodbye appropriately appear important in understanding, preventing and treating grief following COVID-19 deaths.

Antecedentes: El duelo agudo es más severo después de las muertes por COVID-19 que las muertes naturales. El trastorno de duelo prolongado (PGD, por sus siglas en inglés) también parece ser prevalente después de las muertes por COVID-19. Los investigadores plantean la hipótesis de que las características específicas de la pérdida y las circunstancias relacionadas con la pandemia pueden precipitar un duelo más severo después de las muertes por COVID-19 en comparación con las muertes naturales. La investigación sistemática sobre estas hipótesis puede ayudar a identificar a las personas con mayor riesgo de sufrir reacciones de duelo graves, pero es escasa.Objetivo: Comparar las características de la pérdida, las circunstancias de la pérdida y los niveles de duelo entre las personas en duelo debido al COVID-19, causas naturales y no naturales.Métodos: Adultos en duelo por COVID-19 (n = 99), causas naturales (n = 1006) y causas no naturales (n = 161) completaron una encuesta en línea. Administramos medidas de autoinforme de variables demográficas, características de la pérdida (es decir, ingreso en cuidados intensivos, muerte inesperada), circunstancias de la pérdida (es decir, despedirse adecuadamente, infección por COVID-19, cuarentena, contratiempos financieros, satisfacción con el apoyo social, arreglos funerarios alterados, satisfacción con el funeral), y síntomas de trastorno de duelo prolongado.Resultados: Las muertes por COVID-19 (frente a otras muertes) fueron con mayor frecuencia muertes de padres y menos muertes de niños. Las muertes por COVID-19 (frente a las muertes naturales) fueron más a menudo inesperadas y se caracterizaron por la incapacidad de despedirse adecuadamente. Las personas en duelo debido al COVID-19 (frente a otras muertes) más frecuentemente se infectaron y tuvieron que hacer cuarentena. Las muertes por COVID-19 (en comparación con otras muertes) involucraron con mayor frecuencia la admisión a cuidados intensivos y la alteración de arreglos funerarios. Las muertes por COVID-19 produjeron niveles de duelo más altos que las muertes naturales (pero no las muertes no naturales). La expectativa de la muerte y la incapacidad de decir adiós explicaron apropiadamente este efecto.Conclusiones: El duelo por COVID-19 se caracteriza por un conjunto único de características y circunstancias de pérdida y niveles elevados de duelo. Mejorar las oportunidades para decir adiós antes y después de la muerte (p. ej., mediante rituales) puede proporcionar un medio importante para prevenir y reducir el duelo después de las muertes por COVID-19.

Acute grief after deaths due to COVID-19, natural causes and unnatural causes: An empirical comparison.

BACKGROUND: There are now over 800,000 registered deaths due to the COVID-19 pandemic worldwide. Researchers have suggested that COVID-19 death characteristics (e.g., intensive care admission, unexpected death) and circumstances (e.g., secondary stressors, social isolation) will precipitate a worldwide increase of prolonged grief disorder (PGD) and persistent complex bereavement disorder (PCBD). Yet, no study has investigated this. Since acute grief is a strong predictor of future pathological grief, we compared grief levels among people recently bereaved due to COVID-19, natural, and unnatural causes. METHODS: People bereaved through COVID-19 (n = 49), natural causes (n = 1182), and unnatural causes (n = 210), completed self-report measures of demographic and loss-related characteristics and PGD and PCBD symptoms. RESULTS: COVID-19 bereavement yielded higher symptom levels of PGD (d = 0.42) and PCBD (d = 0.35) than natural bereavement (but not unnatural bereavement). Effects held when limiting analyses to recent losses and those who participated during the pandemic. Expectedness of the death explained this effect. LIMITATIONS: Limitations include using a convenience sample and self-report measures. CONCLUSIONS: Higher grief levels occur among people bereaved due to COVID-19 compared to people bereaved due to natural loss. We predict that pandemic-related increases in pathological grief will become a worldwide public health concern.

Grief Before and During the COVID-19 Pandemic: Multiple Group Comparisons.

CONTEXT: Grief researchers are concerned that the coronavirus disease 2019 (COVID-19) pandemic will precipitate increases in severe, persistent, and disabling grief, termed prolonged grief disorder or persistent complex bereavement disorder. We recently demonstrated that higher grief levels are experienced after COVID-19-related bereavement than natural bereavement. Death circumstances during the pandemic (e.g., reduced social support, limited opportunities for death rituals) may also hamper the grief process for non-COVID-19-related bereavement, yet no quantitative research has specifically addressed this issue. OBJECTIVES: To test if grief severity is higher during than before the lockdown after non-COVID-19-related bereavement. METHODS: A cross-sectional survey including questions on sociodemographic and loss-related variables and a grief measure was conducted among a sample of 1600 bereaved adults (78% females), participating before (n = 731) or during (n = 869) the pandemic, including people who had experienced a loss before the pandemic (n = 456) or during the pandemic (n = 200) recently (five months ago or less). RESULTS: No significant differences emerged between grief levels in people participating before or during the pandemic. However, being recently bereaved during the pandemic elicited more severe grief than before it (d = 0.17; d = 0.18). Effects remained significant after controlling analyses for relevant loss-related variables. CONCLUSION: Among all bereaved persons, grief severity was no different during the pandemic compared with before the pandemic. However, experiencing a recent loss during the pandemic elicited more severe acute grief reactions than before the pandemic, suggesting that dealing with loss may be more difficult during this ongoing health crisis.

Three Diagnoses for Problematic Hypersexuality; Which Criteria Predict Help-Seeking Behavior?

This study aimed to assess the best combination of indicators of problematic hypersexuality (PH), in a survey (n = 58,158) targeting individuals wondering if they were sex addicted. The survey allowed for testing of criteria from three theoretical models used to conceptualize PH. Factor analyses for women and men yielded an interpretable grouping of indicators consisting of four factors. In subsequent logistic regressions, these factors were used as predictors for experiencing the need for help for PH. The factors Negative Effects and Extreme positively predicted experiencing the need for help, with Negative Effects as the most important predictor for both women and men. This factor included, among others, withdrawal symptoms and loss of pleasure. The Sexual Desire factor negatively predicted the need for help, suggesting that for the targeted population more sexual desire leads to less PH. The Coping factor did not predict experiencing the need for help. Outcomes show that a combination of indicators from different theoretical models best indicates the presence of PH. Therefore, a measurement instrument to assess existence and severity of PH should consist of such a combination. Theoretically, this study suggests that a more comprehensive model for PH is needed, surpassing existing conceptualizations of PH.