Showing papers on "Complicated grief published in 2023"

Validation of the Persian Traumatic Grief Inventory- Self Report Plus (TGI-SR+) to Assess Prolonged Grief Severity.

Abstract: The Traumatic Grief Inventory-Self Report Plus (TGI-SR+) is a self-report measure to assess Prolonged Grief Disorder (PGD) in terms of ICD-11 and DSM-5-TR. Till now this measure has shown to yield good psychometric properties in Dutch and French speaking bereaved people. This study aimed to evaluate the psychometric properties of the Persian TGI-SR+. 461 individuals (280 women) fully completed the scales. The participants were recruited using convenience sampling. The Confirmatory factor analysis and concurrent validity, and reliability of the Persian version of the TGI-SR+ were evaluated. Confirmatory factor analysis results of a two-dimensional model support the construct validity of this version of the TGI-SR+, while concurrent validity was shown with significant correlations between the TGI-SR+ and measures of depression, anxiety, and ptsd. These results indicate satisfactory psychometric properties of the instrument, thus supporting the use of the TGI-SR + as a valid measure of PGD in bereaved Iranian adults.

Prolonged grief disorder in ICD-11 and DSM-5-TR: Challenges and controversies

Abstract: Prolonged grief disorder has recently been added to the International Classification of Diseases, 11th edition and the Diagnostic and Statistical Manual of Mental Disorders 5, Text Revision. This historical development is often presented as a linear process culminating in the inclusion of valid, clinically relevant prolonged grief disorder criteria in diagnostic handbooks. The present contribution provides an overview of work contradicting this dominant narrative. First, I show that the developmental history of prolonged grief disorder has been nonlinear and that this yields questions on generalizability and problems with measurement of the newest criteria sets. Second, I highlight an important gap in the validity evidence: the distinction of prolonged grief disorder from normal grief. Third, I discuss concerns relating to the societal effects of the inclusion of prolonged grief disorder in diagnostic handbooks, including the medicalization of grief, development and adverse effects of pharmacotherapy and stigmatization. A more realistic, balanced view on the history, validity and societal impact of prolonged grief disorder appears appropriate. I recommend stringent validation of assessment instruments for prolonged grief disorder, convergence of criteria-sets, closing gaps in validity evidence and developing strategies to mitigate the negative effects of grief diagnoses.

A mixed methods evaluation of a program exploring predeath grief and loss for carers of people with rarer dementias.

Abstract: OBJECTIVES Predeath grief conceptualizes complex feelings of loss experienced for someone who is still living and is linked to poor emotional well-being. The Road Less Travelled program aimed to help carers of people with rarer dementias identify and process predeath grief. This study evaluated the feasibility, acceptability, and preliminary effectiveness of this program. DESIGN Pre-post interventional mixed methods study. SETTING Online videoconference group program for carers across the UK held in 2021. PARTICIPANTS Nine family carers of someone living with a rare form of dementia. Eight were female and one male (mean age 58) with two facilitators. INTERVENTION The Road Less Travelled is an online, facilitated, group-based program that aims to help carers of people with rarer dementias to explore and accept feelings of grief and loss. It involved six fortnightly 2-hour sessions. MEASUREMENTS We collected measures for a range of well-being outcomes at baseline (T1), post-intervention (T2), and 3 months post-intervention (T3). We conducted interviews with participants and facilitators at T2. RESULTS Participant attendance was 98% across all sessions. Findings from the semistructured interviews supported the acceptability of the program and identified improvements in carer well-being. Trends in the outcome measures suggested an improvement in quality of life and a reduction in depression. CONCLUSION The program was feasible to conduct and acceptable to participants. Qualitative reports and high attendance suggest perceived benefits to carers, including increased acceptance of grief, and support the need for a larger-scale pilot study to determine effectiveness.

Prolonged grief disorder: Nature, risk-factors, assessment, and cognitive-behavioural treatment

Abstract: Most people who are confronted with the death of a loved adjust without needing professional help. A significant minority of people confronted with loss develops symptoms of prolonged grief disorder (PGD), sometimes accompanied by bereavement-related post-traumatic stress disorder (PTSD) and depression. PGD is newly included in the psychiatric classification systems of the ICD-11 and DSM-5-TR. In Ukraine, many people are currently facing losses, in circumstances that may render them vulnerable to develop PGD and associated symptoms. In this article, we address “healthy” grief and discuss the nature, assessment, risk factors, and treatment of “unhealthy” grief, now referred to PGD. We also introduce a cognitive behavioural theory that helps to understand problematic psychological processes involved in the persistence and maintenance of PGD and that offers a clear framework for the application of all kinds of cognitive behavioural interventions and other treatment interventions that can be used to alleviate the pain of people with PGD. Examples of these interventions are described. Attention is paid to how the situation of war affects the development and treatment of PGD.

Integrating Loss and Processing Grief in Psychotherapy of Psychosis.

Abstract: Objective: While recovery from psychosis is possible, recovery is a multidimensional construct driven by various factors. One relevant factor to recovery from psychosis that has often been overlooked in the psychotherapy literature is the importance of facing loss and processing grief in relation to psychosis. Methods: A review of the existing empirical literature on grief associated with psychosis was conducted. Clinicians with significant therapeutic experience working with persons with psychosis reviewed cases to examine the losses the patients had suffered and how they responded to these losses. The clinicians considered essential principles that are relevant when helping patients with psychosis integrate loss and process grief. Results: Persons who have experienced psychosis often experience the loss of role functioning, interpersonal relationships, cognition, and self-concept. However, when these losses are not fully integrated into the person's identity, it can result in either more losses due to denial and metacognitive impairments or increased hopelessness and depression due to internalized stigma. Five elements in psychotherapy of psychosis were identified that can facilitate the integration of loss and processing of grief: understand the personal experience of the psychotic episode, attend to feelings of grief and the primary loss, explore the meaning of psychotic symptoms and identity implications, integrate psychotic vulnerabilities into the sense of self, and foster realistic hope in the face of an uncertain future. Conclusion: Psychotherapy can enable persons with psychosis to make meaning of their losses, process their grief, integrate their psychotic vulnerability into their sense of self, and develop realistic hope.

Co-occurrence of approach and avoidance in prolonged grief: a latent class analysis

Abstract: ABSTRACT Background: Prolonged grief disorder (PGD) has been included in the International Classification of Diseases (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders 5 Text Revision (DSM-5-TR). Loss-related avoidance behavior perpetuates grief and effective interventions for prolonged grief symptoms target such avoidance behavior. Yet, behaviors characterized by approach of loss-related cues (i.e. rumination, yearning, proximity seeking) are also implicated in prolonged grief reactions. Objective: To solve this paradox, we will test the Approach Avoidance Processing Hypothesis, which holds that loss-related approach and avoidance behaviors co-occur in PGD, using latent class analyses (LCA). Methods: Two-hundred eighty-eight bereaved adults (92% female) completed questionnaires assessing loss-related approach behaviors (rumination, yearning, proximity seeking), loss-related avoidance behaviors (anxious avoidance, experiential avoidance) and ICD-11 and DSM-5-TR prolonged grief symptoms. Results: LCA demonstrated the best fit for a three-class solution comprising a low approach/low avoidance class (n = 98, 34%), a high approach/low avoidance class (n = 79, 27%), and a high approach/high avoidance class (n = 111, 39%). The latter class showed significantly higher prolonged grief symptom levels and higher odds of probable PGD compared to the other classes. Conclusions: Co-occurrence of loss-related approach and avoidance appears characteristic to prolonged grief reactions. Distinguishing bereaved people with these behavioral patterns from those solely experiencing loss-related approach behaviors may improve the efficacy of PGD therapies.

Complicated Grief Following the Traumatic Loss of a Child: A Systematic Review.

Abstract: Complicated grief is a disabling condition that occurs when the natural grief process is disturbed or prolonged. Research demonstrates that complicated grief is more prevalent following the sudden or violent loss of a child. Despite the high incidence of accidental death worldwide, little research has focused on parental grief trajectories following this form of traumatic loss. A systematic review was conducted to explore parental bereavement outcomes following accidental death. Studies were included if they specifically examined complicated grief in parents bereaved by the accidental death of their child. A total of 767 articles were identified and seven studies met the eligibility criteria for review. Poorer outcomes were identified in relation to the mode of death, relationship type, time post-loss, perceived support, perceived justice and comorbidities. Results of the current study may be used to inform the development of clinical practice guidelines for the treatment of complicated grief.

The Cultural Supplement: A New Method for Assessing Culturally Relevant Prolonged Grief Disorder Symptoms

Abstract: Background The new diagnosis of prolonged grief disorder (PGD) is both an opportunity and a challenge for researchers, clinicians, and bereaved individuals. The latest definition of PGD includes a refreshing and novel feature: the cultural caveat, i.e., clinicians must determine that the grief presentation is more severe and of longer duration than would be expected by an individual’s culture and context. Currently, there are no guidelines on how to operationalize the cultural caveat in mental health care settings. Method To respond to this important demand we have developed, piloted, and tested the cultural supplement module of the International Prolonged Grief Disorder scale (IPGDS). The cultural supplement aims to provide clinicians with a catalogue of culturally relevant symptoms of grief that indicate probable PGD alongside a simple framework for cultural adaptation for use in specific clinical settings. Results In this short report we outline the rationale and aim of the cultural supplement and provide a summary of our latest validation studies of the IPGDS with bereaved German-speaking, Chinese and Swiss migrant individuals. We also provide a step-by-step framework for adaptation of the cultural supplement that clinicians and researchers may use when working with different cultural groups. Conclusion To date, this is the first PGD questionnaire based on the ICD-11, and the first to include a cultural supplement that can be adapted to different contexts and groups. This cultural supplement will provide clinicians and researchers an easy-to-use assessment tool with the aim to improve the global applicability of the ICD-11 PGD definition.

Effectiveness of a cognitive–behavioral group therapy for complicated grief in relatives of patients with cancer: A randomized clinical trial

Abstract: Complicated grief can affect a large number of individuals who have lost a relative due to cancer.To assess the efficacy of a cognitive-behavioral grief therapy (CBGT) group for complicated grief (CG) in those who have lost a relative due to cancer in comparison with a psychoeducational and emotional expression intervention group (PSDEEI).A randomized clinical trial was used, in which 249 relatives of deceased cancer patients with CG were randomly assigned to CBGT or PSDEEI. Complicated grief (Inventory of Complicated Grief [ICG]), depression (Beck Depression Inventory [BDI-II]), hopelessness (Beck Hopelessness Scale [BHS]), anxiety (Beck Anxiety Inventory [BAI]) symptoms, and general health (Goldberg's General Health Questionnaire [GHQ28]) were assessed at pretreatment, posttreatment, and follow-up at 6 and 12 months.The CBGT group improved significantly (p < 0.001), with the scores in ICG, BDI-II, BAI, BHS, and GHQ28 (p < 0.001) being higher than those for the PSDEEI group in each of the assessed moments, with high effect sizes: ICG (η2 = 0.16), BDI (η2 = 0.10), BAI (η2 = 0.06), BHS (η2 = 0.21), and GHQ28 (η2 = 0.21). At the 12-month follow-up, the number of cases of CG decreased by 81.1% for the CBGT group vs. 31.7% in the PSDEEI group.The CBGT treatment was effective for CG, depression, anxiety, and hopelessness symptoms and for mental health and was superior to the PSDEEI treatment.

Pandemic grief risk factors and prolonged grief disorder in bereaved young adults during COVID-19

Abstract: Abstract Objectives This study evaluated whether COVID-19-specific risk factors (e.g., feeling guilty for not being present with the deceased at the time of the loss and feeling emotionally distant from the deceased prior to the loss) were associated with prolonged grief disorder (PGD) symptomatology or diagnosis among young adults bereaved due to any cause (e.g., illness and violent loss). Methods We surveyed 196 young adults who had a family member/close friend die during the COVID-19 pandemic. Participants completed the PGD-12 Questionnaire and the 10-item Pandemic Grief Risk Factors (PGRF) Questionnaire. Results More time spent with the deceased before the loss and greater endorsement of pandemic grief risk factors were associated with increased PGD symptoms and a greater likelihood of meeting the diagnostic criteria for PGD. Significance of results The COVID-19 pandemic created unique risk factors that affected the grieving process for bereaved individuals, regardless of whether the death was related to COVID-19 infection. These findings add to a growing body of literature examining grief and loss within the unique context of the COVID-19 pandemic and suggest that there may be detrimental long-term psychological outcomes for these bereaved individuals, regardless of the cause of death. Routine screening for these unique risk factors in medical and psychological clinics is warranted to help identify those individuals who could benefit from early intervention. Also, it will be important to understand and possibly modify evidence-based interventions and prevention programs to directly address the identified unique PGRF.

‘Doing the same puzzle over and over again’: a qualitative analysis of feeling stuck in grief.

Abstract: 2022 has witnessed a crescendo of controversial debate in grief and bereavement research, surrounding the inclusion of Prolonged Grief Disorder (PGD) in the revised Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V-TR). Criticisms of the inclusion of PGD focus on the potential for diagnosis narrowing the range of healthy functioning and any treatment gains associated with a PGD diagnosis being outweighed by the risk of pathologising individual differences and diversity in human behaviour (Ben-Zeev, Young & Corrigan, 2010). This qualitative research approaches ‘stuckness’ in grief from a non-pathologising, inductive and curious position that embodies the core, humanistic values of Counselling Psychology (Cooper, 2009). Four participants who reported feeling stuck in grief were interviewed and the resultant transcripts were analysed using Interpretative Phenomenological Analysis (IPA). The four superordinate themes: (‘Eclipsed by the deceased’; ‘The power in powerlessness’; ‘The double-edged sword of coping behaviours’ and ‘Living in Purgatory’) reveal novel insights into the significance and consequences of living with unresolved dilemmas of grieving. Findings support a meaning reconstruction approach to grief therapy and highlight the negative implications of holding a pathologising, time-limited, stage-based conceptualisation of grief. Implications for practice include combining person-centred therapy with targeted cognitive-behavioral grief interventions.

Pandemic grief in El Salvador: factors that predict dysfunctional grief due to a COVID-19 death among Salvadoran adults

Abstract: Abstract Thousands of people have died of COVID-19 in El Salvador. However, little is known about the mental health of those who are mourning the loss of a loved one to COVID-19. Therefore, the objective of this study was to examine the dysfunctional grief associated with COVID-19 death among Salvadoran adults. A sample of 435 Salvadorans ( M = 29 years; SD = 8.75) who lost a family member or loved one to COVID-19 completed a digital survey using the Google Forms platform, during April 2 and 28, 2022. The results revealed that 35.1% reported clinically elevated symptoms of dysfunctional grief and among those mourners, and 25.1% also exhibited clinical levels of coronavirus anxiety. A binary logistic regression revealed that predictor variables such as COVID-19 anxiety ( p = .003), depression ( p = .021), and COVID-19 obsession ( p = .032) were significant ( χ 2 = 84.31; Nagelkerke R 2 = .242) and predict a 24.2% chance of dysfunctional bereavement.

A grief farewell scene design for children based on virtual reality

Abstract: The global outbreak of Covid-19 causes a large number of casualties. Due to the suddenness and infectivity of virus, the bereaved were unable to say goodbye to the deceased. This leads to a series of psychological disorders of grief. In response to the above problems, a virtual reality(VR) grief farewell scene is designed to help bereaved children bid farewell to their deceased relatives and regain their confidence in life. To verify the effectiveness of the scene, 30 respondents were recruited by us to conduct a user experience survey. To a certain extent, the results show that grief empathy can be aroused by our design and the VR scene can assist subjects to vent their emotions and complete grief cognitive education. In terms of user experience, the scene fluency and refinement are basically intact. In future work, the VR grief scene design will be improved and more in-depth research on grief counseling will be conducted.

Prolonged Grief in Times of Lockdown During the COVID-19 Pandemic

Abstract: This study aimed to estimate the prevalence of prolonged grief (PG) during the COVID-19 pandemic and to analyze associated variables. 142 family members of patients who died during the lockdown at a hospital were surveyed 6 months after the death. Prolonged grief, depression and anxiety, grief rumination, and loss-related variables were captured. Logistic regression analyses were conducted to detect the associated variables of PG symptoms. Prolonged grief was present in 44.4% of the bereaved. 76.2% of the relatives reported feeling distressed due to visitor restrictions, and the majority of them were unable to bid farewell to their family member at the time of death. Pastoral or psychological care was also lacking. Low education (p < 0.001), emotional closeness (p = 0.007), loss of a spouse (p < 0.001), inability to bid farewell after death (p = 0.024), feeling of threat due to the pandemic (p < 0.001), depression (p = 0.014), and anxiety (p = 0.028) were significantly associated with prolonged grief.

A Review of the Psychometrics of Perinatal Grief Instruments

Abstract: The intense emotional and psychological consequences of pregnancy loss have been studied for decades. With the growing body of literature regarding women's experiences of pregnancy loss, there is an increased need for high quality evidence that underpins perinatal grief and bereavement support interventions. In this paper, we describe and analyze the psychometric properties of existing tools (the Perinatal Grief Scale, the Perinatal Bereavement Scale, the Perinatal Grief Intensity Scale) developed specifically to measure grief following perinatal loss. The psychometric properties of these instruments are presented along with an assessment of their trustworthiness. Of the three perinatal grief instruments, the PGS is the most well-established measure of perinatal grief. The PBS, although promising, has not been as extensively tested as the PGS. The PGIS has compared favorably with the PGS and is also a good choice for use in perinatal bereavement studies despite its shorter history of use and less extensive psychometric testing.

Prolonged Grief Disorder and the DSM

Abstract: In the early 1990s, a research group that included Holly Prigerson and Charles Reynolds established that disordered grief overlaps with depression and anxiety but is not the same. They also developed a research inventory for studying disordered grief. Subsequently, Prigerson focused on measuring disordered grief using advanced psychometric techniques. Because treatment for grief-related depression reduced symptoms of depression but not grief, Katherine Shear was recruited to develop a more effective therapy. Prigerson came to conceptualize disordered grief as prolonged grief that is associated with negative outcomes. Shear came to conceptualize disordered grief as intense grief that is complicated by features that interfere with adaption to the loss. In 2013 a hybrid disorder composed of criteria from both groups was placed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) appendix. Under the leadership of the DSM Steering Committee, a summit meeting in 2019 helped break an impasse, and a revised prolonged grief disorder became an official DSM diagnosis.

Prolonged Grief Disorder

Abstract: Prolonged grief disorder (PGD), sometimes called complicated grief, can impair a person's ability to function in daily life and elevate the risk for physical and mental decompensation. In 2022, PGD was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), increasing the potential for treatment with interpersonal therapy and medication. Nurses with knowledge of the signs and risk factors of PGD can identify people experiencing extended, unresolving grief and can offer care and referrals for therapy and support.

Grief and bereavement in the time of COVID-19: a thematic analysis exploring psychotherapists’ observations of clients’ experiences

Abstract: Research published at the outset of the COVID-19 pandemic predicted additional complexity and difficult experiences for those who experience grief and bereavement in this context. The current study aimed to explore the observations of professionals who have worked with grieving clients during the pandemic. This qualitative study targeted psychotherapists with experience of supporting bereaved and grieving clients during the COVID-19 pandemic. A sampling frame of psychotherapists specialising in bereavement was generated from the website of a professional body and potential participants were randomly selected for invitation. Snowball sampling was used as a supplementary method. An inductive thematic analysis was used to generate themes based on 10 interviews. Six key themes were identified; “Restricted access to dying loved ones,” “Cut off from expected supports and ways of grieving,” “Scope to find positives in the changed experience of grief,” “Enhanced emotions,” “Loss of focus on individual grief,” and “Additional complexities surrounding a COVID-19 death.”. The findings provide support for predictions made around additional complexity for grieving persons during the COVID-19 pandemic. However, they also demonstrate the potential for bereaved persons to find positives in their grief experience. These findings have implications for professional practice, policy, and future research directions.

Grief Walking in the Sandtray

Abstract: This article reviews the symptoms of grief and complicated grief that can be reported or observed by therapists as well as the importance of therapists addressing these grief experiences first in their own lives before witnessing and supporting the grief journey of others. The Sandtray Worldplay © (De Domenico, 2002) method of witnessing a sandtray will be reviewed and integrated with stages of grief walking. Grief walking is defined as the mutual experience of processing grief by witness and builder but is unique given the builder is leading the journey. A review of healing tools for sandtray grief walking is discussed.

Living with loss: a cognitive approach to prolonged grief disorder – incorporating complicated, enduring and traumatic grief – ADDENDUM

Abstract: The subject of prolonged, complicated and traumatic grief has become more topical as a consequence of the Covid-19 pandemic. CBT practitioners have been asked to provide effective therapeutic responses for clients with enduring distressing grief reactions. These enduring grief conditions have now been categorised as Prolonged Grief Disorder in the two main mental health classification systems: in the ICD -11 in November 2020 and as a revision to the DSM-5 in 2021. In this paper we draw on our research and clinical experience in applying cognitive therapy for PTSD (CT-PTSD) to traumatic bereavement to derive lessons for the treatment of prolonged grief. During the pandemic the authors of this paper delivered several workshops on prolonged grief disorder (PGD) during which clinicians raised several thought-provoking questions; how do we differentiate between normal and abnormal or pathological grief; how do we categorise pathological grief; how effective are existing therapies and is there a role for CBT; and how do our experiences with Cognitive Therapy for PTSD help with conceptualisation and treatment of PGD. The purpose of this paper is to answer these important questions and in so doing, consider the historical and theoretical concepts relating to complex and traumatic grief, factors that differentiate normal grief from abnormal grief, maintenance factors for PGD and implications for CBT treatments.

The Smoldering Pandemic: Self-Reported Prevalence Assessment of Prolonged Grief Disorder. A cross sectional study of bereaving adults during the Covid Pandemic in Pakistan.

Abstract: Introduction: The Covid-19 pandemic brought forward unprecedented psycho-social challenges for the world. The devastating loss of human lives created a burden of grief throughout the world. The bereaved were put at a greater risk of grief complications with high death tolls, strict social isolation guidelines and a halt to communal funeral practices. Prolonged Grief Disorder is a young psychiatric condition which refers to an abnormal grief reaction that exceeds the normal cultural, social and religious norms. In this study, we assessed the prevalence of Prolonged Grief Disorder (PGD), as mentioned in ICD-11 in Pakistan, along with its correlation to anxiety, depression and psychological distress. Severity of grief reactions were compared with the place of death and relationship with the deceased. Methods: A cross sectional online survey was conducted during the month of October 2021. Sample size was calculated using OpenEpi and data was collected through non probability sampling. The questionnaire was validated and shared through multiple social forums. A total of 737 participants residing in Lahore Pakistan, who had lost a close one due to Covid-19 participated in the study. Demographics, loss related information, and self-reported symptoms measured by 13-item Prolonged Grief Disorder Scale, Patient Health Questionnaire-4 and Kessler-6 scales were obtained. Results:The prevalence of Prolonged Grief Disorder was found to be 15.4%. There was a significant correlation of grief intensity with depression and anxiety.Prolonged Grief Disorder puts individuals at greater risk of suffering from serious mental illnesses. People who were closely related to the deceased were more likely to experience severe Prolonged Grief Disorder symptoms. Conclusion: Early detection and treatment of high risk individuals is necessary to mitigate the burden of grief and associated risk of anxiety and depression. Overall we conclude that discussions pertaining to grief and measures to curb the psychological effects are crucial in the post-pandemic world.

Internet-Based Grief Therapy Program for Bereaved Individuals at Risk: A Case Series Study

Abstract: Interest in internet-based interventions has increased considerably. Prolonged grief disorder is one of the subjects studied with this method. This study includes preliminary findings of the internet-based and therapist-supported prolonged grief intervention program developed in Turkish. The internet-based program consists of 10 written sessions, and after each session, written feedback is given to the participants by the practitioner. The program takes approximately 6-8 weeks. The preliminary effect of the program was handled in a proof-of-concept study style based on a case series design. Self-report measures were taken from the first eight participants who completed the program at four different times (pre-test, post-test, and 1 and 3-month follow-ups). In addition, the written contents of the first and last sessions were analysed by content analysis. As a result of the descriptive findings, remarkable decreases were observed in traumatic grief, global meaning violation, depression, and stress levels in a significant part of the participants between pre-post and follow-up measurements. Also, at least half of the participants had considerable increases in meaning reconstruction scores. In addition, the results of the content analysis indicated that following the intervention, the bereaved individuals expressed less negative and more positive content, as expected. These two data show that the intervention program is promising in reducing the negative symptoms of bereaved individuals and may yield good results with controlled designs for a broader range of participants.

‘Feeling disconnected’ – risk factors for PGD and themes in grief counselling during the COVID-19 pandemic. A mixed-method study

Abstract: ABSTRACT Background: Due to its high death toll and measures to curb the pandemic, COVID-19 has affected grieving experiences and may contribute to risk factors for Prolonged Grief Disorder (PGD). Persons at risk for PGD often seek support from grief counselling. Objective: To explore whether pandemic-associated risk factors have become more important topics in counselling in a mixed-method design. Method: German grief counsellors (n = 93) rated whether pre-defined risk factors had become more important in grief counselling and indicated additional important themes in an open format. Results: The counsellors indicated that all pre-defined risk factors had become more important, though differing significantly in their frequency. Most frequently endorsed risk factors were lack of social support, limited possibilities to accompany a dying loved one and absence of traditional grief rituals. Qualitative analysis identified three additional themes: the societal impact of the pandemic, its impact on bereavement support and health care, and a chance for personal growth. Conclusions: The pandemic has affected bereavement experiences and grief counselling. Counsellors should monitor grief processes and specific risk factors to provide the best possible care for bereaved people when needed. HIGHLIGHTS Pandemic-associated risk factors for PGD have become more important topics in grief counselling during COVID-19. Risk factors include especially a lack of social support, limited possibility to accompany a dying significant other and absence of traditional grief rituals. Future research is needed to investigate whether monitoring and addressing these risk factors can improve bereavement care.