Bereavement during the COVID-19 Pandemic: Impact on Coping Strategies and Mental Health

Abstract

The COVID-19 coronavirus has caused 5.4 million deaths worldwide, including over 800,000 deaths in the United States (as of December 2021). In addition to these staggering statistics, an even greater number of individuals have died from other causes during the COVID-19 pandemic. As a result, a large portion of the global population has faced bereavement during the COVID-19 pandemic and resulting quarantine. The often rapid and unexpected nature of COVID-19 deaths and the presence of pandemic-related stressors and living restrictions make it more difficult for individuals bereaved during the pandemic to implement effective strategies for coping with the loss compared to non-pandemic periods. Quarantine-related constraints (e.g., social distancing, availability of and access to resources) impede coping strategies that have been found to be adaptive after a loss, such as supportive (e.g., seeking emotional and instrumental support) and active (e.g., problem-focused and cognitive reframing) coping, and they augment avoidant strategies (e.g., substance use, denial, and isolation) that have been found to be maladaptive. Poorer mental health outcomes (including prolonged grief disorder; PGD) have been associated with less healthy coping. This article reviews research findings regarding bereavement during the COVID-19 pandemic, discusses the effects of pandemic-related stressors on bereavement coping strategies, and proposes how different types of coping during the pandemic may account for the poorer mental health outcomes described in recent reports. Interventions for promoting adaptive coping strategies and minimizing maladaptive coping strategies are also outlined.

DISCLOSURE STATEMENT

The contents of this publication are the sole responsibility of the author(s) and do not necessarily reflect the views, opinions, or policies of The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government.

The opinions and assertions expressed herein are those of the author(s) and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences or the Department of Defense.

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Notes on contributors

Joscelyn E. Fisher

Joscelyn E. Fisher, Ph.D. is a Research Associate Professor in the Department of Psychiatry at the Uniformed Services University (USU) and a Project Director/Research Psychologist for the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. at the Center for Study of Traumatic Stress (CSTS). She received a Bachelor of Arts (majors: Music and Psychology) from the University of Virginia and a PhD in Psychology from the University of Illinois Urbana-Champaign (UIUC). She then completed her post-doctoral training at the Maryland Psychiatric Research Center (MPRC) at the University of Maryland, Baltimore (UMB) where she transitioned to a faculty position. At CSTS, she has been investigating indicators of risk and resilience and their associations with depression, anxiety, grief, and other health outcomes in bereaved family members.

Alexander J. Rice

Alexander J. Rice, Ph.D. is a Senior Outcomes Research Associate with QualityMetric. His research focuses on grief, coping, cardiovascular health, and survey development and validation. He has a PhD in Counseling Psychology and a master’s degree in Educational Measurement and Statistics, both from the University of Iowa, and completed a postdoctoral research fellowship at the Uniformed Services University as part of the Military Cardiovascular Outcomes Research team.

Rafael F. Zuleta

Rafael F. Zuleta, B.S. is a Program Manager at the Center for the Study of Traumatic Stress working with the Child and Family Program. He graduated from the University of Maryland, College Park, in May 2018 with a Bachelor of Science degree in Psychology. During his time as an undergraduate, Mr. Zuleta worked at numerous research labs including Dr. Cassidy’s Child and Family Development Lab and Dr. Hill’s Maryland Psychotherapy Clinic and Research Lab. During his senior year, Mr. Zuleta worked with Dr. Slevc at the Language and Music Cognition Lab and conducted research on musical factors and their effect on creativity, which he wrote a thesis and prepared a defense for.

Stephen J. Cozza

Stephen J. Cozza, MD is Professor of Psychiatry and Pediatrics at the Uniformed Services University where he serves as Associate Director, Center for the Study of Traumatic Stress and is responsible for the Child and Family Program. He is a graduate of the United States Military Academy and the George Washington University School of Medicine and Health Sciences. He is a Distinguished Fellow in the American Academy of Child and Adolescent Psychiatry and a Distinguished Life Fellow in the American Psychiatric Association. Dr. Cozza’s professional interests have been in the areas of clinical and community response to trauma in both military and civilian communities, including the impact of deployment and combat injury, illness, and death on military service members, their families, and their children. Dr. Cozza has also examined the risk for prolonged grief disorder, a unique grief-related clinical condition, in families affected by sudden and violent deaths, including those bereaved due to combat, suicide, homicide, accident, and terrorism. He is published in the scientific literature and has presented on these topics at multiple national and international scientific meetings. Dr. Cozza serves as a scientific advisor to several national organizations that focus on the needs of military children and families.