Correlates of Mental Health After COVID-19 Bereavement in Mainland China

doi:10.1016/j.jpainsymman.2021.02.016

Journal of Pain and Symptom Management

Volume 61, Issue 6, June 2021, Pages e1-e4

https://doi.org/10.1016/j.jpainsymman.2021.02.016 Get rights and content

Abstract

Context

Pioneering empirical studies show that people bereaved due to COVID-19 experience elevated acute grief, posttraumatic stress, anxiety, and depressive symptom levels, which relate to functional impairment. However, studies focused on Western samples and multivariate analyses of relations between potential risk factors and mental health in this population are lacking.

Objectives

To assess the mental health of Chinese adults bereaved due to COVID-19. To elucidate the associations of demographic and loss-related characteristics with mental health after COVID-19 bereavement.

Methods

Four hundred twenty-two Chinese adults (56% male; Mean age: 32.73 years) recently bereaved due to COVID-19 completed an online survey. Demographic and loss-related characteristics and prolonged grief, posttraumatic stress, anxiety, and depressive symptoms were assessed.

Results

Clinically relevant prolonged grief (49%, n = 207), posttraumatic stress (22%, n = 92), depressive (70%; n = 294), and anxiety symptoms (65%; n = 272) were reported by a substantial group of participants. In four multiple regressions predicting each mental health indicator, Fs(15,406) = 5.08–7.74, Ps < 0.001, loss-characteristics (i.e., a shorter time since loss, βs =  -.12–.11, loss of a first-degree relative, βs =  .18-.37) and subjective loss experiences (i.e., feeling traumatized by the loss, βs =  .13-.18, or a close and/or conflictual relation with the deceased, βs =  .12-.23) related most consistently to mental health problems.

Conclusion

Many Chinese adults bereaved due to COVID-19 experience severe mental health problems. The recent loss of first-degree relatives, feeling traumatized by the loss, and having a close and/or conflictual relationship with the deceased may elevate risk for these mental health problems, which could require indicated psychological treatment.

Section snippets

Key Message

Prolonged grief, posttraumatic stress, anxiety, and depressive symptom levels are elevated among Chinese people bereaved due to COVID-19. Shorter time since loss, closer kinship with the deceased, feeling traumatized by the loss, and a close and/or conflictual relationship with the deceased relate most consistently to these mental health problems.

Methods

The first author's institutional ethics committee approved this study. We conducted an online survey in mainland China between September and October 2020. We recruited adult participants bereaved due to COVID-19 via advertisements on social network websites (e.g., Baidu, Weibo) and mobile applications (e.g., WeChat). Advertisements linked to an online information page explaining the aims and procedure of the study (e.g., voluntariness, confidentiality, data handling). After providing online

Results

The 422 participants were on average 33 years old (Mean = 32.73; SD = 9.31). More than half was male (56%; n = 234). The majority reported no religious beliefs (94%; n = 395). On average, the deceased was 48 years old (Mean = 47.81; SD = 21.55). Participants had lost a partner (33%; n = 139), child (6%; n = 24), parent (23%; n = 97), grandparent (16%; n = 69), other relative (5%; n = 22), friend (15%; n = 64), or another relationship (2%; n = 7). Most deceased died directly from COVID-19 (97%; n

Discussion

This study's first main aim was to conduct a comprehensive assessment of the mental health problems experienced by Chinese adults bereaved due to COVID-19. The finding that high proportions of participants reported clinically relevant prolonged grief, posttraumatic stress, anxiety and depressive symptoms align with the concerns of grief researchers,³ and with empirical findings from pioneering empirical studies.⁴^,⁵ Specifically, the high levels of prolonged grief symptoms found in this study

Disclosures

Funding: This study was supported by the Guangdong Planning Office of Philosophy and Social Science [grant number GD20YSH06] and the Shenzhen University Natural Science Research Grant [grant number 860-000002110172].

The authors have nothing to disclose.

References (12)

MC Eisma et al.
Acute grief after deaths due to COVID-19, natural causes and unnatural causes: an empirical comparison
J Affect Disord
(2021)
C Killikelly et al.
Development of the international prolonged grief disorder scale for the ICD-11: measurement of core symptoms and culture items adapted for Chinese and German-speaking samples
J Affect Disord
(2020)
World Health Organization. WHO coronavirus disease (COVID-19) dashboard. 2021. Available at: https://covid19.who.int/....
AM Verdery et al.
Tracking the reach of COVID-19 kin loss with a bereavement multiplier applied to the United States
PNAS
(2020)
M Stroebe et al.
Bereavement in times of COVID-19: a review and theoretical framework
Omega—J Death Dying
(2021)
LJ Breen et al.
Psychological risk factors of functional impairment following COVID-19 deaths
J Pain Symptom Manage
(2021)

There are more references available in the full text version of this article.

Cited by (29)

The relationship between depression, stress and anxiety levels of mothers with preschool children and their stress-coping styles during the pandemic: A descriptive study in Turkey
2024, Journal of Pediatric Nursing
This study aims to determine the depression, stress and anxiety levels of mothers with preschool children during the pandemic and to determine their coping strategies with stress.
This descriptive study sampled 300 mothers with kindergarten children in the 2021–2022 academic year. The data were collected with a personal information form, The Depression, Anxiety and Stress Scale-21 (DASS-21) and Stress-Coping Styles Scale (SCSS). Numerical variables were presented as mean and standard deviation, and categorical variables were presented as numbers and percentages. The Mann Whitney U test was used for the dual group and the Kruskal Wallis test for more than two groups in the comparison of the scale mean scores. The relationship between the two scales was determined by Pearson's correlation analysis. p < 0.05 value was accepted statistically significant.
The depression, anxiety and stress mean scores of the mothers in the study were high (10.01 ± 4.79; 9.07 ± 5.09; 10.28 ± 4.28, respectively). There is a high level of negative correlation between the SCSS self-confidence approach scores, optimistic approach scores and depression, anxiety and stress scores, and a high level of positive correlation between the helpless/self-accusatory approach, submissive approach, optimistic approach and depression, anxiety and stress scores.
Mothers with pre-school children have been found to experience intense depression, anxiety and stress during the pandemic, and as their depression, stress and anxiety levels increase, they move away from self-confident and optimistic approaches, and they embrace more the helpless/self-accusatory approach and submissive approach, seeking social support.
In the event of a future pandemic, psychiatry and pediatric nurses should strengthen positive coping styles and make mothers aware of social support resources to ensure that mothers, who are the most vulnerable group in terms of mental health, and thus children, do not experience psychiatric problems. Thus, nurses, as mandated by the holistic care approach, provide the qualified care that the individual and his family deserve.
Grief and Palliative Home-Care Services for Patients at the End of Life During the COVID-19 Pandemic in Colombia: Analysis from the Relatives’ Perspective
2022, Revista Colombiana de Psiquiatria
El cuidado al final de la vida es una de las experiencias más cruciales tanto para el paciente como para sus seres queridos. Sin embargo, a raíz de los cambios generados por la pandemia de COVID-19, el proceso de final de vida ha sufrido cambios a nivel familiar, social y sanitario. A su vez, esto ha alterado la percepción y desarrollo del duelo de familiares de pacientes que fallecieron durante la pandemia, independientemente de la causa de muerte. Así, el presente estudio tiene el objetivo de analizar las percepciones y algunos aspectos del proceso de duelo de los familiares de pacientes fallecidos durante la pandemia.
Se aplicó la versión adaptada del cuestionario internacional Care Of the Dying Evaluation a los familiares de personas fallecidas durante la pandemia en 2 momentos diferentes tras la muerte de su familiar.
Se encuestaron 239 familiares, de los cuales 112 realizaron el cuestionario de seguimiento. Los pacientes fallecieron mayoritariamente en su domicilio y su familia estuvo altamente involucrada en su cuidado. La atención médica fue evaluada como adecuada y el síntoma que se percibió con mayor frecuencia fue el dolor. El 87% de los encuestados participaron en ritos fúnebres, y el 42% los calificó como muy sobrios. En cuanto al duelo, predomina la subescala de crecimiento personal, sin embargo, en los aspectos negativos predomina la sensación de presión en el pecho y llanto frecuente.
El fin de la vida durante la pandemia de pacientes de atención domiciliaria fue percibido como adecuado, permitiendo el acompañamiento por parte de la familia y el control de los síntomas. El proceso de duelo no evidencia complicaciones. Es importante la formación de los profesionales de la salud en estos aspectos fundamentales de la atención y el cuidado de los pacientes.
End-of-life care is one of the most crucial experiences for both the patient and their loved ones. However, as a result of the changes generated by the COVID-19 pandemic, the dynamics of the end-of-life process has undergone changes at both the family, social and health levels. In turn, this has altered the perception and development of the grief of relatives of patients who died during the pandemic regardless of the cause of death. Then, the aim of this study is to analyze the perceptions and some aspects of bereavement of died patients’ relatives during the pandemic of COVID-19.
Through the admission evaluation and follow-up of the relatives with an adapted version of the international Care Of the Dying Evaluation questionnaire.
Two hundred and thirty-nine relatives were surveyed, of which 112 completed the follow-up questionnaire. Most of the patients died at home and their family members were highly involved in their care. Medical attention was considered adequate and the symptom with the highest perception was pain. A percentage of 87 of those surveyed participated in funeral rites, and 42% rated them as very sober. Regarding grief, the scale of personal growth predominates, however, in the negative aspects, the feeling of pressure in the chest and frequent crying predominates.
The end of life of home-care patients during the pandemic was perceived as adequate, allowing family support and symptom control. The grieving process shows no complications. The training of health professionals in these fundamental aspects of patient care is important.
The mental health of Australians bereaved during the first two years of the COVID-19 pandemic: A latent class analysis
2024, Psychological Medicine
Long-term bereavement outcomes in family members of those who died in acute care hospitals before and during the first wave of COVID-19: A cohort study
2024, Palliative Medicine
Healing grief–an online self-help intervention programme for bereaved Chinese with prolonged grief: study protocol for a randomised controlled trial
2024, European Journal of Psychotraumatology
Death Unpreparedness Due to the COVID-19 Pandemic: A Concept Analysis
2024, Healthcare (Switzerland)

View all citing articles on Scopus

View full text

COVID-19Correlates of Mental Health After COVID-19 Bereavement in Mainland China

Abstract

Context

Objectives

Methods

Results

Conclusion

Section snippets

Key Message

Methods

Results

Discussion

Disclosures

J Affect Disord

J Affect Disord

Tracking the reach of COVID-19 kin loss with a bereavement multiplier applied to the United States

PNAS

Bereavement in times of COVID-19: a review and theoretical framework

Omega—J Death Dying

Psychological risk factors of functional impairment following COVID-19 deaths

J Pain Symptom Manage

COVID-19
Correlates of Mental Health After COVID-19 Bereavement in Mainland China