Supporting family members with severe grief reaction during the COVID-19 pandemic

This program of research looked at the experiences of both dying and grieving during the COVID-19 pandemic.

To do this, we did a medical chart review of adult patients who died in three Ottawa acute care hospitals just before and during the COVID-19 pandemic. The group included 170 patients who died pre-pandemic (between November 2019 and February 2020), 85 patients who died during the first wave of the pandemic (March 2020 to August 2020) and were COVID positive, and 170 patients who died during the first wave but were COVID negative. Of this study group, the average age was 79 and just over half were male.

First, we looked at how communication at end of life was affected, both between patients and their family members and between family members and the healthcare team. We found that in-person family presence at end of life was significantly lower during the pandemic, and the COVID-positive group had the lowest rates of in-person family presence. The COVID-negative and COVID-positive groups had increased communication by phone or video call, instead.

We also looked at the bereavement experience of the family members of these same patients, 6-12 months after the patients had died. This part of the study aimed to understand the impact of the pandemic on grief experiences, and to understand the supports available to and used by grieving family members.  We did this through grief questionnaires and interviews with family members of these patients who died.

Of the family members assessed, 68% were the child and 21% were the spouse of the deceased. 68% of the family members were female, and 79% had no history of mental health conditions.

Overall, almost 30% of family members had severe grief symptoms, regardless of whether their loved one died before or during the pandemic. Rates of severe grief are normally only 2-3%! The serious increase suggests that aspects of the pandemic itself may contribute to severe grief.

We then followed up with these family members 6 months after that initial assessment, and these results were just as concerning. Severe grief was still high for all groups. Some had got better, but almost a quarter got significantly worse.

Results of this project will help support family members through their grief and bereavement in both pandemic and non-pandemic times. The results show a serious need for effective and scalable ways to address severe grief.