Levels Of Grief Research Articles

How do homeless service users view their own health and healthcare? An ethnographic study

BackgroundThe provision of healthcare to those in homelessness often fails to consider what is important to those receiving care. Using an ethnographic approach grounded in a social constructivist research paradigm, this study aimed to explore the perspectives of homeless service users in Dublin, Ireland on their priority health and healthcare needs. MethodsActive participant observations and informal interviews were conducted with 74 adult clients attending a low-threshold primary care and addiction service between October, 2022 and April, 2023. Participants were selected using purposive, critical case sampling; clinic medical or operations staff identified adult homeless clients of sound mental capacity with whom they had an established rapport. Field note data were collected, anonymised, and analysed using inductive thematic analysis in accordance with the Declaration of Helsinki and the researchers’ institutional Research Ethics Committee. All participants gave informed verbal consent. FindingsClients’ priority concerns relate to their mental health and personal safety, strengthening ties with children and families, finding a sense of purpose, and alleviating physical pain. These challenges are acute both prior to and during experiences of homelessness, coupled with disproportionately high levels of grief, fear, isolation, and fatigue. In terms health services, clients value accessing primary care and harm reduction in a social environment where positive exchanges with friends and providers take place. Conversely, barriers to accessing mental health and addiction services persist including the internalised belief that one is beyond help, lack of access to information on available services and their entry requirements, and lingering stigma within a health system that treats addiction as separate to health. InterpretationHealth initiatives recommended by homeless service users to improve their lives and conditions include the provision of more/more acceptable single occupancy housing, refuge spaces, mental health and parenting supports, residential addiction treatment, and meaningful social activities. Study limitations include the obtention of data from a single site and from only English speakers. FundingThe authors received no specific funding for this work.

An examination of the factors influencing grief cognition and meaning reconstruction among older bereaved spouses

The study investigated the effect of grief cognitions on grief and meaning reconstruction levels and explored how sociodemographic factors and loss-related variables relate to these outcomes, using a sample of 155 older bereaved spouses in Türkiye. The sample for the study, which used a relational screening model, consisted of 155 participants aged 60 and over from Çankaya district of Ankara. Data were collected using the socio-demographic information form, the grief cognition questionnaire, and the grief and meaning reconstruction inventory. Spearman correlation analyses were conducted to evaluate the correlations between variables, and multiple and hierarchical regression analyses were performed to ascertain the predictors of the scales. The analysis revealed a negative correlation between grief cognitions and grief and meaning reconstruction levels. Expectedness of death and the time elapsed since the spouse’s death were predictors of both grief cognitions and levels of grief and meaning reconstruction.

Is COVID-19 loss more associated with prolonged grief disorder than other losses?

The COVID-19 pandemic raised fears about a rise in prolonged grief rates. To determine if these fears are justified, we examined an online sample of 329 Turkish adults for their level of prolonged grief symptoms (as well as probable Prolonged Grief Disorder-PGD) and associated factors in relation to losses during the pandemic. Respondents completed measures of prolonged grief, post-traumatic stress disorder, and depression. Overall, 10% of participants reported symptoms indicating a probable PGD diagnosis. Surprisingly, loss due to COVID-19 or disruption of the natural mourning process did not relate to higher levels of prolonged grief. Our findings suggest that although levels of prolonged grief (and rates of PGD) may have increased during the pandemic, prolonged grief (or PGD) during this time is likely not linked to losses due to COVID-19 or to disruptions in the normal grieving process.

Perinatal Grief Counseling and Its Effect on Grief Levels in Women Who Underwent Pregnancy Termination: A Comparative Experimental Study.

This study was designed as a two-group pre-test post-test comparative experimental study to examine the effects of grief counseling on perinatal grief levels in women who underwent pregnancy termination before discharge from the clinic. This study was conducted with 70 women who underwent medical termination of pregnancy. The intervention group (n = 35) received perinatal grief care, while the control group (n = 35) received only routine hospital care. In this study, the Introductory Information Form, Perinatal Grief Scale, and evaluation form of the care received were completed. While the perinatal grief level of the intervention group decreased after the application of grief care, a significant difference between the groups was detected only in women with a history of medical termination according to obstetric characteristics (p < .05). The findings obtained from this study showed that perinatal grief care support decreased grief scores on perinatal grief instruments and their sub-dimensions in the intervention group.

Prolonged Grief, Posttraumatic Stress and Depression Symptoms Before and After COVID-19 in Brazil.

This study aims to explore the differences in prolonged grief (PDG), posttraumatic stress (PTSD), and depression symptoms (MDD) following the loss of a loved one before and after the COVID-19 pandemic. Using a cross-sectional design, 888 bereaved individuals were classified on different groups according to the cause of death. Results indicate that participants who experienced a loss during the pandemic, regardless of the cause, presented higher levels of prolonged grief, posttraumatic stress and depression when compared to those who lost a loved one before the pandemic. This study sheds light on the environmental influences (ex: the COVID-19 pandemic) on the grieving process, emphasizing the need to take the context into account when tailoring interventions in bereavement and mental health care.

Psychometric Evaluation of the Traumatic Grief Inventory-Self Report Plus (TGI-SR+) in Chinese Bereaved People.

The Traumatic Grief Inventory-Self Report Plus (TGI-SR+) measures the most recent prolonged grief disorder (PGD) symptom sets defined in the 11th edition of the International Statistical of Diseases and Related Health Problems (ICD-11) and the text revision of the fifth edition of the Diagnostical and Statistical Manual of Mental Disorders (DSM-5-TR). However, the TGI-SR+ has not yet been translated and validated in Chinese. This study aims to evaluate the psychometric properties of the Chinese translation of the TGI-SR+. We examined the Chinese TGI-SR+'s factor structure, internal consistency, convergent validity, discriminant validity, known-groups validity, and optimal clinical cut-off scores in 443 Chinese bereaved adults. Confirmatory factor analyses showed that the two-factor models showed the best fit for the Chinese TGI-SR+ items assessing ICD-11 and DSM-5-TR prolonged grief symptoms. Items assessing ICD-11 and DSM-5-TR prolonged grief symptoms demonstrated good internal consistency. Associations of TGI-SR+ scores with symptom levels of prolonged grief (assessed by the International Prolonged Grief Disorder Scale), posttraumatic stress, anxiety, and depression supported convergent and discriminant validity. Associations with background/loss-related variables provided evidence for known-groups validity. Cut-off points for probable ICD-11 PGD (liberal scoring rule), probable ICD-11 PGD (conservative scoring rule), and probable DSM-5-TR PGD were ≥67, ≥75, and ≥68, respectively. The Chinese TGI-SR+ appears to be a reliable and valid measure to assess prolonged grief symptoms per ICD-11 and DSM-5-TR among Chinese bereaved adults.

Trajectories of sexual well-being and links with grief after a recent pregnancy loss: a dyadic longitudinal study.

Pregnancy loss affects 1 in 4 women and is linked with poorer overall health and relationship outcomes. Despite sexual well-being's importance to health, how sexual well-being changes across time after a pregnancy loss and what might predict such changes, like perinatal grief, have never been examined, leaving practitioners and couples without knowledge of what to expect. We aimed to examine (1) how sexual satisfaction, sexual desire, sexual distress, and perinatal grief change from 10 to 25weeks postloss for both couple members; and (2) if perinatal grief levels at 10weeks postloss predict sexual well-being trajectories. Women and gender-diverse individuals who were pregnant when a pregnancy loss occurred (within the last 4months) and men, women, and gender-diverse partners who were not pregnant (N = 132 couples) independently completed 4 monthly assessments of sexual well-being and perinatal grief. Outcomes included sexual satisfaction (Global Measure of Sexual Satisfaction), sexual desire (Sexual Desire Inventory), sexual distress (Sexual Distress Scale-Short Form), perinatal grief (Perinatal Grief Scale). Dyadic growth curve modeling indicated that, from 10 to 25weeks postloss, both couple members' sexual satisfaction increased, and their sexual desire remained stable; sexual distress decreased for partners but remained stable for individuals who were pregnant; and both couple members' perinatal grief decreased. Perinatal grief levels at 10weeks postloss did not predict sexual well-being trajectories over time. Given sexual well-being's dynamic nature, clinicians should regularly discuss sexuality with both couple members after pregnancy loss. During such discussions, clinicians could reassure couples about their sexual relationship's recovery by sharing that, on average, sexual satisfaction, sexual desire, and sexual distress tend to improve or stay the same (rather than worsen) from 10 to 25weeks postloss. They can also share that perinatal grief tends to decrease during this time and is unrelated to trajectories of sexual satisfaction, sexual desire, and sexual distress. This is the first study, to our knowledge, to examine how sexual well-being changes across time after a pregnancy loss and perinatal grief's role in such changes. The results may not generalize broadly, as most couples were in mixed-gender/sex relationships, identified as White, and were relatively affluent. From 10 to 25weeks postloss, both couple members tend to experience improvements in their overall sexual well-being and declines in their perinatal grief. Early perinatal grief levels and subsequent sexual well-being trajectories are seemingly unrelated.

Pathways between grief, depression, hopelessness, reasons for living, and suicidal ideation in bereaved individuals

BackgroundAssociations between comorbid depression and grief with suicidal ideation (SI) have been inconsistent. To identify at-risk individuals, it is important to determine the role of symptom severity by examining both continuous and clinical-threshold grief and depression, in addition to other factors (i.e., hopelessness, reasons for living—RFL) associated with SI. MethodsParticipants (n = 216) bereaved by combat, accident, or suicide completed an online survey. Associations between depression, grief, SI, RFL, and hopelessness were examined by multivariable logistic regressions and structural equation modeling (SEM). ResultsAcross the sample, hopelessness and RFL were associated with SI while continuous measures of grief and depression were not. In contrast, clinical-threshold grief, clinical-threshold depression, hopelessness, and RFL each were associated with SI. In addition, of the grief characteristics, yearning was the most robust correlate of SI, and Survival/Coping Beliefs (SCB) was the RFL most associated with SI. SEM indicated that direct paths between grief and SI, hopelessness and SI, and RFL and SI were significant, but not between depression and SI. Instead, depression had a strong direct effect on hopelessness, and hopelessness had a direct effect on SI. DiscussionResults are consistent with previously-identified associations between SI and clinical levels of depression and grief. More nuanced findings suggest hopelessness, yearning, and SCB as additional targets for reducing risk for SI in bereaved individuals regardless of whether they meet clinical thresholds for grief or depression.

Evaluating the Effect of Participation in Bereavement Support Groups on Perceived Mental Well-Being and Grief Reactions.

The study aimed to evaluate the effect of participating in bereavement support groups on mental well-being and levels of grief and to gather information about participants´ experiences of participation. The programme consisted of six sessions over six weeks. Data were collected with the Warwick Edinburgh Mental Well-Being Scale (WEMWBS) and the Adult Attitude to Grief scale (AAG) as well as demographic and open-ended questions. 64 bereaved spouses returned at least parts of the study´s questionnaires before participating in the programme while 39 returned the complete WEMWBS and 36 the complete AAG both before and after participation. Most participants were women >60 years old. Participation in the programme resulted in a significant increase in perceived mental well-being and significantly lower levels of vulnerability in grief. Responses to open-ended questions revealed both positive and negative experiences. A lowered WEMWBS score and a relatively high AAG underscore the importance of providing services to the recently bereaved. Routine screening for complicated grief before participating in the bereavement support group sessions is recommended.

Pathological Grief in Geriatric Age Group Affected by COVID-19 Deaths: A Community-Based Study

Background: Deaths by COVID-19 have left behind nearly 12 million recent bereaved individuals worldwide and researchers have raised concerns that the circumstances of COVID-19 related deaths will lead to a rise in prevalence of prolonged grief disorder (PGD) cases. Nevertheless, no research has looked at the PGD incidence among older Indians who have lost a loved one to COVID-19. The aim this research is to determine the prevalence of PGD and the demographics of older people who have experienced COVID-19-related bereavement. Methods: This is a cross-sectional study and house to house survey was conducted between August 2022 and August 2023. Forty geriatric adults aged above 60 years, who consented to participate were assessed for PGD. Demographic details and loss-related information were collected. Self-reported prolonged grief symptoms were measured using Pandemic Grief Scale (PGS) and Traumatic Grief Inventory Self Report (TGI-SR). Anxiety and depression were measured using Hamilton Rating Scale for Anxiety (HAM-A) and Hamilton Rating Scale for Depression (HAM-D). Multiple linear regression analysis was used to determine the associated factors of grief symptoms. Results: Our study indicates that individuals who experienced loss due to COVID-19 exhibited higher levels of grief. Most of the participants were females (65%). Prevalence of PGD was 10% by TGI-SR. HAM-A scores (14.28 +/- 1.42) were higher than HAM-D scores (12.02 +/- 1.58). Conclusion: It is essential to counsel families early and offer supportive services to prevent pathological grief associated with COVID-19 deaths.

When does disruption of meaning in bereavement become debilitating? Screening for deleterious outcomes with the ISLES-SF

Meaning reconstruction is a central process in bereavement adaptation. However, clinical measures or means for identifying individuals whose struggles with meaning making have become dysfunctional have yet to be developed for clinicians to readily use in practice. Therefore, the objective of this study was to evaluate the diagnostic effectiveness of the Integration of Stressful Life Experiences Scale-Short Form (ISLES-SF) for measuring clinically significant struggles with meaning making of loss. The results of this study of 118 bereaved adults support the diagnostic use of the ISLES-SF (sensitivity of 83% and specificity of 73%), as well as an identified cut-score (≥ 14) that researchers and clinicians can employ to accurately and efficiently identify those whose difficulties with making meaning of loss have become debilitating. The results also showed that those who scored in the clinical range of the ISLES-SF displayed higher levels of anxiety, depression and prolonged grief than those not struggling with meaning making.

The relationship between healthcare satisfaction after miscarriage and perinatal grief symptoms: A cross-sectional study on Portugal residents

Objective15–20% of identified pregnancies result in miscarriage, which may lead to persistent symptoms of psychological morbidities in some women. Healthcare satisfaction is among the factors believed to influence such negative psychological responses. Here, we present the results of a study conducted in Portugal that analyzes the relationship between healthcare satisfaction, information and support provision and perinatal grief symptoms. MethodsIn a cross-sectional study, symptoms of perinatal grief, degree of satisfaction with healthcare received, and information and support provision data were collected through an online survey aimed at women in Portugal who suffered a miscarriage. 873 were considered eligible. Correlations were performed between perinatal grief scores and healthcare satisfaction rates. Finally, the proportions of information and support received were compared after distributing the sample in groups according to their perinatal grief levels. ResultsHealthcare satisfaction correlated significantly with perinatal grief scores, the latter increasing as satisfaction levels decreased. 61.1% of our sample received information about the physical consequences of miscarriage and showed a significantly lower rate of above-threshold perinatal grief symptoms in this group. 18.2% received information about its mental health consequences, with no significant differences in above-threshold symptom rates. 11.7% were offered or recommended mental health support, but no significant differences in above-threshold symptom rates were found. ConclusionHealthcare satisfaction and information on after-miscarriage physical changes correlated significantly with reduced perinatal grief rates after miscarriage. However, any effects of mental health information and psychological support provision need further studies. Training for healthcare providers dealing with pregnancy loss, implementing national guidelines that include follow-up on the parents' physical and psychological health, and including a specialized area in medical structures are advised.

Psychiatry Resident Physicians Experience Personal and Professional Grief, Burnout and Depression: Results From a National Survey.

Resident physicians experience personal and professional stressors throughout training. These experiences may increase levels of burnout, depression, and grief. Understanding how these stressors impact trainees is essential for improving wellbeing during residency. We examined the prevalence and associations between burnout, depression, and grief among a national sample of psychiatry resident physicians. A survey including validated scales for burnout (Modified Maslach Burnout Inventory-Health Services Survey [MBI]), depression (Patient Health Questionnaire-9 [PHQ-9]), and grief (Traumatic Grief Inventory Self Report [TGSIR]) was distributed to 296 psychiatry program directors in January 2023 for dispersal to their respective residents. Fifty-seven participants completed the survey out of 245 participants who opened and started the survey (23.3%). All participants were current psychiatry residents. MBI scores averaged 21.2 (SD 6.5, range 11-40); 11 participants reported high levels of burnout (scores >27; 19.3%). PHQ-9 scores averaged 3.42 (SD 3.0, range 0-14), with 8 responses meeting the criteria for moderate depressive symptoms (scores >10-14; 14.0%). Suicidal ideation was reported by 5 of 57 participants (8.7%). TGISR scores averaged 12.2 (SD 11, range 0-43); no participants met the criteria for pathologic grief. TGISR scores were correlated with MBI (r = .30; P = .02) and PHQ-9 scores (r = .53; P < .0001). MBI scores were also correlated with PHQ-9 scores (r = .54; P < .0001). Non-pathological grief was correlated with burnout and depression. 14% to 20% of psychiatry residents reported clinically significant levels of burnout and depression. Future studies should aim to further characterize burnout, depression, and grief in larger samples of trainees.

A machine learning personalized treatment rule to optimize assignment to psychotherapies for grief among veterans

BackgroundComplex grief patterns are associated with significant suffering, functional impairments, health and mental health problems, and increased healthcare use. This burden may be even more pronounced among veterans. Behavioral Activation and Therapeutic Exposure (BATE-G) and Cognitive Therapy for Grief (CT-G) are two evidence-based interventions for grief. The goal of this study was to use a precision medicine approach to develop a personalized treatment rule to optimize assignment among these psychotherapies. MethodsWe analyzed data (N = 155) from a randomized clinical trial comparing BATE-G and CT-G. Outcome weighted learning was used to estimate an optimal personalized treatment rule. Baseline characteristics including demographics, social support, variables related to the death, and psychopathology dimensions were used as prescriptive factors of treatment assignment. ResultsThe estimated rule assigned 72 veterans to CT-G and 56 to BATE-G. Assigning participants according to this rule was estimated to lead to markedly lower mean grief level following 6 months from treatment compared to assigning everyone to either BATE-G (Vdopt – VBATE-G = −18.57 [95 % CI: −29.41, −7.72]) or CT-G (Vdopt – VBATE-G = −20.89 [95 % CI: −30.7, −11.07]) regardless of their characteristics. LimitationsParticipants were primarily male veterans, and identified with Black or White race. The estimated rule was not externally validated. ConclusionThe estimated rule used relatively simple, easily accessible, client characteristics to personalize assignment to treatment using a precision medicine approach based on machine learning and causal inference. Upon further validation, such a rule can be easily implemented in clinical practice to prescriptively maximize treatment benefits.

Resilience, Migratory Grief, and the Influence of Sociodemographic Factors on Venezuelan Immigrants, Case of Peru

The current study aimed to determine the relationship between resilience and migratory grief among Venezuelan immigrants in Peru. This was a basic, quantitative, correlational, cross-sectional study. The sample consisted of 267 Venezuelan immigrants aged between 18 and 50 years from the human mobility and human trafficking board of a diocese in Peru. To measure the variables, the RS-14 Resilience Scale by Wagnild and Young and the Migratory Grief Questionnaire created by De la Revilla et al. were used. For the data analysis, SPSS v25 software was used, and Spearman's correlation coefficient was calculated to determine the relationship between resilience and migratory grief. Additionally, to understand the influence of sociodemographic factors, analysis of variance (ANOVA) and the Scheffé post hoc test were utilized. The results showed that there was a statistically significant relationship between the level of resilience and migratory grief. Similarly, employment status is an influential factor for both resilience and migratory grief. Received: 6 March 2024 / Accepted: 16 April 2024 / Published: 5 May 2024

클라이언트 사망을 경험한 사회복지사를 위한 집단인지행동치료 효과성 연구

The objective of this study was to develop and validate a group cognitive behavioral therapy based on William Worden's four-stage grief model for social workers who have experienced client death. For this study, both the experimental group and the comparison group completed pre-tests and post-tests to assess their levels of prolonged grief, PTSD, anxiety, and depression. In addition, the experimental group completed SUDs before and after each session. This group cognitive behavioral therapy was conducted online due to the COVID-19 pandemic. The study revealed that the experimental group had a significantly lower prolonged grief score. Furthermore, their post-traumatic stress symptoms, anxiety, and depression were found to be lower than their pre-score, although this difference was not statistically significant. The SUDs for the experimental group were measured before and after each session, and a reduction was observed. A plan to assist social workers in their recovery from the death of a client was proposed based on the findings of the study.

Psychometric properties of the German version of the Pre-loss Grief Questionnaire (PG-12-R)

This study aimed to develop a German version of the revised Pre-loss Grief Questionnaire (PG-12-R) and examine its factor structure, reliability and validity. The PG-12-R was assessed in a representative German sample (N = 2,515). Of these, 362 (14.4%) reported to have a loved one suffering from an incurable disease and 352 provided full data sets. Principal component factor analysis, scree-plot and parallel analysis were conducted. Results supported a one-factor model of PG-12-R with high internal consistency. Convergent validity was confirmed by negative correlations with psychological well-being and time since diagnosis and positive correlations with a more difficult perception of circumstances surrounding the illness and unpreparedness. The German version of the PG-12-R represents a reliable and valid measurement tool of pre-loss grief. It may be used as a screening measure for high levels of pre-loss grief to identify individuals who may need additional support.

Spanish adaptation of the perinatal grief intensity scale

ABSTRACT Aims/Background Assessing the intensity of perinatal grief is very important for identifying the more complex cases in mothers and fathers. Despite this, there are few assessment tools available. The aim of this study was to analyse the psychometric properties (factorial structure, reliability, and validity) of the Spanish version of the Perinatal Grief Intensity Scale (PGIS). Design/Methods An online survey was completed by 291 mothers and fathers who had suffered perinatal loss in the previous six years. Results The results showed adequate fit indexes for the three-factor model of the PGIS: reality, confront others, and congruence. Reliability values for the overall scale and subscales were adequate. Finally, with regard to validity, significant (p < .05) and positive relationships were found with levels of complicated grief, event centrality, guilt, anxiety, and depression. There were also differences depending on whether participants exhibited high or low levels of complicated grief, and on the number of weeks of pregnancy at the time of the loss. Conclusion In conclusion, the Spanish adaptation of the PGIS has adequate reliability and validity scores and a factorial structure consistent with the original version.

Between loss and restoration: The role of liminality in advancing theories of grief and bereavement

A recent national survey of bereaved partners found high levels of complicated grief and psychological distress, with evidence that loneliness and isolation may contribute to these outcomes. However, the mechanisms of action for this have not been explored. To advance grief theory this paper reports analysis of the survey free-text data to examine the relationship between social support and emotional responses to bereavement. Individuals bereaved of a civil partner or spouse 6–10 months previously were identified through death registration data. 569/1945 (29 %) completed surveys were received. Of those, 311 participants (55 %) provided responses to two free-text questions which asked about their ‘feelings since the death of their partner or spouse’, and ‘about the support around’ them. Data were analysed using corpus-assisted discourse analysis and the discourse dynamics approach for figurative language. Participants described diverse emotional responses to the bereavement (e.g. sadness, anger, denial, acceptance), and the value of formal and informal bereavement support. Although many of the experiences described are accounted for in existing grief theory, some participants described a liminal experience not recognised within these theories. They felt trapped, unable to engage with loss or restoration, and unable to move forward as their planned future no longer existed. They sought out ‘communitas’ (solidarity in experiences), but often found support from their social networks had diminished. Metaphors were used to describe this liminality, with partner grief expressed as a dark agentic force, a monster, an abyss, and as water. The findings of this study offer original insights into experiences and trajectories of bereavement, and our understandings of prolonged or complicated grief. A novel model ‘Between Loss and Restoration’ is presented to include these experiences. Recognition of the place for liminality within the spectrum of grief experiences could enhance grief literacy and improve formal and informal bereavement support provision.

The mental health of Australians bereaved during the first two years of the COVID-19 pandemic: a latent class analysis.

The COVID-19 pandemic disrupted many areas of life, including culturally accepted practices at end-of-life care, funeral rites, and access to social, community, and professional support. This survey investigated the mental health outcomes of Australians bereaved during this time to determine how these factors might have impacted bereavement outcomes. An online survey indexing pandemic and bereavement experiences, levels of grief, depression, anxiety, and health, work, and social impairment. Latent class analysis (LCA) was used to identify groups of individuals who shared similar symptom patterns. Multinomial regressions identified pandemic-related, loss-related, and sociodemographic correlates of class membership. 1911 Australian adults completed the survey. The LCA identified four classes: low symptoms (46.8%), grief (17.3%), depression/anxiety (17.7%), and grief/depression/anxiety (18.2%). The latter group reported the highest levels of health, work, and social impairment. The death of a child or partner and an inability to care for the deceased due to COVID-19 public health measures were correlated with grief symptoms (with or without depression and anxiety). Preparedness for the person's death and levels of pandemic-related loneliness and social isolation differentiated all four classes. Unemployment was associated with depression/anxiety (with or without grief). COVID-19 had profound impacts for the way we lived and died, with effects that are likely to ricochet through society into the foreseeable future. These lessons learned must inform policymakers and healthcare professionals to improve bereavement care and ensure preparedness during and following future predicted pandemics to prevent negative impacts.