Online Grief Research Articles

An online grief intervention to improve well-being and reduce clinical symptoms: a randomized controlled trial

The COVID-19 pandemic amplified the emotional impact of losing a loved one, deteriorating well-being, and increasing dysphoric symptoms in mourners. This study evaluated the efficacy of COVID Grief, a self-applied online cognitive-behavioral intervention for Mexican adults facing grief during the pandemic. We conducted a randomized clinical trial, enrolling 1,109 participants, 45 of whom completed the full intervention, and 69 of whom completed the waiting list control (WLC). Between-subject analysis showed that intervention group (IG) participants reported significantly higher satisfaction with life and quality of life and a reduction in depression, anxiety and stress levels compared to those in the WLC. Within-subjects analysis showed that IG presented no significant changes in satisfaction with life, whereas the quality of life was increased, and levels of depression, anxiety, and stress were reduced after treatment. For WLC, satisfaction with life and quality of life were significantly decreased, and symptoms of depression and anxiety -but not stress symptoms- increased after the waitlist. Completer’s opinions of the treatment were highly positive, although they only represent 5% of participants who accessed the intervention. High dropout rates should be addressed in future studies.

The meaning in loss protocol: A clinical trial of online grief therapy

For a minority of the bereaved, the loss of a significant other can trigger an overwhelming emotional reaction and impaired functioning across life domains, known as prolonged grief disorder (PGD). Hence, ongoing efforts have been made to refine existing treatments to increase their efficacy and to accommodate the idiosyncrasies of grief reactions. This study presents the results of an open clinical trial of the feasibility and effectiveness of the Meaning in Loss (MIL) protocol in an online format. The brief intervention of 12 to 16 sessions combines constructivist and narrative strategies to explore and work through impediments to meaning reconstruction in loss. The sample included 25 participants diagnosed with PGD who were treated by six therapists. Baseline and post-therapy comparisons showed a significant improvement in all clinical measures (grief symptomatology, depression and general distress) and an increase of meaning making regarding the loss. Meaning making was found to be a prospective mediator of symptomatic improvement in grief across the course of therapy. These findings suggest the effectiveness of the MIL protocol in decreasing grief specific and associated symptomatology and argue for the relevance of further controlled evaluations of its efficacy. Moreover, results confirm previous findings that meaning making is a relevant factor in the evolution of grief reactions, including in the context of psychotherapy.

Understanding the Features of Text-Image Posts and Their Received Social Support in Online Grief Support Communities

Understanding the Features of Text-Image Posts and Their Received Social Support in Online Grief Support Communities

"I hate you. I love you. I'm sorry. I miss you." Understanding Online Grief Expression Through Suicide Bereavement Letter-Writing Practices

When bereaved individuals seek online support in response to the suicide of a loved one, their expressions of grief take many forms. Although the intense grief expressions individuals bereaved by suicide commonly share in private therapeutic settings can be helpful in healing from traumatic loss, these same expressions may potentially cause harm to others when shared in a public online support community. In this study, we present a qualitative analysis of letters posted on the r/SuicideBereavement subreddit, and comments replying to those posts, to explore what diverse expressions of grief additionally demand of platform design. We find that letter posts contain potentially harmful grief expressions that, in this community, generate mutual support among community members. Informed by our findings, this study considers the design challenges for online platforms as they simultaneously support users receiving support and healing through sharing certain grief expressions, while also supporting users who will be harmed by exposure to those grief expressions. Taking inspiration from offline therapy modalities, we consider the design implications of creating specialized online grief support spaces for diverse grief expressions.

Grieving the Loss of a Child and the Use of Online Social Support: An Exploratory Survey Study.

To describe social media online grief supports, accessing behaviors, psychosocial variables, and feelings of support among individuals grieving the loss of a child aged <18 years. This online survey study recruited 26 adults grieving the loss of a child using social media. Dependent variables included feelings of support and frequency of access. Independent variables included sleep disturbance, cognitive function, depression, anxiety, and self-efficacy to manage emotions (SEMA). Data were collected from May to September 2018. Participants' T scores were higher in level of sleep disturbance (mean = 59.4, SD = 6.1), depression (mean = 62.1, SD = 6.1), and anxiety (mean = 62.8, SD = 7.9), and lower in cognitive function (mean = 37.4, SD = 7.3) and SEMA (mean = 39.3, SD = 5.7). SEMA showed a positive correlation with feeling emotionally supported (p = 0.034). Participants who were accessing online grief supports more frequently reported higher levels of emotional support (F = 9.31, p = 0.006). Current findings will help guide the design of online grief support interventions for individuals grieving the loss of a child. [Journal of Psychosocial Nursing and Mental Health Services, 62(8), 47-55.].

Good (virtual) grief: The potential of online communities for bereaved older adults during Covid-19

During the pandemic, older adults were at risk of heightened social isolation and bereavement overload. However, engagement in online grief communities can facilitate meaningful social connections and promote healthy bereavement practices. This paper highlights the benefits of engaging in meaning-making, community building, and griefwork in later life. We engage with recent literature on virtual bereavement practices and discuss the ongoing potential for bereaved older adults to engage in online grief communities amid the new realities of Covid-19. We consider what it means to process grief in a virtual space and how this may shape approaches to death, dying, and bereavement during and after a global pandemic. We conclude with a call to action to develop accessible and affordable online engagement technologies for older adults to help mitigate a decline in well-being and promote healthy bereavement practices.

#LongLiveDaGuys: Online Grief, Solidarity, and Emotional Freedom for Black Teenage Boys after the Gun Deaths of Friends

This ethnographic study follows a group of Black teenage boys in their Philadelphia high school and online in the years following the shooting death of their friend. Within their peer group, the boys generally focus their shared memorializations on upbeat and affirming reminiscences, protecting each other from sadness but constraining their own emotional displays. In contrast, in the boys’ private worlds, most spend years actively working through their grief in material and embodied ways, including through objects they keep or wear. On social media, these private and public worlds converge as the boys regularly share their private grief expressions with public audiences and define their digital identities by loss. Contrary to popular worries about adolescent social media use, this research finds that for grieving Black boys online worlds offer unusual space for emotional freedom, social support, and solidarity around loss and a counter to restrictive racialized and gendered feeling rules.

Online Presence of the Funeral Industry: The Example of the Quebec Federation of Funeral Cooperatives.

The digitalization of modern societies has offered new tools for funeral industries to reach the communities they serve, ranging from using technologies in funeral planning, in commemoration of the dead, or to support the bereaved. The COVID-19 pandemic only pushed this need for online presence of the funeral industries further. We explore the digitalization of funeral industries through the example of Quebec (Canada), where many funeral institutions are regrouped under a federation of funeral cooperatives. We analyze how this influences the delivery of funeral services and allows the development of common services answering various needs of the population (e.g., a funding program for youth funerals, an ecological memorialization program, online grief support). Finally, we discuss how the federation's online presence contributes to its mission, and more largely whether it changes the perception of the industry.

Manifestations of Racial Trauma in Bereaved Middle to Older Aged Black Adults

Black adults have a higher likelihood of experiencing bereavement and increased negative implications of systemic racism compared to other groups. The effects of racism have also been suggested to have an impact on how bereaved Black individuals conceptualize their loss and the deceased. However, there is limited literature on how direct and indirect childhood experiences with racial violence and viewing racially violent deaths impact bereaved Black adults later in the lifespan. The current study seeks to explore the impacts childhood engagement with racial violence might have on bereaved middle to older Black adults. 103 middle to older aged Black adults (M=44.72, SD=5.48, 67% male) from a larger online grief study were probed about factors including somatization, depression, affect, grief, and the prevalence and intensity of exposure to race-based violence during their childhoods. Linear regressions and bivariate correlations were used for data analysis. Childhood racial violence significantly predicted grief (F=6.348, p=.013). Additionally, experiencing childhood racial violence was significantly associated with somatization (r=.197, p=.047), depression (r=.198, p=.045), and negative affect (r=.256, p=.010). Endorsed intensity of racial violence was significantly associated with depression and negative affect (r=.464, p=.000; r=.440, p=.000, respectively). Bereaved Black middle to older adults seem greatly impacted by childhood experiences of racial violence. It is important to consider the role outside cultural influences such as racial trauma might have on other deleterious mental health experiences such as bereavement. Furthermore, in the assessment of ACEs among Black and other people of color, it could be important to include childhood racial violence.

Keep on Keepin’ On: Investigating ACES and Positivity among Bereaved Black Middle Aged and Older Adults

Many of the most damaging life events are more prevalent among Black older adults. Black people have been found to have higher amounts of adverse childhood experiences (ACEs), which are linked to detrimental life impacts. Additionally, bereavement occurs at a higher rate among Black people and older adults. Despite these challenges, Black older adults have been repeatedly cited overcoming these challenges. Accordingly, the present study sought to investigate whether Black middle to older aged adults who encountered two of life’s most difficult challenges (i.e. bereavement and ACEs) would still maintain positivity. 103 middle to older Black adults (M=44.72, SD=5.48, 67% male) from a larger online grief study were probed about factors including time since loss, positive outlook, and ACES. A linear regression and mediation analysis were used to analyze the data. ACES were found to significantly predict positive outlook among bereaved middle to older Black adults (F=11.46, p=.001), such that as the number of ACES increased, so did positivity in spite of bereavement. Notably, this association was not mediated by time since loss. Results from this study provide evidence that even when faced with some of life’s most difficult events, Black middle to older adults were still able to reframe their situation with a positive focus. The ability for Black middle to older aged adults to reframe their tragedies into positivity could provide a basis for the use of Positive Psychological techniques specifically within this population. Additionally, this study provides further evidence that Black people exhibit exceeding resilience.

Treatment gap in bereavement care: (Online) bereavement support needs and use after traumatic loss.

People bereaved through road traffic accidents (RTAs) are at risk for severe and disabling grief (i.e., pathological grief). Knowledge about needs and use of bereavement care, including psychotherapy, pharmacotherapy, and support groups, is limited. This study charted (correlates of) the needs and use of bereavement care in RTA bereaved people. Furthermore, although online grief treatment seems effective, it is unknown whether it is perceived as acceptable. Accordingly, we examined the acceptability of online treatment. Dutch RTA bereaved adults (N = 273) completed self‐report measures about needs and use of bereavement care, acceptability of online grief treatment, and pathological grief. Regression analyses were used to identify correlates of care needs and use and acceptability of online treatment. The majority (63%) had received help from psychotherapy, pharmacotherapy, and/or support groups. One in five participants had not used bereavement care services, despite reporting elevated pathological grief levels and/or expressing a need for care, pointing to a treatment gap. Use of psychological support before the loss was the strongest predictor of bereavement care needs and use following the loss. A minority (35%) reported being inclined to use online grief treatment if in need of support. More openness towards online services was related to greater acceptability of online treatment. In conclusion, 20% of RTA bereaved people with pathological grief or care needs had not received care. This treatment gap may be reduced by improving accessibility of online treatments. However, as only 35% was open to using online treatments, increasing the acceptability of (online) treatments appears important.

Actual Solidarity through Virtual Support: A Pilot Descriptive Study of an Online Support Group for Bereaved Parents.

Background: Hospital-based support for bereaved parents is regarded as best practice. Little is known about parental perceptions or programmatic potential of online grief support. Objectives: To learn from bereaved parent participants' experiences with an online support group to include perceptions of technology acceptance and group communication dynamics. Design: Descriptive study reporting on an eight-week online bereavement support group offered during summer 2020. Subjects and Setting: Inclusive of six bereaved parent participants in the Midwestern United States. Measurements: Post-intervention survey consisting of 49-items with the Technology Acceptance Model and Other Communicated Perspective-Taking Ability instruments embedded. Results: Five bereaved mothers and one father (mean age 32 years) residing an average 126 miles from hospital participated in an online support group in a timeframe seven months to one year from the death of their child. Intensity of grief emotion (5/6 parents) and physical distance (4/6 parents) were notable barriers to in-person visits to the hospital, where bereavement support was to be offered. Parents uniformly reported feeling benefit from the program and satisfaction with the program. Respondents self-reported gaining improved communication (4/6 parents), coping (3/6 parents), peer support (3/6 parents), education (3/6 parents), and emotional expression (3/6 parents). Mean scores on the technology acceptance and communication experiences scales were 4.7/5. The virtual format was an acceptable modality with perceived supportive interpersonal communication dynamics. Conclusion: Pediatric palliative care teams may consider the offering of online bereavement support groups. Further research is warranted on the impact and outcomes of online bereavement support groups for bereaved parents.

Digital mourning on Facebook: the case of Filipino migrant worker live-in caregivers in Israel

The practice of mourning on social media, known as digital mourning, has become a worldwide phenomenon. While scholarly attention focuses on manifestations of online grief, there is a dearth of research regarding this process among immigrants. Based on a digital ethnography on Facebook on the Filipino community in Israel, this study inquires how migrant workers construct their mourning on digital networks. Focusing on grief upon death in the host country, two different practices of digital mourning were found. When Filipino live-in caregivers announce the loss of their elderly employers, their personal pain is shared on their own Facebook wall, receiving personal condolence comments. However, when a fellow Filipino migrant worker passes away, the pain is shared in closed community groups on Facebook, which are followed by thousands of condolence comments. This practice creates a communal feeling that can be termed Communal Digital Grief, and differs from the Personal Digital Grief experienced by migrants as a result of the loss of their employer. This study sheds light on two different practices of digital mourning. One appears on the personal Facebook walls of the bereaved and has therapeutic impact, while the other appears on closed Facebook groups and contributes to community building.

LEAVES (optimizing the mentaL health and resiliencE of older Adults that haVe lost thEir spouSe via blended, online therapy): Proposal for an Online Service Development and Evaluation.

BackgroundLoss of a spouse is a frequent occurrence in later life. While most older adults successfully process this loss and will return to a normal life, about 10% of the individuals are unable to cope, and progress to prolonged grief (PG). PG, in turn, can result in mental and physical problems including poor sleep, cardiovascular problems, depression, and suicidal tendencies.ObjectiveLEAVES (optimizing the mentaL health and resiliencE of older Adults that haVe lost thEir spouSe via blended, online therapy) is an online bereavement program that will support the prevention and treatment of PG, so that elderly mourners can continue to lead an active, meaningful, and dignified life. LEAVES will cater to secondary end users (eg, family, informal caregivers) by reducing stress.MethodsLEAVES will help older adults to process the loss of a spouse in an online environment, which consists of (1) an existing online grief self-help program LIVIA, (2) the Before You Leave program that allows for storing personal memories, (3) a virtual agent platform, and (4) an accessible front-end design. LEAVES can detect persons at risk for complications, reveal negative trends in their emotional life, and act to counter such trends. The service relies on online support whenever possible but is blended with telephone or face-to-face counseling when necessary.ResultsThe project will take place between February 2020 and January 2023 and includes a real-life evaluation in which 315 end users will use the service across 3 countries (the Netherlands, Portugal, and Switzerland). The evaluation of LEAVES will focus on clinical effect, its business case, and technology acceptance. The results will pave the way for smooth integration into existing care paths and reimbursement schemes.ConclusionsThe LEAVES service aims to soften the mourning process, prevents depression or social isolation, strengthens widow(er)s resilience and well-being, and quickens one’s return to societal participation.International Registered Report Identifier (IRRID)DERR1-10.2196/19344

Conducting ethical internet-based research with vulnerable populations: a qualitative study of bereaved participants’ experiences of online questionnaires

ABSTRACTBackground: Bereavement can be considered a potentially traumatic experience, and concerns have been raised about conducting grief research responsibly online.Objective: Given that online research introduces new methodological opportunities and challenges, we aimed to develop a greater understanding of how bereaved individuals experience participation in online research.Method: One day after participation in an online grief study, 876 participants, bereaved on average for 40 months, received a ‘check-in’ email to support well-being and offer further contact if needed. Although not explicitly asked to respond if no help was needed, 300 participants sent email replies, with only six requesting support. These responses were analysed qualitatively using content analysis.Results: Results suggested that participants found it acceptable to be asked about their grief and while difficult emotions were frequently described in response to the questionnaires, these reactions were temporary. A range of positive reactions was also reported, including new realizations arising from completing the research and changes in thinking related to grief. Participants also wrote about their appreciation for the study and how it was carried out, as well as a desire to contribute more to the study and to help others in a similar position.Conclusions: We suggest that the use of the check-in email to support well-being following study completion, along with advice on preparing to take part, contributed to positive experiences of participation and we recommend these strategies for future studies. These findings could allay clinical concerns about conducting online research with vulnerable populations, as well as raising questions about the possible therapeutic impact of measurement.

Meaning-making after partner suicide: A narrative exploration using the meaning of loss codebook

ABSTRACTThis study explored meaning-making in the narratives of survivors of partner suicide. The 117 posts of 50 users of a public online grief support forum were analyzed using the Meaning of Loss Codebook (MLC; Gillies, Neimeyer, & Milman, 2014). There was evidence of substantial psychological distress and an ongoing struggle to make meaning of the death, in addition to focusing on memories, longing for the deceased, and efforts to actively cope with the loss. Given the importance of meaning-making in the adjustment to loss, and through the application of the MLC, these findings deepen the understanding of this component of grief.

Bereaved Parents’ Online Grief Communities: De-Tabooing Practices or Relation-Building Grief-Ghettos?

This article presents results from case studies of online grief communities for bereaved parents in Denmark and Sweden, analyzing how development of practices and norms for grieving and mourning online are related to the conditions for participation in the online forums, and to dominant ideas of grief in society as such. Rooted in contemporary research on grief and mourning, we discuss practices of tabooization, de-tabooization, or even re-tabooization in the different online forums and how norms and traditions are performed, challenged, and negotiated in the various formats.

Coping With Loss: Mapping Digital Rituals for the Expression of Grief

ABSTRACTAlthough death has been frequently discussed in health communication, there has been a lack of research on coping with loss. Nevertheless, there are many websites and social network sites that offer suggestions to people as to how to cope with loss, including sites for support, sharing of experiences, and expressing grief. This article provides a theoretical understanding of grief by considering it as an emotional experience in terms of how it is expressed, its consequences, and the confrontation between the offline and online grief experience.

Use of Contemporary Film as a Medium for Teaching an Online Death and Grief Course

ABSTRACTOnline education is becoming commonplace in the academic world. Schools now offer totally online degree programs or provide a hybrid of face-to-face and online courses for fulfilling academic requirements. Developing courses and teaching online requires instructors to rethink the educational paradigms they have relied upon in the past. The Net Generation of learners brings a different set of expectations, styles, and needs to the classroom than those of previous generations; this mandates that instructors redesign courses and use contemporary teaching modalities. This article describes how film was successfully used as the primary medium to teach a graduate online Social Work course, Death and Grief.

“Please Know That You Are Not Alone with Your Pain”: Responses to Newcomer Posts in an Online Grief Support Forum

In an effort to better understand how the Internet can provide support to bereaved individuals, this discourse analysis study examined the responses to 107 initial posts in an online grief support group to understand how newcomers’ bids for group membership were taken up by current members. Discursive features included validation and empathy through second stories, constructing grief through descriptions, and accepting bids for membership through advice giving and invitations to return to the group. These features illustrate how grief and being a griever are constructed in an online context and how they deviate from the “normal” grief expectations in the offline world.