Survey: Bereaved people who are socially isolated have higher levels of grief and support needs

People in the UK bereaved during the first nine months of the COVID-19 pandemic showed higher levels of grief and support needs if they were socially isolated or lonely.

Millions of people's experiences of bereavement have been affected by the challenges of the COVID-19 pandemic. The Economic and Social Research Council (ESRC)-funded study, led by Cardiff University and the University of Bristol and published as a pre-print publication on MedRxiv, aimed to identify risk factors for grief and support needs.

An online survey was completed by 711 people who had been bereaved in the UK between 16 March 2020 and 2 January 2021. People were recruited through the media, social media, national associations and organizations. Grief was assessed using the Adult Attitude to Grief scale, which calculates an overall index of vulnerability, and practical and emotional support needs were assessed in 13 domains.

The study found the relationship to the deceased was most strongly associated with higher levels of grief and support needs. Bereaved people who had lost a partner, child or sibling were more likely to show higher levels of grief and support needs compared with bereavements of more distant relatives and friends.

Age of the deceased had a strong effect, with younger age a risk factor for vulnerability in grief and higher support needs. Social isolation and loneliness had a medium-large effect, particularly on emotional support needs.

Other risk factors identified in the study included people feeling unsupported by health professionals after the death of a loved one, the place of death being in hospital, hospice or at home rather than in a care home, experiencing funeral restrictions, and a lower level of qualification among the bereaved.

Lead author Dr. Lucy Selman, associate professor in palliative and end of life care at the Centre for Academic Primary Care at the University of Bristol, and Founding Director of Good Grief Festival, said: "Our findings confirm the importance of social connectedness and relationships with others during early bereavement. The pandemic's impact on this connectedness could lead to longer-term difficulties for bereaved people as well as increased demand for bereavement support services. The study findings highlight the need for all of us to play a role and ensure bereaved people are well supported in our communities.

"We hope our findings can help inform bereavement support and policy both now and during any future pandemics. Our results highlight the particular complexities and challenges of pandemic bereavement as well as identifying who is at particular risk of poor grief outcomes and may require additional support."

Dr. Emily Harrop, research fellow at the Marie Curie Research Centre, Cardiff University and co-Lead on the research study added: "These findings demonstrate the importance of receiving good support and care from healthcare professionals and friends and family in the immediate aftermath of a bereavement, as well as opportunities to collectively mourn and celebrate the life of the person who died. Without this people are likely to experience more difficulties in their grieving. We are working with the UK Commission on Bereavement to ensure that steps are taken to improve the quality of support that is available to people at this most challenging of times."

The study authors make the following evidence-based recommendations:

1. Statutory, voluntary and community bereavement support services require increased investment, underpinned by national and local policies to meet high levels of need, given the high levels of grief vulnerability and needs for bereavement support, especially psycho-emotional support, among people bereaved during the COVID-19 pandemic.
2. Close relatives are at particular risk of poor outcomes, especially when socially isolated, and should be targeted for additional support and follow-up after a death.
3. The importance of funerals and other group mourning social practices must be recognized, with restrictions considered carefully. Funeral providers and celebrants play an important role in providing meaningful services in the contexts of restrictions.
4. The quality of care and support provided by healthcare professionals to bereaved people immediately after a death influences bereavement outcomes and support needs, and must be prioritized and adequately resourced in the pandemic context, just as in non-pandemic times.
5. Clinicians and bereavement services need to consider the needs of and prioritize people less able to advocate for themselves, including those subject to social disadvantage and discrimination.
6. Following public health strategies, compassionate community-based initiatives in bereavement are needed to strengthen, support and learn from communities' own approaches to informal bereavement support.