A new psychometric assessment tool has been introduced to screen for dysfunctional grief after the loss of a loved one during the coronavirus pandemic. Worryingly, 66% of the study’s sample showed scores in the clinical range. The research was published in the journal Death Studies.
The COVID-19 crisis has had a profound impact around the globe, giving rise to political strife, overrun healthcare systems, and economic concern. Researchers Sherman A. Lee and Robert A. Neimeyer point out that with efforts being concentrated on slowing the spread of the virus and on the development of a vaccine, mental health concerns have been put to the wayside.
Lee and Neimeyer worry that these mental health concerns are building up, particularly when it comes to the millions of people who are grieving the loss of loved ones. “The rates of both infection and death are at the time of this writing increasing exponentially in many nations, including the United States, suggesting that these figures will grow enormously in the months to come,” the researchers report.
In addition to the sheer number of people grieving, the researchers say the circumstances of the pandemic place mourners at risk for a prolonged and arduous grieving process. These risk factors include being isolated from social support, the suddenness of the death, and difficultly making sense of the loss. Due to COVID-19 social distancing regulations, many mourners are additionally facing a lack of mental health services, an inability to visit dying loved ones in person, and disrupted funeral services.
Lee and Neimeyer were motivated to develop a screening tool that could help clinicians identify those dealing with dysfunctional grief during the pandemic. Data was collected from a sample of 831 adults surveyed between November 3 and 5, 2020. The sample consisted of 494 men and 337 women, all of whom had lost a loved one to COVID-19. The respondents answered a series of questions concerning their grieving experiences and their mental health.
The researchers began with 37 items addressing various symptoms of grief. Sixteen of the items were modified from the DSM-5’s Persistent Complex Bereavement Inventory, and 21 items were generated from the researchers’ observations of mourners during the pandemic.
The researchers used a process called a principal component analysis (PCA) to pinpoint the five strongest and most reliable symptoms of COVID-19 grief, to make up the Pandemic Grief Scale (PGS). Next, a confirmatory factor analysis (CFA) confirmed that these five items made up a “uniform construct” that could be applied across age, gender, and race. Then, a receiver operating characteristic (ROC) determined that a cut-off score above or equal to 7 demonstrated dysfunctional COVID-19 grief.
The construct validity — which describes whether or not the scale measures what it is supposed to — was high. Scores on the PGS were tied to suicidal ideation as well as the use of substances to cope with the death of a loved one to COVID-19. The researchers then tested the scale for incremental validity — the extent that the scale offers new information beyond other psychometric assessments. This was particularly encouraging, the researchers say, highlighting that the PGS “explained 18% additional variance in functional impairment above and beyond measures of generalized anxiety and depression.”
The authors point to the fact that those who met clinical symptoms using the PGS were more likely to report having used professional services to cope with their grief, further supporting the validity of the scale.
Notably, 66% of the study’s sample met the cut-off for dysfunctional grief according to the PGS. The authors express their concern about these findings. “If this finding is replicated in future studies,” Lee and Neimeyer say, “it raises the specter of a second pandemic in the shadow of the first, one characterized by widespread intense and problematic grief that could pose profound long term challenges in adjustment among mourners already struggling with pervasive psychological, social and economic stressors resulting from the spreading infection and policies to mitigate it.”
Overall, a series of statistical analyses suggest that the Pandemic Grief Scale can be used as a reliable screening tool for COVID-19 grief. “The PGS performed well as a mental health screener,” the researchers contend, “with a sensitivity rate of 87%, a specificity rate of 71%, and an AUC value of 0.87.” However, the authors say that further research is needed to replicate their findings, particularly using probability sampling and structured interviews.
The study, “Pandemic Grief Scale: A screening tool for dysfunctional grief due to a COVID-19 loss”, was authored by Sherman A. Lee and Robert A. Neimeyer.