“It was brutal. It still is”: A qualitative analysis of the challenges of bereavement during the COVID-19 pandemic reported in two national surveys

ABSTRACTThe COVID-19 pandemic has been a devastating, mass bereavement event characterised by sudden unexpected deaths and high levels of disruption to end-of-life, grieving and coping processes, as well as social life more broadly. We analysed qualitative free-text data from two independent UK-wide online surveys to describe in depth the experiences of 881 people bereaved during the Covid-19 pandemic using. We analysed the data in two phases, conducting an inductive thematic analysis and then applying Stroebe and Schut’s Dual Process Model (DPM) (1999; 2010) as an analytic lens to further contextualise and interpret the data. The DPM identifies loss-oriented and restoration-oriented coping processes between which grieving people naturally oscillate. Loss-oriented coping involves coming to terms with the death and lost relationship, while restoration-oriented coping involves adapting to new ways of life. We identified six main themes: troubled deaths (guilt, anger and unanswered questions); mourning, memorialisation and death administration; mass bereavement, the media and the ongoing threat of the pandemic; grieving and coping (alone and with others); work and employment; and support from the health and social care system. Examples of loss-oriented stressors included being unable to visit or say goodbye, the sudden and traumatic nature of many deaths, and restricted funeral and memorialisation practices. Associated reactions were feelings of guilt and anger, and problems accepting the death and starting to grieve. Examples of restoration-oriented stressors and reactions were stressful death-related administration and severely curtailed social networks, support systems and social/recreational activities, which impacted people’s ability to cope. Study results demonstrate the exceptionally difficult sets of experiences associated with pandemic bereavement, and the utility of the DPM for conceptualizing these additional challenges and their impacts on grieving. Our analysis builds and expands on previous use of the DPM (Stroebe and Schut, 2021) in explicating the impact of the pandemic on bereavement. We make recommendations for statutory, private and third sector organisations for improving the experiences of people bereaved during and following this and future pandemics.

“Locked Out of Caregiving”: A Case Study of Dementia Caregiving During the Covid-19 Pandemic

It is unclear how ambiguous loss in dementia caregiving is impacted by conditions of the Covid-19 pandemic. Ambiguous loss describes situations in which closure is impossible and ambiguities within a family system ensue. Two situations of ambiguous loss exist. In the first type, one is psychologically absent, yet physically present, e.g. when one has dementia. In the second type, one is physically absent but psychologically present, e.g. moving to a nursing home. Ambiguous loss theory was applied to longitudinal interviews with an adult-child caregiver (age=52) of a mother with dementia, who resided in memory care during the Covid-19 pandemic. Theoretical analysis revealed both types of ambiguous loss were experienced in the dementia caregiving relationship. This was embedded within ambiguous loss type 2 due to the Covid-19 pandemic, e.g. social distancing and quarantine practices led to physical estrangement from others and ambiguity ensued about when, or if, estrangement would end before resulting in death. Further, the coping mechanisms defined in the ambiguous loss framework: restructuring identity, finding meaning, gaining mastery, increasing ambivalence capacity, reframing attachments, and gaining hope, were compromised due to overarching ambiguous loss attributed to the pandemic. Continued panic and frustration regarding lack of communication with and access to the memory care center instilled a sense of being “locked out of caregiving.” Findings suggest dementia caregivers may experience both types of ambiguous loss compounded during the Covid-19 pandemic, suspending grief and coping processes, and inciting poorly understood needs and challenges that must be better understood to support dementia caregivers.

The two roads of passionate goal pursuit: links with appraisal, coping, and academic achievement

Background and Objectives: In this research, we testing the role of cognitive appraisals in explaining why harmonious and obsessive passion dimensions are related to distinct forms of coping, and explored if performance was impacted by these appraisal and coping processes.Design: Undergraduate students (N = 489) participated in a longitudinal study and completed three surveys throughout the course of an academic year.Methods: Participants completed assessments of both passion dimensions (Time 1), reported how they were appraising and coping with the mid-year exam period (Time 2), and provided consent to obtain their final grade in Introductory Psychology (Time 3). The hypothesised model was tested using structural equation modeling.Results: Harmonious and obsessive passion dimensions were linked with approach and avoidant coping responses, respectively. Cognitive appraisals, particularly appraisals of challenge and uncontrollability, played an indirect role in these relationships. In addition, both appraisals and coping responses had an indirect effect in the relationship between passion dimensions and final grade. Conclusions: These results identify cognitive appraisal as a reason why passion dimensions are linked with distinct coping tendencies, and demonstrate the role appraisal and coping processes in the journey toward passionate goal attainment.

Development of Constructive Coping Scale

The present study aimed to develop a measurement scale for constructive coping, which is a significant concept in the coping process. Constructive coping refers to efforts to deal with a stressful event that is considered relatively healthy. Therefore, understanding the relationship between coping processes and adaptation outcomes has become a major concern among stress researchers. The items were designed in the form of statements on a Five-Point Likert scale. The population sample included postgraduate students between 20 and 23 years old. A sample size of 511 was considered, of which 357 were females and 154 males. Item analysis was performed using Mathew Item Analysis table and item selection was performed using the highest correlation values (Phi) and medium P values. The final scale consists of twenty-one items for which Split-Half Reliability, as well as validity using coefficients of Pearson and Spearman’s Rank correlation, were calculated respectively.

Illness perceptions of adults with eczematous skin diseases: a systematic mixed studies review

Background Eczematous skin diseases, e.g., atopic dermatitis or contact dermatitis, are associated with a high disease burden, a significant impact on quality of life and a higher risk for anxiety and depression. Therefore, coping strategies are of interest. In order to understand coping processes, it is necessary to examine the patients’ perspectives on their illness. The aim of this systematic mixed studies review is to investigate the illness perceptions of patients with eczematous skin diseases to get a better understanding of their coping processes. Methods We performed a systematic literature search in PubMed, The Cochrane Library, PsycInfo, PSYNDEX, CINAHL, Web of Science, and Scopus until February 20, 2019. Both qualitative and quantitative studies were included in the review. Two independent reviewers conducted data extraction and carried out a narrative synthesis. We assessed study quality with the Mixed Methods Appraisal Tool. Results Three qualitative and four quantitative studies were included in the systematic review. We found different methodological approaches for investigating illness perceptions: guided interviews, focus group interviews as well as standardized questionnaires, e.g., the Brief Illness Perception Questionnaire. All studies report suspected causes of the skin disease, such as endogenous and exogenous causes (namely, psychological or occupational factors). We found long timeline beliefs as well as various perceived and experienced social, economic, and psychological consequences. Our analysis reveals complex emotional representations in patients with eczematous skin diseases, in particular impairment of emotional well-being, and feelings of shame or helplessness. Qualitative and quantitative data were predominantly complementary and convergent. Conclusion Patients with eczematous skin diseases have complex illness representations regarding their disease. These representations interrelate with the coping behavior of patients. Therefore, medical professionals should consider them for counseling and treatment. Systematic review registration PROSPERO 2018 CRD42018109217.

Resilience in the Salutogenic Model of Health

This chapter discusses the question, how does Antonovsky’s salutogenic model of health address the concept resilience? Resilience scholarship focuses on coping processes in persons and groups who experience severe adversity and deprivation, while salutogenic processes are posited to be descriptive of coping in all persons. Resilience scholarship has always had a focus on developing interventions to help people do well in life despite barriers, while salutogenesis has until recently been more concerned with descriptive research. Resilience and salutogenesis share the perspective that coping is culturally and contextually bounded. Resilience scholarship is principled, but no single, articulated theory is dominate. Salutogenesis is well developed as a theory, following the scholarship of Aaron Antonovsky. The concept resilience does not have a formal place in salutogenesis theory, yet when salutogenesis scholars focus on coping under conditions of severe adversity, they apply resilience approaches and strategies, even if the concept resilience is not explicit.

“If you and I and our Lord . . .”: A qualitative study of religious coping in Hodgkin’s disease

Religious coping and spiritual struggles were qualitatively analyzed in 15 semi-structured interviews with Norwegian Hodgkin’s disease survivors. We asked, How is religious coping expressed in 15 Norwegian Hodgkin’s disease survivors? The analyses were theory-driven, using religious coping and spiritual struggles theories as explorative tools. Especially we focused on coping processes, coping dynamics, coping styles, and coping activities. The analyses show that religiousness functioned as a positive factor in coping with cancer in 14 of the 15 participants, equally distributed as conservational and transformational coping. The combination of the belief in a good, present God, eventually positive divine power, accessible through prayer, and religious support from people around the participants, were the most prominent activities in the religious coping processes. The religious coping had a character of being collaborative for almost all of the participants. Many participants had severe spiritual struggles. For many of the participants, it was difficult not only to be sick, but also to be a survivor. Theories on religious coping and spiritual struggles were useful and adaptable to a Norwegian sample regarding the main dynamics in the religious coping and spiritual struggles processes. The analyses detected a few different religious coping activities in this Norwegian sample compared to those identified in American samples, with the importance of meeting God in nature as the most significant difference.