• Julie Lapenskie, Koby Anderson, Peter G Lawlor, Monisha Kabir, Chelsea Noel, Brandon Heidinger, Henrique A Parsons, Leila Cohen, Valérie Gratton, Ella Besserer, Samantha Adeli, Rebekah Murphy, Grace Warmels, Adrianna Bruni, Khadija Bhimji, Claire Dyason, Paula Enright, Isabelle Desjardins, Krista Wooller, Kyle Arsenault-Mehta, Colleen Webber, Daniel Bedard, Akshai Iyengar, Shirley H Bush, Sarina R Isenberg, Peter Tanuseputro, Brandi Vanderspank-Wright, and James Downar.
• Ottawa Hospital Research Institute, Ottawa, ON, Canada.
• Palliat Med. 2024 Feb 1; 38 (2): 264271264-271.

BackgroundSevere grief is highly distressing and prevalent up to 1 year post-death among people bereaved during the first wave of COVID-19, but no study has assessed changes in grief severity beyond this timeframe.AimUnderstand the trajectory of grief during the pandemic by reassessing grief symptoms in our original cohort 12-18 months post-death.DesignProspective matched cohort study.Settings/ParticipantsFamily members of decedents who died in an acute care hospital between November 1, 2019 and August 31, 2020 in Ottawa, Canada. Family members of patients who died of COVID (COVID +ve) were matched 2:1 with those who died of non-COVID illness (COVID -ve) during pandemic wave 1 or immediately prior to its onset (pre-COVID). Grief was assessed using the Inventory of Complicated Grief (ICG).ResultsFollow-up assessment was completed by 92% (111/121) of family members in the initial cohort. Mean ICG score on the 12-18-month assessment was 19.9 (SD = 11.8), and severe grief (ICG > 25) was present in 28.8% of participants. One-third (33.3%) had either a persistently high (>25) or worsening ICG score (⩾4-point increase between assessments). Using a modified Poisson regression analysis, persistently high or worsening ICG scores were associated with endotracheal intubation in the deceased, but not cause of death (COVID +ve, COVID -ve, pre-COVID) or physical presence of the family member in the final 48 h of life.ConclusionsSevere grief is a substantial source of psychological morbidity in the wake of the COVID-19 pandemic, persisting more than a year post-death. Our findings highlight an acute need for effective and scalable means of addressing severe grief.

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