Original Article

Knowledge Level of Health Care Providers about Complicated Grief during the COVID-19 Pandemic


Objective: The coronavirus 2019 (COVID -19) pandemic had great psychological impact on COVID-19 patients and their families. Relatives of the deceased COVID-19 patients are at risk for complicated grief. Healthcare providers (HCPs) should be able to identify complicated grief cases. The aim of this study was to assess HCP knowledge regarding complicated grief during the COVID-19 pandemic.

Method: This cross-sectional study was conducted using an online researcher-made questionnaire. The questionnaire was designed and validated before being used in this study. The questionnaire included demographic questions as well as knowledge about complicated grief and its symptoms, risk factors and management. The link to the questionnaire website was sent to HCP governmental and private sectors. Data was analyzed using the ordinal regression model by the SPSS 16 software.

Results: A total of 887 HCPs (69% female and 31% male) participated in this study. Majority of the participants (594, 70%) had fair overall knowledge about complicated grief while 206 (23.2%) participants had poor knowledge. Poor knowledge level about risk factors for complicated grief was observed in 44.3% of the participants. Fair or poor knowledge about prevention and management of complicate grief was observed in 39.2% of participants. Knowledge about complicated grief had a significant positive relationship with female gender (OR: 1.55; 95% CI: 1.15-2.08) and higher education level (OR: 1.86; 95% CI: 1.37-2.54).

Conclusion: Knowledge of HCPs about complicated grief was low. There is need for HCP knowledge improvement regarding complicated grief by appropriate education.

1. Ciotti M, Ciccozzi M, Terrinoni A, Jiang WC, Wang CB, Bernardini S. The COVID-19 pandemic. Crit Rev Clin Lab Sci. 2020;57(6):365-88.
2. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
3. Smith EM. Ethnic minorities: Life stress, social support, and mental health issues. J Couns Psychol. 1985;13(4):537-79.
4. Maunder RG. Was SARS a mental health catastrophe? Gen Hosp Psychiatry. 2009;31(4):316-7.
5. Rajkumar RP. COVID-19 and mental health: A review of the existing literature. Asian J Psychiatr. 2020;52:102066.
6. Huremović D. Brief history of pandemics (pandemics throughout history). InPsychiatry of pandemics: 2019. p. 7-35, Springer, Cham.
7. Ren SY, Gao RD, Chen YL. Fear can be more harmful than the severe acute respiratory syndrome coronavirus 2 in controlling the corona virus disease 2019 epidemic. World J Clin Cases. 2020;8(4):652-7.
8. Prigerson HG, Maciejewski PK. Grief and acceptance as opposite sides of the same coin: setting a research agenda to study peaceful acceptance of loss. Br J Psychiatry. 2008;193(6):435-7.
9. Petersen A, Jacobsen MH. Grief: The painfulness of permanent human absence. In Emotions, Everyday Life and Sociology: 2018. p. 191-208. Routledge.
10. Kowalski SD, Bondmass MD. Physiological and psychological symptoms of grief in widows. Res Nurs Health. 2008;31(1):23-30.
11. Mason TM, Tofthagen CS, Buck HG. Complicated Grief: Risk Factors, Protective Factors, and Interventions. J Soc Work End Life Palliat Care. 2020;16(2):151-74.
12. DiMaio L. The effects of participation in a grief choir on perceived grief, coping, energy, social support, and health among bereaved adults: a mixed methods randomized control study. 2019. Temple University.
13. LeBlanc NJ, Simon NM, Reynolds III CF, Shear MK, Skritskaya N, Zisook S. Relationship Between Complicated Grief and Depression: Relevance, Etiological Mechanisms, and Implications. In Neurobiology of Depression: 2019. p. 231-9. Elsevier.
14. Hasson-Ohayon I, Peri T, Rotschild I, Tuval-Mashiach R. The Mediating Role of Integration of Loss in the Relationship Between Dissociation and Prolonged Grief Disorder. J Clin Psychol. 2017;73(12):1717-28.
15. Hall C. A Systematic Review of the Literature on Complicated Grief [Book Review]. Grief Matters: The Australian Journal of Grief and Bereavement. 2006;9(2):44.
16. Mason TM, Tofthagen CS. Complicated Grief of Immediate Family Caregivers: A Concept Analysis. ANS Adv Nurs Sci. 2019;42(3):255-65.
17. Machin L, Spall B. Mapping grief: A study in practice using a quantitative and qualitative approach to exploring and addressing the range of responses to loss. Couns Psychother Res. 2004;4(1):9-17.
18. Chiu YW, Huang CT, Yin SM, Huang YC, Chien CH, Chuang HY. Determinants of complicated grief in caregivers who cared for terminal cancer patients. Support Care Cancer. 2010;18(10):1321-7.
19. Fujisawa D, Miyashita M, Nakajima S, Ito M, Kato M, Kim Y. Prevalence and determinants of complicated grief in general population. J Affect Disord. 2010;127(1-3):352-8.
20. Cohen J. Statistical power analysis Jbr the behavioral. Sciences Hillsdale (NJ): Lawrence Erlbaum Associates. 1988:18-74.
21. Ayre C, Scally AJ. Critical Values for Lawshe’s Content Validity Ratio:Revisiting the Original Methods of Calculation. Meas Eval Couns Dev. 2014;47(1):79-86.
22. Ekolu SO, Quainoo H. Reliability of assessments in engineering education using Cronbach’s alpha, KR and split-half methods. Glob J Eng Educ. 2019;21(1):24-9.
23. Wallace CL, Wladkowski SP, Gibson A, White P. Grief During the COVID-19 Pandemic: Considerations for Palliative Care Providers. J Pain Symptom Manage. 2020;60(1):e70-e6.
24. Iglewicz A, Shear MK, Reynolds CF, 3rd, Simon N, Lebowitz B, Zisook S. Complicated grief therapy for clinicians: An evidence-based protocol for mental health practice. Depress Anxiety. 2020;37(1):90-8.
25. Mayland CR, Harding AJE, Preston N, Payne S. Supporting Adults Bereaved Through COVID-19: A Rapid Review of the Impact of Previous Pandemics on Grief and Bereavement. J Pain Symptom Manage. 2020;60(2):e33-e9.
26. Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. Gen Psychiatr. 2020;33(2):e100213.
27. Dodd A, Guerin S, Delaney S, Dodd P. Complicated grief: Knowledge, attitudes, skills and training of mental health professionals: A systematic review. Patient Educ Couns. 2017;100(8):1447-58.
28. Latin L, Fort J. Preliminary Study: Evaluation of health care professionals' attitudes and knowledge on traumatic grief in hospitals and hospices. Bios. 2011;82(1):13-7.
29. Dodd A, Guerin S, Delaney S, Dodd P. Complicated grief knowledge, attitudes, skills, and training among mental health professionals: A qualitative exploration. Death Stud. 2020:1-12.
30. Dube FN, Uys LR. Integrating mental health care services in primary health care clinics: a survey of primary health care nurses’ knowledge, attitudes and beliefs. S Afr Fam Pract. 2016;58(3):119-25.
31. Dysvik E, Sommerseth R. A man could never do what women can do: Mental health care and the significance of gender. Patient Prefer Adherence. 2010;4:77-86.
IssueVol 17 No 2 (2022) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijps.v17i2.8905
Adjustment Disorder COVID-19 Grief; Health Personnel Knowledge

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Dashti S, Fathi Najafi T, Mohammadzadeh F, Rezaei Kalat A, Bahri N. Knowledge Level of Health Care Providers about Complicated Grief during the COVID-19 Pandemic. Iran J Psychiatry. 2022;17(2):154-161.