# Health Burden of Bereavement: Emphasis on Covid-19

Shin

## The Covid-19 Bereavement Multiplier

The Covid-19 death toll is still counting in the United States at the rate of hundreds to a thousand deaths per day in the last few weeks. A lesser asked question is how many Americans have lost (or will lose) at least one relative? A July 2020 study, “Tracking the reach of COVID-19 kin loss with a bereavement multiplier applied to the United States,” published in the Proceedings of the National Academy of Sciences (PNAS) sought to find out.

Using a computer simulation, Ashton M. Verdery (an assistant professor of sociology, demography, and social data analytics at the Pennsylvania State University) and co-workers introduced the ‘Covid-19 bereavement multiplier’. This multiplier gives the ratio of the number of bereaved relatives for each Covid-19 death. Based on the table below, here are a few key points:

• For example, a multiple of 2.15 in the ‘Parent’ column means that if 100,000 parents die, there will be 215,000 bereaved children. Or if 1 million parents die, there will be 2.15 million bereaved children.
• Likewise, a multiplier of 8.91 in the ‘Any type’ (which includes a grandparent, parent, sibling, spouse, or child) column means that if 1 million Americans eventually die, there will be 8.9 million bereaved Americans.

Is this model reliable? While there is no guarantee, they have taken tedious steps to fine-tuned it to adapt to various possible situations. As the authors explained, “we demonstrate that the Covid-19 bereavement multiplier is highly stable to epidemiological variation (e.g., infection rate, total deaths, and distribution of deaths), meaning that the results are constant under a range of potential epidemic trajectories.” They further showed that their model was compatible with datasets from Italy and China.

The researchers cautioned for “a potential second wave of population health issues tied to bereavement.”

“Already, more than a million Americans will forever have a hole in their family,” Emily Smith-Greenaway (associate professor of sociology and spatial sciences), who is part of the study, commented in a press release. “In just a few short months, over one million Americans have experienced an irreplaceable loss that not only leaves them grieving and possibly traumatized, but may come with long-lasting health and economic consequences…” The study authors then cautioned for “a potential second wave of population health issues tied to bereavement,” which awaits or has come.

## The Health Burden of Bereavement

In a 2014 study in the American Journal of Psychiatry, 20–30% of 27,534 Americans reported the unexpected passing of a loved one as the most traumatic experience in their lifetime. The study showed that the sudden death of kin was a risk factor for various psychiatric disorders, such as major depression (12 out of 14 age groups), dysthymia (persistent mild depression; six age groups), mania (five age groups), and alcohol use disorders (six age groups after 45 y/o). And these were true even for those with no history of psychiatric disorders.

Bereavement takes a toll on life satisfaction as well. In 2015, researchers in Germany studied 2,760 adult children of 17–70 years old who had lost a parent. “Children who lost a parent in younger adulthood experienced steeper declines in life satisfaction,” the study found. “Daughters who are untimely bereaved of their mothers did not fully adapt even several years after the death.”

“The death of a loved one is recognized as one of life’s greatest stresses.”

It is not just the brain or mind. A 2012 review has tied bereavement to increased cortisol (a stress hormone), inflammation, T-cell (required to fight cancerous or virus-infected cells) deficits, prothrombotic (blood clotting) cell state, blood pressure, and sleep disturbance. These cellular disorders are the root cause of all diseases; after all, diseases begin in the cell that later spreads to organs and systems. As the review authors recognized: “The death of a loved one is recognized as one of life’s greatest stresses.”

In a 2007 paper in The Lancet, Margaret S. Stroebe (an emeritus professor who specializes in bereavement research) and fellow professors noted that bereaved spouses had an increased risk of early death. This observation was made based on 16 longitudinal studies “In [these] published studies, confounders have been well-controlled, and patterns are quite consistent, enabling the conclusion that the mortality of bereavement is attributable in large part to a so-called broken heart,” the scholars affirmed.

Social bonds help people live longer, healthier, and happier. The absence of it makes people live shorter, sicker, and sadder.

All of these relate to what predicts longevity. Quality social bonds help people live longer, healthier, and happier. The absence of it does the opposite: Bereavement, for example, makes people live shorter, sicker, and sadder. In specifics, bereavement heightens the risk of early mortality (in spouses), weak cellular health (e.g., elevated inflammation, cortisol, etc.), and psychiatric disorders (e.g., depression, alcohol abuse, low life satisfaction, etc.).

The incidence of broken heart syndrome (stress-induced heart attack) has increased from 1.7% to 7.8% during the pandemic.

Interestingly, a July study of 1914 patients with acute coronary syndrome showed that the incidence of stress cardiomyopathy has increased from 1.7% to 7.8% during the pandemic. “This study found that there was a significant increase in the incidence of stress cardiomyopathy during the COVID-19 pandemic when compared with prepandemic periods,” the authors stated. Stress cardiomyopathy is also known as broken heart syndrome, a heart attack that happens following extreme stress, such as the loss of a loved one.

(For more information on how the state of mind affects the heart, kindly see my article, “Depression and Anxiety Exhaust the Heart,” written back in February, or a recent article in Elemental, “Broken Heart Syndrome Is Real — And the Pandemic Is Making It Worse.”)

## The Other Side of Bereavement

Lawrence G. Calhoun, a professor of psychology at the University of North Carolina, is one of the pioneers of the posttraumatic growth theory. In a 2010 review, “Positive outcomes following bereavement: Paths to posttraumatic growth,” he and fellow professors mentioned that not every bereaved person suffers indefinite psychological anguish.

Some will be bereaved for life, some will not, and some may be somewhere in the middle.

“For many people, the distress triggered by loss does not dissipate within a few short months, but it can last for many years,” the professors first admitted. But “there is also evidence that for some people, perhaps many, coping with bereavement can provide the context for significant positive changes, i.e., posttraumatic growth.” In posttraumatic growth, the professors noted five recurring patterns.

1. A greater sense of personal strength and self-confidence to face adversity.
2. A greater appreciation of life that may end sooner than expected.
3. Increased compassion and empathy for others.
4. Opening up to new life opportunities such as taking over responsibilities or fostering meaningful relationships.
5. Existential questioning that may or may not include spiritual or religious beliefs.

However, posttraumatic growth is not without posttraumatic stress. A 2014 meta-analysis of 42 studies (N = 11,469) found that posttraumatic growth increases in those with greater posttraumatic stress, but up to a point only. At the extreme levels of posttraumatic stress, posttraumatic growth became less likely. This growth-stress relationship is akin to an inverted U-shape curve:

Of course, traumatic experiences are just one factor. Whether growth occurs after trauma would also depend on other biological, social, or environmental factors. The point is, as the meta-analysis also shows, that posttraumatic growth does not just happen magically. Some will be bereaved for life, some will not, and some may be somewhere in the middle.

This article was originally published here with minor modifications.