Complicated Grief in the Shadow of the COVID-19 Pandemic Among Adults and the Elderly in Israel

A mixed methods study


The COVID-19 pandemic has been a mass bereavement event disrupting social functioning of individuals in the general population, restricted and changed end-of-life, mourning and grief processes. In these circumstances grief may become pathologic and complicated grief (CG) may rise. The vulnerability of elders to CG in times of loss and bereavement in the COVID-19 context was hardly researched.



The current study aimed to examine grief processes, complicated grief and their association with protective and vulnerability factors among adults and elders (45 years old and above) who experienced loss at the time of the COVID-19 pandemic.



We included 122 individuals, aged 45 and above, that had lost family members or other close persons during the COVID-19 pandemic. Cause of death was not restricted (i.e. any death cause could be included as long as the loss was during the COVID-19 pandemic). Participants were approached through virtual social networks and organizations related to grief and loss.



Self-reported data were collected using questionnaires of complicated grief, personal resilience, subjective well-being, negative engagement with hostile world scenarios, subjective health. In addition, qualitative data was collected by semi-structured interviews focusing on grief experiences.



  • Quantitative analyses identified factors with unique contribute to CG:  female gender, state anxiety and negative engagement with hostile world scenarios were identified as vulnerability factors, whereas resilience emerged as a protective factor.
  • Qualitative thematic analysis identified two main themes: (1) COVID-19 as an emotional accelerator and (2) Support from social resources in COVID-19 times.


A manuscript showing the complete results of our analysis is under preparation and will be submitted for publication in an international journal.



Findings provide important information regarding the psychological factors that are associated with complicated grief and add to our understanding of complicated grief among adults and elders in epidemic times. This highlights the importance of examining how individuals facing adversities in general and loss in particular, perceive their ability to cope with life adversities. 



The study was supported by the Minerva Center for Interdisciplinary Study of the End-of-Life award, Tel Aviv University.


By Dr. Irit Bluvstein and Prof. Silvia Koton, 

Herczeg Institute on Aging, Tel Aviv University

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