Original Article

Predicting factors of complicated grief in Iranians after COVID-19 losses: A descriptive–correlational study

Abstract

Background & Aim: Understanding predictive factors for complicated grief after COVID-19 losses is critical for developing targeted support strategies. This study aimed to examine predictors of complicated grief among Iranians who lost a family member during the pandemic.
Materials & Methods: This descriptive-correlational study was conducted from December 2022 to August 2023. A total of 150 relatives of COVID-19 victims were recruited via convenience sampling. Data were collected using the Inventory of Complicated Grief, the Burdened by Grief and Loss questionnaire, the WHO-5 Well-being Index, and a measure of pandemic-related burden. Data were analyzed using SPSS v. 26, employing chi-square, Fisher's exact test, and multiple logistic regression to identify predictors.
Results: The likelihood of developing complicated grief among women compared to men was 3.77 times higher (p<0.001, OR=3.77), and the chance of complicated grief in close family members compared to distant relatives was 4.55 times higher (p<0.001, OR=4.55). An increase in psychological well-being score significantly lowered the likelihood of complicated grief in bereaved companions (p<0.001, OR=0.86); however, an increase in being burdened by grief and loss scale significantly augmented the likelihood of complicated grief in bereaved companions (p<0.001, OR=1.11). However, an increase in the Burdened by Grief and Loss score significantly increased the likelihood of complicated grief in bereaved companions (p<0.001, OR=1.11). The prevalence of complicated grief in Iranian people who have lost their family members because of COVID-19 was higher compared to similar studies.
Conclusion: Female gender, close kinship with the deceased, and a heavier psychological burden of loss were significant risk factors for complicated grief, while stronger mental health served as a protective factor. Given the crucial role of nurses in bereavement care, there is an urgent need for structured, supportive interventions and psychological services, ideally delivered through clinical guidelines tailored for these vulnerable groups.

1. World Health Organization. Number of COVID-19 cases and deaths reported to WHO (cumulative total) 2024 [Available from: https://data.who.int/dashboards/covid19/deaths?n=o.
2. Javadi SMH, Sajadian M. Coronavirus pandemic a factor in delayed mourning in survivors: A letter to the editor. Journal of Arak University of Medical Sciences. 2020;23(1):2-7.
3. Sina V, Seyede Mona N, Parvin M. Nurses’ experiences of caring for COVID-19 patients: A systematic review of qualitative studies. Nursing Practice Today. 2024;11(2):107-23.
4. Nakajima S. Complicated grief: Recent developments in diagnostic criteria and treatment. Philosophical Transactions of the Royal Society B: Biological Sciences. 2018;373(1754):20170273.
5. Shear MK. Complicated grief. New England Journal of Medicine. 2015;372(2):153-60.
6. Jordan TR, Wotring AJ, McAfee CA, Polavarapu M, Cegelka D, Wagner-Greene VR, et al. The COVID-19 pandemic has changed dying and grief: Will there be a surge of complicated grief? Death Studies. 2022;46(1):84-90.
7. Khoury B, Barbarin O, Gutiérrez G, Klicperova-Baker M, Padakannaya P, Thompson A. Complicated Grief during COVID-19: An International Perspective. International Perspectives in Psychology. 2022;11:214-21.
8. Diolaiuti F, Marazziti D, Beatino MF, Mucci F, Pozza A. Impact and consequences of the COVID-19 pandemic on complicated grief and persistent complex bereavement disorder. Psychiatry Research. 2021;300:113916.
9. Rassouli M, Farahani AS, Mojen LK, Ashrafizadeh H. The Impact of Culture and Beliefs on Cancer Care. Global Perspectives in Cancer Care: Religion, Spirituality, and Cultural Diversity in Health and Healing. 2022;215.
10. Lightbody S, Catt L, Ahmad A, Glover D, Whitney J, Hasan S. Bereavement in the time of COVID-19: Learning from experiences of those bereaved as a result of deaths in an acute hospital setting in 2020. OMEGA-Journal of Death and Dying. 2022:00302228221113214.
11. Büssing A, Baumann K. Experience of loss and grief among people from Germany who have lost their relatives during the pandemic: the impact of healthcare professionals' support. Frontiers in Public Health. 2023;11.
12. Shear MK. Grief and mourning gone awry: pathway and course of complicated grief. Dialogues in Clinical Neuroscience. 2012;14(2):119-28.
13. Prigerson H, Maciejewski P, Reynolds C, Bierhals A, Newsom J, Fasiczka A, et al. Inventory of Complicated Grief: A scale to measure maladaptive symptoms of loss. Psychiatry Research. 1995;59:65-79.
14. Yousefi S, Mayeli P, Ashouri A. Psychometric Properties of the Persian Version of the Inventory of Complicated Grief. Omega. 2024;90(1):302-17.
15. Bech P, Olsen LR, Kjoller M, Rasmussen NK. Measuring well-being rather than the absence of distress symptoms: a comparison of the SF-36 Mental Health subscale and the WHO-Five well-being scale. International Journal of Methods in Psychiatric Research. 2003;12(2):85-91.
16. Farahani AS, Kerdar SH, Ashrafizadeh H, Büssing A, Mehrnoush N, Akbari ME, Karami M, Tajalli S, Mojen LK, Rassouli M. The predictors of spiritual dryness among Iranian cancer patients during the COVID-19 pandemic. Frontiers in Psychology. 2023 Jan 20;13:1024009.
17. First M, Pies R, Zisook S. Depression or bereavement? Defining the distinction. Medscape News: Psychiatry and Mental Health. 2011.
18. von Blanckenburg P, Seifart C, Ramaswamy A, Berthold D, Volberg C. Prolonged Grief in Times of Lockdown During the COVID-19 Pandemic. Omega. 2023:302228231182738.
19. Shahini N, Abbassani S, Ghasemzadeh M, Nikfar E, Heydari-Yazdi AS, Charkazi A, et al. Grief Experience After Deaths: Comparison of Covid-19 and non-Covid-19 Causes. Journal of Patient Experience. 2022;9:23743735221089697.
20. Farahti M. Psychological Impacts of the Spread of Coronavirus in Society. 2020;1(2):207-25.
21. Nielsen MK, Neergaard MA, Jensen AB, Vedsted P, Bro F, Guldin M-B. Predictors of Complicated Grief and Depression in Bereaved Caregivers: A Nationwide Prospective Cohort Study. Journal of Pain and Symptom Management. 2017;53(3):540-50.
22. Stroebe M, Stroebe W, Schut H. Gender differences in adjustment to bereavement: An empirical and theoretical review. Review of General Psychology. 2001;5(1):62-83.
23. Thimm JC, Kristoffersen AE, Ringberg U. The prevalence of severe grief reactions after bereavement and their associations with mental health, physical health, and health service utilization: a population-based study. European Journal of Psychotraumatology. 2020 Dec 31;11(1):1844440.
24. Shear K, Monk T, Houck P, Melhem N, Frank E, Reynolds C, Sillowash R. An attachment-based model of complicated grief including the role of avoidance. European archives of psychiatry and Clinical Neuroscience. 2007 Dec;257(8):453-61.
25. Shear K, Shair H. Attachment, loss, and complicated grief. Developmental Psychobiology. 2005;47(3):253-67.
26. Tang S, Xiang Z. Who suffered most after deaths due to COVID-19? Prevalence and correlates of prolonged grief disorder in COVID-19-related bereaved adults. Globalization and Health. 2021;17(1):19.
27. Breen LJ, Lee SA, Neimeyer RA. Psychological risk factors of functional impairment after COVID-19 deaths. Journal of Pain and Symptom Management. 2021;61(4):e1-e4.
28. Shear MK, Ghesquiere A, Glickman K. Bereavement and complicated grief. Current Psychiatry Reports. 2013;15:1-7.
29. van Denderen M, de Keijser J, Huisman M, Boelen PA. Prevalence and correlates of self-rated posttraumatic stress disorder and complicated grief in a community-based sample of homicidally bereaved individuals. Journal of Interpersonal Violence. 2016;31(2):207-27.
30. Field NP. Unresolved grief and continuing bonds: An attachment perspective. Death Studies. 2006 Sep 1;30(8):739-56.
Files
IssueVol 13 No 1 (2026): Winter QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/npt.v13i1.20599
Keywords
grief loss bereavement complicated grief COVID-19

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Eshaghian Dorcheh A, Ashrafizadeh H, Khademi F, Barasteh S, Büssing A, Baumann K, Salesi M, Babaie M, Karami M, Jaras M, Rassouli M. Predicting factors of complicated grief in Iranians after COVID-19 losses: A descriptive–correlational study. Nurs. pract. today. 2025;13(1):74-83.