For Every COVID-19 Death, 9 Close Family Members Are Left to Grieve

Updated: 2020-07-14 18:45:06
Bereavement multiplier shows over one million Americans have lost a family member. Deaths from COVID-19 will have a ripple effect causing impacts on the mental health and health of surviving family members. But the extent of that impact has been hard to assess until now. Every death from COVID-19 will impact approximately nine surviving family members, according to a study.

The  new analysis finds more than one million Americans have been swept up in the tidal wave of grief resulting from the COVID-19 pandemic.

Using new indicator they call the 'bereavement multiplier,' researchers found that on average each COVID-19 death corresponds with approximately 9 individuals who have lost a grandparent, parent, sibling, spouse or child. With an estimated 137,871 lives lost, that corresponds with nearly 1.22 million having lost a close relation.

Coronavirus Disease 2019 (COVID-19) illustration
Credit: CDC

The analysis was published in PNAS.

"Already, more than a million Americans will forever have a hole in their family," said study author Emily Smith-Greenaway, associate professor of sociology and spatial sciences at the USC Dornsife College of Letters, Arts and Sciences. "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 for themselves and others in their family."

By turning attention to the COVID-19 bereavement burden, the study authors say they want to remind Americans that even as the pandemic abates, it will leave many grieving in its wake. Because many individuals who have died were simultaneously a spouse, parent, grandparent, sibling, and child, the collective toll of the crisis is far greater when considering all of the individuals bereaved by each death.

Researchers say their COVID-19 bereavement multiplier has also provided a clearer picture of how the crisis is affecting different racial and ethnic groups as well as different age groups.

Although there is a steep age gradient in hospitalizations and deaths from COVID-19, study authors say their work demonstrates that young people are not unscathed. Instead, they are suffering from the sudden death of their parents and grandparents.

In addition, race-specific COVID-19 mortality data demonstrates how Black Americans are disproportionately affected by COVID-19 bereavement, which study authors say will exacerbate racial inequalities in the U.S.

"There are substantial concerns about the health impacts of COVID-19 for individuals, but one area that has received less attention is how the deaths caused by this disease will reverberate through families," said study author Ashton Verdery, associate professor of sociology, demography, and social data analytics at Penn State University. "Our results show that these impacts will be substantial, they'll affect people at all ages, and they may exacerbate existing inequalities in bereavement and social support."

Some people experience serious and prolonged mental health consequences from bereavement and grief in the wake of a family member's death, including major depression and anxiety. Bereavement is also tied to physical health risks including worse cardiovascular health and mortality. The risk of experiencing these negative outcomes is more likely in the case of a family member's sudden, unexpected death, which will be the case for many during the COVID-19 pandemic.

"In the news cycle, the emphasis is on tracking the total number of lives lost, but what's missing is how these premature deaths reflect in family systems," said Smith-Greenaway. "What about the numerous loved ones left behind?"

Just weeks into the pandemic, Verdery and Smith-Greenaway combined data on predicted deaths with demographic information about family structures -- called kinship models -- to estimate the number of Americans who could lose a parent or grandparent to COVID-19. Initially, their work relied on specific prediction models and offered a sense of the overall bereavement burden based on different scenarios.

Now using the multiplier approach, the study authors say it's possible to continuously calculate the number of Americans bereaved by the death of a close relation in lockstep fashion with the rising death toll. Given that each death corresponds with approximately 9 bereaved by a close relation, they can track the bereavement burden in real time over the course of the epidemic.




In their study of kinship networks in the United States, the researchers said that approximately nine surviving close family members will be affected by each death from the virus in the country. For example, if the virus kills 190,000 people, 1.7 million will experience the loss of a close relative, said Ashton Verdery, associate professor of sociology, demography and social data analytics, and an affiliate of the Population Research Institute and Institute for Computational and Data Sciences, Penn State.

A kinship network includes grandparents, parents, siblings, spouses and children.

According to Verdery, the multiplier could serve as an indicator to help raise awareness about the scale of the disease and the ripple effects that the disease may have on a community, as well as prepare officials and business leaders to manage those effects.

"It's very helpful to have a sense of the potential impacts that the pandemic could have," said Verdery. "And, for employers, it calls attention to policies around family leave and paid leave. At the federal level, it might inform officials about possible extensions for FMLA (Family and Medical Leave Act). There could also be some implications for caretaking. For example, a lot of children grow up in grandparent-led houses and they would be impacted."

The researchers, who released their findings in the current issue of the Proceedings of the National Academy of Sciences, said some slight differences in the bereavement multiplier exist between white and black Americans. For white Americans, the median multiplier is estimated at 8.86, while it is 9.18 for black Americans, said Verdery.

The researchers also suggest that people may be facing the loss of a close loved one at a younger age because of the virus, according to Verdery, who worked with Emily Smith-Greenaway, associate professor of sociology, USC; Rachel Margolis, associate professor of sociology, the University of Western Ontario and Jonathan K. Daw, associate professor of sociology and demography, Penn State.

"There are a substantial number of people who may be losing parents that we would consider younger adults and a substantial number of people may be losing spouses who are in their 50s or 60s," he said.

While there are some limitations, the indicator could help local officials understand the waves of grief that may affect specific areas and regions of the country.

"Our statistics are based on national averages, so it might not translate perfectly, but you could imagine that this could serve as a baseline level to go forward to understand the differences between areas where the outbreaks are severe and places where the outbreaks may not be so severe," said Verdery. "There are regional differences in some of these kinship statistics that would make it less than perfect, but it would be a reasonable first approximation."

For this study, the team built on previous investigations that happened soon after the virus began to spread worldwide.

"The big challenge with the former work was that we used a certain percentage of infections and a certain percentage of deaths," said Verdery. "In that model, there is an inherent prediction that if so many people are infected, there would be a certain number of people who would die and, then, the model estimated how many people will be affected by those deaths. But, thinking through this, we wanted to create a statistic that is easy to understand and one that doesn't rely on specific predictions about death counts."

The researchers undertook a computational analysis of COVID-19 mortality in kinship networks of white and black Americans. The demographic data was drawn from the historical record or recent Census Bureau national projections to create a complete kinship network, from which the researchers analyzed grandparents, parents, siblings, spouses and children.

In the future, the researchers plan to investigate how the bereavement factor during other mortality spikes, such as the opioid epidemic, changes over time and how to better understand when that factor becomes broadly felt across the community.

Contacts and sources:
Jenesse Miller
University of Southern California

Sara LaJeunesse
Penn State

Publication: Tracking the reach of COVID-19 kin loss with a bereavement multiplier applied to the United StatesAdditional authors include Rachel Margolis, Department of Sociology, University of Western Ontario and Jonathan K. Daw, Department of Sociology and Criminology, The Pennsylvania State University. The study was funded by the National Institute on Aging (1R01AG060949), the Penn State Population Research Institute, which is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2C-HD041025), the University of Southern California Center for the Changing Family, and the Government of Canada--Canadian Institutes of Health Research (MYB-150262) and Social Sciences and Humanities Research Council (435-2017- 0618 and 890-2016-9000). Data collection for the Panel Study of Income Dynamics (PSID) was partly supported by the National Institutes of Health (R01 HD069609) and the National Science Foundation (1157698). http://dx.doi.org/10.1073/pnas.2007476117 





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