by Dr Alex Burrell, Foundation Year 2 doctor, North Bristol NHS Trust and Dr Lucy Selman, Senior Research Fellow, Centre for Academic Primary Care, University of Bristol
Restrictions on funeral attendance have been put in place to try to prevent the spread of COVID-19. We conducted a rapid systematic review to try to understand what impact these restrictions might have on the bereaved. We found that the impact of funeral practices was not clear-cut: observational studies assessed different outcomes and their results varied. However, there were important lessons from qualitative research. What seems to be most important is helping people create a meaningful personal ritual which provides a sense of social support however they mourn, whether together in person or virtually.
COVID-19 has caused hundreds of thousands of deaths around the world, with over 45,000 confirmed deaths in the UK as of 23 July 2020. To try to reduce the spread of the disease, governments around the world put rules in place aiming to reduce contact between people. This included limiting the number of people who could attend funerals, as well as making sure those who could attend were “socially distanced”: not only could fewer people go to the funerals of their loved ones, but people who did attend weren’t allowed to shake hands or hug each other.
In our systematic review, we wanted to see if there were any existing studies looking at how funerals might impact those who attend them, including if not being able to attend a funeral (or the funeral being restricted in some way) had an effect. We then wanted to apply what we found to the COVID-19 pandemic to work out how funeral restrictions might affect those who have lost loved ones during this time.
We found 17 relevant research studies, 11 of which used statistical analysis of questionnaire data and six which used in-depth interviews to understand people’s experiences. The studies looked at the impact on the bereaved of being involved in planning a funeral, attending the funeral, and their experience of the funeral. Most of the studies were done in the US with participants who were white Christians.
The quantitative studies didn’t give us a clear answer: some found that funeral practices had an impact on people’s mental health and grief, and some did not, and there were no obvious patterns related to the quality of the study or the outcome assessed. However, the qualitative studies gave more insight: the benefit of being involved in a funeral seemed to depend on people being able to shape the experience themselves and say goodbye in a way which was meaningful for them.
A participant in a study of immigrants in the US described how technology could enable this kind of farewell:
“We were on Skype and whatever was going on—I was there. The whole night, sitting online, praying and seeing my daddy until the last moment when they took him away. So, I felt that I was there with him all the time.”
A sense of control and feeling connected to people going through the same thing really mattered. Feeling support from the community, not just for the people who were grieving but also for the people who had died, helped those who were bereaved.
In the context of COVID-19, what we found suggests that restricting the numbers of people at funerals and how they interact doesn’t necessarily mean that people will suffer from mental health problems or more intense or prolonged grief. What is important is that funeral providers, officiants and others supporting the bereaved (including friends and family), help people create funerals which are personal, meaningful, and enable communities to express their grief and support for the bereaved.
Recent research in the UK has already shown that smaller funerals during the pandemic can be positive experiences, and virtual funerals might actually improve access to mourning rituals.
However, some communities are more affected than others by the pandemic. Black, Asian and minority ethnic communities were not well represented in the research we identified and are at higher risk of dying from COVID-19. Helping vulnerable communities feel in control through financial support, community engagement, and provision of locally relevant information is crucial.
We won’t know the full impact of a loved one dying during the pandemic on people’s mental health and bereavement for some time. The best way to understand will be by inviting those who have experienced it to share their views and listening to their stories.
Resources for meaningful funerals during COVID-19
Planning a meaningful funeral
- For adults: Coronavirus: organising a meaningful funeral. Quaker Social Action website. Accessed 23 July 2020.
- For children: Coronavirus: How to say goodbye when a funeral isn’t possible. 26 March 2020. Winston’s Wish website. Accessed 23 July 2020.
Memorialising:
- COVID-19 bereavement: memorialising. Sudden website. Accessed 23 July 2020.
Information and resources for funeral staff and the bereaved
Mourning collective loss