Prevalence and correlates of problematic grief in bereaved adults in the wake of the COVID-19 pandemic: A systematic review and meta-analysis

The COVID-19 pandemic resulted in many people being bereaved under extremely stressful circumstances. The present review aimed to assess the prevalence of problematic grief reactions in bereaved adults during the COVID-19 pandemic, and identify potential correlates. Five databases (Pubmed (MEDLINE), PsycINFO (Ovid), PTSDpubs, Web of Science and SCOPUS) were systematically searched in this study from December 2019 to 22 nd January 2025. Studies assessing the prevalence of problematic grief reactions in adults bereaved since the start of the COVID-19 pandemic and using validated instruments were included. Fifty-five articles comprising 58 unique samples and 20,264 participants were identified. Across studies, the data collection endpoint ranged from August 2020 to May 2023. The prevalence of problematic grief reported during the COVID-19 pandemic was 27.8% ([95% CI: 22.8, 33.5]) with high between-study heterogeneity (Q [ df ] =3615.41 [57], I 2 = 98.42, p <0.0001) . Exploratory moderation analyses revealed that experiencing a sudden death event was associated with a higher prevalence of problematic grief. It should be noted that the included studies were methodologically heterogenous, where all but one study utilised convenience sampling, and approximately half of all studies reported on non-response rates. The prevalence of problematic grief during the COVID-19 pandemic may be higher than the expected prevalence reported outside of this pandemic context. Additional representative research is needed to help clarify the prevalence and correlates of problematic grief related to the COVID-19 pandemic. This will allow for context- and time sensitive bereavement support in future pandemics. • We conducted a systematic review and meta-analysis of the prevalence of problematic grief reactions in those bereaved in the wake of the COVID-19 pandemic; • The prevalence of problematic grief reported during the COVID-19 pandemic was 27.8%, which was higher than pre-pandemic global estimates; • Exploratory moderation analyses revealed that experiencing a sudden death event was associated with a higher prevalence of problematic grief.