Table 1.

LO and RO Stressors and Associated Reactions/Consequences (Compiled From Reviewed Articles).

LO stressors	LO-related reactions	RO stressors	RO-related reactions
– Lack of emotional & practical preparation time – Circumstances of terminal illness, dying process (e.g., isolation, desolate dying situation; patient’s physical discomfort, difficulty breathing; illness-related uncertainty) – The traumatic burden for (bereaved) relatives of treatment of their dying relative in isolated ICU conditions – Difficulty/impossibility to say goodbye due to enforced isolation; realization of death more difficult without viewing the body or saying goodbye, associated with denial and avoidance of the loss); but – Morally distressing circumstances: perceptions of violation to one’s own moral or ethical code (relating to suboptimal care of the dying person, due to resource scarcity (including difficulties relating to ethical decisions in limited resources) – Circumstances of death unexpected and/or traumatic (associated with continued confrontation, rumination and complicated grieving, but note avoidance too). – Experience of “staggering”, multiple losses/deaths of close persons and their ongoing nature; threat to oneself (particularly. among vulnerable older, sick) – Frequent reminders of death (rates), media coverage, exposure to distressing images; hearsay, potentially impacting negatively on adaptation but: – Pandemic circumstances may be dealt with by suppression of emotions (in certain cultures particularly), linked to avoidance and denial rather than confrontation – Profound changes in funeral practices, severe restrictions (inc. social & relational ones): enforced direct cremations; banned ceremonial attendances – Lack of opportunity for physically-given/received support – Lack of social/cultural recognition of the loss, related to impaired support resources; absence of the soothing rituals with opportunity to express grief/comfort	– Guilt/shame/regrets (e.g., if one infected the deceased, feeling Responsible for the death; at one’s powerlessness, perceived neglect of the dying or deceased person) – Anger toward system/officials about the death: “undignified” body disposal; regarding the patient’s own mistakes; – Moral responsibility: guilt, anger, anguish, distress exacerbated by feelings of moral responsibility – Loneliness; excessive bitterness and a sense of perceived purposelessness in life. – Anticipatory grief phenomena, which are also threatening, given uncertainty of illness outcome – Disenfranchised grief: 1. Too many COVID-19 deaths for individual recognition, the deceased considered a statistic, causing complications in grieving 2. Linked to failure by deceased to follow mandated rules, impacting on social interactions in bereavement	– Economic difficulties, high financial costs (particularly in U.S.) – Loss of work, unemployment, livelihood/financial insecurity, furloughs, salary reductions, homelessness – Lockdown-related difficulties with one’s work, harder to get new employment if needed post-loss – Medical support concerns (e.g., lack of insurance; health care access; failed medical intervention due to lack of resources, facilities, means to pay) – Care, management and treatment for existing mental and physical illnesses (associated with accentuation of health care disparities) – High-risk frontline, repeated exposure stress; own COVID-19 illness, intensive care admission – Quarantine/confinement/social isolation (restrictions in social, recreational, and occupational activities, including travel e.g., for attending memorial ceremonies) – Family (particularly children) and community level difficulties/disruptions in living arrangements (e.g., schooling irregularities: home schooling; access to shops) – Painful physical separation from family and close friends. – Family tensions and quarrels (violence) associated with staying at home, no family/friends visits – Disruption of connectedness, autonomy and freedom through suspension of gatherings, travel, closing of religious centers, lockdowns, social distancing – Erosion of coping resources (social support), relating to social isolation, (lack of positive appraisal: sense of community, uplift). – Needed support for vulnerable bereaved people may be lacking due to distancing and withdrawal – (Perceived) rejection (e.g., stigmatization from others due having a COVID-19 death in the family) – Impact of negative campaigns, victimization, rise in racism – Disruptions to social norms, face-to-face rituals, mourning practices impacting on ongoing life beyond grief, grieving – Worries, fears about getting the viral infection, fear of contamination/contaminating others – Difficulties dealing with new technology needed due to distancing (online medical forms, phone appointments, etc.) – Uncertainty about the future (under pandemic circumstances) – Lack of/disruption of routines, dislocation, loss of pre-crisis ways of life, threatened loss of hopes and dreams for the future, shattered assumptions about normal life and connections with the world	– A rise in level of general anxiety, worries – Feelings of lack of safety, insecurity – Experiencing prejudice against oneself – Feeling upset related to an intolerance of uncertainty – Loss of feelings of control or purpose – Feeling trapped through isolation – Feeling vulnerability to the spread of rumors, misinformation – Fears for one’s own mortality – Experiencing the allocation of blame toward oneself, a victim of discrimination or of hate crimes