Bereaved in Me: Understanding the Vicarious Grief Experiences Among Helping Professionals During the COVID-19 Pandemic

Abstract

Literature on the experience of the bereaved during the COVID-19 pandemic suggests how complicated it has been for those who lost loved ones. However, the sense of grief experienced by those who journey with them is relatively unexplored. The present study examines vicarious experiences of grief of healthcare workers, faith-based workers and mental health workers who worked with the bereaved due to COVID-19 deaths. The study was done in two phases. In the first phase, a survey showed that compared to other helping professionals, healthcare workers reported the highest levels of vicarious grief. In the second phase, in-depth interviews revealed five themes: acknowledging contexts of grief, navigating relations with the bereaved, sharing others’ grief, internalizing encounters, and negotiating challenges. Findings highlight the need for supportive interventions at the organizational level.

As of May 2022, over 6.2 million people worldwide have died due to COVID-19 (World Health Organization, 2022). A study in the US reports that with every death, nine loved ones are expected to grieve (Verdery et al., 2020). This estimate may be even higher in non-Western collectivist societies where closer kinship ties and larger families are prevalent (Kumar, 2021). In light of the pandemic, helping professionals (HPs) assisting the bereaved are expected to carry their burden.

Studies on grief typically focus on those who have lost a loved one or significant person. Largely unexplored is vicarious grief (VG), defined as the grief evoked by another person’s loss that does not necessitate an intimate relationship with the bereaved (Kastenbaum, 1987; Rando, 2003). To address this gap, the study aims to explore the case of VG of HPs who work with the bereaved, specifically healthcare workers (HCWs), faith-based workers (FBWs), and mental health workers (MHWs). Specifically, it asks: (1) To what extent do HPs experience VG?, (2) Are there differences in the levels of VG by type of HP?, (3) How do HPs experience VG? and (4) How do HPs cope with VG?

Grief Theories

Among contemporary models of grief, Kübler-Ross’s stages of grief model has shaped prevalent notions of grief. However, more recent perspectives also focus on the impact of grief on beliefs and meaning-making. In particular, the meaning reconstruction approach posits that as loss shatters one’s beliefs, grief involves the process of reconstructing meaning systems. It also recognizes the intersubjectivity of grief and how meaning-making surrounding loss is influenced by context, culture, and interpersonal relations (Boerner et al., 2016; Neimeyer, 2014).

In addition, the continuing bonds theory, which challenges the necessity of cutting ties with the bereaved, likewise recognizes that bonds with the deceased are interpersonal, maintained within communities, and embedded in sociocultural narratives. In this view, HPs participate in the relationship of the bereaved with the departed as they engage with grief (Klass & Steffen, 2018).

Vicarious Grief

Vicarious grief (VG) refers to the grief experienced in response to someone else’s loss. It was first introduced by Robert Kastenbaum (1987) who observed elderly women express sorrow for the death of others not personally known by them. Its manifestations are similar but not identical to direct loss, and he describes reactions such as weeping, feelings of emptiness and heaviness, problems with sleep and appetite, and a preoccupation with the incident as signs of VG.

Rando (2003) built upon Kastenbaum’s work, emphasizing that “[v]icarious grief is genuine grief” (p. 59). However, she described two types of VG. In Type 1, the vicarious griever feels what it must be like for the bereaved. Type 2 VG, on the other hand, is stimulated by both vicarious and personal losses, meaning that the vicarious mourner is experiencing their own grief while empathizing with the bereaved. The losses may be indistinguishable in some cases, such as when another person’s grief serves as a reminder of one’s unfinished grieving (Sullender, 2010). This may include the intense reactions felt by the vicarious mourner to the loss of the bereaved, including extreme shock to temporary impairment (Rando, 2003). Type 2 VG may also elicit a violation or destabilization of their assumptions of reality, themselves, and the world (Rando, 2003). These disruptions may trigger a crisis of meaning and a re-examination of beliefs (Sullender, 2010).

Several factors determine the likelihood and potency of VG. One is the physical, psychological, and social distance between the helper and the bereaved. Another is identification with the bereaved; the more similarities between the mourners, the greater the probability and intensity of VG (Sullender, 2010). Related to this are the psychological processes of empathy and sympathy. Additionally, specific features of the death situation may heighten VG, including unpredictability and uncontrollability.

There are several “empathy-based strain” constructs related to VG, however, they do not particularly center around the ways secondhand engagements with issues of death and loss can elicit distress-related responses (Rauvola et al., 2019; Sullender, 2010). Examples are the widely explored concepts of vicarious trauma, secondary traumatic stress, and compassion fatigue. Furthermore, existing literature on VG often focuses on public mourning in times of disaster or tragedy (Brennan, 2008; Nelson, 2012), whereas those referring to helping professionals are frequently not derived from evidence-based data (Richmond et al., 2021; Strom-Gottfried & Mowbray, 2006). Thus, only a few studies have sought to apply and empirically validate the theories of Kastenbaum (1987) and Rando (2003).

COVID-19 and Vicarious Grief Among Helping Professionals

Although death is ubiquitous, contexts such as disasters may compound the exposure to bereaved individuals (Richmond et al., 2021). During the COVID-19 pandemic, HPs were exposed to death at an unprecedented rate (Mosheva et al., 2021). This was exacerbated by the disruption of cultural funeral practices during the pandemic. The isolation of patients from their family members also brought about challenges to mental health and grief outcomes (Mortazavi et al., 2021).

HCWs witnessed families grieve in harrowing conditions and played a significant role in communicating the circumstances around the death of their loved ones (O’Sullivan et al., 2021). A study reported that HPs who treated COVID-19 patients reported high levels of secondary traumatic stress because of the heightened danger perception that comes with exposure to the virus (Arpacioglu et al., 2020).

Moreover, families ask FBWs to preside over death rituals and provide socio-spiritual support (Becker et al., 2020). MHWs doing grief counseling bear the brunt of surges in clients with mental health issues that may put them at risk for VG (Richmond et al., 2021).

Theoretical Framework

Due to the varying experiences of different helping professions in grief work, we posit that the sectors will have significantly different levels of VG. In addition, we sought to examine the lived experiences of the various types of professionals dealing with the bereaved, utilizing a multi-perspectival Interpretative Phenomenological Analysis (mIPA) approach. IPA served as a lens to explore the ways people experience and make sense of their grief (Poxon, 2013). However, mIPA expands traditional IPA by including two or more focal perspectives within and across groups “to consider the relational, intersubjective, and microsocial dimensions of a given phenomenon” (Larkin et al., 2018, p.2).

Methodology

Design

The study used an explanatory sequential mixed methods design (Creswell & Clark, 2006). In Phase 1, a survey to measure VG levels among 60 HPs was administered. In Phase 2, 12 in-depth interviews were conducted among a sample that experienced VG.

Participants

The study examined the VG experiences of HPs, aged 18 and above. Participants were recruited from the researchers’ networks, medical schools, hospitals, psychological service centers, seminaries, and parishes through email correspondence and social media dissemination.

For Phase 1, the sample comprised 60 Filipino HPs, aged 22–64 (M = 37.28, SD = 12.64). Majority of the participants were female (58.33%) and the rest were male (41.67%). Participants belonged to one of the following sectors: HCW (40.00%), FBW (28.33%), and MHW (31.67%).

In Phase 2, the following inclusion criteria were utilized in sampling. First, the participants had regular exposure to individuals bereaved due to COVID-19 deaths, as part of their occupation. Second, to ensure that COVID-19 grief experiences were indeed vicarious rather than personal, participants had not lost a loved one (i.e., close friends, significant other, or family) due to the disease. Third, participants in the revised Vicarious Trauma Scale (VTS) scored moderately (29–42) or high (43–56). Low scores (8–28) were excluded in order to elicit deeper qualitative inquiry from participants (Vrklevski & Franklin, 2008). The final sample comprised twelve interviewees, four from each sector, drawing from the minimum recommendation of Smith et al. (2009). Their involvement with the bereaved includes contexts in patient/relative communication (HCWs), ministry and pastoral counseling (FBWs), and clinical practice and psychosocial interventions (MHWs). Further demographic information is provided in Table 1.

Table 1.

Participant Demographics - Qualitative Phase.

Sector	Gender	Age	Setting	Occupation	VTS Score
HCW	Male	28	COVID-19 ward	Physician	41
	Female	33	COVID-19 ward	Frontline Nurse	37
	Male	27	Emergency ward	Physician	43
	Male	23	COVID-19 ward	Staff Nurse	46
FBW	Male	64	Seminary	Pastoral counselor	29
	Male	48	Parish	Religious priest	52
	Male	26	Parish	Resident deacon	37
	Male	47	Psycho-spiritual center	Pastoral counselor	30
MHW	Female	25	Psychological center	Psychologist	36
	Female	25	Psychological center	Graduate intern counselor	42
	Male	32	Psychological center	Psychologist	42
	Male	23	Crisis line	Helpline staff responder	46

Measures

Phase 1: Survey

The study made use of the revised VTS scale developed to assess subjective distress levels associated with working with traumatized clients (Vrklevski & Franklin, 2008). Following the suggestion of Benuto et al. (2018), grief was specified as the traumatic material. It consisted of eight items on a seven-point Likert scale (from 1 = “Strongly Disagree” to 7 = “Strongly Agree”). The revised scale demonstrated good internal consistency (∝ = .80).

Phase 2: In-Depth Interviews

The interview schedule included participants’ background information on their work, experiences, difficulties, and coping strategies. Probes and follow-up questions were asked as appropriate. Interviews were done in English, Filipino, or a combination of both, depending on what was comfortable for participants. The questions were pilot tested and revisions were made based on feedback. The interviews were conducted synchronously via a video conferencing platform. Each session ran for about one to 2 hours and was recorded with the participant’s consent.

Procedures

Prior to data gathering, ethics approval was obtained from the University Research Ethics Committee. Participants were briefed and asked to sign consent forms. Safeguards to ensure the safety of participants included asking about how they felt during the interview proper and twice after the interview, with each attempt having a 1-month interval from the other. Participants were given PHP 200 (approx. USD 3.75) as compensation for data load.

Data Analysis

Descriptive statistics were used to describe the experience of VG among survey respondents. Since the normality assumption was not met, Kruskal–Wallis test was used to compare scores among the sectors. Dunn’s pairwise comparisons using Bonferroni correction were conducted to identify the pairs of categories that were significantly different from each other.

Multi-perspectival IPA (Larkin et al., 2018) was used and consisted of the following phases: (1) individual case reading and rereading the transcript, (2) identifying patterns of meaning, and (3) clustering themes. The process was repeated until a cross-case analysis can be conducted across groups in order to identify superordinate themes and subthemes. Unique cases, similar experiential claims, and divergent meanings were considered in thematic development. To ensure validity, the researchers compared each other’s coding (Yardley, 2007). Repeated meetings were done to triangulate perspectives and to discuss and modify codes and themes. Having no professional experience in grief counseling nor involvement in critical care, the researchers provided an “outsider” perspective that allowed for a detached analysis of the subject, which those who share the same background as the participants may not sufficiently provide in some cases (Holmes, 2020). To observe distance, multiple consultations were done with the senior researcher.

Results

Quantitative Analysis

Results showed that most respondents have moderate (51.67%) or high (38.33%) levels of VG (M = 38.72, SD = 8.08). The revised VTS items are presented in Table 2. Items comprising the cognitive dimension (CD) had a mean of 4.19 (SD = 1.59), whereas items constituting the affective dimension (AD) had a mean of 4.67 (SD = 1.79).

Table 2.

Revised VTS Items.

Item	M	SD	χ2	Adj. Sig.	Mean Ranks
					HCW	MHW	FBW
#1 (D) My job involves exposure to grief and loss brought by COVID-19 deaths.	6.12	1.28	3.17	.205	34.85	28.11	27.03
#2 (D) My job requires exposure to traumatized or distressed clients due to COVID-19 deaths.	6.02	1.28	6.50	.039*	35.38	31.53	22.47
#8 (AD) Sometimes I feel overwhelmed by the workload involved in my job.	5.18	1.61	13.93	.001**	36.46	34.63	17.47
#3 (CD) I find myself distressed by listening to my clients’ stories and situations related to COVID-19 deaths.	4.80	1.29	1.24	.537	31.92	32.18	26.62
#7 (AD) Sometimes it is hard to stay optimistic given the COVID-19-death-related grief I encounter.	4.42	1.32	7.32	.026*	37.71	26.92	24.32
#6 (AD) Sometimes I feel helpless to assist my clients bereaved due to COVID-19 in the way I would like.	4.40	1.32	1.78	.411	33.77	26.76	30.06
#5 (CD) I find myself thinking about my clients’ grief and loss due to COVID-19 at home.	4.22	1.30	.60	.741	28.44	31.50	32.29
#4 (CD) I find it difficult to deal with the content of my work related to COVID-19 deaths.	3.57	1.29	3.60	.166	35.65	27.18	26.94
Total	38.72	8.08	6.47	.039*	36.98	28.84	23.21

Note. p < .05*, p < .01**.

The sectors had significantly different VG levels (χ² (2, N = 60) = 6.47, p = .039), with HCWs (M = 36.98) reporting higher scores than MHWs (M = 28.84) and FBWs (M = 23.21). Post hoc Dunn’s pairwise comparisons showed that scores of HCWs were significantly higher than those of FBWs. In particular, they differed on the items regarding their exposure to clients distressed due to COVID-19 deaths, the feeling of being overwhelmed by their workload, and the ability to remain optimistic amidst the COVID-19-death-related grief they encounter. Contrastingly, MHWs did not differ significantly compared to HCWs and FBWs (see Table 2).

Qualitative Analysis

The interviews revealed how VG was experienced across the different sectors of HPs. Five superordinate themes were identified, with respect to cross-case shared and diverging perspectives. Table 3 presents the matrix of key themes, subthemes, and meaning units.

Table 3.

Themes and Subthemes - Multi-perspective Matrix.

Subtheme	Meaning unit	HCW	FBW	MHW
Acknowledging Contexts of Grief
Acknowledging Grief as a Process		✓	✓	✓
Acknowledging COVID-19 Circumstances	Disruptions in the Grieving Process	✓	✓	✓
	Disease Progression as Swift	✓
Navigating Relations with the Bereaved
Disclosing the News		✓
Processing Memories and Emotions			✓	✓
Valuing Presence and Silence		✓	✓	✓
Sharing Others’ grief
Foregrounding Empathy		✓	✓	✓
Experiencing Depressive Affect and Exhaustion		✓	✓	✓
Experiencing Anxious Apprehension		✓	✓	✓
Internalizing Encounters
Confronting Death	Grappling with Death Realities	✓	✓	✓
	Experiencing Spillovers of Grief	✓	✓	✓
	Surfacing Personal Circumstances	✓	✓	✓
	Underscoring Health Concerns	✓	✓	✓
Rethinking Society	Encountering Flaws in the System	✓	✓	✓
	Shifting Views on Human Nature	✓	✓	✓
Reconstructing Life Attitudes	Making the Most out of Life	✓	✓	✓
	Enriching Relationships	✓	✓	✓
Negotiating Challenges
Strengthening Spirituality			✓
Seeking Support		✓	✓	✓
Reframing Situation		✓	✓	✓
Regulating Emotions	Being Mindful	✓	✓	✓
	Disengaging from the Role	✓	✓	✓
	Releasing Stress	✓	✓	✓

Acknowledging Contexts of Grief

HPs articulated contexts of grief that underpin their encounters with the bereaved.

Acknowledging Grief as a Process.

A number of participants drew from the five-stage grief theory in engaging with narratives of loss. For instance, one nurse said that he let them cry because “it’s part of the grieving process that the person goes through denial. They haven’t accepted the fact that [their loved one] is gone, so they need to go through the stages.” A psychologist recalled the process of denial, anger, bargaining, depression, and acceptance, and how these were less fitting in describing the bereaved, who “could be experiencing different emotions, different levels at the same time, and go back and forth [for] years [or] months.”

Acknowledging COVID-19 Circumstances.

HPs' grief narratives were entrenched in the pandemic.

Disruptions in the Grieving Process.

Participants encountered stories of social isolation that have complicated mourning. For instance, one deacon described his experience:

I blessed a cremated remain who died of COVID. They weren’t with the grandfather because he was quarantined for two weeks in the hospital. The family, too, was quarantined so they were only able to see their loved one as ashes already. They still can’t move on [from] this pandemic experience.

Disease Progression as Swift.

HCWs witnessed how the illness abruptly progressed to the death of their patients. For them, such suddenness informed how they talk to the bereaved. One recounted how quickly death occurred:

Events just happen too fast. Like, I just received the patient endorsed to me, then they die, and I call the relative for the first time. I haven’t even introduced myself properly, we haven’t established rapport. Then the first thing I say is ‘he’s nearing [death]’.

Navigating Relations with the Bereaved

HPs recounted their experiences with the bereaved in terms of disclosing news, processing their emotions, and just being present for them.

Disclosing the News

HCWs articulated their role of being the bearer of information. For instance, a physician expressed the need to be candid and not to “sugarcoat” the facts to the bereaved to enable them to handle what happened. An HCW also shared their role in answering the many questions of the bereaved:

‘How was my grandmother before she died? Was she fed, bathed?’ That’s it. I just need to assure the relatives that her last moments were comfortable. Their grandmother didn’t die in pain. And I think it’s very important for them [to know] that the patient didn’t experience difficulties.

Processing Memories and Emotions

FBWs described their involvement with the bereaved as a “journey” and their role in honoring their memories with them. As an FBW explained, “We’re having conversations and oftentimes, the stories take even more time than the blessing.” He also shared how he made the bereaved feel they are not alone and are part of a community, “Whenever I preside over the sacraments and these kinds of blessings, I make it personal and relational. I say, ‘WE will bid goodbye to him, WE will pray for him, WE are sad with his passing.”

Meanwhile, MHWs focused on the emotions and overall psychological well-being of the bereaved and on building their capacity to cope. A helpline responder explained:

We assess how they are feeling, what they are going through. Or, maybe we could try to provide them catharsis. ‘Who was that person to you? How would you honor them? How did you grieve when you lost them?’ We just ask questions and we help them process their emotions. And hopefully, somewhere along the way, we could talk about their coping mechanisms, their resiliency.

Valuing Presence and Silence

Beyond providing information and processing, HPs emphasized just being present and providing moments of silence. A physician expressed:

What is important is that you are there for the family even if you have nothing to say. That just shows that I’m giving my time to you as you grieve. You don’t need to say anything. You just need to be there.

Sharing Others’ Grief

As part of their occupation, participants recounted sharing in the grief of the bereaved.

Foregrounding Empathy

Participants acknowledged that they would feel the emotions exhibited and expressed by their bereaved clients. They saw this as necessary to their role. A psychologist elaborated:

It’s just to have enough of that empathy, to know how to be in that person’s shoes, to relate with them. I try to really understand what they’re going through, to be with that kind of emotion, and to have my own personal experiences as a way to connect with them.

Experiencing Depressive Affect and Exhaustion

The empathy they manifested meant they had to themselves deal with the heavy emotions of their clients. A psychologist shared:

There’s a lot of sadness. It’s really saddening to listen to what people say. There will be times when I will also cry after the session or after the end of the day to allow that heaviness to come out.

For some, these emotions manifested physically. A deacon described, “In my experience of having to attend three successive deaths in a day, all of whom are my age, I just threw myself at my bed after the third. It’s really heavy emotionally and physically.” Another psychologist also expressed exhaustion to the extent of losing motivation: “It was so taxing. Because, at the back of my mind, I would ask: ‘what if those were my parents?’ I wanted to check up on [my client] but I couldn’t bring myself to call anymore.”

Experiencing Anxious Apprehension

Participants also experienced anxiety as patients recounted their stories. As a helpline responder narrated:

My palms get sweaty when hearing their stories, especially detailed ones. I could imagine their stories as my own experiences as well. I get sweaty, I get nervous. Sometimes, my heart would beat faster because I empathize with their experiences.

For some, the experiences of anxiety were intrusive. A nurse shared that his worries following exposure to loss would come unconsciously, “Because you don’t know what could happen in a day, it is overwhelming. Even if you don’t consciously think about them or you keep yourself from doing so, you will still think about them.”

Internalizing Encounters

Participants shared how their experiences influenced their notions of death, safety, society, and the self.

Confronting Death

HPs face the reality of death as a universal experience. However, the COVID-19 pandemic made them face these realities more incessantly.

Grappling with Death Realities

In doing grief work, participants wrestled with the inevitability and unpredictability of death. However, the frequency of death heightened the intensity of the experience. As one counselor shared:

It became more real that we’re only here for a period of time. I guess that wouldn’t have been so real for me without those experiences of talking to people, and realizing that there’s so much loss in this time.

Experiencing Spillovers of Grief

Participants observed that their thoughts about death and the grief of the bereaved spilled over outside work. A helpline responder expressed, “After the call, I would [still] remember those calls. For example, watching movies or reading books would trigger my memories of those calls.”

Some participants' encounters with grief had also heightened their anticipation of loss. One priest expected such an outcome whenever he was notified:

Because of my engagements, sometimes I even fear receiving a text update. I get paranoid that something bad would happen. And it has happened. ‘Father, grandmother is gone, dad passed away.’ It scares me to read messages in my chat box.

Surfacing Personal Circumstances

For participants, witnessing the grief of others evoked their open emotions especially when they identified with the bereaved. One nurse recounted his experience after witnessing a son bid farewell to his COVID-19-positive mother: “I felt the pain as someone who is close with his mother. When someone is close to your heart, there will always be certain circumstances where you will feel emotions. The experience was really difficult for me.”

Participants were also reminded of their own losses and past experiences of bereavement. According to one minister, being able to relate their experiences with that of their clients elicited memories of his own grief: “If a client’s father died, I also think of my dad who passed away. I know how it feels to lose a father. I don’t just feel sympathy towards the bereaved, but I also feel sad for myself.”

Underscoring Health Concerns

Faced with death realities, participants became more cautious about possible contamination. A counselor shared, “What I noticed was, I became careful in terms of adhering to safety measures. In terms of going out, I became more conservative. There’s this added fear. I became protective because I don’t want COVID to reach my home.”

Rethinking Society

The experience of grief led to shifts in perspectives and reinforced some of their attitudes.

Encountering Flaws in the System

One priest shared that his view on society changed as a result of being in close contact with the bereaved:

One thing that really became clear to me was the inequality that is around us. The pandemic really brought that so much to light. The inequality, the privilege, sometimes we take them for granted, the plight of people who are less fortunate.

Other HCWs also noted the gaps in healthcare structures and their own frustrations, “You will see the flaws in the healthcare system in the Philippines and you’ll get slapped by reality, that healthcare workers like us are apparently treated as dispensable here.”

Shifting Views on Human Nature

Participants also highlighted both the cruelty and kindness of people. For one nurse, her VG experiences made her realize how “insensitive and manipulative” people can be during the health crisis. Alluding to some relatives of COVID-19 patients who deprive other patients of medicines, she shared: “Before the pandemic, we gave away stock medicines freely, but we now choose who is in need and who is merely opportunity-grabbing.”

In contrast, one physician cited how strangers and private individuals donated to their hospital: “The goodness of humanity is further manifested during times of crisis. It’d be sad to think about the pandemic, but at least we have each other’s backs. If the government can’t find a way, people will always work together.”

Reconstructing Life Attitudes

Despite the frustration and cynicism, HPs shared that they learned to develop a positive outlook from their experience.

Making the Most out of Life

Confronted with death realities, participants articulated concerns about the temporality of life. One MHW shared how his engagement with COVID-19 grief changed his outlook: “My views [about life] changed. Time really is important because once we’re dead, time stops. Every second counts.” Likewise, one priest realized the value of “living life to the fullest.”

Enriching Relationships

For HPs, the experience encouraged them to seize every opportunity to bond and connect with others. As a psychologist shared:

After sessions, you have this urge to connect with other people and talk to your family, friends. You’d want every chance to say how you feel because you know that their life is very finite. So, you try to connect as much as you can.

Negotiating Challenges

In dealing with articulated difficulties, HPs utilized various coping strategies to effectively fulfill their supportive roles.

Strengthening Spirituality

FBWs found solace in their faith, with prayers and beliefs playing key roles. One priest saw their engagements within the scope of spiritual duty:

It is not only I doing something for Christ, but it’s also God doing something for me. He is acting in my life, he is present in my life. But, this is what I like the most: ‘what more can I do for Christ or for God?’

Seeking Support.

Many HPs sought social support from colleagues formally and informally. Some workplaces established measures that provide space to process the emotions of their personnel and protect them against occupational hazards. A physician noted that their residency program holds “psychosocial processing sessions once a year where they ask about experiences on how they coped with [emotions].” Others talked to co-workers who could relate to their experiences, such as a priest who shared:

It is of great importance that they know what it’s like to be a priest precisely because they are also priests. When I say ‘I am sad,’ they’ll know that I’m referring to the sadness of a priest which is different from that of laypeople.

Participants also found comfort in spending time with others outside work. One said that adjacent to his work, he “relies on friends and family” to be his “helpline responders.”

Reframing the Situation

Participants coped by making sense of their experiences. For instance, one nurse tried to accept that some “deaths are inevitable” and that “they did their best, given the limits of medicine.” In this line, participants admitted that they could only do so much for the bereaved. Many of them reframed their efforts on the things that they can control while letting go of those they cannot. A helpline responder shared:

The goal of our call [is] to help bring them to a better place and to help them release those emotions. But I remind myself that I shouldn’t be the one to put the goals; it should be the caller. So, I just focus on what I can control.

Regulating Emotions

Participants found the need to manage their feelings arising from the challenges in engaging with the bereaved.

Being Mindful

Participants practiced mindfulness and developed an awareness of their thoughts and emotions to better understand themselves and their situation. A psychologist shared:

When [I am] in touch with [my] own emotions, I’m able to notice some nuances and some behavioral changes in myself. I try to give myself some space to process and reflect on what I’m going through so I’ll be able to cope better.

Disengaging from the Role

At the end of their workday, participants looked for ways to step out of their roles. A physician, for instance, expressed “not wanting to bring emotions from work to relationships with family and friends.” Similarly, MHWs gave themselves time to recover before writing case notes or meeting other clients. As shared by a psychologist, “if I feel I’m not ready to go back to that session and work again, then I’m giving myself a break first.”

Releasing Stress

Participants across all sectors engaged in other pursuits to seek relief from stress and intense emotions. This included hobbies such as watching television and movies, listening to music and podcasts, reading books, singing, cooking, and eating. Some also engaged in physical activities like walking, biking, stretching, and practicing yoga. A priest particularly shared that his body “carries the load of what people go through,” so he “would rather stretch than shrink.”

Discussion

Vicarious Grief Among Helping Professionals

The results highlight VG as entrenched in the exposure to narratives of death and loss that were complicated by the realities of COVID-19 (e.g., Kumar, 2021). Scores suggest moderate and high levels of vicarious experience of grief among HPs that are higher than those in previous studies among law solicitors (Vrklevski & Franklin, 2008), social workers (Aparicio et al., 2013), and victim advocates (Benuto et al., 2018).

Magnifying on the affective dimension, the interviews revealed that participants experienced Type 1 VG, as characterized by the feeling of being in the actual mourner’s position (Rando, 2003). This was manifested in their accounts of experiencing depressive mood, exhaustion, anxiety, and crying when doing grief-related work—responses common among individuals bereaved due to COVID-19 deaths (Arslan & Buldukoğlu, 2021). These experiences may be attributed to how HPs exercise empathy in their respective occupations. Such practices reflect emotional participation in the grief of their bereaved clients (Pearlman & Saakvitne, 1995).

Interviews also highlighted the cognitive impact of VG in the form of intrusive thoughts. Reactions to the actual mourner’s loss evoked personal losses and destabilized assumptive worldviews suggesting Type 2 VG (Rando, 2003). Engagement with the bereaved reminded some HPs of past losses which has been reported in other studies (Richmond et al., 2021). The heightened sense of health security mirrors a previous study where psychologists acknowledged their vulnerability and became more conscious of their safety because of exposure to trauma (Sui & Padmanabhanunni, 2016).

Moreover, most participants also claimed that their engagement with the bereaved shifted or reinforced their beliefs about human nature. The heightened belief in an unjust world is consistent with literature showing that individuals who experienced vicarious trauma are less likely to assume benevolence on others (Matthews & Marwit, 2004). However, for other participants, the core assumption that the world is benevolent was also reinforced upon witnessing acts of kindness towards the bereaved. Feldman and Kaal (2007) posit that maintaining positive worldviews amid exposure to trauma may be attributed to higher empathy. The participants also noted changes and reinforcements in their views towards greater social structures which have not been explored by previous studies.

For other participants, the experiences led to positive changes in views on the self, relationships, and the world. The reality that ‘life is short’ urged most HPs to pursue their passions and invest more time in their relationships. Manning-Jones et al. (2015) described this as Vicarious Posttraumatic Positive Growth (VPTG). Thus, VG may have positive outcomes such as the recognition of the preciousness of life, reconstruction of new goals and priorities, development of positive relationships, completion of mourning from previous losses, and rehearsal of future losses (Rando, 2003; Varga & Gallagher, 2020).

There were differences noted in levels of VG. Specifically, HCWs had higher scores on the scale than FBWs. Qualitative findings suggest more intense VG in HCWs owing to their role in end-of-life situations. They not only encountered the death of their patients, they also had to notify their kin and experience their bereavement in the rawest form. Indeed, studies have shown that working in contexts of hospice and end-of-life care, where exposure to death experiences are recurrent, facilitates grief among HCWs (Hartley et al., 2019). In contrast, FBWs had significantly lower scores. Studies suggest that while priests and pastors do experience adverse consequences from exposure to the suffering they encounter in their ministry, they are able to leverage their spiritual beliefs in managing them (Ehusani, 2021). The scores of MHWs and HCWs are not significantly different and this may be due to comparable engagements with other forms of trauma (Manning-Jones et al., 2017).

HPs reported trying a variety of ways to cope including disengaging from stressful situations and engaging in pleasurable activities such as reading, watching shows, and exercising. These strategies are frequently used to relieve stress (Reilly et al., 2021). HPs also reported using faith practices that are helpful in managing negative emotions (AlJhani et al., 2021). Finally, others report using mindfulness-based strategies and reframing that are linked with positive mental health outcomes (AlJhani et al., 2021). HPs also utilize social support that has been shown to be a protective factor from the adverse effects of problematic situations (Manning-Jones et al., 2016). Moreover, a few reported receiving supervisorial and organizational support that have been linked with lower levels of traumatic stress (Reilly et al., 2021).

Limitations and Implications for Future Research

The study had a number of limitations. Firstly, VG was measured using the revised VTS, as a specified traumatic material. Future researchers can develop an instrument particularly for VG to capture nuances with VT and other empathy-based strain constructs. They may also analyze vicarious experiences of HPs through other paradigms such as disenfranchised grief to note possible overlaps with VG. Moreover, this study was conducted among Filipino health providers and the small sample size does not allow generalizability of findings. Analyzing demographic data and other factors possibly affecting VG may also yield important results. Future research may consider examining the phenomenon of VG across varied contexts.

Practical Implications

The results highlight the need for greater support among HPs who deal with grief, especially amidst a pandemic. Although self-care methods were found to be helpful in coping, Sprang et al. (2019) suggest that these merely alleviate VT symptoms. As such, psychoeducation on mental health and self-care can be integrated into further training of HPs. Apart from highlighting awareness of adverse vicarious experiences, such intervention may equip them with skills to cope with trauma-related alterations in emotions, beliefs, behaviors, and occupational skills (Kim et al., 2021).

Given that most respondents in the study had moderate to high levels of VG, institutions that provide service to the bereaved should first consider assessing their HPs for VG regularly as its manifestations are not as noticeable as other occupational psychological sequelae (Benuto et al., 2018). A study on doctors suggested that they are compelled to engage in deindividuation practices and empathy reduction in order to meet the demands of their occupation (Haque & Waytz, 2012). As such, prevention of VG at the organizational level may be necessary to decrease such risks. For instance, caseloads among HPs should be balanced and diversified such that their exposure to COVID-19 bereavement is mitigated (Sutton et al., 2022).

Furthermore, since all participants shared that social support was integral in their coping with VG, group therapy programs and peer-group-based interventions may also help provide a sense of group cohesion that could mitigate symptoms of VT (Kim et al., 2021). Given differences in VG levels, specific debriefing measures tailored within the sector may also be explored.

Conclusion

The study sought to contribute to the sparse literature on the vicarious experience of grieving. Findings illuminate the ways that regular exposure to grief manifests in VG symptoms—emotional, behavioral reactions, and altered worldviews. It highlights the need for resources and interventions to equip HPs for grief encounters and foster positive practices to prevent VG. Moreover, it calls for sensitivity and support for HP who may be experiencing VG, and suggests ways to enable their wellbeing and growth.

Author Biographies

Kaina Marie Clare Sera Jose graduated from the Ateneo de Manila University with a Bachelor of Science degree in Psychology. Her research interests include mental health of vulnerable populations, psychological well-being, and gender and sexuality issues.

Agham Josiah Navarro graduated from the Ateneo de Manila University with a Bachelor of Science degree in Psychology. His research interests include mental health systems, psychopathology, and critical psychology.

Angelo Nico Pomida graduated from the Ateneo de Manila University with a Bachelor of Science degree in Psychology. He is currently involved in mental health advocacy work.

Maria Regina Hechanova-Alampay is a licensed psychologist and a professor of Psychology at the Ateneo de Manila University. Her research interests are mental health, substance use, implementation science and technology-mediated interventions, and community and organizational psychology.

ORCID iD

Angelo Nico Pomida https://orcid.org/0000-0001-6959-1791