Center for the Study of Traumatic Stress
CSTS | Department of Psychiatry | Uniformed Services University | 4301 Jones Bridge Road, Bethesda, MD 20814-4799 | www.CSTSonline.org

When A Loved One Dies froman Infectious Disease
Death of a loved one is a painful
and have many questions.
As we move through the pain of grief,experience. However, death due toWhen a loved one dies, we are
an infectious disease outbreak may
it is important to remember that
forever changed. As we move throughbe more difficult for several reasons:the pain of grief, it is important tomany people find new strengths andthe death is unanticipated andremember that many people find newcapabilities and develop enduring
families may be separated from theirstrengths and capabilities and develop
hospitalized loved one due to potential
enduring relationships with others.
relationships with others.
contagion. Families may be unable toThis Fact Sheet provides helpfulgrieve and memorialize their loss in
information to families (or thoseways that are religiously and culturally familiar. It is likely
caring for them) to help cope with their loss.
that family and close friends will be distressed, confused,Circumstances Surrounding the Loss
Deaths due to an infectious disease outbreak may occur
in several types of environments, such as hospitals, nursing
and assisted living facilities, and at home. Many may die
without their loved ones present, unable to hold theirhand, or grieve at their bedside. It is expected that family
members will want to know the circumstances surrounding
the death. That information may not be immediately
available and loved ones may experience delays orincomplete information.
When the News Comes
As much as one might be prepared for the death ofa loved one, we are never ready to receive such news.
Notification of a death is likely to come as a phone call fromsomeone representing the place where the death occurred.
That person may or may not be known to the family andmight only have a few details about the death (e.g., timeof death, who was with the patient at the time of death,and any final message from the deceased to their family).
Additionally, family members are likely to be distressed
and unable to pose questions to the notifier, often requiring
additional contact after the initial notification.
In addition, the deceased’s remains and personal
belongings may not be quickly available, further distressing
the family. For families whose religion or culture prescribes
rituals for the management of the body, the absence of thebody can be an additional loss.
Adult family members should properly explain thecircumstances of the death to children using simple andclear language that is developmentally appropriate foreach child. The nature of a child’s relationship to thedeceased and age will likely determine the intensity of
their responses. Older children and teenagers may havemore questions, and family members need to be prepared
to share information in a calm and clear manner. Families
may want to seek professional help to understand how best
to inform and support children when someone close tothem dies. This could be either face-to-face or virtual.
Initial Reactions
Grief is a normal and expected reaction to the lossof a loved one. There are many ways to grieve, including
emotional reactions ranging from stunned disbelief, togreat sadness or rage. There is no “right” way to express
grief, especially immediately after notification when thenews is fresh and feelings are raw. Due to potential physicaland emotional separation due to the infectious disease
outbreak, family members may have been out of contact
with the deceased, so the death may feel less “real.” When
individuals cannot share their grief with others in waysthat provide comfort and validation, they may feel that
their grief is not shared or acknowledged. When grief goes
unacknowledged, people may experience disenfranchised
grief, or that their grieving is unvalued, resulting in feelingsof helplessness and powerlessness.
Grief impacts us in nearly all aspects of our lives:■ Cognitive — Problems remembering, concentrating,prioritizing
Continued

■ Emotional — Strong feelings of sadness, anger, guilt,
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loneliness and even joy in remembering
Behavioral — Increased/decreased activity
Spiritual — Questioning faith or increased religious
activities
Social — Craving being alone or with others
Physical — Fatigue, sleep difficulties, appetite changes
Secondary loss — financial insecurity or loss

Collective Grief
How people express grief is influenced by culture.
Cultures vary in acceptance of intense displays of emotion
and sharing of feelings and difficulties. It is most helpful
to offer support, respect, and recognition of culturalrituals for grieving families. It is important for people togrieve together, even when they are unable to be together
physically. Family members can receive support from eachother, as well as friends and mental health professionals(e.g., grief counselors or chaplains). Support can beprovided “virtually” through phone calls, texts, emails, andvideo chat, and all these modalities should be encouraged.
Families are encouraged to consider options formemorials and burials at a time when family members
can be together. It may be necessary to modify traditional
memorialization practices. Importantly, memorialization
offers comforting ways to be together and mourn loved
ones.

Grief Adaptation

Grief can be a prolonged process that isneither linear nor predictable. Acute grief is raw,
disorganizing, and highly emotional, however,intensity of grief usually diminishes over the firstyear after the death. Although grief never really“ends”, with time it usually becomes a less central
and dominating part of one’s life. However, in certain
circumstances (e.g., sudden or violent deaths) theintensity of acute grief can continue unabated, attimes requiring intervention.
Those bereaved by infectious disease areencouraged to reach out to others to both receiveand offer support. Being open and honest willencourage others to do the same, creating importantconnections. Practicing good self-care (e.g., eating
properly, exercising, maintaining good sleep hygiene)
supports health, well-being, and resilience. Bereaved
persons are encouraged to seek help when required,including formal help from trusted health careproviders or mental health professionals, such as theDisaster Distress Helpline (1-800-985-5990).

Center for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University
4301 Jones Bridge Road, Bethesda, MD 20814-4799
www.CSTSonline.org