Principal Findings
hopelessness, anxiety, psychotic disorder, psychosis, CGD, PTSD, depressed, depression, posttraumatic stress
CGD
The objective of this study was to present the efficacy of Grief COVID in decreasing the risk of developing CGD and in reducing symptoms of anxiety, depression, hopelessness, PTSD, and risk of suicide.The findings of this study showed a reduction in depression, hopelessness, grief, anxiety, and suicide risk and a lesser effect on posttraumatic stress scores in the IG. The results were maintained at the 3-month postintervention follow-up. These results reflect a statistically significant difference compared with the CG scores, which showed an increase in suicide risk after the waitlist period.Proposals for grief intervention during the COVID-19 pandemic are scarce. Tur et al [One of the few RCTs that sought to alleviate the psychological distress caused by COVID-19 is a study by Brog et al [The Grief COVID intervention was designed using techniques that draw on CBT, behavioral activation therapy, mindfulness, and positive psychology. Most studies to date on grief intervention during the COVID-19 pandemic used CBT based on its known effectiveness in treating grief [Important issues to consider stem from the unique circumstances that people have experienced during the COVID-19 pandemic. For example, face-to-face contact was restricted, and a large part of society was affected by the economic impact of the pandemic. In this context, web-based interventions have a promising potential for several reasons. First, treating people in this way can reduce the time required to access support services. Second, the cost of web-based treatments may be more affordable for much of the population [The results of this study have several implications for health care providers and local governments. First, web-based interventions have been shown to be effective in reducing psychological distress, including the symptoms of grief, depression, anxiety, and posttraumatic stress [This study does have some limitations, the first of which is related to the dropout rate. Only 5.1% (45/882) of the IG participants completed the intervention. It is not uncommon for internet-based and self-administered interventions to have high dropout rates, particularly among participants assigned to the waitlist group. This may be due to reasons such as a preference for face-to-face treatment or lack of internet access or a digital device on which to access the platform. Another consideration is that 12 modules may be too long for a preventive intervention of this type. However, similar intervention proposals have ranged from 8 to 12 sessions [Another limitation of the study is that because the intervention was web-based, unguided, and preventive in nature, we did not consider it ethical to include individuals who reported substantial suicidality (ie, suicidal intent or plans). This limited external validity, particularly by decreasing the proportion of severely depressed participants in the sample. A further limitation is that to evaluate the results of the intervention, only the participants who completed the intervention could access the postmeasurement assessment. Evaluating participants only at the posttreatment point, and not evaluating them during the intervention, limits our knowledge regarding the treatment’s efficacy at different stages of the intervention. Future studies should include assessment measures at several points throughout the intervention to provide a more complete picture of the treatment’s efficacy at different stages. In this regard, we have conducted 2 studies (Dominguez-Rodriguez, A, unpublished data, March 2023) that help us to better understand the reasons some participants continued with the intervention, whereas some others dropped out. In the first study, the participants who dropped out of the intervention were invited to respond to the SUS, along with ad hoc instruments designed to allow us to analyze the participants’ reasons for abandoning the intervention. The study was conducted using 3 psychological intervention platforms that were available during the COVID-19 pandemic: Salud Mental COVID-19 [The results of these studies will be published in the later articles and will help us understand the underlying causes of the dropout rates (Another limitation is that one of the exclusion criteria was that the participants have a diagnosis of a psychotic disorder. However, no specific instrument was included to assess this criterion, apart from asking the participants if they were taking any form of medication, which could indicate if they were consuming an antipsychotic drug. Future studies similar to ours might consider including assessment measures for psychosis as a part of the intervention. For example, Rüegg et al [Regarding the strengths of this study, to the best of our knowledge, this is the first study to publish the results of an intervention aimed at preventing CGD in Latin America. Furthermore, this study is one of a small number of studies that examined grief in the context of the COVID-19 pandemic. In addition, the sample size of our study is sufficiently large to show statistically significant results, and the study included data from 3 time points. The platform was created using principles of responsive design, which permitted the intervention to be accessed on devices of different screen sizes, including cell phones, tablets, and computers [