How do Funeral Practices Impact Bereaved Relatives' Mental Health, Grief and Bereavement? A Mixed Methods Review with Implications for COVID-19

“Furthermore, it has been argued that alternative ways of commemorating the deceased person may compensate for the minimalization of services or lack of attendance at the funeral (see Burrell & Selman, 2020).”

“The psychological effects of the epidemic will last for many years due to certain negative experiences, such as not being able to fulfill religious and cultural rituals after deaths during the pandemic period [16,32].”

“…for people who have died as a result of coronavirus disease has a positive effect on the bereaved people and is effective in passing through the mourning process in a better way (Burrell & Selman, 2020; Corpuz, 2021; Lowe et al., 2020; Mayland et al., 2020; Petryet al., 2021; Wallace et al., 2020).”

“…although some authors have emphasized that restrictions on funeral practices could influence mourning and grief, leading to complicated grief, Burrell and Selman (2020) did not find any conclusive evidence for the effect of funeral participation in their systematic literature review on…”

“These findings connect well with Burrell and Selman’s (9) conclusion, that the benefit of rituals depends on the ability of bereaved individuals to shape rituals in such a way that is meaningful to them.”

“Funeral providers and celebrants play an important role in providing alternative meaningful services in the contexts of restrictions (Burrell & Selman, 2020; Mitima-Verloop et al., 2022).”

“Collective structures for grieving have been difficult or impossible to access (64).”

“Without funeral ceremonies, families may miss a crucial occasion to give meaning to the loss and find social and emotional support (Burrell & Selman, 2020).”

“Evidence suggests that in fact funeral restrictions do not inevitably lead to poor bereavement outcomes [50]; rather, the value of post-death rituals to the bereaved lies in their personal meaningfulness and ability to demonstrate social support.”

“Regardless the format of saying goodbye, it is essential to make sure the arrangement is meaningful to the bereaved and they feel supported through the process (Burrell & Selman, 2020).”

“This uncertainty regarding the impact of funerals on bereavement outcomes is also reflected in the wider literature, which has been inconclusive (57) or found no effect (28), but also pointed to the important role of funeral providers and celebrants in providing alternative meaningful services in the contexts of restr…”

“Funerals and other customs, that would normally help families, friends and communities to honor the deceased, provide support and share their grief, were impacted or sometimes even prohibited during COVID-19 (Burrell & Selman, 2020; Imber-Black, 2020; Walsh, 2020).”

“The literature highlights that what constitutes a meaningful funeral is subjective, and it is essential that people find meaning in a way that feels appropriate to them (Burrell & Selman, 2020).”

“Being in an intercorporeal relationship with the loved one and “being really present” seems to be part of a search for meaningful communication with the other as death approaches (Burrell & Selman, 2020; Holm et al., 2019; Otani et al., 2017; Pattison, 2020).”

“The very necessary exclusion of physical presence at funerals, however, could have some impact on psychological health (Beaunoyer et al., 2020; Burrell & Selman, 2020).”

“Although it has been stated that changes due to the COVID-19 pandemic can increase the risk of complicated grief (Mayland, Harding, Preston & Payne, 2020), there are no convincing results regarding how death and grief rituals will affect the grieving process (Burrell & Selman, 2020).”

“Funeral practices, including planning a meaningful funeral, memorializing lost one, mourning the collective loss, and the ability to personalize the funeral shown to have an impact on how the family received closure or went through the bereavement process (Burrell and Selman, 2020).”

“Also, traditional funeral ceremonies - which usually have an important role in the grieving and recovery process, as they foster emotions’ expression, social support, and give meaning to the loss (5) - have been banned or limited (6).”

“Therefore, people might have different impressions of the contribution and benefits of bereavement outcomes that funeral practitioners can bring to the family (49).”

“Consequently, the influence of this variable on the mental health of survivors is dependent on cultural sensitivities, the relevance of mourning rites for survivors, as well as mourners’ ability to perform this ritual and their meaningful farewell.(42) Another result mentioned by study participants was the incredulity…”

“Additionally, the regulations regarding the limited number of attendees at funerals made the loss of a loved one, even more unbearable [38].”

“…physically present with the patients in their final moments, or the bereavements could not say goodbye to their loved ones due to the limitation of the funeral during the COVID-19, which aggravated the grief, guilt, and pain of the patients and bereavements (Burrell & Selman, 2020; Corpuz, 2021).”

“There has also been a loss in lifestyle, cultural, and social practices due to the pandemic.(59) Although research has not yet addressed the psychological impact of COVID-19 on informal caregivers, it can be reasonably assumed that this pandemic, and the unique circumstances which accompany it, can exacerbate feelings…”

“…rites at death, and psychological problems due to quarantine and the refusal to visit the patient during the hospitalization (Bermejo, 2020; Burrell & Selman, 2020; Cardoso et al., 2020; Carr et al., 2020; Ferna´ndez & Gonza´lez-Gonza´lez, 2020; Hamid & Jahangir, 2020; Mayland et al.,…”

“(52) revealed that restrictions on funeral practices did not necessarily entail poor outcomes or experiences for the bereaved.”

“The lack of such rituals can prevent mourners from dealing with loss, as physical death was not accompanied by social and psychological death, making psychological reorganization and the revaluation of the bereaved people’s lives difficult (Burrell & Selman, 2020; Junior et al., 2020).”

“This finding also supports findings in previous literature (Burrell & Selman, 2020; Hamid & Jahangir, 2020; Ingravallo, 2020) that the funeral protocol prevented bereaved families from performing the cultural and religious funeral rituals they considered necessary.”

“The issues of bereavement and grief have been studied only by looking at the negative consequences of not being able to have a proper funeral or not being able to accompany the relative in the last moments of life (Burrell & Selman, 2020).”

“The literature highlights that complicated grief may appear when people face traumatic loss, mourn in isolation, and are unable to say goodbye to the deceased (Burrell & Selman, 2020), and experience excessive negative emotions (Li et al., 2019).”

“Most research was conducted either during the pandemic or retrospectively soon after, potentially capturing grief responses that do not persist in the medium to long term (Burrell & Selman, 2022).”

“Traditionally, participating in a funeral provides an opportunity to “say goodbye,” signaling the end of the relationship (Burrell and Selman 2020).”

“Therefore, families were prevented from sharing their grief and elaborating on it through symbolic rituals (Burrell & Selman, 2020 ; Imber‐Black, 2020).”

“Therefore, studies with individual in-depth interviews seem necessary to shed more light on the issue (Burrell & Selman, 2022; S ¸ ims ¸ ek Arslan & Bulduko ˘ glu, 2021).”

“In many directives, mourners showing COVID-19 symptoms were prohibited from attending funerals (Burrell & Selman, 2020; Jahangir & Hamid, 2020).”

“…of physical contact (hugging, touching) as a form of consolation, to the interdiction of touching the casket or the deceased, of performing gatherings after the ceremony as well as to the interdiction of farewell and paying respects to the deceased (Aguiar et al., 2020; Burrell & Selman, 2022).”

“However a rapid review of the utility of funerals during the COVID-19 pandemic (Burrell and Selman, 2020) has not been able to ratify this supposition, and a recent empirical study into what constitutes a ‘good funeral’ found that a funeral service may ‘not necessarily be the most important thing’…”

“process their grief through funeral ceremonies [23,27,28].”

“When the bereaved family faces an overwhelming sense of powerlessness, funeral directors can give them a space to reassert choice and control [44]; this choice and control appear essential for families to find funeral practices helpful and therapeutic [45].”

“Burrell and Selman (2020) additionally suggested that hybrid funerals might represent ‘an opportunity for immigrants to virtually cross large distances and borders, and to be present at the funeral services for a loved one’ (p. 22).”

“Many of the supports that participants described as unavailable to clients, such as control over funeral arrangements and access to social support, have previously been shown to be protective in adapting to bereavement (Burrell & Selman, 2020; Ha, 2008; Kissane et al., 2003).”

“The absence of funeral rituals may induce feelings of guilt and indignation, increasing the risk of developing prolonged grief (Cardoso et al., 2020).”

“Burrell and Selman (2020) have suggested that ‘it is not the number of attendees or even the type of funeral which determines how supportive it is, but rather how meaningful the occasion is, and how connected it helps mourners feel’, emphasising the role of funerary professionals in enabling the…”

“Virtual funerals changed the way people grieved during the pandemic (Burrell & Selman, 2020; Carr et al., 2020; Corpuz, 2021b, 2021a; Goveas & Shear, 2020; Johns et al., 2020; Maitra, 2020), given the inability for in-person gatherings and to mourn collectively in traditional ways (Carr et al.,…”

“For funeral practices, a review conducted by Burrell and Selman (2022) highlights the importance of meaningful and supportive memorial services for the bereaved.”

“With funerals seen as a way of providing comfort to the bereaved often manifested through physical touch such as hugging, to be denied these supports may be detrimental to ongoing mental health in bereavement (Burrell & Selman, 2020).”

“Participation in these rituals and activities can affect coping within the immediate aftermath of the death, as well as long-term bereavement (Burrell & Selman, 2020; Jonas et al., 2018).”

“This can make family members feel that they did not say goodbye the way they wished for (31) and that the deceased did not receive the funeral he or she deserved, was victim of negligence, or has undergone inhumane treatment.”

“Research studies before the global pandemic found inconclusive results regarding the impact of participation in funerals on bereavement (Burrell & Selman, 2022).”

“Recent studies have shown that the inability to engage in these rituals due to pandemic restrictions has had a profound impact on bereavement experiences (Burrell & Selman, 2020; Chen, 2022).”

“Despite numerous studies documenting elevated levels of grief among bereaved during the pandemic (Breen et al., 2022; Dyregrov et al., 2023; Gang et al., 2022; Neimeyer & Lee, 2022), other research advises caution in drawing such conclusive conclusions (Burrell & Selman, 2022).”

“The mourners can deliver their eulogies virtually, but these cannot equal the honour they would have otherwise given to the deceased if the gathering was face-to-face (Burrell & Selman, 2022).”

“While rituals are generally perceived as important for bereaved families, our study suggests that their impact on grief reactions and health problems beyond the first few months is not well established (Burrell & Selman, 2022; Mitima-Verloop et al., 2021; S¸ims¸ek Arslan & Bulduko (cid”

“In consequence, those wishing to express condolences and console the griever are left with little guidance from societal norms and traditional rituals (Burrell & Selman, 2022; Jedan et al., 2018).”

“…regarding funerals were highly distressing for bereaved relatives (Hanna et al., 2021; Onwuteaka-Philipsen et al., 2021), with potential long-term impacts on the grieving process (Neimeyer & Lee, 2022; Burrell & Selman, 2022; Hanna et al., 2021; Lee & Neimeyer, 2022; Pearce et al., 2021).”

“Others have explored ‘configurational eulogies’ at funerals with few or no attendees (Caswell, 2021; Caswell & O’Connor, 2019; Turner & Caswell, 2020; Yardley & Rolph, 2020).”

“Some studies indicated that a lack of social connection and unexpressed emotions during the mourning period in the pandemic era might lead to psychological disturbances (Burrell & Selman, 2022; Mortazavi et al., 2021; Shear, 2015).”

“Quantitative studies show that individuals diagnosed with COVID-19, are at great risk of health problems, such as depression, stress, anxiety, fear of contagion and insomnia, apart from the physical problems that they face (Burrell & Selman, 2020; Eisma & Tamminga, 2020).”

“In that sense, our findings align with Burrell and Selman’s [11] reflection on the importance of the meaning rather than the form of rites.”

“The pediatric remembrance committee does great work by allowing us an opportunity to honor and remember the patients we have lost as a community – very grateful for all of their efforts!”

“According to recent research (Burrell & Selman, 2020; Chen, 2022), the inability to do these rituals as a result of pandemic limitations has had a signi fi cant effect on grief experiences.”

“They also found that the benefits of rituals after death depend on the ability of the bereaved person to shape those rituals and say goodbye in a way that is meaningful to them (Burrell & Selman, 2022).”