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Cited by 25Grief, Bereavement, and Mental HealthDigital Mental Health InterventionsCOVID-19 and Mental Health

The Efficacy and Usability of an Unguided Web-Based Grief Intervention for Adults Who Lost a Loved One During the COVID-19 Pandemic: Randomized Controlled Trial

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Dominguez-Rodriguez, Alejandro, Sanz-Gomez, Sergio, González Ramírez, Leivy Patricia, Herdoiza-Arroyo, Paulina Erika, Trevino Garcia, Lorena Edith, de la Rosa-Gómez, Anabel, González-Cantero, Joel Omar, Macias-Aguinaga, Valeria +1 more·2023·Journal of Medical Internet Research
DOI 10.2196/43839PMC PMC10131766

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Abstract

Background: The death of a loved one was a challenge many people faced during the COVID-19 pandemic within the context of extraordinary circumstances and great uncertainty. Grief is an unavoidable part of life, and for most people, feelings of grief decrease naturally over time. However, for some people, grieving can become a particularly painful process with clinical symptoms that may require professional help to resolve. To provide psychological support to people who had lost a loved one during the COVID-19 pandemic, an unguided web-based psychological intervention was developed. Objective: The main objective of this study was to evaluate the efficacy of the web-based treatment, Grief COVID (Duelo COVID in Spanish; ITLAB), in reducing clinical symptoms of complicated grief, depression, posttraumatic stress, hopelessness, anxiety, and suicidal risk in adults. The secondary aim was to validate the usability of the self-applied intervention system. Methods: We used a randomized controlled trial with an intervention group (IG) and a waitlist control group (CG). The groups were assessed 3 times (before beginning the intervention, upon completing the intervention, and 3 months after the intervention). The intervention was delivered on the web in an asynchronous format through the Duelo COVID web page. Participants created an account that could be used on their computers, smartphones, or tablets. The evaluation process was automated as part of the intervention. Results: A total of 114 participants were randomly assigned to the IG or CG and met criteria for inclusion in the study (n=45, 39.5% completed the intervention and n=69, 60.5% completed the waitlist period). Most participants (103/114, 90.4%) were women. The results indicated that the treatment significantly reduced baseline clinical symptoms in the IG for all variables (P<.001 to P=.006), with larger effect sizes for depression, hopelessness, grief, anxiety, and risk of suicide (all effect sizes ≥0.5). The follow-up evaluation showed that symptom reduction was maintained at 3 months after the intervention. The results from the CG showed that participants experienced significantly decreased levels of hopelessness after completing the time on the waitlist (P<.001), but their suicidal risk scores increased. Regarding the usability of the self-applied intervention system, the results indicated a high level of satisfaction with the Grief COVID. Conclusions: The self-applied web-based intervention Grief COVID was effective in reducing symptoms of anxiety, depression, hopelessness, risk of suicide risk, posttraumatic stress disorder, and complicated grief disorder. Grief COVID was evaluated by the participants, who reported that the system was easy to use. These results affirm the importance of developing additional web-based psychological tools to help reduce clinical symptoms in people experiencing grief because of the loss of a loved one during a pandemic. Trial Registration: ClinicalTrials.gov NCT04638842; https://clinicaltrials.gov/ct2/show/NCT04638842

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  • Previous studies conducted by the team members have found that participants do answer all the assessments.

    “furthermore previous studies conducted by the team members (Dominguez-Rodriguez et al., 2023; Martínez-Arriaga et al., 2023) have found that participants do answer all the assessments, and this helps to analyze the impact of the intervention.”

    From Internet-based self-administered intervention to reduce anxiety and depression symptomatology and improve well-being in 7 countries: protocol of a randomized control trial (2024) · cites this paper as Dominguez-Rodriguez et al., 2023

    The Results (comparisons between groups, Table 3; no page available) show incomplete posttest responses: 43 of 45 treatment participants answered several measures. The Results (three-month follow-up, Table 5) include only 18 participants, and the Discussion (Principal Findings) says only intervention completers could access the postmeasurement assessment. These findings contradict the claim that participants answered all assessments. (LLM, conf=0.88)

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  • Web-based psychological interventions, particularly those based on cognitive behavioral therapy, have shown promising results in efficacy and prevention strategies.

    “In this context, web-based psychological interventions, particularly those based on CBT, have been gaining strength and visibility in recent years as innovative and valuable tools aimed at promoting mental health [29], offering promising results in terms of efficacy and prevention strategies [30].”

    From Evaluation and Future Challenges in a Self-Guided Web-Based Intervention With and Without Chat Support for Depression and Anxiety Symptoms During the COVID-19 Pandemic: Randomized Controlled Trial (2024) · cites this paper as [30]

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  1. [31]Worden JW Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner. 3rd edition 2002 Cham, Switzerland Springer

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Authors
Dominguez-Rodriguez, A., Sanz-Gomez, S., González Ramírez, L. P., Herdoiza-Arroyo, P. E., Trevino Garcia, L. E., de la Rosa-Gómez, A., González-Cantero, J. O., Macias-Aguinaga, V., & Miaja, M.
Affiliations
  • Universidad Internacional del Ecuador (EC)
  • Universidad de Guadalajara (MX)
Corresponding author
Herdoiza-Arroyo, Paulina Erika
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2023-04-06
Volume
25
Pages
e43839
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/43839
PMC
PMC10131766
OpenAlex
W4322582674
Cited by
25
References
54
Citations by year
2026: 5 · 2025: 8 · 2024: 11 · 2023: 1
FWCI
7.26
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Medical Internet Research (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • University of Twente Research Information (submittedVersion, cc-by)
  • University of Twente Research Information (submittedVersion, other-oa)
  • Greater South Information System
Funders
Instituto Tecnológico y de Estudios Superiores de Monterrey
Topics
  • Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
Keywords
bereavement, COVID-19 pandemic, online intervention, depression, hopelessness, anxiety, suicide risk, post-traumatic stress, intervention usability, waitlist control, user satisfaction, Spanish-language intervention
MeSH terms
Internet-Based Intervention, COVID-19, Adult, Depression, Female, Grief, Humans, Male, Pandemics

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