The COVID-19 pandemic has been a mass bereavement event disrupting social functioning of individuals in the general population, restricted and changed end-of-life, mourning and grief processes. In these circumstances grief may become pathologic and complicated grief (CG) may rise. The vulnerability of elders to CG in times of loss and bereavement in the COVID-19 context has been hardly studied. The current study aimed to examine grief processes, complicated grief and their relationship with protective and vulnerability factors among adults and elders (45 years old and above) who experienced loss at the time of the COVID-19 pandemic. Methods: A total of 113 adults aged 45 and above were included in the analytic convenience sample. Quantitative data was collected by self-reported questionnaires of CG, resilience, well-being, state anxiety and negative engagement with hostile world scenarios (HWS). Additionally, qualitative data on grief experiences was collected in semi-structured interviews of 9 participants.

Factor analysis results supported prior identified factors of CG among the aged. Multivariate analysis and stepwise regression identified factors associated with CG: female gender, state anxiety and negative engagement with HWS were identified as vulnerability factors whereas resilience emerged as a protective factor. Thematic analysis identified two main themes among participants: (1) COVID-19 as an emotional accelerator and (2) Support from social resources in COVID-19 times.

Findings add to our understanding of complicated grief among adults and elders in epidemic times. A unique and novel finding is the relationship found between negative engagement with HWS and complicated grief. This highlights the importance of examining how individuals facing adversities in general and loss in particular, perceive their ability to cope with life hardships. Furthermore, further research for establishing diagnostic criteria of CG for the aged is recommended.