Survey finds widespread grief among children from COVID-19 losses

Brianna Angela, 14, hugged her mother, Kristen, outside their home in Lincoln, R.I.Craig F. Walker/Globe Staff

Nearly 60 percent of Massachusetts parents and caregivers who responded to a recent online survey said their family had lost at least one person to COVID-19, another sign that the pandemic’s effects promise to be far-reaching and long-lasting.

“We have an epidemic of grief among children and their families,” said Lisa Lambert, executive director of the Parent/Professional Advocacy League, a Massachusetts organization focused on the mental health of children and families, which conducted the survey in February. Lambert said she was surprised by the high number who reported losses.

A total of 243 people responded to the survey, which P/PAL sent to its members and to other family forums. Responses were accepted only from people in Massachusetts. The survey did not draw a representative sampling of all parents in the state, and it’s possible that families that had experienced a loss were more likely to respond. Nine out of 10 respondents had a child with mental health issues, in most cases problems that started before the pandemic – and have only gotten worse.

But the results from this small survey are still telling, and data from elsewhere document the pervasiveness of childhood loss, which can affect mental health and school performance.

Imperial College London estimates that nearly 200,000 children in the United States have lost one or both parents. Worldwide, that number was estimated to be 5.2 million as of October. In Massachusetts, more than 1,700 people died during their prime parenting years, with the heaviest toll falling on people of color.

Losing a parent during childhood can have profound and lasting effects. A recent study found that such children tend to perform poorly in school and are less likely to continue their education beyond high school.

Eight in 10 respondents to P/PAL survey said their child’s behavior got worse during the pandemic and 44 percent said their children lost ground or became more immature. Two-thirds said that children also felt grief over other types of losses, such as after-school activities, sports, and social groups. As a result of the many losses during the pandemic, two-thirds of respondents said their children experienced increased anxiety, and more than half had increased anger or irritability.

And yet, Lambert said, children’s grief is getting little attention. She recalled raising the issue with a group of mental health providers in a recent meeting. At first, they fell silent. Then they mentioned that grief comes up in individual conversations. But it wasn’t being addressed on a broad public health level, she said. Schools, Lambert said, “are not geared up for grief-informed care.”

Asked what help was needed, three-quarters of respondents called for more personal connection and support from community or spiritual groups. Four in 10 wanted more access to child therapy and one third called for more support in the schools.

Sarah DeCosta, grief support manager at HopeHealth, an Attleboro-based hospice agency, said the agency’s support groups have seen a lot of children affected by COVID-19.

Even though they result from an illness, COVID-19 deaths feel similar to traumatic deaths “because it happened so quickly and it’s so widespread,” said DeCosta, a licensed mental health counselor who was not involved with the P/PAL survey.

Cut off from friends, teachers, and relatives in the early days of the pandemic, children also lost the social connections that can help them cope, she said. “That really complicated this type of grief for kids,” she said.

Parents and caregivers sometimes mistakenly think children grieve less than adults, because children express their grief differently. They often have trouble finding the words for their feelings. They can get absorbed in other activities even as sadness simmers unseen, bursting forth in unexpected behaviors later on.

Grief “can certainly exacerbate already present mental health issues,” especially anxiety, DeCosta said.

On its own, grief can cause anxiety. “For a child who has anxiety or even anxious tendencies, it might feel ramped up, more intense,” she said. They may fear their own death or that of another loved one.

For Brianna Angela, who lost her beloved grandfather, José Araujo, in May 2020, the anxiety she’d always felt intensified when she had to return to middle school in Lincoln, R.I. Seeing her classmates with their masks hanging below their noses or on their chin pricked her fears.

Then, when the mask mandate was lifted, “I went into a panic attack. I was stuck in the guidance office, just crying.” It didn’t help that her desire to continue wearing her own mask led to taunting by classmates, who called her a “sheep” and a “coward.”

Brianna said her grief has taken her on a roller coaster. Her grandfather had often been hospitalized, but always pulled through despite doctors’ dire predictions. So when Araujo came down with COVID-19, Brianna expected a similar comeback. Instead, he died in a HopeHealth hospice facility before the family could visit him. “That was very soul-shattering,” she said.

At first she was in shock, not quite believing what had happened. But when the reality that he was never coming back finally sunk in, Brianna said, “I’d go through waves in the middle of the night thinking about him and crying in the bed and missing him.” For a time she couldn’t even draw, once a calming pastime. Her grandfather had shared her interest in art and they used to work on drawings together.

Brianna has a close friend who lost an aunt and a grandmother to COVID-19, and she takes solace in talking with him. She also feels better chatting with other friends, not necessarily about her grandfather, but “just talking to them so you can feel happy.” Writing in her journal, playing games with her family, and listening to music all soothe.

These days, Brianna, now 14, can talk about her grandfather without crying. She sometimes cries at night, but not as much as before. “I don’t think it’s something I’m going to be free from,” she said of her grief. “It’s something I’m going to be able to learn to grow with.”

“I think about him almost daily,” she said. “Sometimes it’s bitter and sad and other times I’m happy – I’ll remember something he said… and the things he did for me and my family.”

Children don’t “get over’' the death of a loved one, said DeCosta, of HopeHealth, but their grief changes as they heal.

Grief is love for someone who died, she said. “They’re going to love that person forever, so they’re going to grieve forever,” DeCosta said. “They will get to a place where they’re able to participate more in life and get to enjoy it.”

Brianna offers this advice for other grieving children: “Things will never fully heal, but they’ll get better, and you’ll get better. You’ll be able to be happy again. You’ll remember [the deceased] in a good way.”