As of 5 May 2020, COVID-19 has swept into over 200 countries with over 3 million cases and more than 239 604 deaths. The mortality rate is around 5.4% globally. With an increasing number of deaths occurring, we need to address the mental health care of the bereaved in order to prevent these individuals from having psychological issues. COVID-19 is transmitted through personal contact and respiratory droplets; thus, family members are often separated from their relatives with COVID-19 and are unable to be with them as they suffer or die. To avoid transmission after death, decedents’ bodies have to be transferred and buried by trained burial teams. Being unable to comfort or care for family members and not having the chance to be with dying loved ones can dramatically increase feelings of grief, distress, and guilt. Although most individuals ultimately successfully adjust to the loss, some bereaved individuals fall into a state of unremitting and disabling mourning and suffer from physical and psychological effects, such as depression, post-traumatic stress disorder, and complicated grief. Relatives who do not have the opportunity to say good-bye to loved ones have a higher risk of these morbidities. Bereaved individuals may be treated in hospitals or mobile clinics or be isolated as suspected cases because of the high rate of familial clusters of cases, therefore they experience fear and worry about themselves while grieving the loss of family members. Risk factors that impact bereavement outcomes include situational, intrapersonal, interpersonal, and coping factors. For example, traumatic or sudden loss during public health emergencies or disasters can be more detrimental and harder to resolve than natural or less sudden losses. Other factors, such as low self-esteem, previous mental health problems, low socioeconomic status, a lack of social support, and a lack of economic resources can also increase vulnerability of the bereaved. With high risks of incident mental disorders among the bereaved, more intervention strategies need to be implemented to address the psychological needs of bereaved individuals to identify their mental status, provide timely psychological interventions, and prevent the development of mental disorders. During the COVID-19 outbreak, acute grief combined with depression and anxiety should be considered among the bereaved. Under strict infection measures, nonessential personnel, such as psychiatrists and psychologists, are strongly discouraged from entering isolation wards for those in hospital with confirmed infection. However, we can utilize existing health-care resources to screen for mental health issues and address psychosocial interventions. For example, frontline health workers in hospitals can quickly learn specific mental health competencies from psychiatrists through face-to-face meetings or long-distance guidance via the Internet. Additionally, community workers and social workers can be well trained for dealing with grief among the isolated cases, along with the provision of telephone hotlines and online counseling. For bereaved individuals with acute grief, psychotherapy (e.g., complicated grief treatment) has been shown to have better efficacy than grief-focused interpersonal psychotherapy and can be adopted as a first-line treatment. For individuals who are diagnosed with complicated grief, antidepressants (e.g., citalopram) can be used to optimize the efficacy. Bereavement follow-up visits and consultations with mental health professionals and social workers should be available to identify people who are having a particularly difficult time adjusting to the loss of loved ones. Therapy can help reduce the risk of mental health disorders by providing psychoeducation and cognitive restructuring of grief and focusing on behavioral approaches to socializing and forming new interpersonal attachments. In any epidemic or pandemic, there are a great number of deaths. However, the psychological condition of bereavement is often ignored or misdiagnosed; indeed, few evidence-based bereavement support services are currently available. During recovery from a pandemic and the reconstruction period, evidence-based psychological interventions for the bereaved are needed. The current lack of mental health care for the bereaved may due to a lack of mental health awareness, stigma and discrimination, or the lack of mental healthcare resources. Therefore, for better preparation for dealing with mental health issues among the bereaved, we should first emphasize the promotion of mental health literacy of the general public in order to improve coping skills and awareness of psychological issues. Second, concerted action is needed to strengthen and modify the evidence base for interventions under specific cultural concepts and practices. Third, the availability of mental health resources will need to be increased for successful implementation of these interventions to ensure that such services are sustainable and of sufficient quality. Finally, further research needs to confirm whether evidence-based interventions can be safely and sustainably implemented in lowresource settings where the bereaved are exposed to high ongoing risks.

中文翻译：

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在 COVID ‐19 大流行期间解决丧亲者的心理健康问题

截至 2020 年 5 月 5 日，COVID-19 已席卷 200 多个国家，确诊病例超过 300 万，死亡人数超过 239,604。全球死亡率约为5.4%。随着死亡人数的增加，我们需要解决死者的心理健康问题，以防止这些人出现心理问题。COVID-19 通过个人接触和呼吸道飞沫传播；因此，家庭成员经常与患有 COVID-19 的亲属分开，并且在他们受苦或死亡时无法与他们在一起。为了避免死后传播，死者的尸体必须由训练有素的埋葬队转移和埋葬。无法安慰或照顾家人，也没有机会与垂死的亲人在一起，会大大增加悲伤、痛苦和内疚的感觉。尽管大多数人最终成功地适应了失去，但一些失去亲人的人却陷入了无法自拔的哀悼状态，并受到身心影响，如抑郁、创伤后应激障碍和复杂的悲痛。没有机会与亲人告别的亲属患这些疾病的风险更高。失去亲人的人可能会在医院或流动诊所接受治疗，或者因为家庭聚集性病例发生率高而被隔离为疑似病例，因此他们在为失去家人而悲痛的同时感到恐惧和担心。影响丧亲结果的风险因素包括情境、人际、人际关系和应对因素。例如，突发公共卫生事件或灾害期间的创伤性或突然性损失可能比自然或非突然性损失更有害，也更难解决。其他因素，如自尊心低、以前的心理健康问题、社会经济地位低、缺乏社会支持和缺乏经济资源，也会增加丧亲者的脆弱性。丧亲中发生精神障碍事件的风险较高，需要采取更多的干预策略来解决丧亲的心理需求，以识别其精神状态，及时进行心理干预，防止精神障碍的发展。在 COVID-19 爆发期间，应考虑在丧亲者中的急性悲痛以及抑郁和焦虑。在严格的感染措施下，非必要人员、强烈不鼓励精神科医生和心理学家等确诊感染的住院患者进入隔离病房。然而，我们可以利用现有的卫生保健资源来筛查心理健康问题并解决心理社会干预。例如，医院的一线卫生工作者可以通过面对面的会议或互联网的远程指导，快速向精神科医生学习特定的心理健康能力。此外，社区工作者和社会工作者可以接受良好的培训，以处理孤立案件中的悲伤，以及提供电话热线和在线咨询。对于有急性悲痛的丧亲者，心理治疗（例如，复杂的悲伤治疗）已被证明比以悲伤为中心的人际关系心理治疗有更好的疗效，可以作为一线治疗。对于被诊断为复杂悲伤的个体，抗抑郁药（例如西酞普兰）可用于优化疗效。应该提供丧亲随访以及与精神卫生专业人员和社会工作者的咨询，以识别那些特别难以适应失去亲人的人。治疗可以通过提供心理教育和对悲伤的认知重构，并专注于社交和形成新的人际关系依恋的行为方法，来帮助降低精神健康障碍的风险。在任何流行病或大流行中，都有大量死亡。然而，丧亲之痛常被忽视或误诊；事实上，目前很少有基于证据的丧亲支持服务。在从大流行中恢复和重建期间，需要对死者进行循证心理干预。当前对丧亲者缺乏精神卫生保健可能是由于缺乏精神卫生意识、污名和歧视，或缺乏精神卫生保健资源。因此，为更好地应对丧亲者的心理健康问题，首先要重视提高广大群众的心理健康素养，提高心理问题的应对能力和意识。第二，需要采取协调一致的行动来加强和修改特定文化概念和做法下干预措施的证据基础。第三，为了成功实施这些干预措施，需要增加精神卫生资源的可用性，以确保此类服务具有可持续性和足够的质量。最后，进一步的研究需要确认循证干预是否可以在资源匮乏的环境中安全、可持续地实施，而这些地方的丧亲者面临着持续的高风险。