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Article
COVID-19
Bereavement in
Ten Latin American
Countries:
Measurement
Invariance of the
Pandemic Grief Scale
and Its Relation to
Suicidal Ideation
To m a
´s Caycho-Rodr
ıguez
1
,
Pablo D. Valencia
2
, Lindsey W. Vilca
3
,
Sherman A. Lee
4
, Carlos Carbajal-Le
on
1
,
Andrea Vivanco-Vidal
5
,
Daniela Saroli-Aran
ıbar
5
,
Mario Reyes-Bossio
5
, Michel White
6
,
Claudio Rojas-Jara
7
,
Roberto Polanco-Carrasco
8
,
Miguel Gallegos
9,10
, Mauricio Cervigni
1,1,12
,
Pablo Martino
12
,
1
Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Per
u
2
Facultad de Estudios Superiores Iztacala,Universidad Nacional Aut
onoma de M
exico, Tlanepantla de Baz,
State of Mexico, Mexico
3
Departamento de Psicolog
ıa, Universidad Peruana Uni
on, Lima, Per
u
4
Department of Psychology, Christopher Newport University, Newport News, Virginia, United States
5
Facultad de Psicolog
ıa, Universidad Peruana de Ciencias Aplicadas, Lima, Per
u
6
Direcci
on General de Investigaci
on, Universidad Peruana Uni
on, Lima, Per
u
7
Facultad de Ciencias de la Salud, Departamento de Psicolog
ıa, Universidad Cat
olica del Maule, Talca, Chile
8
Cuadernos de Neuropsicolog
ıa, Centro de Estudios Acad
emicos en Neuropsicolog
ıa, Rancagua Chile
9
Pontificia Universidade Cat
olica de Minas Gerais, Minas Gerais, Brasil
10
Consejo Nacional de Investigaciones Cient
ıficas y T
ecnicas, Rosario, Argentina
11
Centro Interdisciplinario de Investigaciones en Ciencias de la Salud y del Comportamiento, Universidad
Adventista del Plata, Consejo Nacional de Investigaciones Cient
ıficas y T
ecnicas, Rosario, Argentina
OMEGA—Journal of Death and Dying
0(0) 1–29
!The Author(s) 2021
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/00302228211048566
journals.sagepub.com/home/ome
Diego Alejandro Palacios
13
,
Rodrigo Moreta-Herrera
14
,
Antonio Samaniego-Pinho
15
,
Marlon El
ıas Lobos Rivera
16
,
Andr
es Buschiazzo Figares
17
,
Diana Ximena Puerta-Cort
es
18
,
Ibra
ın Enrique Corrales-Reyes
19
,
Raymundo Calder
on
20
,
Bismarck Pinto Tapia
21
,
Ilka Franco Ferrari
10
,
Carmen Flores-Mendoza
22
, and
Walter L. Arias Gallegos
23
Abstract
The present study aimed to evaluate the cross-cultural measurement invariance of
the Pandemic Grief Scale (PGS) in ten Latin American countries. A total of 2,321
people who had lost a family member or other loved one due to COVID-19 partic-
ipated, with a mean age of 34.22 years old (SD ¼11.99). In addition to the PGS, a
single item of suicidal ideation was applied. The unidimensional model of the PGS had
adequate fit in most countries and good reliability estimates. There was evidence of
measurement invariance by country and gender. Also, a one-point increase in the
12
Centro de Investigaci
on en Neurociencias de Rosario, Facultad de Psicolog
ıa, Universidad Nacional de
Rosario, Rosario, Argentina
13
Centro de Desarrollo Humano, Universidad Mariano Ga
´lvez, Guatemala, Guatemala
14
Escuela de Psicolog
ıa, Pontificia Universidad Cat
olica del Ecuador, Ambato, Ecuador
15
Carrera de Psicolog
ıa, Facultad de Filosof
ıa, Universidad Nacional de Asunci
on, Asunci
on, Paraguay
16
Escuela de Psicolog
ıa, Facultad de Ciencias Sociales, Universidad Tecnol
ogica de El Salvador, San
Salvador, El Salvador
17
Instituto Alfred Adler Uruguay, Centro de Estudios Adlerianos, Montevideo, Uruguay
18
Programa de Psicolog
ıa, Universidad de Ibagu
e, Ibagu
e, Colombia
19
Servicio de Cirug
ıa Maxilofacial, Hospital General Universitario Carlos Manuel de C
espedes, Universidad
de Ciencias M
edicas de Granma, Bayamo, Granma, Cuba
20
Carrera de Psicolog
ıa, Facultad de Ciencias de la Salud, Universidad del Valle de M
exico, Ciudad de
M
exico, M
exico
21
Carrera de Psicolog
ıa, Universidad Cat
olica Boliviana San Pablo, La Paz, Bolivia
22
Facultad de Filosof
ıa y Ciencias Humanas. Universidad Federal de Minas Gerais, Minas Gerais, Brasil
23
Departamento de Psicolog
ıa, Universidad Cat
olica San Pablo, Arequipa, Per
u
Corresponding Author:
Toma
´s Caycho-Rodr
ıguez, Facultad de Ciencias de la Salud, Universidad Privada del Norte, Av. Alfredo
Mendiola 6062, Los Olivos, Lima, Per
u.
Email: tomas.caycho@upn.pe
2OMEGA—Journal of Death and Dying 0(0)
PGS was associated with an almost twofold increase in the odds of suicidal ideation.
Scores greater than or equal to 4 on the PGS are proposed as a cut off to identify
individuals with suicidal ideation. Strong evidence of the cross-cultural validity of the
PGS is provided.
Keywords
invariance, cross-cultural, grief, COVID-19, Latin America
Introduction
The COVID-19 pandemic is one of the largest health crises in contemporary
history (Albuquerque et al., 2021), generating more than 171 million diagnosed
cases and more than 3.5 million deaths. In the case of Latin America, as of June
29, 2021, there are a total of 37,208,956 registered cases of COVID-19, with
Brazil being the country most affected by this pandemic in the region, with
about 18.4 million confirmed cases, followed by Argentina with approximately
4.4 million infected and Mexico with a total of 2,507,453 cases. Colombia, Peru,
Chile and Ecuador are also among the countries most affected by the new
type of coronavirus in Latin America. Likewise, as of the same date, almost
1.3 million people had died due to the COVID-19 pandemic in Latin America,
where the majority of fatal cases occurred in Brazil, with a total of 514,092
deaths, followed by Mexico, with 232,608 deaths. This situation has led to
efforts being focused mainly on overcoming the virus (Scholten et al., 2020);
however, not much attention has been given to the grief of people who have lost
a loved one to COVID-19. It is now suggested that there is an urgent need to
prepare for a possible “grief pandemic” due to COVID-19 (Weinstock et al.,
2021).
Grief is a painful but expected emotional response to loss that is present in all
human cultures (Weinstock et al., 2021). Grief due to the death of loved ones
during the COVID-19 pandemic is estimated to be more severe compared to pre-
pandemic grief (Eisma & Tamminga, 2021). In this regard, prior to the COVID-
19 pandemic, about 10% of people who have lost a loved one had complications
in the grieving process (Lundorff et al., 2017). Currently, the COVID-19 pan-
demic is generating an increase in the prevalence of dysfunctional grief world-
wide (Eisma et al., 2020). It is estimated that the death of one person from
COVID-19 would emotionally affect about 9 family members (Verdery et al.,
2020) and that in total there are approximately 16 million bereaved people
worldwide (Tang, & Xiang, 2021). This increase in the prevalence of dysfunc-
tional grief is associated with the characteristics that accompany death from
COVID-19, such as “grief overload” due to the increase in deaths of family
Caycho-Rodr
ıguez et al. 3
members and other loved ones, which interferes with the ability to cope, as well
as restrictions that prohibit visiting relatives or loved ones in hospitals or inten-
sive care units, accompanying them in their last days of life and performing
funeral ceremonies, which can generate or increase feelings of guilt (Kokou-
Kpolou et al., 2020). However, it is also important to note that these
pandemic-related difficulties may also have produced feelings of solidarity
among some survivors who were comforted by their feelings of unity and
shared adversity (Juth et al., 2015). Studies have shown that bereaved people
who have greater contact with family and friends, whether the support is
through technology or in person, exhibit better quality of life and well-being
(Burke & Neimeyer, 2012).
Bereaved persons tend to experience feelings of denial, anger and guilt, bar-
gaining, depression, and acceptance at the onset of loss (Maciejewski et al.,
2007). However, when grief symptoms are prolonged, obstructed, intensified
or delayed (unresolved grief), it can become a psychiatric problem. (Wallace
et al., 2020), due to the inability to say goodbye to the deceased, excessive levels
of guilt, and lack of social support (Mortazavi et al., 2020). This can negatively
impact family, work, and general social relationships for several months after
the death of the loved one (Menzies et al., 2020). Likewise, the grief experience
can generate physical health risks, such as the onset of cardiac and immune
system problems, addictions, deterioration of overall quality of life and even
suicide (Maercker et al., 2017). Regarding this last point, there is evidence that
dysfunctional grief associated with the death of a loved one during the COVID-
19 pandemic leads to increased suicidal ideation and attempts (Halford et al.,
2020; Reger et al., 2020; Wand et al., 2020). Moreover, suicide has long been
recognized as a serious global public health concern, as it is responsible for more
deaths worldwide than malaria, breast cancer, war, and homicide (World Health
Organization, 2019).
This indicates that the prevalence of grief related to COVID-19 and its con-
sequences for physical and mental health are an important public health prob-
lem that countries around the world must face (Doka, 2021; Verdery &
Smith-Greenway, 2020); therefore, grief care should be considered an important
part of health and social care (Pearce et al., 2021). However, the absence of a
valid instrument to assess grief due to the loss of a loved one produced by the
COVID-19 pandemic means that its symptoms may not be recognized or are
misdiagnosed (for example, as symptoms of depression) and, therefore, are not
treated or are treated with general and ineffective interventions (van Eersel et al.,
2019). Seeking to fill this instrumental gap, Lee and Neimeyer (2020), developed
the Pandemic Grief Scale (PGS) to quickly identify possible cases of dysfunc-
tional grief due to COVID-19-related loss. The PGS is comprised of five items
and was validated in a sample of 831 U.S. adults who experienced the death of a
person due to COVID-19. The original validation study concluded that the PGS
measures the COVID-19 grief construct in a unidimensional model and is
4OMEGA—Journal of Death and Dying 0(0)
reliable (a¼.86) and invariant across different gender, age and race groups; it
also exhibits adequate diagnostic properties (87% sensitivity and 71% specific-
ity), comparable or superior to other psychiatric measures (Lee & Neimeyer,
2020).
Likewise, the PGS has been translated and validated in Turkish (Evren et al.,
2021), Polish (Skalski et al., 2021) and Spanish (Caycho-Rodr
ıguez et al.,
2021a), confirming in all contexts its adequate psychometric properties.
However, no evidence has been provided on the equivalence of PGS measure-
ment between different countries, which is crucial to test the cross-cultural appli-
cability of theoretical models of grief related to COVID-19 (Sue, 1999). In this
regard, measurement invariance (MI) would indicate whether the construct dys-
functional COVID-19 pandemic grief retains its meaning across different
groups, which is important when comparing groups using psychological meas-
ures (Millsap & Kwok, 2004). Making comparisons between groups with
non-invariant measures would lead to biased results and inappropriate interpre-
tations of mean differences between groups (Hoyle & Smith, 1994). Thus, differ-
ences in instrument scores would not reflect true differences in the construct
being measured (Cheung & Rensvold, 2002).
A study to establish MI for a COVID-19-related measure of grief is impor-
tant considering that it is a complex process, shaped by individual experiences,
such as the person’s understanding of the meaning of death and the relation-
ships between the living and the dead (Neimeyer et al., 2014), which can be
shaped by cultural factors (Silverman et al., 2021). This is corroborated by
cross-cultural studies indicating differences in the way people grieve (Smid et
al., 2018). Thus, bereavement is an individual experience that would also be
influenced by the social norms of each culture (Lund, 2021). In this sense, the
way in which people handle the death of a loved one and the emotional expe-
rience that this entails also depends on the cultural context in which it occurs
(Jakoby, 2012). For example, experiencing pain and grief in a context such as
Latin America, characterized by stressors such as inequality, poverty and high
prevalence of chronic diseases (Pablos-M
endez et al., 2020), as well as a high
number of people diagnosed with and killed by COVID-19 (e Silva, & Pitzurra,
2020; Mu~
noz, 2020) can negatively affect people’s ability to accept the loss of
loved ones (Kim et al., 2017). However, despite these cultural differences, there
may be enough similarities in some of the symptoms of dysfunctional grief that
people from different cultures may find that a screening tool such as the PGS
(Lee & Neimeyer, 2020) would be of universal application.
Accordingly, the study of cross-cultural MI would also allow for a compre-
hensive assessment of mental health associated with grief. Smid et al. (2018)
indicate that a cultural perspective of grief assessment for the loss of loved ones
would allow health care professionals to: (1) understand cultural norms linking
grief to the onset of mental disorders; (2) facilitate exploration of the psycho-
logical consequences of not having been able to perform rituals to say goodbye
Caycho-Rodr
ıguez et al. 5
to loved ones and the role of cultural traditions and beliefs about death in
maintaining or increasing distress; (3) learn expectations about the most appro-
priate type of help; (4) facilitate decision making regarding intervention practi-
ces and the integration of culturally appropriate rituals.
Taking the above into consideration, and as part of a broader project eval-
uating the psychometric properties of different instruments measuring mental
health indicators during the COVID-19 pandemic (see, for example, Caycho-
Rodr
ıguez et al., 2021b), the present study aimed to evaluate the cross-cultural
MI of the PGS in ten Latin American countries, namely Brazil, Bolivia, Chile,
Colombia, Ecuador, El Salvador, Guatemala, Mexico, Paraguay, and Peru.
Evaluating the MI of the PGS would provide evidence to support the general-
izability of the measure to different cultures besides that in which it was devel-
oped, supporting in turn the universality of the construct across different
cultural groups. Given previous evidence indicating the presence of a unifacto-
rial structure (Evren et al., 2021; Lee & Neimeyer, 2020; Skalski et al., 2021), the
presence of at least partial invariance would be expected. Additionally, the
prevalence of dysfunctional grief related to COVID-19 was assessed as well as
the ability of the PGS to predict suicidal ideation cross-sectionally. Regarding
prevalence, studies indicate that between 56.6% and 66% of US persons present
clinically relevant COVID-19-related grief (Lee & Neimeyer, 2020; Lee et al.,
2021). Therefore, with Latin America being one of the regions most affected by
COVID-19, similar prevalence percentages would be expected. Finally, as indi-
cated by the literature on suicide (Halford et al., 2020; Hill et al., 2021; Reger et
al., 2020; Wand et al., 2020), grief from the death of a loved one during the
COVID-19 pandemic is expected to be associated with an increased likelihood
of suicidal ideation. The link between dysfunctional grief and suicidal ideation
during the COVID-19 pandemic is particularly important to examine given that
suicide continues to be one of the leading causes of death worldwide (World
Health Organization, 2019). Moreover, assessing this association in different
countries is valuable if we consider that public spending, financial resources
available to citizens, medical care, and variations in social support may influ-
ence the likelihood of suicidal ideation (Cheung et al., 2021).
Method
Participants
Participants were 2,321 people who had lost a family member or other loved one
due to COVID-19 from 9 Spanish-speaking Latin American countries (Bolivia,
Brazil, Chile, Colombia, Ecuador, El Salvador, Guatemala, Mexico, Paraguay,
Peru) and 1 Portuguese-speaking country (Brazil), selected non-probabilistically
by convenience. All participants had to be of legal age, have suffered the death
of a family member or friend from COVID-19, and give informed consent to
6OMEGA—Journal of Death and Dying 0(0)
participate in the study. The minimum number of participants in each country
was calculated with Soper software (Soper, 2021), taking into account the
number of observed variables (5 items), latent variables of the model to be
evaluated (dysfunctional grief related to COVID-19), the anticipated effect
size (k¼0.3), the probability (a¼0.05) and the statistical power (1 b¼0.95).
The average number of participants in each country was 232 people and
ranged from 156 (Bolivia) to 441 (Paraguay). A total of 708 women, 1,721
men, and 7 transgender people participated, with an average age of
34.22 years old (SD ¼11.99), where the Ecuadorian sample was the youngest
(M ¼28.81, SD ¼10.65) and the sample from Guatemala had the highest aver-
age age (M ¼41.57, SD ¼12.90). Furthermore, 448 participants indicated
having been diagnosed with COVID-19 (19.30%) and 389 (16.76%) reported
having had suicidal ideation. More detailed demographic information for each
country is shown in Table 1.
Instruments
Sociodemographic Data. The survey provided information on age, sex, marital
status, educational level, employment and COVID-19 diagnosis.
Pandemic Grief Related to COVID-19. The Pandemic Grief Scale (PGS; Lee &
Neimeyer, 2020) assesses symptoms of dysfunctional grief related to the death
of a loved one due to COVID-19 in the past two weeks. The PGS is comprised of
5 items that have four response options, (0 ¼“not at all” to 3 ¼“almost every
day”). The total score of the PGS ranges from 0 to 25, where higher values
indicate a higher frequency of dysfunctional grief symptoms. Similarly, a score
equal to or greater than 7 allows for adequate discrimination between people
with and without dysfunctional grief related to COVID-19. The PGS was
translated into Brazilian Portuguese using the back-translated method.
Initially, two independent researchers, one content expert, familiar with the
COVID-19 and bilingual in English and Portuguese, and another native
English language expert, translated the PGS from English to Portuguese.
Then, two different researchers, one a content expert and the other a language
expert, who were not familiar with the first translation, translated the
Portuguese version back into English. Both versions were compared and
evaluated for possible inconsistencies to produce a harmonized version. This
version was subjected to a pilot test with the participation of 15 Portuguese-
speaking people, and any inconsistencies in phrasing were rectified in order to
have a final version in Brazilian Portuguese. The same procedure was followed
for the translation of the PGS from English to Spanish, as published in
Caycho-Rodr
ıguez et al. (2021a). See Table 2 for the final Spanish and
Portuguese version of the PGS.
Caycho-Rodr
ıguez et al. 7
Table 1. Demographic Information of the Participants in Each Country.
Bolivia
(n¼156)
Brazil
(n¼206)
Chile
(n¼179)
Colombia
(n¼215)
Ecuador
(n¼295)
El Salvador
(n¼437)
Guatemala
(n¼171)
Mexico
(n¼202)
Paraguay
(n¼441)
Peru
(n¼234)
Gender (%)
Female 56 (35.9) 49 (23.8) 45 (25.1) 69 (32.1) 98 (33.2) 167 (38.2) 65 (38.0) 80 (39.6) 111 (25.2) 68 (29.1)
Male 99 (63.5) 157 (76.2) 134 (74.9) 146 (67.9) 197 (66.8) 268 (61.3) 106 (62.0) 120 (59.4) 328 (74.4) 166 (70.9)
Transgender/
Nonbinary
1 (0.6) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (0.5) 0 (0.0) 2 (1.0) 2 (0.4) 0 (0.0)
Age (M SD) 40.60 14.74 35.23 10.83 38.45 12.61 30.65 13.04 28.81 10.65 29.49 9.05 41.57 12.90 33.89 14.22 31.59 11.02 31.97 10.87
Marital status (%)
Single 71 (45.5) 108 (52.4) 80 (44.7) 154 (71.6) 205 (69.5) 315 (72.1) 70 (40.9) 113 (55.9) 285 (64.6) 147 (62.8)
Married 52 (33.3) 57 (27.7) 53 (29.6) 35 (16.3) 61 (20.7) 79 (18.1) 69 (40.4) 70 (34.6) 106 (24.0) 51 (21.8)
Divorced 21 (13.5) 16 (7.8) 16 (8.9) 6 (2.8) 18 (6.1) 9 (2.1) 15 (8.8) 12 (5.9) 14 (3.2) 8 (3.4)
Cohabiting 7 (4.49) 23 (11.2) 27 (15.1) 17 (7.9) 7 (2.4) 33 (7.6) 12 (7.0) 4 (2.0) 33 (7.5) 26 (11.1)
Widowed 5 (3.21) 2 (1.0) 3 (1.7) 3 (1.4) 4 (1.4) 1 (0.2) 5 (2.9) 3 (1.5) 3 (0.7) 2 (0.9)
Higher education (%)
No 7 (4.5) 30 (14.6) 12 (6.7) 46 (21.4) 53 (18.0) 118 (27.0) 16 (9.4) 14 (6.9) 51 (11.6) 15 (6.4)
Yes, technical level
a
5 (3.2) 70 (34.0) 21 (11.7) 24 (11.2) 8 (2.7) 26 (6.0) 14 (8.2) 34 (16.8) 16 (3.6) 17 (7.3)
Yes, university level
a
144 (92.3) 106 (51.5) 146 (81.6) 145 (67.4) 234 (79.3) 293 (67.0) 141 (82.5) 154 (76.2) 374 (84.8) 202 (86.3)
Job type (%)
Permanent 67 (43.0) 135 (65.5) 107 (59.8) 71 (33.0) 108 (36.6) 221 (50.6) 120 (70.2) 94 (46.5) 252 (57.1) 92 (39.3)
Temporary 35 (22.4) 15 (7.3) 23 (12.8) 36 (16.7) 46 (15.6) 65 (14.9) 28 (16.4) 37 (18.3) 69 (15.6) 50 (21.4)
Unemployed 54 (34.6) 56 (27.2) 49 (27.4) 108 (50.2) 141 (47.8) 151 (34.6) 23 (13.4) 71 (35.2) 120 (27.2) 92 (39.3)
Had COVID-19 (%)
Yes 48 (30.8) 41 (19.9) 14 (7.8) 42 (19.5) 53 (18.0) 72 (16.5) 14 (8.2) 38 (18.8) 69 (15.6) 57 (24.4)
No 82 (52.6) 107 (51.9) 151 (84.4) 120 (55.8) 187 (63.4) 211 (48.3) 136 (79.5) 125 (61.9) 283 (64.2) 124 (53.0)
Maybe yes 17 (10.9) 26 (12.6) 7 (3.9) 34 (15.8) 33 (11.2) 119 (27.2) 12 (7.0) 17 (8.4) 50 (11.3) 37 (15.8)
Maybe no 9 (5.8) 32 (15.5) 7 (3.9) 19 (8.8) 22 (7.5) 35 (8.0) 9 (5.3) 22 (10.9) 39 (8.8) 16 (6.84)
Suicidal ideation
No 136 (87.2) 183 (88.8) 160 (89.4) 186 (86.5) 230 (78.0) 355 (81.2) 147 (86.0) 172 (85.2) 381 (86.4) 197 (84.2)
Yes 20 (12.8) 23 (11.2) 19 (10.6) 29 (13.5) 65 (22.0) 82 (18.8) 24 (14.0) 30 (14.8) 60 (13.6) 37 (15.8)
a
Both complete and incomplete studies were included.
8
Suicidal Ideation. A single item used in the Lee and Neimeyer (2020) study was
used to assess suicidal ideation during the past 2 weeks. The content of the single
item is “I wish I were dead so I would not have to deal with this loss.”
Originally, the item had four response options (0 ¼Not at all, 1 ¼Several
days, 2 ¼More than half of the days, 3 ¼Almost every day); however, in the
current study, the responses were dichotomized as follows: the first option was
recoded as no suicidal ideation, while the remaining three were coded as pres-
ence of suicidal ideation.
Procedure
The study was conducted during the COVID-19 pandemic between January 25
and February 26, 2021. During this period of time, Latin America reached the
figure of nearly 21 million people infected and almost 700,000 deaths from
COVID-19 according to figures compiled by Johns Hopkins University, with
Brazil being the country with the most deaths (more than 250,000), followed by
Mexico (more than 115,000), Colombia (more than 50,000) and Argentina
(more than 48,000) (Coronavirus Resource Center, 2021). Thus, Latin
America is the second most affected region, in number of deaths, after
Europe, representing almost a quarter of the deaths reported worldwide. The
data were collected simultaneously in the ten participating countries, and the
Table 2. Portuguese and Spanish Version of the Pandemic Grief Scale.
Portuguese version Spanish version
Nas
ultimas 2 semanas, quantas vezes
voce
ˆexperimentou os seguintes
pensamentos, sentimentos, compor-
tamentos relacionados a
`sua perda?
Durante las
ultimas 2 semanas, >con
qu
e frecuencia ha experimentado los
siguientes pensamientos, sentimien-
tos o comportamientos relacionados
con su p
erdida?
I
´tem 1: Eu queria morrer para estar
com o falecido
I
´tem 1: Quer
ıa morir para estar con la
persona que falleci
o
I
´tem 2: Experimentei confus~
ao sobre
meu papel na vida ou senti que minha
identidade foi diminu
ıda por causa da
perda
I
´tem 2: Experiment
e confusi
on sobre
mi papel en la vida o sent
ı que mi
identidad hab
ıa cambiado debido a la
p
erdida
I
´tem 3: Nada parecia importar muito
para mim por causa dessa perda.
I
´tem 3: Nada parec
ıa importarme
debido a esta p
erdida
I
´tem 4: Achei dif
ıcil ter lembranc¸as
positivas sobre o falecido
I
´tem 4: Me result
o dif
ıcil tener recuer-
dos positivos de la persona fallecida
I
´tem 5: Eu acreditava que sem o falecido
a vida seria sem sentido, vazia ou n~
ao
poderia continuar
I
´tem 5: Cre
ıa que, sin la persona fall-
ecida, la vida carec
ıa de sentido,
estaba vac
ıa o no pod
ıa continuar
Caycho-Rodr
ıguez et al. 9
collection procedure was the same in all of them. The online questionnaire was
designed using Google Forms and distributed by email, as well as different
social media platforms (Facebook, Instagram, WhatsApp). The questionnaire
included questions related to sociodemographic data, COVID-19 pandemic
grief, and suicidal ideation. Only those who reported having suffered the
death of a family member or friend from COVID-19 and gave informed consent
participated. This information was requested in the first section of the online
form. Participants completed the online survey in approximately 10 minutes.
Participation in the study was voluntary and no financial compensation was
received for participation. Participants were required to answer all items in the
questionnaire before submitting their responses. The study was approved by the
Ethics Committee of the Universidad Privada del Norte (registry number:
20213002).
Data Analysis
First, preliminary analyses were conducted at the item-level. Specifically,
descriptive statistics and single-group confirmatory factor analyses (CFAs)
were examined in each country separately. A robust maximum likelihood esti-
mator (MLR) was used (Yuan & Bentler, 2000). The fit of a CFA was evaluated
following widely used indices that complemented the chi-square (v
2
) test: the
comparative fit index (CFI), the Tucker-Lewis index (TLI), the root-
mean-square error of approximation (RMSEA), as well as the standardized
root-mean-square residual (SRMR). A non-significant v
2
test, CFI >.95,
TLI >.95, RMSEA <.06, and SRMR <.08 were considered evidence of good
fit (Hu & Bentler, 1999). However, it should be noted that the RMSEA tends to
perform poorly in models with small degrees of freedom (Kenny et al., 2015).
Thus, this index should be interpreted with caution in the present study. The
CFI,TLI, and RMSEA values were computed using specialized formulae devel-
oped for situations in which a robust estimator is used (Brosseau-Liard et al.,
2012; Brosseau-Liard & Savalei, 2014).
Second, multi-group CFAs were used to examine factorial invariance across
country and gender (again using a MLR estimator). Sequential constraints were
added to a baseline (configural) model: equal loadings (metric invariance), equal
intercepts (scalar invariance), and equal latent means. A model was judged to be
non-invariant if it had a significant Dv
2
test and a jDCFIj>.01 (Cheung &
Rensvold, 2002). Given that moderate unbalance was present between some
groups, a special subsampling approach with 100 replications was followed
(Yoon & Lai, 2018).
Finally, the association between PGS scores and suicidal ideation was eval-
uated from the odds ratio (OR) obtained from a logistic regression. An adjusted
OR (aOR) was also computed after controlling for country, age, and gender.
Next, a receiver operating characteristic (ROC) curve was plotted, and the area
10 OMEGA—Journal of Death and Dying 0(0)
under the curve (AUC) was quantified. Following Hosmer et al. (2013), an
AUC .90 was considered outstanding. Finally, an optimal cutoff score of the
PGS was identified by maximizing sensitivity and specificity to detect individu-
als with suicidal ideation.
All the analyses were computed in R 4.0.3. The following specialized pack-
ages were used: lavaan 0.6–8, semTools 0.5–3, and cutpointr 1.1.0.
Results
Preliminary Analyses
Table 3 presents the descriptive statistics of the PGS items across countries. All
of them had large skewness and kurtosis values, as can be expected for the
construct under study. Item 1 (I wished to die in order to be with the deceased)
was the one that showed the greatest deviation from normality, as well as the
lowest mean values in most countries.
Next, CFAs were conducted for each country separately. The unidimensional
model had excellent fit in most countries, except for Colombia, Ecuador and
Paraguay, where the fit was nonetheless acceptable (Table 4). Modification
indices were examined for these countries, but no theoretically defensible re-
specification was identified. Thus, the unidimensional model was taken as a
baseline for the following invariance analyses. The standardized factor loadings,
as well as the internal consistency reliability estimates, are presented in Table 5.
Factorial Invariance
First, invariance was examined across countries. As presented in Table 6, evi-
dence of scalar invariance was found both under the Dv
2
and the DCFI criteria.
When the equal means restriction was added, model fit did not worsen to a
significant degree. Thus, latent means were assumed to be similar across coun-
tries. Second, invariance was also tested across genders and evidence of scalar
invariance was found (Table 5). The model with equal means showed a signif-
icant reduction in fit according to the Dv
2
criterion, but not to the pragmatic
DCFI, thus suggesting that the difference was negligible in magnitude.
Association With Suicidal Ideation and Proposed Cut-Off
In order to examine associative evidence of validity, we observed how well the
PGS scores predicted suicidal ideation cross-sectionally. We found an
OR ¼1.90, 95% CI [1.80, 2.02], meaning that an increase in one point on the
PGS was related to almost a twofold increase in the odds of suicidal ideation.
These results were unchanged after adjusting for country, age and gender,
aOR ¼1.90, 95% CI [1.79, 2.01].
Caycho-Rodr
ıguez et al. 11
Table 3. Item-Level Descriptive Statistics of the Pandemic Grief Scale.
Country Statistic
Pandemic Grief Scale item
1 2345
Bolivia (n¼156) M0.23 0.54 0.43 0.42 0.33
SD 0.64 0.88 0.76 0.76 0.67
g
1
3.11 1.59 1.80 1.73 2.12
g
2
9.49 1.58 2.53 2.11 4.19
Brazil (n¼206) M0.17 0.41 0.40 0.28 0.34
SD 0.59 0.74 0.78 0.68 0.79
g
1
3.96 1.92 2.10 2.69 2.36
g
2
15.26 3.30 3.74 6.86 4.57
Chile (n¼179) M0.23 0.42 0.36 0.22 0.34
SD 0.69 0.78 0.75 0.61 0.73
g
1
3.07 1.91 2.18 2.88 2.17
g
2
8.55 2.92 4.05 7.75 3.92
Colombia (n¼215) M0.26 0.43 0.39 0.40 0.33
SD 0.72 0.85 0.79 0.80 0.73
g
1
2.94 1.96 2.06 1.90 2.31
g
2
7.71 2.74 3.30 2.44 4.49
Ecuador (n¼295) M0.31 0.60 0.55 0.51 0.46
SD 0.72 0.88 0.85 0.86 0.79
g
1
2.50 1.29 1.44 1.62 1.73
g
2
5.59 0.55 1.11 1.57 2.22
El Salvador (n¼437) M0.33 0.57 0.56 0.51 0.47
SD 0.78 0.93 0.92 0.89 0.88
g
1
2.35 1.49 1.51 1.67 1.85
g
2
4.45 0.97 1.08 1.59 2.27
Guatemala (n¼171) M0.24 0.49 0.42 0.35 0.41
SD 0.68 0.88 0.82 0.77 0.85
g
1
2.98 1.63 1.88 2.15 1.96
g
2
8.06 1.40 2.42 3.58 2.56
Mexico (n¼202) M0.31 0.65 0.53 0.46 0.43
SD 0.77 0.99 0.90 0.88 0.83
g
1
2.55 1.36 1.61 1.81 2.02
g
2
5.43 0.56 1.44 1.99 3.20
Paraguay (n¼441) M0.28 0.39 0.39 0.38 0.35
SD 0.73 0.79 0.79 0.78 0.74
g
1
2.69 2.06 2.08 2.08 2.21
g
2
6.19 3.31 3.41 3.39 4.08
Peru (n¼234) M0.29 0.53 0.50 0.43 0.37
SD 0.68 0.86 0.86 0.83 0.77
g
1
2.51 1.58 1.69 1.97 2.18
g
2
5.71 1.55 1.88 2.87 3.95
12 OMEGA—Journal of Death and Dying 0(0)
Given the strong association between the PGS scores and suicidal ideation,
we considered the possibility that the former may be used to identify possible
cases of the latter. The ROC curve is presented in Figure 1; the AUC was .94,
suggesting outstanding discrimination. Different cutoff values were examined
until we found one that gave an optimal trade-off between sensitivity and spe-
cificity. We propose that scores greater than or equal to 4 may be used
to identify individuals presenting suicidal ideation (sensitivity ¼.85,
Table 4. Single-Group Confirmatory Factor Analyses of the Pandemic Grief Scale.
Country v
2
df p CFI TLI RMSEA SRMR
Bolivia 3.81 5 .577 1 1.02 0 .03
Brazil 8.06 5 .153 .98 .96 .08 .04
Chile 3.83 5 .574 1 1.01 0 .02
Colombia 17.51 5 .004 .96 .92 .16 .04
Ecuador 22.09 5 .001 .97 .95 .13 .02
El Salvador 10.81 5 .055 .99 .98 .08 .02
Guatemala 10.46 5 .063 .98 .96 .12 .04
Mexico 4.51 5 .478 1 1 0 .02
Paraguay 14.91 5 .011 .98 .96 .11 .03
Peru 9.55 5 .089 .99 .98 .09 .03
Note. The estimator was robust maximum likelihood (MLR). Robust versions of the CFI, the TLI, and the
RMSEA are reported (Brosseau-Liard et al., 2012; Brosseau-Liard & Savalei, 2014). CFI ¼comparative fit
index; RMSEA ¼root-mean-square error of approximation; SRMR ¼standardized root-mean-square
residual.
Table 5. Factor Loadings and Internal Consistency Reliability of the Pandemic Grief Scale.
Country
Items
Ax1 2345
Bolivia .68 .59 .77 .59 .77 .80 .80
Brazil .71 .71 .80 .56 .66 .81 .82
Chile .87 .78 .85 .52 .81 .88 .89
Colombia .89 .73 .83 .65 .93 .90 .90
Ecuador .79 .85 .91 .70 .84 .91 .91
El Salvador .81 .88 .89 .72 .86 .92 .92
Guatemala .80 .83 .96 .49 .88 .89 .90
Mexico .77 .77 .89 .70 .83 .89 .90
Paraguay .80 .86 .87 .69 .84 .91 .91
Peru .89 .79 .83 .73 .87 .91 .91
Note. Completely standardized factor loadings are presented. The estimator of the confirmatory factor
analysis was maximum likelihood.
Caycho-Rodr
ıguez et al. 13
Table 6. Measurement and Structural Invariance of the Pandemic Grief Scale.
Grouping variable Model v
2
df CFI RMSEA Dv
2
Ddf DCFI
Country Configural 85.73** 50 .98 .10
Metric 123.14** 86 .98 .08 38.63 36 0
Scalar 172.68** 122 .98 .07 47.91 36 0
Equal means 185.97** 131 .98 .07 13.62 9 0
Gender Configural 29.87*** 10 .99 .08
Metric 32.98** 14 .99 .06 2.31 4 0
Scalar 39.78** 18 .99 .05 4.04 4 0
Equal means 44.39*** 19 .99 .06 7.17** 1 0
Note. Yoon and Lai’s (2018) subsampling approach with 100 replications was followed in both cases. Robust
versions of the CFI and the RMSEA are reported (Brosseau-Liard et al., 2012; Brosseau-Liard & Savalei,
2014). CFI ¼comparative fit index; RMSEA ¼root-mean-square error of approximation.
*p<.05. **p<.01. ***p<.001.
Figure 1. ROC Curve of the PGS Total Score as Predictor of Suicidal Ideation.
14 OMEGA—Journal of Death and Dying 0(0)
specificity ¼.91). Figure 2 shows the percentages of participants who scored
above this value (as well as the original 7 cutoff) in each country.
Discussion
The aim of the present study was to examine the cross-cultural measurement
invariance (MI) of the Pandemic Grief Scale (PGS; Lee & Neimeyer, 2020) and
its relation to suicidal ideation in samples from 10 Latin American countries.
The PGS is a simple and easy instrument to screen for the presence of dysfunc-
tional grief related to the COVID-19 pandemic, making it a useful tool for the
evaluation of mental health indicators. However, to date there are no studies
evaluating the MI of the PGS in the general population in countries other than
the one in which it was originally developed, such as the Latin American coun-
tries in this study. In general, the PGS demonstrated adequate psychometric
properties in all countries evaluated. Specifically, the results of the CFA show
that the PGS presents a unidimensional factor structure in all the countries
involved. Although the RMSEA values were higher than recommended in
some countries, such as Colombia, Ecuador, Guatemala, Paraguay and Peru
(Kline, 2015; Schumacker & Lomax, 2015), this was to be expected, since the
RMSEA tends to perform poorly in factor models with few degrees of freedom
(Kenny et al., 2015; Taasoobshiraz & Wang, 2016). On the other hand, the
Figure 2. Percentage of Individuals Scoring Above Two Alternative Cutoffs of the Pandemic
Grief Scale.
Caycho-Rodr
ıguez et al. 15
results for the reliability of the PGS were also promising in all samples analyzed,
where the values of the alpha and omega coefficients ranged between .80 and
.92, which is an adequate range for internal consistency. The above confirms
previous findings in the United States (Lee & Neimeyer, 2020), European coun-
tries such as Turkey (Evren et al., 2021) and Poland (Skalski et al., 2021), and a
single-country study in Latin America (Caycho-Rodr
ıguez et al., 2021a).
In addition, full configural, metric, and scalar invariance was established
among the 10 countries assessed. The results with respect to configural invari-
ance indicate that, across the 10 countries, the concept of COVID-19 pandemic-
related dysfunctional grief can be assessed using all five PGS items and that
these same items can best be represented in a single latent variable. Therefore, it
is suggested that the concept of COVID-19 pandemic-related dysfunctional grief
as assessed in this study has uniform meaning across the 10 countries included in
the analysis. Similarly, the presence of metric invariance showed that all items
had similar factor loadings in all samples. Thus, the items are interpreted and
responded to in a similar way across countries. Finally, scalar invariance shows
that the observed differences in item means reflect true differences in the latent
construct and not measurement errors. These findings regarding cross-cultural
MI have important implications, as they ensure that the PGS would be assessing
dysfunctional grief related to the COVID-19 pandemic in a similar way across
countries. This is even more relevant in cultural regions, such as Latin America,
where expressions of grief and crying during grief are considered healthy and
encouraging (Hardy-Bougere, 2008; Parry & Ryan, 1996). These findings are
inserted in a line of research that has received much attention from researchers
for some years: the scientific study of grief within different sociocultural con-
texts (Stroebe et al., 2001a).
Additionally, it is suggested that gender would explain part of the variability
observed in grief (Lundorff et al., 2020). In this sense, the MI of the PGS was
also assessed between men and women in the 10 countries evaluated, indicating
that the scale would assess dysfunctional grief related to the COVID-19 pan-
demic in a similar way between male and female groups. This finding is consis-
tent with the original study in the U.S. population, where the construct is
reported to be measured in the same way across the gender variable (Lee &
Neimeyer, 2020). This evidence that men and women in the 10 countries under-
stand COVID-19 grief in the same way could be explained by social role theory
(Eagly et al., 2000). Latin American countries share many cultural beliefs about
what social roles men and women should occupy within a society (Stelzer et al.,
2019). Thus, it is customary that women tend to be more expressive in their pain
and trust others more than men (Stroebe et al., 2001b). This finding is important
for comparative studies of gendered grief where information is contradictory.
For example, part of the scientific literature points to female gender as a poten-
tial risk factor for intense and prolonged grief reactions (Burke & Neimeyer,
2012; Heeke et al., 2019; Lee & Neimeyer, 2020); while others point out that
16 OMEGA—Journal of Death and Dying 0(0)
gender does not significantly moderate grief prevalence rates following a loss
(Djelantik et al., 2020; Lundorff et al., 2017). Even a longitudinal study points
out that men would express prolonged grief as an acute and decreasing reaction;
while women present an increasing grief reaction (Lundorff et al., 2020).
Another analysis suggested that each one-point increase in PGS scores was
associated with a nearly twofold increase in the odds of suicidal ideation in
people across the 10 countries, even after holding country, age, and sex variables
constant. This aligns with other findings indicating an increase in suicidal ide-
ation resulting from grief reactions ( Doering & Eisma, 2016; Halford et al.,
2020; Reger et al., 2020; Wand et al., 2020). This result can be explained from
the interpersonal theory of suicide, where the belief of being a burden and the
perception that other people would benefit from our death, together with lone-
liness, social isolation and poor social support, contribute to the presence of
suicidal ideations (Van Orden et al., 2010). Likewise, indicating that dysfunc-
tional grief related to COVID-19 predicts suicidal ideation would suggest that
identifying suicidal ideation during grief would be of utmost importance within
therapeutic interventions in each country (Jang et al., 2018).
The present study also proposed that scores greater than or equal to 4 on the
PGS would allow for identifying people with suicidal ideation. Based on this, it
was identified that Ecuador and El Salvador were the countries with the highest
probability of people with suicidal ideation, while Brazil presented the lowest
probability. The variation in suicidal ideation between countries during the
COVID-19 pandemic has been reviewed previously, and it has been suggested
that the differences may be related to public spending and financial resources
available to citizens (Cheung et al., 2021). In this regard, lower incomes, poor
social support, and deficits in medical care may increase the likelihood of sui-
cidal ideation due to a lack of hope for the future during the COVID-19 pan-
demic. On the other hand, these same countries had the highest prevalence rates
of dysfunctional grief related to COVID-19 along with Guatemala. Overall, the
percentages of dysfunctional grief related to COVID-19 ranged from 7.3%
(Brazil and Chile) to 14.6% (El Salvador), which are lower than those reported
in U.S. individuals which ranged from 56.6% to 66% (Lee & Neimeyer, 2020;
Lee et al., 2021). This was to be expected as the United States is so far, the
country with the most deaths from COVID-19, which could have led to an
unprecedented grief overload (Kokou-Kpolou et al., 2020). According to the
latest reports of the Coronavirus Resource Center, the United States has more
than 606,300 thousand deaths (https://coronavirus.jhu.edu/map.html). The fact
that Ecuador and El Salvador have the highest prevalence of dysfunctional grief
is associated with the number of deaths and the management of the pandemic at
the time of the study in each country. Thus, at the time of data collection, in
El Salvador, there were 63,344 confirmed cases of COVID-19, of which 1,986
were reported as deaths; while the type of transmission of the disease was clas-
sified as “Local”, specifically at the community level (phase III). In addition, the
Caycho-Rodr
ıguez et al. 17
country was in phase II of economic reactivation, which led to an increase in the
number of infections at the national level. In the case of Ecuador, during the
same period of time, 16,780 deaths from COVID-19 were reported, which led
Ecuador to face one of the highest periods of hospitalizations for this disease,
characteristic of a third mortality wave of this health emergency. In Guatemala,
at the time information was collected for this study, there were more than
164,746 confirmed cases and 5,989 deaths. This scenario has also led to the
emergence of negative mental health outcomes in these countries in terms of
anxiety, stress and a worsening of pre-existing mental disorders (Alonzo et al.,
2021; Orellana, & Orellana, 2020; Tera
´n-P
erez et al., 2021). These prevalence
rates could have significant physical and mental health consequences that will
necessitate preventive and supportive interventions for bereaved persons
(Kokou-Kpolou et al., 2020).
Although the present study constitutes a pioneering effort in the scientific
literature on the cross-cultural validity of instruments to measure mental health
symptoms during the COVID-19 pandemic, the results should be evaluated in
light of its limitations. First, most participating countries were from South
America (Bolivia, Brazil, Chile, Colombia, Ecuador, Paraguay and Peru) and
only three from Central and North America (El Salvador, Guatemala and
Mexico). Therefore, future studies should include more Latin American coun-
tries, especially from Central America. In addition, due to the non-probability
convenience sampling used to select participants, the national samples included
in this study are not representative of each of the countries. This limits the
possibility of generalizing the results to the entire population of each of the
countries. Furthermore, even though the ten countries present different social
and cultural backgrounds, future studies should be conducted with samples
from other Western and Eastern countries to corroborate the generalizability
of the PGS across different cultural contexts. Also, there are different sample
sizes across countries and some imbalances in the number of participants
according to certain sociodemographic variables such as gender, where signifi-
cantly more men than women participated in the study. Thus, it is possible that
the same levels of variability in expressions of grief across countries were not
captured, which would further limit the generalizability of the findings. While it
has been suggested that differences in sample size between groups could bias the
results when conducting an MI analysis (Brown, 2006); the use, in this study, of
the procedure suggested by Yoon and Lai (2018) has helped moderate the
impact of different sample sizes. Even so, it is important for future studies to
have larger samples which are equivalent in number and balanced by gender
from Latin American countries to obtain firmer conclusions.
Additionally, the use of an online survey caused a selection bias in favor of
people with Internet access and experience in answering this type of survey. This
means that the sample is not completely generalizable to the population of
people who have suffered the loss of a loved one due to COVID-19 in each of
18 OMEGA—Journal of Death and Dying 0(0)
the countries involved. Another limitation of this study involves the relevance of
the death wish item of the Pandemic Grief Scale (Lee & Neimeyer, 2020) for
some respondents. Specifically, the death wish item, “I wished to die in order to
be with the deceased,” may not be relevant for respondents who do not believe
in the existence of an afterlife and interpret this statement in those terms.
Furthermore, participants were not asked if they believe or do not believe in
any religion. This information would be useful for a study on the impact of
specific religious beliefs on grief management, as previous studies have indicated
(Feldman et al., 2016). This type of information would help to better understand
the low scores shown by participants for item 1 (“I wished to die in order to be
with the deceased”), which presupposes that respondents believe in some kind of
life after death. Future research should empirically examine this potential issue.
Although the recoding of the single item options of suicidal ideation (the first
option was coded as no suicidal ideation, while the remaining three were coded
as presence of suicidal ideation) may imply that some detailed information
about the different levels of suicidal ideation was lost, it is also true that
having two categories of suicidal ideation facilitates the interpretation of the
results for decision making. Indeed, measuring suicide-related variables as
binary is common practice in public health research (e.g., Kappel et al., 2021;
Xu et al., 2020). Furthermore, given that the original measure had only four
categories, it would have been problematic to treat it as continuous.
Consequently, for both substantive and methodological reasons, it was decided
to treat suicidal ideation as a dichotomous variable. Future studies should test
the usefulness of this strategy. Finally, bereavement experience and suicidal
ideation, as well as some sociodemographic variables were assessed by self-
report measures, which could lead to the presence of social desirability bias
and an underreporting of information.
Despite these limitations, the current findings are encouraging with respect to
the MI of the PGS in 10 countries. The strengths of the study were its use of two
language versions of the PGS (Spanish and Portuguese) including individuals
from economically, culturally and religiously diverse countries. In this way, it
was possible to cover a greater range of people and countries, as well as to
extend the findings to multicultural contexts. In conclusion, the PGS showed
good psychometric properties in samples from Bolivia, Brazil, Chile, Colombia,
Ecuador, Paraguay, El Salvador, Guatemala and Mexico. In addition, it was
established that the cross-cultural MI of the PGS remains strong despite the
greater number of countries evaluated, which provides solid evidence of cross-
cultural validity of the scale. Although further studies are needed to confirm the
current psychometric findings, the PGS can be considered a reliable measure
that, because of its brevity, can be used in large-scale cross-cultural studies for
rapid and cost-effective assessment of pandemic-related grief. Although the
associations between psychological conditions and attitudes during the
COVID-19 pandemic are complex, the PGS may be useful in epidemiological
Caycho-Rodr
ıguez et al. 19
studies as a screening tool to identify individuals who are at risk of experiencing
suicidal thoughts. Suicide and suicidal ideation are a global concern, especially
during a pandemic. Finally, it may also be useful to evaluate which interventions
have had an effect on the management of pandemic-related grief and the pos-
sibility of growth (Doka, 2021). Highly stressful circumstances are known to
contribute to positive and deeply meaningful shifts in the way people view
the world.
Author’s Note
Miguel Gallegos is now affiliated with Departamento de Psicolog
ıa. Universidad
Cat
olica del Maule, Talca, Chile and Programa de Posgrado en Psicolog
ıa. Pontificia
Universidade Cat
olica de Minas Gerais, Minas Gerais, Brasil. Ilka Franco Ferrari is now
affiliated with Programa de Posgrado en Psicolog
ıa. Pontificia Universidade Cat
olica de
Minas Gerais, Minas Gerais, Brasil.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publi-
cation of this article.
Ethical Approval
The study was approved by the Ethics Committee of the Universidad Privada del Norte
(Registry Number: 20213002).
ORCID iDs
Toma
´s Caycho-Rodr
ıguez https://orcid.org/0000-0002-5349-7570
Sherman A. Lee https://orcid.org/0000-0003-1878-3472
Antonio Samaniego-Pinho https://orcid.org/0000-0003-4178-6639
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Author Biographies
Toma
´s Caycho-Rodr
ıguez: Doctor in Psychology from the University of San
Mart
ın de Porres. Researcher Professor at the Universidad Privada del Norte,
Renacyt Researcher Carlos Monge II category.
Pablo D. Valencia: PhD Student, School of Higher Studies (F.E.S.) Iztacala,
Universidad Nacional Aut
onoma de M
exico.
Lindsey W. Vilca: Mg, professor and researcher at the Universidad Peruana
Union in Lima, Peru. He is a member of the National System of Researchers,
level Mar
ıa Rostworowski I of the National Council of Science, Technology and
Technological Innovation (Peruvian Government).
Sherman A. Lee: PhD, is an associate professor of psychology at Christopher
Newport University. He studies negative feeling states, such as anxiety and grief,
and the role personality and religion play in those emotional experiences. He
teaches courses in the psychology of personality, psychology of the humanani-
mal bond (Anthrozoology), and the psychology of death, dying, and bereave-
ment (Thanatology).
Carlos Carbajal-Le
on: Dr. in psychology from the University of San Mart
ın de
Porres. Master in Educational Psychology, Universidad Nacional Mayor de San
Marcos. Cognitive behavioral therapist. Specialist Director of Psychology,
Universidad Privada del Norte. Research professor at the Peruvian University
of Applied Sciences.
26 OMEGA—Journal of Death and Dying 0(0)
Andrea Vivanco-Vidal: Psychologist with a specialty in organizational psychol-
ogy (Peruvian University of Applied Sciences, Peru). Talent Attraction Analyst
at Caja Cencosud of Grupo Scotiabank.
Daniela Saroli-Aran
ıbar: Psychologist with a specialty in Educational
Psychology (Peruvian University of Applied Sciences, Peru). Research professor
at the Peruvian University of Applied Sciences. Psychologist at Markham
College (Peru).
Mario Reyes-Bossio: Master in Psychology, University of San Mart
ın de Porres.
Researcher at the Peruvian University of Applied Sciences.
Michel White: Head of Scientific Publications and Translations, Direcci
on
General de Investigaci
on, Universidad Peruana Uni
on.
Claudio Rojas-Jara: Master in drug addiction. Master in prevention and treat-
ment of addictive behaviors. Academic of the Department of Psychology,
Faculty of Health Sciences, Universidad Cat
olica del Maule, Chile.
Roberto Polanco-Carrasco: Bachelor of Psychology, Scientific Editor of
Cuadernos de Neuropsicolog
ıa – Panamerican Journal of Neuropsychology.
Director of the Chilean Association of Scientific Journals of Psychology.
Miguel Gallegos: Doctor of Psychology from the National University of
Rosario, Argentina, and Doctor of Education from the Federal University of
Minas Gerais, Brazil. Post-doctorate from the National Autonomous University
of Mexico, and the Pontificia Universidade Cat
olica de Minas Gerais, Brazil.
Mauricio Cervigni: Doctor in Psychology from the National University of
Rosario (UNR). Researcher at the National Council for Scientific and
Technical Research (CONICET - Argentina). Professor-Researcher at the
National University of Rosario (UNR).
Pablo Martino: Doctor in Psychology (National University of San Luis-Arg).
Adjunct professor at the Faculty of Psychology, National University of Rosario.
National Council for Scientific and Technical Research postdoctoral fellow.
Diego Alejandro Palacios: Clinical Psychologist, Master in Clinical Psychology
and Mental Health. Psychotherapist at the Human Development Center Clinics
-CDH- and teacher at the University of San Carlos de Guatemala.
Caycho-Rodr
ıguez et al. 27
Rodrigo Moreta-Herrera: Clinical Psychologist and University Master’s Degree
in Psychology. Doctor (c) in Psychology from the University of Girona.
Professor and researcher at the Pontifical Catholic University of Ecuador.
Antonio Samaniego-Pinho: Psychologist with a specialty in Occupational
Psychology. Master in Clinical Psychology. Teacher in the career of
Psychology at the Faculty of Philosophy (National University of Asunci
on).
Marlon El
ıas Lobos Rivera: Psychologist. Master in University Education.
Research professor at the School of Psychology, Faculty of Social Sciences,
Technological University of El Salvador.
Andr
es Buschiazzo Figares: Degree in Psychology (University of the Republic,
Uruguay). Psychotherapist. Academic Director of the Center for Adlerian
Studies, Uruguay.
Diana Ximena Puerta-Cort
es: Doctor in Psychology (Ramon LLull University
of Barcelona, Spain). Master’s degree in psychology with an emphasis on addic-
tions and violence (Universidad Cat
olica de Colombia). She is a researcher for
the GESS group and director of the NeuroTech research hotbed. Professor at
the University of Ibagu
e in Colombia.
Ibra
ın Enrique Corrales-Reyes: Dentist. Maxillofacial surgeon. Professor and
researcher at the Carlos Manuel de C
espedes General University Hospital.
Granma University of Medical Sciences. Cuba. Editor of the Cuban Journal
of Stomatology and the Cuban Journal of Biomedical Research.
Raymundo Calder
on: Master of Science in Education. National Director of
Psychology, Universidad Del Valle de M
exico Bismarck
Pinto Tapia: Doctor in Psychology from the University of Granada-Spain.
Professor and researcher at the Universidad Cat
olica Boliviana San Pablo.
Editor of the Ajayu Magazine of the Department of Psychology of the
Universidad Cat
olica Boliviana San Pablo.
Ilka Franco Ferrari: Doctor in Psychology from the University of Barcelona.
Professor of the Postgraduate Program in Psychology at the Pontificia
Universidad Cat
olica de Minas Gerais, Brazil.
Carmen Flores-Mendoza: Doctor in School Psychology and Human
Development from the University of S~
ao Paulo. She is a postdoctoral fellow
28 OMEGA—Journal of Death and Dying 0(0)
at the Autonomous University of Madrid, Spain and the University of
California, United States.
Walter L. Arias Gallegos: Doctor of Psychology, San Agust
ın National
University, Arequipa, Peru. Researcher at the San Pablo Catholic University,
Arequipa, Peru.
Caycho-Rodr
ıguez et al. 29
