Global prevalence of prolonged grief disorder during the COVID-19 pandemic under standardized diagnostic frameworks: A systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not reported for primary outcome

• Effect Size: 24% prevalence

• Primary Outcome: Pooled prevalence of prolonged grief disorder during COVID-19 pandemic

• Nnt Or Sensitivity: Highest prevalence in China: 43% (95% CI: 33%-54%); DSM-5-TR criteria: 18% vs ICD-11 criteria: 26%

• Confidence Interval: 95% CI: 13%-36%

Clinical Application

Screening using validated instruments (PG-13-R, ICG, BGQ) is feasible in clinical settings, though resource-intensive for population-level implementation Relevant for Australian mental health services planning post-COVID-19, aligns with RACGP guidelines on grief assessment, may inform PBS mental health treatment plans and Medicare-subsidized psychological services Adults experiencing bereavement during pandemic or similar public health emergencies, particularly those with disrupted mourning rituals

Abstract

Prolonged grief disorder (PGD), recently classified in ICD-11 and DSM-5-TR, is characterized by persistent and functionally impairing grief lasting beyond 6-12 months. The COVID-19 pandemic was accompanied by widespread mortality, social isolation, disrupted mourning rituals, and social disconnection, raising concerns about a potentially high burden of PGD during the pandemic period. We conducted a systematic review and meta-analysis, following PRISMA guidelines and PROSPERO registration (CRD42023463720), to estimate PGD prevalence under standardized ICD-11 and DSM-5-TR diagnostic frameworks and to examine potential moderators during the COVID-19 pandemic. PubMed, EMBASE, and the Cochrane Library were searched from inception to October 2024. Eligible studies included adults who experienced bereavement during the pandemic and were assessed using validated PGD instruments (PG-13-R, ICG, BGQ). Random-effects models were applied to pool prevalence estimates, with subgroup and meta-regression analyses. Thirteen studies comprising 5,766 participants were included. The pooled prevalence of PGD during the pandemic period was 24% (95% CI: 13%-36%), with the highest estimates observed in China (43%, 95% CI: 33%-54%). In the overall pooled analysis, studies applying DSM-5-TR criteria yielded lower prevalence estimates than those using ICD-11 criteria (18% vs.26%, p = 0.41). Digital interventions showed no statistically significant pooled effects (Hedges' g = -0.38, 95% CI: -0.90 to 0.14). The high and geographically heterogeneous prevalence of PGD observed during the COVID-19 pandemic underscores the need to strengthen mental health surveillance, standardized assessment, and service accessibility in large-scale public health emergencies, and provides important evidence to inform population-level interventions and resource allocation strategies.

References

1. 1.Li, S., Qiu, L., Li, Y., Liu, X., Luo, Z., Liu, J., & Ma, X. (2026). Global prevalence of prolonged grief disorder during the COVID-19 pandemic under standardized diagnostic frameworks: A systematic review and meta-analysis. Psychological Medicine. https://doi.org/10.1017/S0033291726104541