Santos Susana, Sá Teresa, Aguiar Inês, Cardoso Inês, Correia Zulmira, Correia Teresa
Department of Child and Adolescent Mental Health, Centro Materno-Infantil Do Norte, Centro Hospitalar e Universitário Do Porto, Porto, Portugal.
Front Psychiatry. 2021 Feb 11;12:626940. doi: 10.3389/fpsyt.2021.626940. eCollection 2021.
The coronavirus disease 2019 (COVID-19) pandemic is an unprecedent public health crisis, transforming many aspects of our daily life. Protection measures, such as social distancing, nationwide lockdowns, and restrictions on hospital visits and funerals have a serious impact on how people mourn their loved ones. The grieving process during childhood and adolescence evolves along the developmental stages and is a dynamic, non-linear process that needs time. Parental death increases the risk for psychopathology in the short and long term. We present a case of an 11-year-old girl referred to child psychiatry-liaison service by her neurologist due to peer relationship problems and sadness. Fifteen days before her first psychiatric consultation, her father suffered a myocardial infarction complicated with hypoxic ischemic encephalopathy, and he was hospitalized in the intensive care unit. Positive coping mechanisms and adaptive emotional expression strategies were explored during her consultations. Her father died 2 weeks after emergency state and nationwide lockdown was declared in Portugal, during the first COVID-19 outbreak. The family did not have the opportunity for a proper farewell, the funeral obeyed strict rules, and the patient and her family were at home, due to social distancing and school closure policies. Consultations were maintained by telephone calls and, less frequently, by face-to-face appointments. Adaptive and helpful strategies to grieve were shared with the patient and her mother. Intervention with the mother alone was also helpful. Death circumstances related to COVID-19, confinement policies, and social-economical stressors can intensify the grief experience, increasing the risk for complicated grief. Although psychiatric teleconsultation is essential during COVID-19 pandemic, it poses various limitations. Non-verbal communication clues may not be totally apprehended; it may represent a problem in the therapeutic relationship, and access to technology can be difficult for psychiatric patients and clinicians. COVID-19 pandemic policies should include mental health protection measures, which should facilitate adjusted grief responses for those who lose a loved one during this pandemic.
2019年冠状病毒病（COVID-19）大流行是一场前所未有的公共卫生危机，改变了我们日常生活的许多方面。诸如社交距离、全国范围封锁以及对医院探视和葬礼的限制等防护措施，对人们悼念亲人的方式产生了严重影响。儿童和青少年时期的悲伤过程会随着发育阶段而演变，是一个动态的、非线性的过程，需要时间。父母死亡无论在短期还是长期都会增加精神病理学风险。我们报告一例11岁女孩的病例，她因同伴关系问题和悲伤情绪被神经科医生转介至儿童精神科联络服务。在她首次精神科会诊前15天，她的父亲突发心肌梗死并伴有缺氧缺血性脑病，随后入住重症监护病房。在会诊期间探索了积极的应对机制和适应性情绪表达策略。在葡萄牙首次出现COVID-19疫情并宣布进入紧急状态和全国封锁后的2周，她的父亲去世。由于社交距离和学校停课政策，家人没有机会进行恰当的告别，葬礼遵循严格规定，患者及其家人只能待在家中。会诊通过电话进行，面对面预约则较少。与患者及其母亲分享了适应性且有益的悲伤应对策略。单独对母亲进行干预也很有帮助。与COVID-19相关的死亡情况、隔离政策以及社会经济压力源会加剧悲伤体验，增加复杂性悲伤的风险。尽管在COVID-19大流行期间精神科远程会诊至关重要，但它也存在各种局限性。非言语交流线索可能无法完全被理解；这可能会给治疗关系带来问题，而且精神科患者和临床医生可能难以获得技术支持。COVID-19大流行政策应包括心理健康保护措施，这应有助于那些在此次大流行期间失去亲人的人进行适应性的悲伤反应。
