JMIR Publications

ABSTRACT

Background:

The loss of a loved one, through death or separation, is one of the most stressful life events. It is associated with negative consequences for both health and well-being. As many as 15% of people show clinically significant difficulties in coping with such an event. Internet-based interventions (IBIs) are effective for a variety of mental health disorders, including complicated grief. A few IBIs are available in French, but none are validated for treating symptoms of complicated grief.

Objective:

This article presents the results of a randomised controlled trial comparing the efficacy and adherence rates of two IBIs for grief-related symptoms following the loss of a loved one through death or romantic separation, using an on-demand guidance framework. LIVIA 2.0 has been developed on the basis of theoretical and empirical findings on bereavement processes and IBIs, and will be compared with LIVIA 1, which has already demonstrated its efficacy.

Methods:

Outcomes were assessed at pretest, posttest (12 weeks later), and follow-up (24 weeks later). Primary outcomes are grief symptoms, depressive symptoms, and eudemonic well-being. Secondary outcomes are anxiety symptoms, grief coping strategies, aspects related to self-identity reorganization, and program satisfaction.

Results:

A total of 62 participants were randomized, making up the Intent-To-Treat (ITT) sample, with an average age of 45.2 years, 77.4% were female, 61% having a university degree, 72.5% working part- or full-time, and 50% being in a romantic relationship. The drop-out rate was 56.5%, leading to a final Per Protocol (PP) sample of 27 completers who differed from non-completers only on reporting less anxiety symptoms (t(60) = 3.03, p = .004). Separated participants reported more grief symptoms (t(60) = 2.22, p = .03) and attachment anxiety (t(60) = 2.26, p = .03), compared to bereaved participants. Several outcomes showed pre-post within group differences for both LIVIA programmes in the PP sample, with significant reductions in grief (d=-1.19), depressive (d=-.50), anxiety symptoms (d=-.45) and centrality of the loss (d=-.45). The same pattern of results was observed in the ITT sample. No difference in efficacy between the two programmes was found (all p > .19). Participants (ITT sample) reported overall high levels of programme satisfaction (M = 3.18, SD = .54, over a max. = 4). Effect stability was confirmed throughout time at the 6-month follow-up for all outcomes, self-concept clarity even improving.

Conclusions:

The results indicate that the two grief-related IBIs were effective to diminish grief, depressive and anxiety symptoms for bereaved and separated participants. The analyses did not reveal any pre-post between-group differences, possibly suggesting that the innovations brought to LIVIA 2.0 did not significantly affect the outcome compared to the original version. Clinical Trial: The protocol for this RCT was previously published at https://www.researchprotocols.org/2022/6/e39026, and registered in the ClinicalTrials.gov database (“Trial Registration: ClinicalTrial.gov NCT05219760”; https://tinyurl.com/3dzztjts) and its International Registered Report Identifier (IRRID) is PRR1-10.2196/39026.